Pathology

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1
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Courvoisier's GB

Distension without wall thickening

due to obstruction distal to the cystic duct

*Panncreatic head mass

* Duodenal papilla mass

*CBD mass

2
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RUQ pain

Jaundice

recurrent cholangitis

Mirizzi SYndrome

impacted stone in the cystic duct or GB neck

presence of two tubular structures representing the bile duct above the level of the cystic duct

3
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Mirizzi SYndrome

impacted stone in the cystic duct or GB neck

presence of two tubular structures representing the bile duct above the level of the cystic duct

4
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Patient has been fed intravenously for 3 days.

Sludge

highly concentrated bile

5
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Gravity dependent

Cholelithiasis

Mobile, hyperechoic, round or triangular structures casting a well defined posterior acoustic shadowing

Will change when patient’s body position changes (Gravity dependent)

6
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RUQ pain

fever

leukocytosis

Positive Murphy's sign

Acute cholecystitis

inflamation of the GB wall w/ stone

7
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Diabetic

RUQ pain

fever

leukocytosis

Emphysematous Cholecystitis

Gas forming bacteria in gallbladder wall yields to high intensity echoes and comet tail artifact

8
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RUQ pain

fever

leukocytosis

Empyema of the gallbladder

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Perforation in the gallbladder wall

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Typically secondary event in critically ill

Acalculus Cholecystitis

Inflammation of GB wall without stones

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Chronic Cholecystitis

Contracted gallbladder with acoustic shadowing from cholelithiasis

Thick hyperechoic gallbladder wall greater than 4 – 5 mm

Sludge may be present

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patient present with chronic Cholecytitis

Milk of calcium Bile (Limy bile)

13
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Asymptomatic with palpable RUQ mass

Hydrops GB

Greater than 4cm in diameter

14
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Female patient with Chronic Cholecystitis

Porcelain GB

Calcification of GB wall due to chronic cholecytitis

15
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Gangrenous Cholecystitis

16
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GB Ademoma

epithelial tumor

overgrowth of the lining

17
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GB Ademoma

epithelial tumor

overgrowth of the lining

18
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Asymptomatic

Gallbladder Adenomyomatosis

diverticulum of the GB

Focal, segmental or diffuse smooth muscle proliferation with exaggerated diverticular appearance of the Rokitansky – Aschoff sinuses into the muscular wall

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Gallbladder Cholesterolosis

Non shadowing, hyperechoic, polyp

Strawberry GB

Lipids

20
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60 year old with long standing cholecystitis

and porcelain GB

Gallbladder Carcinoma

Most commonly a mass from the gallbladder fossa replaces the gallbladder and invades adjacent liver.

Focal or diffuse irregular gallbladder wall thickening

Polypoid intramural lesions with irregular borders

21
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Stage 4 colon cancer

Gallbladder Metastasis

commonly from stomach, pancreas and bile ducts

22
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RUQ pain

Jaundice

Elevated Alkaline phosphatase

Elevated conjugated bilirubin

Elevated Gamma gluamyl transpeptidase

Choledocholithiasis

obstrution by biliary stone

23
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RUQ pain

Fever

Jaundice

Elevated Conjugated bilirubin

Elevated Alkaline phosphatase ALP

Elevated GGT

Elevated amylase and lipase

Elevated white blood count

Cholangitis

inflamation of the duct walls

24
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asymptomatic

biliary colic

cholangitis

Poor hygiene

Ascariasis

infection of round worms

25
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asymptomatic

biliary colic

cholangitis

Poor hygiene

Ascariasis

infection of round worms

26
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Pain

Hematemesis

caused by procedures or biopsy

Hemobilia

blood in the biliary tree

caused by procedures or biopsy

27
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Patient recently had ERCP

pneumobilia

Air within the biliary tree

28
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Jaundice

weight loss

abdominal pain

Cholangiocarcinoma

typically originate within the extrahepatic bile ducts

29
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Neonate presents with Jaundice for 14+ days

Biliary Atresia

Congenital

cystic formation without dilated interhepatic ducts

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congenital hepatic fibrosis

Portal hypertension

Caroli's Disease

congenital cystic dilatation of the intrahepatic biliary tree

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9 year old Japanese patient

Choledochal Cyst

Congenital cystic dilation of the extrahpatic biliary tree

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Klatskin Tumor

malignant tumor arising between the left and right hepatic ducts

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Patient in Great Lakes basin

Liver granulomas

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Hypoechoic renal cortex

obese

Type II diabetes

Fatty infiltration

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Fat Sparing

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  • diabetes mellitus
  • obesity
  • alcohol abuse
  • exogenous steroids
  • drugs (amiodarone, methotrexate, chemotherapy)
  • IV hyperalimentation

focal fatty infiltration

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Infant

impaired growth

hypoglycemia

CHF

delayed puberty

osteoporosis

Glycogen Storage Disease

Autosomal recessive disorder of carb metabolism

found in infants

seen with adenomas

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Elevated

ALT

AST

Bilirubin con & un

Acute Hepatitis

Generally normal

but can have portal cuffing (starry sky)

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Elevated

ALT

AST

Bilirubin con & un

Chronic Hepatitis

course texture

increased echogenicity

40
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chronic hepatitis

alcoholism

elevated

AST

ALT

GGT

LDH

conjugated bilirubin

Cirrhosis

nodular and course

heterogenic

Ascites

41
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Cirrhosis

nodular and course

heterogenic

Ascites

42
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asymptomatic

sudden painless upper GI hemorrhage due to ruptures esophageal varices

Portal Hypertension

43
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Portal Hypertension

44
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Budd-Chiari

Life threatening emergency

45
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Portal vein Thrombosis - cavernous transformation

replacement of the normal single channel portal vein with numerous tortuous venous channels.

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50+

Cysts

True cysts are congenital

other cysts lack an epithelial lining and are not true cysts

47
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Presentation

Fever

pain

N&V

Leukocytosis

Elevated LFTs

Pyogenic (bacterial) abscess

48
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Presentation

fever

pain

diarrhea

Leukocytosis

Elevated LFTs

Amebic abscess

contaminated food or water usually in colon but can invade the liver through the portal vein

fever

pain

diarrhea

49
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May also present

wheel within a wheel

Bull's eye

Echogenic focus

Candidiasis

early wheel within wheel

later hypoechoic

50
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# cause of portal hypertension

Schistosomiasis

#1 cause of portal hypertension in the world. Not common in US but estimated 400,000 infected people have immigrated

parasitic infection mainly in Egypt

  • irregular surface of liver
  • hyperechoic thickened walls of portal venules giving the "clay-pipestem" pattern of periportal fibrosis
  • marked thickening and echogenecity of the gallbladder bed
  • splenomegaly
  • portal vein and splenic vein dilatation with maintained continuous hepatopetal flow and average velocity
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Sheep herder

Echinococcal Cyst

Sheep Herders

AKA Hydatid Cyst

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Sheep herder

Echinococcal Cyst

Sheep Herders

AKA Hydatid Cyst

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Water lily

Sheep herder

Echinococcal Cyst

Sheep Herders

AKA Hydatid Cyst

54
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24 year old female on birth control pills

Pain

Liver Adenoma

Females taking birth control

*Hypoechoic

*Hyperechoic

*Isoechoic

*Mixed

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enlarge with pregnancy

Cavernous Hemangioma

56
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Hepatic lipoma

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Asymptomatic

Focal Nodular Hyperplasia

abnormally arranged hepatocytes

Second most common benign liver mass

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6 month old female

abdominal mass

CHF

Hemangioendothelioma

Benign condition of overgrowth of endothelium of capillaries

Found in infants

Usually seen as hepatic lesions that are predominantly hypoechoic; however, hepatic lesions can also have mixed echotexture or be predominantly hyperechoic.

59
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Two year old with palpable mass on right side

Mesenchymal hamartoma

rare developmental cystic tumor of the lover

complex mass

more common in rt lobe

60
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3 year old

abdominal enlargement

weight loss

nausea and vomiting

marked elevation of AFP

Hepatoblastoma

malignant germ cell tumor

most common malignant liver tumor of children under 3

associated with Beckwith Wiedermann

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Patient with cirrhosis

Hepatocellular Carcinoma

solid

multiple

diffuse

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Hemangiosarcoma

rare in 60 - 80

related to exposure of thorotrast, arsenic or polyvinyl chloride

large mixed mass

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Liver mets from ?

Metastasis to the liver

colon

Most common

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Liver mets from ?

Metastasis to the liver

Breast

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Liver mets from ?

Metastasis to the liver

Lung

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Liver mets from ?

Lymphoma

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Pain

hypertension

after car accident

Liver hematoma

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Annular Pancreas

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6 year old present

Cystic Fibrosis

autosomal Recessive

Pancreas appears hyperechoic due to microcystic changes, increased fibrotic and fat

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severe constant, intense pain radiating to the back

N & V

fever

sweating

paralytic ilius

elevated amylase 48 - 78 hours

elevated lipase 5 - 7 days

WBC

Acute Pancreatitis

71
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severe constant, intense pain radiating to the back

N & V

fever

sweating

paralytic ilius

elevated amylase 48 - 78 hours

decreased hematocrit & calcium

Hemorrhagic Pancreatitis

Type of acute pancreatitis 2% to 5%

significant fat necrosis that results in rupture of pancreatic vessels and secondary hemorrhage

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N & V

fever

sweating

paralytic ilius

elevated amylase 48 - 78 hours

elevated lipase 5 - 7 days

WBC

Phlegmonous Pancreatitis

Type of acute pancreatitis 18%

enlarged solid inflammatory mass with retroperitoneal fat necrosis

usually lesser sac is involved

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Pancreatic Abscess

infection of necrotic pancreatic and retroperitoneal fat

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persistently elevated amylase and lipase

Pancreatic Psydocyst

Spherical fluid collection of pancreatic enzymes that arise from inflamatory, necrotic and hemorrhage processes of the pancrreas

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persistently elevated amylase and lipase

Pancreatic Psydocyst

Spherical fluid collection of pancreatic enzymes that arise from inflamatory, necrotic and hemorrhage processes of the pancrreas

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persistently elevated amylase and lipase

Pancreatic Psydocyst

Spherical fluid collection of pancreatic enzymes that arise from inflamatory, necrotic and hemorrhage processes of the pancrreas

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N & V

flatulence

weight loss

Chronic Pancreatitis

Ongoing inflammation that results in permanent damage

78
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N & V

flatulence

weight loss

Chronic Pancreatitis

Ongoing inflammation that results in permanent damage

79
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Mid epigastric Pain

weight loss

jaundice

palpable mass

Cystadenoma

multiple cystic masses that contain secreted material

80
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Mid epigastric Pain

weight loss

jaundice

palpable mass

Mucinous Cystic / Cystadenocarcinoma

malignant tumor from glandular tissue in which secretions are oobtained

81
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25 year old female with vague abdominal pain

Serious Cystadenoma / Microcystic adenoma

type of serous cystadenoma

lobulated mass of numerous small cysts

82
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Most common cause of malignant neoplasm

abdominal / back pain

jaundice

weight loss

Adenocarcinoma

arises from the epithelium and involves the exocrine portion of the pancreas

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The most common form of fusion anomaly of the kidneys

Horseshoe Kidneys

84
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The most common form of fusion anomaly of the kidneys

Horseshoe Kidneys

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Crossed fused Renal Ectopia

86
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Right kidney

Junctional Parenchymal Defect

87
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often seen with hydronephrosis in the upper pole

Duplex Kidney

Seen in 15% of population

88
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Duplex Kidney

89
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Extrarenal Pelvis

90
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Male neonate

Posterior Urethral valves

91
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30 year old male presents for a renal ultrasound

liver & spleen cysts

Adult Polycystic Kidney Disease

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infant presents with renal dysfunction

Infantile Polycystic Kidney Disease

results from cystic dilation of the collecting tubules

93
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Most common cause of abdominal mass in newborns

unilateral

Multicystic Dysplastic Kidney

94
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chronic renal failure

hemodialysis

Aquired Cystic Disease

multiple cysts in failing kidney during long term hemodialysis

hemorrhage often occurs

95
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Medullary Sponge Kidney

congenital dysplastic dilatation of the medullary pyramids due to tubular ectasia or dysplasia

medullary neprocalcinosis

96
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medullary neprocalcinosis

97
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hypercalcemia

hypercalciuria

Nephrocalcinosis

98

20 year old presents with visual impairments

Von Hippel-Lindau Disease

inhearited usually present in 2nd to 3rd decade

99
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right kidney

Angiomyolipoma

benign fatter renal tumor

80% involve right kidney

echogenicity is gretr than of equal to the renal sinus

100
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right kidney

Angiomyolipoma

benign fatter renal tumor

80% involve right kidney

echogenicity is gretr than of equal to the renal sinus

101
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seizures

mental retardation

facial angiofibroma

bilateral Angiomyolipomas

Tuberous Sclerosis

genetic

102
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Most common solid renal mass in adults

hematuria

flank pain

palpable mass

lung mets

Renal Cell Carcinoma

103
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Most common solid renal mass in adults

hematuria

flank pain

palpable mass

lung mets

Renal Cell Carcinoma

104
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generally appear as hypoechoic or diffuse enlargement

Renal Metastases

105
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3 years

large asymptomatic flank amss

hypertension

fever

hematuria

Wilm's Tumor

3 years

90% survival

106
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Acute Pyelonephritis

travel from bladder

AKA acute focal bateria nephritis / lobar nephritis

107
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Acute Pyelonephritis

travel from bladder

AKA acute focal bateria nephritis / lobar nephritis

108
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diabetic

Emphysematous pyelonephritis

Gas in the kidney

nephroectomy is usually required

109

small hyperechoic kidneys with cortical thinning

Chronic Pyelonephritis

due to recurrent renal infection

110
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type of Chronic Pyelonephritis

Xanthogranulomatous Pyelonephritis XGPN

Chronic Pyelonephritis due to stone

111
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type of Chronic Pyelonephritis

Xanthogranulomatous Pyelonephritis XGPN

Chronic Pyelonephritis due to stone

112
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due to secondary infection from renal obstrution

Pyonephrosis

113
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Mycetoma (fungal ball)

candidiasis is the most common

Non shadowing hyperechoic mass

114
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Most common cause of acute renal failure

prolonged drugs or contrast agents

Acute Tubular Necrosis (ATN)

115
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hematuria

proteinuria

azotemia

red blood cell casts in urine

Acute Glomerulonephritis

gomerular damage

caused by

autoimmune

infection

toxins

116
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anagesic abuse

diabetes mellitus

UTI and obstruction

sickle cell

CHF

Papillary Necrosis

117
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Renal Sinus Lipomatosis

118
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benign prostatic hypertrophy

Bladder diverticula

119
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Urachal Cyst

120
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Ureteroceles

121
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Most common bladder neoplasm

hematuria

hydronephrosis

Transitional Cell Carcinoma

122
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Most common bladder neoplasm

hematuria

hydronephrosis

Transitional Cell Carcinoma

123
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Lymphocele

124
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most common germ cell tumor

white male smoker

infertility

Seminoma

125
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25 - 35 year olds

most aggressive testicular cancer

elevated beta-hcg

elevated AFp

Embryonal Cell carcinoma

126
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common in infants

25 - 35 year olds

Testicular Teratoma

127
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most common testicular tumor in infants and young children

elevated afp

Yolk sac tumors

128
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20 - 30 year old

elevated beta-Hcg

Choriocarcinoma

129
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5-10 year old - benign

precocious puberty

feminizing features (gynecomastia)

Leydig Cell tumors

130
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appears in 10% of population

Epidermoid Cysts

benign testicular cyst

131
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fever

scrotal pain

swelling

untreated orchitis

Testicular abscess

co

132
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Testiular Pearls

testicular calcification

133
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40% have neoplasm asscoiation

Microlithiasis

134
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trauma

torsion

Testicular infarct

135
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trauma

pain

scrotal Hematocele

136
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trauma

pain

swelling

fever

leukocytosis

scrotal pyocele

137
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most common fluid collection of the testicle

Hydrocele

serious fluid between the tunica vaginalis

138
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left side

most common correctible cause of male infertility

Varicocele

139
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left side

most common correctible cause of male infertility

Varicocele

140
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swollen scrotum

persistent or intermittent palpable mass

abdominal pain

blood in stool

Scrotal Hernia

141
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most common extratesticular tumor

adenomatoid tumor

142
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Spermatoceles

AKA Epididymal Cysts

result of dilation of the epididymal tubules

143
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most common condition that causes scrotal pain

possible fever

pyuria

STD

UTI

Epididymitis

inflammation of epididymis usually due to UTI

144
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pain usually during rest or sleep

N & V

torsion

less than 6 hours 80% + salvage

6 - 12 hours 70% salvage

12 + hours :(

145
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most common cause of mender 35 is chlamidia

pain

elevated WBC

Orchitis

146
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50+ year old man

difficult voiding

urinary frequency

small stream

Benign Prostatic Hyperplasia

usually in transitional zones

147
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Mullerian Duct Cyst

usually midline

148
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Utricle Cysts

usually midline

149
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Retention cyst

usually lateral

150
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Ejaculatory duct cyst

Usually lateral & central

151
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pain

rectal and prostate tenderness

Fever

Prostatitis

152
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Accessory Spleen

153
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Splenic granulomas

focal lesions resulting from previous infection

154
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Hemangioma

155
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Splenic infarct

common in patients with bacterial endocarditis and splenic artery aneurysms

156
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general abdominal sepsis

Splenic Abscess

157
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Splenic Artery Aneurysm

158
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Crus of the diaphragm

159
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Crus of the diaphragm

160
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Crus of the diaphragm

161
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asymptomatic

cushing's

conn's

Adreanal Adenoma

162
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cushing's

Adrenal Cortical Carcinoma

163
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hypertension

headache

palpitations

tachycardia

anxiety

excessive persperation

Pheochromocytoma

tumor arising from the adrenal medusa

164
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most common childhood adrenal mass

Adrenal Neuroblastoma

165
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Myelolipoma

benign, nonfunctioning adrenal masses that contain fat

166
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large neonate

difficult birth

Adrenal Hemorrahage

167
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Caucasian male

75 year old

hypertension

abdominal, back and leg pain

palpable abdominal mass

Fusiform aneurysms

168
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Sacular aneurysms

rare

169
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Pseudoaneurysm

170
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tearing back pain

shock

headache

abdominal pain

Aortic Dissection

171
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tearing back pain
shock
headache
abdominal pain

Aortic Dissection

172
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Gastoesophageal Junction

173
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Pain over McBurney's point

umbilical pain shifting to RLQ

loss of appetite

leukocytosis

rebound tenderness

Acute appendicitis

174
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3 - 6 months old

projectile vomiting

palpable olive shaped abdominal mass

Hypertrophic Pyoric Stenosis

175
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Fever

leukocytosis

LLQ pain

Diverticulitis

176
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abdominal distension

pain

vomiting

hypotension

leukocytosis

Small bowel Obstruction

177
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Colon obstruction

178
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vomiting

abdominal pain

rectal bleeding

Intussception

179
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vomiting
abdominal pain
rectal bleeding

Intussception

180
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Biloma

181
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renal trauma

renal transplant

Urinoma

182
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failed thompson test

Achilles Tendon Rupture

183
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inability to extend knee

Patellar tendon Rupture

184
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matted bowel loops

malignant ascites

Pseudomyxoma Peritonel

185

...

Hematoma

186
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sandwich sign

Lymphadenopathy

187
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carpet layer

Baker's Cyst

188
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2nd most common tumor of the hand and wrist

Giant Cell tumor (ganglion cyst)

189
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Rectus Sheath Hematoma