boy parts Flashcards
1
Q
testes develop from the __
A
urogenital ridge
2
Q
what GA do testes descend through inguinal canal into scrotum
A
26-32 w GA
3
Q
what guides testes into scrotum in utero
A
gubernaculum
(adj to peritoneal diverticulum/ process vaginalis)
4
Q
layers of scrotal wall to testes from outer to inner
A
skin
dartos muscle
external spermatic fascia
cremasteric fascia
internal spermatic fascia
parietal tunica vaginalis
cavum vaginale (space)
visceral tunia vaginalis
tunia albuginea
5
Q
extensions of __ tunica enter the testis and divide it into lobules
A
visceral tunica vaginalis
6
Q
lobules of testis contain the __
A
seminiferous tubules
7
Q
what is contained within the seminiferous tubules
A
germ cells (spermatozoa pre)
Leydig cells (produce test and estrodiol)
Sertoli cells (nurse developing germ cells and produce estrodiol)
8
Q
cells that produce testosterone and estrodiol
A
Leydig cells
9
Q
cells that nurse developing germ cells and produce estrodiol
A
Sertoli cells
10
Q
precursor cells to spermatozoa
A
germ cells
11
Q
seminiferous tubules drain into the __
A
rete testes
12
Q
rete testes drain into the __
A
efferent ductules
13
Q
efferent ductules enter the __
A
epi head
14
Q
rete testes are enclosed within the __
A
mediastinum
15
Q
testicular arteries arise from the __
A
mid aorta
16
Q
__ artery is a common variant
A
transmediastinal
17
Q
__ drains testes to testicular veins
A
pampiniform plexus
*RT to IVC and LT to LRV
18
Q
which side is more likely to develop varicoceles and why
A
LEFT
because the LT vein drains into the LRV rather than the IVC
++ hydrostatic pressure
19
Q
arteries supplying the testis should demonstrate __ resistance
A
low resistance
20
Q
arteries supplying the extratesticular tissue should demonstrate __ resistance
A
higher resistance than testis itself
21
Q
epididymis arises from __ and terminates in the __
A
arises from the efferent ductules and terminates in ductus deferens
22
Q
ductus deferens joins the __ at the ejaculatory duct, which enters the prostatic urethra
A
seminal vesicle
23
Q
what is contained within the spermatic cord
A
ductus deferens
pampiniform plexus
deferential artery
lymphatics
nerves
24
Q
__ is the passageway in/out of the pelvis
A
inguinal canal
25
which part of the inguinal canal is nearest the scrotum
external inguinal
26
what type of glandular organ is the testis
heterocrine
exocrine: peroduces spermatozoa
endocrine: produces testosterone (and estradiol)
27
echogenicity of epididymis in comparison to testis
isoechoic or slightly hyperechoic
28
normal epi head measurement
10-12mm
29
relationship of testis to peritoneum
retroperitoneal
30
potential space between visceral and parietal tunica vaginalis
cavum vaginale
31
normal thickness of scrotal wall
2-8mm
32
which layer of scrotal wall causes it to wrinkle inwards
dartos muscle
**scrotal raphe = "seam"
33
normal measurements of testis
4-5cm length
2.5-3cm AP
34
small region not covered by the tunica vaginalis
bare area
adj to mediastinum testis
"hilus testis"
35
each testis divided into __ lobules by extensions of tunica albuginea called septa
250
36
how many seminiferous tubules within each lobule of testis
2-4
37
normal structure that is not typically seen that can be prominent with inflammatory disease
testicular septa
38
what is the most common source of testicular cancer
germ cells
95%
39
__ cells are adj to seminiferous tubules.
Leydig
40
rare malignancy from Leydig cells may cause __ in young male children due to __
precocious puberty
+++ testosterone
41
rare malignancy from Leydig cells may cause __ in young adults due to __
gynecomastia
++estrodiol
42
"nurse" cells
Sertoli
43
relationship of Sertoli cells to seminiferous tubules
within
44
rare malignancy from Sertoli cells may cause __ in young mals due to __
gynecomastia
++ estrodiol
45
a network of fibrous tissue along the length of the testis
mediastinum
46
what is adj to hilum/bare area and encloses the rete testis
mediastinum
47
is the mediastinum at the centre or the periphery of the testis
periphery
48
sono appearance of mediastinum
echogenic line through testis
49
network of tubules draining the sminiferous tubules and leading tot he efferent ductules
rete testis
50
what are the testicular artery branches
capsular
centripetal
recurrent
deferential
cremasteric
51
ductus deferens aka
vans deferens
52
__ arises from the tail of the epididymis, ascends along the posterior border of the testis and travels into the pelvis in the spermatic cord
ductus deferens
53
supporting structure that contains the ductus deferens, arteries, veins, lymph vessels and nerves
spermatic cord
54
passageway for the spermatic cord int he anterior abdominal wall just lateral to the symphysis pubis and superior to the inguinal ligament
inguinal canal
55
spermatozoa develop in the __ and mature in the __
develop in the seminiferous tubules
mature in the epididymis
56
is the pampiniform plexus normally visible with u/s
yes (small)
57
is the rete testis normally visible with u/s
no
58
is the efferent ductules normally visible with u/s
no
59
is the seminiferous tubules normally visible with u/s
no
60
is the testicular septa normally visible with u/s
sometimes
61
is the ductus deferens normally visible with u/s
no
62
is the testicular artery normally visible with u/s
no
63
is the transtesticular artery normally visible with u/s
yes; variant in 50%
64
invagination of the tunica albuginea aka
mediastinum testis
65
mullerian vestigial remnant arising from upper pole of testis
appendix testis
common
66
usually only see appendix testis in presence of __
hydrocele
67
epididymal head aka
globus major
caput epididymis
68
wolffian remnant arising from head of epididymis
appendix epididymis
less common than appendix testis
69
epididymal cyst in the epi head aka
spermatocele
70
spermatocele can be associated with __
tubular ectasia of the rete testis
71
associated concern for isolated right-sided extra-testicular varicoceles
'nutcracker' syndrome
**compression of LRV between Ao and SMA
72
the majority of intratesticular lesions are __
malignant tumours
73
the majority of extratesticular pathologies are __
benign
*related to inflammation, infection, trauma, benign neoplasms
74
most common fluid collection
hydrocele
may be congenital or acquired
most commonly idiopathic
75
what is the most important factor to delineate when working up a hydrocele of any size
ensure the testis is normal
76
congenital anomaly that may lead to hydrocele and inguinal hernia
patent processus vaginalis
77
sono appearance of hematocele and how do you know?
hx is key
may be anechoic, hypo, or echo
may contain septations, loculation or debris
sonographically similar to pyocele
78
lesion due to dilatation of an epididymal tubule
epididymal cysts
may be asymptomatic, mild pain, or palpable mass
79
lab values associated with spermatocele
normal values
80
physics q: movement of tiny particulate matter within fluid due to the acoustic pressure of the ultrasound pulse
acoustic streaming
81
ddx of solid paratesticular mass includes primarily benign entities such as
sperm granuloma
fibrous pseudotumour
adenomatoid
lipoma
leiomyoma
inflammatory nodule
82
3-16% of solid paratesticular masses are malignant; which is the most common variation?
rhabdomyosarcoma
83
varicoceles are dilated, tortuous veins of the __
pampiniform plexus
84
sono sign associated with varicoceles
'bag of worms'
85
criteria / measurements for varicoceles
2 or more >2-3mm AP
enlargement with valsalva
flow reversal with valsalva
86
which position is helpful for assessing varicosities
upright
87
congestive dilatation post vasectomy aka
post vasectomy epididymitis
88
punctate mobile echogenicities within the epididymis
'dancing megasperm'
fairly common in pt with epididymal obstruction or post vasectomy
89
which way does the bacterial infection track with epididymitis
ascending
90
sono features of epididymitis
hypoechoic enlargement
typically in the tail
increased flow (compare to contralateral side)
+/- hydrocele
+/- scrotal skin thickening
common post vasectomy
91
orchitis usually associated with __
epididymitis
can progress to abscess
92
uncommon development of necrotizing fasciitis aka
Fournier's gangrene
gas within
93
scrotal mouse aka
scrotal pearl
extratesticular scrotal calculi
94
painful, swollen scrotum or hemiscrotum aka
'acute scrotum'
large number of causes
**testicular torsion
epididymitis
trauma
hernia
others
95
what is the most common cause for acute scrotum in adult males
epididymitis
96
symptoms of acute epididymitis
gradual increasing pain
+/- fever, dysuria, discharge
+/- increased WBC
97
sono sign for epididymo-orchitis
great ball of fire
98
what kind of flow will you expect to see within an abscess
absence of flow
99
prolapse of bowel or omentum into the scrotum
scrotal hernia
usually an obvious clinical diagnosis
100
bilateral cryptorchidism associated with __
sterility
101
speculated cause of scrotal mice
inflammation of tunica vaginalis or old torsion of appendix testis or epi
102
where would you find a scrotal mouse
in the cavum vaginale
103
'onion skin' appearance associated with scrotal wall thickening
scrotal wall edema
causes:
cardiac failure
hypoalbuminemia
venous obstruction
lymphatic obstruction
idiopathic
104
infection of the lymphatic system by small parasitic round worm
filariasis
(peripherally can cause elaphantitasis)
105
difference between dancing megasperm and filarial dance
megasperm
- more common in west
- within epi
- punctate mobile echogenicities
- acoustic streaming
filarial
- tropical origin
- within lymphatics
- linear echogenicities
- actively mobile
106
most common demographic for testicular tumours
young adult males
107
what is the most common germ cell tumour
seminoma
**least aggressive too
108
how do most testicular tumours present clinically
solid, painless mass
palpable
109
which tumour is AFP a marker for
embryonal cell and yolk sac
110
which tumour is beta hCG a marker for
choriocarcinoma
111
where do testicular primaries metastasize to
retroperitoneum
112
mets to the testicles usually occur in which age group and regarding which primaries
older adult males
lymphoma and leukemia
113
non germ cell tumours most common with what age group
pediatrics
114
what type of gland is the prostate
exocrine
115
normal size prostate in young male; size in >40 y
<20 g young
<40 g older
116
what is prostatic fluid
prostate fluid containing 15-30% semen volume
117
prostate surrounds the __
proximal prostatic urethra
118
the base of the prostate abuts the __
bladder outlet
119
what is the most gravity dependent location in the body
retrocaval pouch
*between visceral and parietal peritoneum
120
what kind of gland are the seminal vesicles
exocrine glands
121
what is inside the seminal vesicles
seminal fluid
- carb rich
- 60% semen volume
122
seminal vesicles join the __ to form the ejaculatory duct
ductus deferens
123
which lobe of the prostate hypertrophies into the bladder
median lobe
124
which zone of the prostate is palpable
peripheral (encompasses 70% of the glandular tissue)
125
which zone of the prostate develops the most cancers
peripheral (posterior)
126
__ separates inner gland of prostate from the peripheral zone
surgical capsule
*becomes better-defined cleavage plane when compressed by BPH
127
which zone of the prostate surrounds the proximal urethra
transition zone
128
what is the name of the inferior margin of the transition zone
verumontanum
129
small bump in the prostatic urethra between the tube for urine and the tube for semen
verumontanum
130
location of the potential posterior urethral valves
verumontanum
131
which zone of the prostate experiences BPH
transition zone
132
BPH is __ mediated
hormonally
*diffuse enlargement
133
decreased force of urination, difficulty voiding and urinary retention, elevated PSA - likely dx
prostatism
134
which zone of the prostate do the ejaculatory ducts run through
central zone
*infrequent site of cancer
135
which zone of the prostate surrounds the prostatic urethra
periurethral glandular zone
136
which zone of the prostate is the anterior section
fibromuscular stroma
137
name for the starchy bodies that can develop within ducts of the prostate
corpora amylacea
*increased incidence with age
*derived from degenerate cells or thickened secretions
138
agenesis or cysts on the seminal vesicles are associated with __
congenital renal anomalies
139
TURP aka
transurethral resection of prostate
140
resection of periurethral prostate for relief of bladder outlet obstruction due to BPH
TURP
141
prostate cancer more common in which demographic
black males ++age
142
what is the most common spread of prostate cancer
local invasion of periprostatic tissue
143
where is common metastatic spread from prostate primary
pelvic lymph nodes and bone
144
PSA aka
prostate specific antigen
*protein produced in prostate measured in blood
145
rapid increase in PSA worrisome for
cancer; both benign and malignant processes
146
PSA is __ for cancer
SENSITIVE
not specific
+++++ false positives
*normal PSA does not rule out cancer
147
serum __ used to monitor prostate cancer
serum acid phosphatase
*enzyme produced by several tissues
*elevated in presence of mets in the liver
148
penile vein located __ while urethra located __
vein is dorsal
urethra is ventral
149
how many erectile columns in the penis; what types
3 total
2 are corpora cavernosa
1 is corpus spongiosum
150
how many paired arteries in the penis
3
dorsal, cavernous (in cavernosa), and bulbourethral (in spongiosum)
151
how many veins in the penis
2; both dorsal
one is superficial (larger) the other is deep
152
prolate ellipse formula
L x W x H x 0.523
153
which penile pathology is Doppler useful for
erectile dysfunction
154
plaques in penile shaft effecting function
Peyronie's disease
155
vast majority of testicular neoplasms are of __ cell origin
germ cell
156
most common demographic for testicular neoplasms
15-40 y
peaks in infancy, 25-40 and >60
157
typical presentation of testicular neoplasm
painless, unilateral testicular enlargement/ palpable mass
very firm, non compressible
sometimes presentation of symptoms secondary to metastatic disease (ie abd pain, cough, hemoptysis)
158
risk factors for test cancer
prev hx
family hx
cryptorchidism
maldescent
testicular atrophy
159
what are the major classifications of germ cell tumours in testicles
seminoma
non seminoma
160
which type of germ cell tumour is most common
seminoma (less aggressive)
161
types of non seminoma tumours
yolk sac tumour
embryonal cell
teratoma
choriocarcinoma
mixes
162
tumour markers for embryonal cell, YS and teratoma tumours
AFP (alphafetoprotein)
163
tumour marker for seminoma
sometimes hCG
164
tumour marker for choriocarcinoma
hCG
165
what is the most common tumour in an undescended testis
seminoma
166
sono features of seminoma
well defined
focal
uniformly hypoechoic
solid
167
common association with seminoma cancer
lymphadenopathy along abdomen
168
sono features of non seminoma neoplasms
mixed echo patterns due to areas of hemorrhage, necrosis and calcifications
poor margins
often small
aggressive invasion of tunica albuginea
169
+/- associated development with choriocarcinoma
gynecomastia
170
what is the second most common testis tumour after seminoma
mixed germ cell tumour
* mix of embryonal, teratoma, choriocarcinoma, yolk sac etc
171
non palpable, small germ cell tumour that has outgrown its blood supply
'burned out' tumour
usually extensive mets
+/- shadowing
small
echogenic foci
172
demographic for yolk sac tumour
'pure' tumour
young children <3 y
173
types of non germ cell tumours
Leydig cell tumour
Sertoli cell tumour
174
sex cord stromal tumours aka
non germ cell
*arise from stroma of testis
175
testicular tumours that can cause virilizing or feminizing effects
non germ cell tumours
precocious puberty (leydig ++testosterone)
gynecomastia (sertoli ++estrodiol)
176
majority of large tumours (>1.6cm) will show __ vascularity compared to normal testis
increased
**WITHIN; not feeding vessel
*may be unhelpful in distinguishing tumour from other non vascular pathology (ie hematoma, abscess)
177
demographic for mets TO the testis; which primaries
usually older males
primary lymphoma or leukemia most common
178
sono signs mets to testis
frequently bilat
firm, painless
non specific focal or diffuse areas of decreased echogenicity in enlarged or normal size testes
179
dilatation of the rete testis (ectasia) often associated with __
spermatocele
180
etiology of tubular ectasia of rete testis
unclear
may be due to epi obstruction
181
sono features of tubular ectasia of rete testes
no flow
often bilateral
small, tubular cystic lesions in region of mediastinum
not usually palpable
increased incidence with age
182
tubular ectasia of the epi associated with __
vasectomy
183
well-circumscribed, firm, avascular lesion presenting with 'onion skin' appearance
epidermoid cyst
*benign tumour
184
what are the layers in an epidermoid cyst
layers of epithelium surrounding keratin-like cyst
etiology unknown; may be teratoma variant
185
what is the criteria amount for testicular microlithiasis
5 or more per field
+/- bilat
186
etioloty of testicular microlithiasis
hydroxyapatite crystals inside the seminiferous tubule
(calc forming around nidus of debris)
**not granulomatous disease
187
what is testicular microlithiasis associated with
neoplasm formation IF associated with risk factors for testicular cancer
188
rare deposition of focal fat in the testes
testicular lipomatosis
189
association with testicular lipomatosis
Cowden's disease
may be cause of subfertility
190
role of u/s with testicular trauma
determine if testicle is ruptured or intact
191
signs of testicular rupture
focal areas of altered echogenicity
hypoechoic, linear fracture plane (not common)
contour distortion or irregularity
**tough to distinguish from hematoma
192
main difference between fracture and rupture
rupture causes break in capsule
fracture = capsule in tact
193
acute twisting of the spermatic cord
testicular torsion
194
anomaly associated with testicular torsion
'bell clapper'
*no bare area; testis free to rotate within the scrotum
195
typical demographic for testicular torsion
12-18 y, neonates
196
how soon does sx have to be performed to save a testicle with compromised blood supply due to torsion
<6 hours
197
acite testicular pain, rapid swelling, nausea, vomiting, fever, increased white count and no cremasteric reflex
testicular torsion
+/- enlarged epi
+/- scrotal wall thickening
+/- hydrocele
198
which acute testicular emergency can mimic an infection
torsion
199
what Doppler findings would you expect with testicular torsion
no flow = torsion
decreased flow = probable torsion
increased flow = likely detorsion
200
detorsion can mimic __
epididymo-orchitis
**use clinical hx
201
spontaneous untwisting of torqued spermatic cord
detorsion
202
49y male, no flow in affected testis, appendix testis seen inf to testis suggesting malrotation and small hydrocele seen with debris - likely dx?
testicular torsion
203
what kind of vascularity would you expect in the extratesticular tissue with torsion
hyperemic
204
testicular torsion >6 hours showing heterogeneity
infarcted, necrotizing
205
sonographic feature of torsion knot
'whirlpool sign'
*superior or inferior to testis, or in inguinal canal
206
likely demographic for torsion of appendix testis
infant and pre-pubescent
*if accurately dx, not a surgical emergency (managed with NSAIDS and is self-limiting)
207
acute vs. chronic testicular infarct
acute = focal, hypoechoic mass or diffuse hypochoic tissue, small testis
chronic = hyperechoic pattern secondary to fibrosis
208
chromosomal syndrome associated with bilat small testes
Kleinfester syndrome
*3 sex chromosomes
209
sono appearance of testicular prosthesis
sinilar to breast implant
* fibrous capsule
typically anechoic
+/- reverberative echoes
+/- SOS artifact
210
wrinkle in prosthesis capsule called
contracture
211
rare incidence of polyorchidism most commonly occuring on which side
left
212
location and demographic of femoral hernias
more common in females
inferior to inguinal ligament
medial to sepheno-femoral function
213
a hernia that can be manually returned to its normal compartment
reducible hernia
214
complications of non reducible hernias
incarceration = maintains blood supply
strangulation = loss of blood supply
215
common contents of hernia
bowel
fat (omental, mesenterc, properitoneal)
216
hernia technique
large footprint linear array >/=12 MHz
217
what type of artifact are you likely to see on a repaired hernia
twinkling
common to use mesh to correct weakened wall
218
ligament that provides support to lower abdomen
inguinal ligament
219
normal contents of inguinal canal (male; female)
male = spermatic cord, ilioinguinal nerve
female = uterine round ligament, ilioinguinal nerve
220
Inguinal triangle aka
Hasselbach's triangle
221
why do we care where the epigastric vessels are
entrance to the internal inguinal RING is lateral to the inferior epigastric vessels
*Inferior epigastric artery/vein arise from external iliacs just superior to the inguinal ligament.
222
why are the inferior epigastric vessels never obscured by gas?
they run anterior to the peritoneal cavity
223
the inguinal triangle is the landmark for __ hernias
direct inguinal hernias
**medial to inferior epigastric artery
224
direct inguinal hernias originate __
medially
225
indirect inguinal hernias originate __
lateral and anterior to epi artery
at the inguinal ring
226
why is it called 'indirect' inguinal hernia
bowel and peritoneum do not herniate directly through the weakness in the abd wall
227
contents of an indirect inguinal hernia move through a patent __
processus vaginalis
* courses anterior to inferior epigastric artery
228
less common inguinal hernia, acquired, most likely in older and +BMI patients
direct inguinal hernia
229
difference (direct, indirect) in hernia extension relating to the spermatic cord
indirect extends anterior to SC
direct extends posterior to SC
230
which type of inguinal hernia can often extend into the scrotum and labium majorum?
indirect
231
contents of femoral sheath
femoral artery, vein and canal (lymph and vessels)
canal is medial to vein (the most medial compartment)
** site of herniation
sheath at saphenous femoral junction
232
key landmark when assessing a femoral hernia
sapheno-femoral junction
**canal is medial to CFV and superior to SFJ
233
which side is more common for femoral hernias
right side
