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ABD & SMALL PARTS > boy parts > Flashcards

boy parts Flashcards

1
Q

testes develop from the __

A

urogenital ridge

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2
Q

what GA do testes descend through inguinal canal into scrotum

A

26-32 w GA

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3
Q

what guides testes into scrotum in utero

A

gubernaculum
(adj to peritoneal diverticulum/ process vaginalis)

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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

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5
Q

extensions of __ tunica enter the testis and divide it into lobules

A

visceral tunica vaginalis

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6
Q

lobules of testis contain the __

A

seminiferous tubules

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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)

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8
Q

cells that produce testosterone and estrodiol

A

Leydig cells

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9
Q

cells that nurse developing germ cells and produce estrodiol

A

Sertoli cells

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10
Q

precursor cells to spermatozoa

A

germ cells

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11
Q

seminiferous tubules drain into the __

A

rete testes

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12
Q

rete testes drain into the __

A

efferent ductules

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13
Q

efferent ductules enter the __

A

epi head

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14
Q

rete testes are enclosed within the __

A

mediastinum

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15
Q

testicular arteries arise from the __

A

mid aorta

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16
Q

__ artery is a common variant

A

transmediastinal

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17
Q

__ drains testes to testicular veins

A

pampiniform plexus

*RT to IVC and LT to LRV

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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

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19
Q

arteries supplying the testis should demonstrate __ resistance

A

low resistance

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20
Q

arteries supplying the extratesticular tissue should demonstrate __ resistance

A

higher resistance than testis itself

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21
Q

epididymis arises from __ and terminates in the __

A

arises from the efferent ductules and terminates in ductus deferens

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22
Q

ductus deferens joins the __ at the ejaculatory duct, which enters the prostatic urethra

A

seminal vesicle

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23
Q

what is contained within the spermatic cord

A

ductus deferens
pampiniform plexus
deferential artery
lymphatics
nerves

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24
Q

__ is the passageway in/out of the pelvis

A

inguinal canal

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25
Q

which part of the inguinal canal is nearest the scrotum

A

external inguinal

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26
Q

what type of glandular organ is the testis

A

heterocrine

exocrine: peroduces spermatozoa

endocrine: produces testosterone (and estradiol)

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27
Q

echogenicity of epididymis in comparison to testis

A

isoechoic or slightly hyperechoic

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28
Q

normal epi head measurement

A

10-12mm

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29
Q

relationship of testis to peritoneum

A

retroperitoneal

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30
Q

potential space between visceral and parietal tunica vaginalis

A

cavum vaginale

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31
Q

normal thickness of scrotal wall

A

2-8mm

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32
Q

which layer of scrotal wall causes it to wrinkle inwards

A

dartos muscle

**scrotal raphe = “seam”

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33
Q

normal measurements of testis

A

4-5cm length
2.5-3cm AP

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34
Q

small region not covered by the tunica vaginalis

A

bare area

adj to mediastinum testis

“hilus testis”

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35
Q

each testis divided into __ lobules by extensions of tunica albuginea called septa

A

250

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36
Q

how many seminiferous tubules within each lobule of testis

A

2-4

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37
Q

normal structure that is not typically seen that can be prominent with inflammatory disease

A

testicular septa

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38
Q

what is the most common source of testicular cancer

A

germ cells
95%

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39
Q

__ cells are adj to seminiferous tubules.

A

Leydig

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40
Q

rare malignancy from Leydig cells may cause __ in young male children due to __

A

precocious puberty
+++ testosterone

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41
Q

rare malignancy from Leydig cells may cause __ in young adults due to __

A

gynecomastia
++estrodiol

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42
Q

“nurse” cells

A

Sertoli

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43
Q

relationship of Sertoli cells to seminiferous tubules

A

within

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44
Q

rare malignancy from Sertoli cells may cause __ in young mals due to __

A

gynecomastia
++ estrodiol

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45
Q

a network of fibrous tissue along the length of the testis

A

mediastinum

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46
Q

what is adj to hilum/bare area and encloses the rete testis

A

mediastinum

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47
Q

is the mediastinum at the centre or the periphery of the testis

A

periphery

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48
Q

sono appearance of mediastinum

A

echogenic line through testis

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49
Q

network of tubules draining the sminiferous tubules and leading tot he efferent ductules

A

rete testis

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50
Q

what are the testicular artery branches

A

capsular
centripetal
recurrent
deferential
cremasteric

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51
Q

ductus deferens aka

A

vans deferens

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52
Q

__ arises from the tail of the epididymis, ascends along the posterior border of the testis and travels into the pelvis in the spermatic cord

A

ductus deferens

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53
Q

supporting structure that contains the ductus deferens, arteries, veins, lymph vessels and nerves

A

spermatic cord

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54
Q

passageway for the spermatic cord int he anterior abdominal wall just lateral to the symphysis pubis and superior to the inguinal ligament

A

inguinal canal

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55
Q

spermatozoa develop in the __ and mature in the __

A

develop in the seminiferous tubules

mature in the epididymis

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56
Q

is the pampiniform plexus normally visible with u/s

A

yes (small)

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57
Q

is the rete testis normally visible with u/s

A

no

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58
Q

is the efferent ductules normally visible with u/s

A

no

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59
Q

is the seminiferous tubules normally visible with u/s

A

no

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60
Q

is the testicular septa normally visible with u/s

A

sometimes

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61
Q

is the ductus deferens normally visible with u/s

A

no

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62
Q

is the testicular artery normally visible with u/s

A

no

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63
Q

is the transtesticular artery normally visible with u/s

A

yes; variant in 50%

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64
Q

invagination of the tunica albuginea aka

A

mediastinum testis

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65
Q

mullerian vestigial remnant arising from upper pole of testis

A

appendix testis

common

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66
Q

usually only see appendix testis in presence of __

A

hydrocele

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67
Q

epididymal head aka

A

globus major

caput epididymis

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68
Q

wolffian remnant arising from head of epididymis

A

appendix epididymis

less common than appendix testis

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69
Q

epididymal cyst in the epi head aka

A

spermatocele

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70
Q

spermatocele can be associated with __

A

tubular ectasia of the rete testis

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71
Q

associated concern for isolated right-sided extra-testicular varicoceles

A

‘nutcracker’ syndrome

**compression of LRV between Ao and SMA

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72
Q

the majority of intratesticular lesions are __

A

malignant tumours

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73
Q

the majority of extratesticular pathologies are __

A

benign

*related to inflammation, infection, trauma, benign neoplasms

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74
Q

most common fluid collection

A

hydrocele

may be congenital or acquired
most commonly idiopathic

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75
Q

what is the most important factor to delineate when working up a hydrocele of any size

A

ensure the testis is normal

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76
Q

congenital anomaly that may lead to hydrocele and inguinal hernia

A

patent processus vaginalis

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77
Q

sono appearance of hematocele and how do you know?

A

hx is key

may be anechoic, hypo, or echo

may contain septations, loculation or debris

sonographically similar to pyocele

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78
Q

lesion due to dilatation of an epididymal tubule

A

epididymal cysts

may be asymptomatic, mild pain, or palpable mass

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79
Q

lab values associated with spermatocele

A

normal values

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80
Q

physics q: movement of tiny particulate matter within fluid due to the acoustic pressure of the ultrasound pulse

A

acoustic streaming

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81
Q

ddx of solid paratesticular mass includes primarily benign entities such as

A

sperm granuloma
fibrous pseudotumour
adenomatoid
lipoma
leiomyoma
inflammatory nodule

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82
Q

3-16% of solid paratesticular masses are malignant; which is the most common variation?

A

rhabdomyosarcoma

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83
Q

varicoceles are dilated, tortuous veins of the __

A

pampiniform plexus

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84
Q

sono sign associated with varicoceles

A

‘bag of worms’

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85
Q

criteria / measurements for varicoceles

A

2 or more >2-3mm AP

enlargement with valsalva

flow reversal with valsalva

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86
Q

which position is helpful for assessing varicosities

A

upright

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87
Q

congestive dilatation post vasectomy aka

A

post vasectomy epididymitis

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88
Q

punctate mobile echogenicities within the epididymis

A

‘dancing megasperm’

fairly common in pt with epididymal obstruction or post vasectomy

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89
Q

which way does the bacterial infection track with epididymitis

A

ascending

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90
Q

sono features of epididymitis

A

hypoechoic enlargement

typically in the tail

increased flow (compare to contralateral side)

+/- hydrocele

+/- scrotal skin thickening

common post vasectomy

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91
Q

orchitis usually associated with __

A

epididymitis

can progress to abscess

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92
Q

uncommon development of necrotizing fasciitis aka

A

Fournier’s gangrene

gas within

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93
Q

scrotal mouse aka

A

scrotal pearl

extratesticular scrotal calculi

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94
Q

painful, swollen scrotum or hemiscrotum aka

A

‘acute scrotum’

large number of causes
**testicular torsion
epididymitis
trauma
hernia
others

95
Q

what is the most common cause for acute scrotum in adult males

A

epididymitis

96
Q

symptoms of acute epididymitis

A

gradual increasing pain

+/- fever, dysuria, discharge

+/- increased WBC

97
Q

sono sign for epididymo-orchitis

A

great ball of fire

98
Q

what kind of flow will you expect to see within an abscess

A

absence of flow

99
Q

prolapse of bowel or omentum into the scrotum

A

scrotal hernia

usually an obvious clinical diagnosis

100
Q

bilateral cryptorchidism associated with __

A

sterility

101
Q

speculated cause of scrotal mice

A

inflammation of tunica vaginalis or old torsion of appendix testis or epi

102
Q

where would you find a scrotal mouse

A

in the cavum vaginale

103
Q

‘onion skin’ appearance associated with scrotal wall thickening

A

scrotal wall edema

causes:
cardiac failure
hypoalbuminemia
venous obstruction
lymphatic obstruction
idiopathic

104
Q

infection of the lymphatic system by small parasitic round worm

A

filariasis

(peripherally can cause elaphantitasis)

105
Q

difference between dancing megasperm and filarial dance

A

megasperm
- more common in west
- within epi
- punctate mobile echogenicities
- acoustic streaming

filarial
- tropical origin
- within lymphatics
- linear echogenicities
- actively mobile

106
Q

most common demographic for testicular tumours

A

young adult males

107
Q

what is the most common germ cell tumour

A

seminoma
**least aggressive too

108
Q

how do most testicular tumours present clinically

A

solid, painless mass

palpable

109
Q

which tumour is AFP a marker for

A

embryonal cell and yolk sac

110
Q

which tumour is beta hCG a marker for

A

choriocarcinoma

111
Q

where do testicular primaries metastasize to

A

retroperitoneum

112
Q

mets to the testicles usually occur in which age group and regarding which primaries

A

older adult males

lymphoma and leukemia

113
Q

non germ cell tumours most common with what age group

A

pediatrics

114
Q

what type of gland is the prostate

A

exocrine

115
Q

normal size prostate in young male; size in >40 y

A

<20 g young
<40 g older

116
Q

what is prostatic fluid

A

prostate fluid containing 15-30% semen volume

117
Q

prostate surrounds the __

A

proximal prostatic urethra

118
Q

the base of the prostate abuts the __

A

bladder outlet

119
Q

what is the most gravity dependent location in the body

A

retrocaval pouch

*between visceral and parietal peritoneum

120
Q

what kind of gland are the seminal vesicles

A

exocrine glands

121
Q

what is inside the seminal vesicles

A

seminal fluid
- carb rich
- 60% semen volume

122
Q

seminal vesicles join the __ to form the ejaculatory duct

A

ductus deferens

123
Q

which lobe of the prostate hypertrophies into the bladder

A

median lobe

124
Q

which zone of the prostate is palpable

A

peripheral (encompasses 70% of the glandular tissue)

125
Q

which zone of the prostate develops the most cancers

A

peripheral (posterior)

126
Q

__ separates inner gland of prostate from the peripheral zone

A

surgical capsule

*becomes better-defined cleavage plane when compressed by BPH

127
Q

which zone of the prostate surrounds the proximal urethra

A

transition zone

128
Q

what is the name of the inferior margin of the transition zone

A

verumontanum

129
Q

small bump in the prostatic urethra between the tube for urine and the tube for semen

A

verumontanum

130
Q

location of the potential posterior urethral valves

A

verumontanum

131
Q

which zone of the prostate experiences BPH

A

transition zone

132
Q

BPH is __ mediated

A

hormonally

*diffuse enlargement

133
Q

decreased force of urination, difficulty voiding and urinary retention, elevated PSA - likely dx

A

prostatism

134
Q

which zone of the prostate do the ejaculatory ducts run through

A

central zone

*infrequent site of cancer

135
Q

which zone of the prostate surrounds the prostatic urethra

A

periurethral glandular zone

136
Q

which zone of the prostate is the anterior section

A

fibromuscular stroma

137
Q

name for the starchy bodies that can develop within ducts of the prostate

A

corpora amylacea

*increased incidence with age
*derived from degenerate cells or thickened secretions

138
Q

agenesis or cysts on the seminal vesicles are associated with __

A

congenital renal anomalies

139
Q

TURP aka

A

transurethral resection of prostate

140
Q

resection of periurethral prostate for relief of bladder outlet obstruction due to BPH

A

TURP

141
Q

prostate cancer more common in which demographic

A

black males ++age

142
Q

what is the most common spread of prostate cancer

A

local invasion of periprostatic tissue

143
Q

where is common metastatic spread from prostate primary

A

pelvic lymph nodes and bone

144
Q

PSA aka

A

prostate specific antigen

*protein produced in prostate measured in blood

145
Q

rapid increase in PSA worrisome for

A

cancer; both benign and malignant processes

146
Q

PSA is __ for cancer

A

SENSITIVE
not specific

+++++ false positives
*normal PSA does not rule out cancer

147
Q

serum __ used to monitor prostate cancer

A

serum acid phosphatase

*enzyme produced by several tissues
*elevated in presence of mets in the liver

148
Q

penile vein located __ while urethra located __

A

vein is dorsal
urethra is ventral

149
Q

how many erectile columns in the penis; what types

A

3 total

2 are corpora cavernosa
1 is corpus spongiosum

150
Q

how many paired arteries in the penis

A

3

dorsal, cavernous (in cavernosa), and bulbourethral (in spongiosum)

151
Q

how many veins in the penis

A

2; both dorsal

one is superficial (larger) the other is deep

152
Q

prolate ellipse formula

A

L x W x H x 0.523

153
Q

which penile pathology is Doppler useful for

A

erectile dysfunction

154
Q

plaques in penile shaft effecting function

A

Peyronie’s disease

155
Q

vast majority of testicular neoplasms are of __ cell origin

A

germ cell

156
Q

most common demographic for testicular neoplasms

A

15-40 y

peaks in infancy, 25-40 and >60

157
Q

typical presentation of testicular neoplasm

A

painless, unilateral testicular enlargement/ palpable mass

very firm, non compressible

sometimes presentation of symptoms secondary to metastatic disease (ie abd pain, cough, hemoptysis)

158
Q

risk factors for test cancer

A

prev hx
family hx
cryptorchidism
maldescent
testicular atrophy

159
Q

what are the major classifications of germ cell tumours in testicles

A

seminoma

non seminoma

160
Q

which type of germ cell tumour is most common

A

seminoma (less aggressive)

161
Q

types of non seminoma tumours

A

yolk sac tumour

embryonal cell

teratoma

choriocarcinoma

mixes

162
Q

tumour markers for embryonal cell, YS and teratoma tumours

A

AFP (alphafetoprotein)

163
Q

tumour marker for seminoma

A

sometimes hCG

164
Q

tumour marker for choriocarcinoma

A

hCG

165
Q

what is the most common tumour in an undescended testis

A

seminoma

166
Q

sono features of seminoma

A

well defined
focal
uniformly hypoechoic
solid

167
Q

common association with seminoma cancer

A

lymphadenopathy along abdomen

168
Q

sono features of non seminoma neoplasms

A

mixed echo patterns due to areas of hemorrhage, necrosis and calcifications

poor margins

often small

aggressive invasion of tunica albuginea

169
Q

+/- associated development with choriocarcinoma

A

gynecomastia

170
Q

what is the second most common testis tumour after seminoma

A

mixed germ cell tumour

  • mix of embryonal, teratoma, choriocarcinoma, yolk sac etc
171
Q

non palpable, small germ cell tumour that has outgrown its blood supply

A

‘burned out’ tumour

usually extensive mets

+/- shadowing
small
echogenic foci

172
Q

demographic for yolk sac tumour

A

‘pure’ tumour

young children <3 y

173
Q

types of non germ cell tumours

A

Leydig cell tumour
Sertoli cell tumour

174
Q

sex cord stromal tumours aka

A

non germ cell

*arise from stroma of testis

175
Q

testicular tumours that can cause virilizing or feminizing effects

A

non germ cell tumours

precocious puberty (leydig ++testosterone)

gynecomastia (sertoli ++estrodiol)

176
Q

majority of large tumours (>1.6cm) will show __ vascularity compared to normal testis

A

increased
**WITHIN; not feeding vessel

*may be unhelpful in distinguishing tumour from other non vascular pathology (ie hematoma, abscess)

177
Q

demographic for mets TO the testis; which primaries

A

usually older males

primary lymphoma or leukemia most common

178
Q

sono signs mets to testis

A

frequently bilat

firm, painless

non specific focal or diffuse areas of decreased echogenicity in enlarged or normal size testes

179
Q

dilatation of the rete testis (ectasia) often associated with __

A

spermatocele

180
Q

etiology of tubular ectasia of rete testis

A

unclear
may be due to epi obstruction

181
Q

sono features of tubular ectasia of rete testes

A

no flow
often bilateral
small, tubular cystic lesions in region of mediastinum

not usually palpable

increased incidence with age

182
Q

tubular ectasia of the epi associated with __

A

vasectomy

183
Q

well-circumscribed, firm, avascular lesion presenting with ‘onion skin’ appearance

A

epidermoid cyst
*benign tumour

184
Q

what are the layers in an epidermoid cyst

A

layers of epithelium surrounding keratin-like cyst

etiology unknown; may be teratoma variant

185
Q

what is the criteria amount for testicular microlithiasis

A

5 or more per field
+/- bilat

186
Q

etioloty of testicular microlithiasis

A

hydroxyapatite crystals inside the seminiferous tubule

(calc forming around nidus of debris)

**not granulomatous disease

187
Q

what is testicular microlithiasis associated with

A

neoplasm formation IF associated with risk factors for testicular cancer

188
Q

rare deposition of focal fat in the testes

A

testicular lipomatosis

189
Q

association with testicular lipomatosis

A

Cowden’s disease

may be cause of subfertility

190
Q

role of u/s with testicular trauma

A

determine if testicle is ruptured or intact

191
Q

signs of testicular rupture

A

focal areas of altered echogenicity

hypoechoic, linear fracture plane (not common)

contour distortion or irregularity

**tough to distinguish from hematoma

192
Q

main difference between fracture and rupture

A

rupture causes break in capsule
fracture = capsule in tact

193
Q

acute twisting of the spermatic cord

A

testicular torsion

194
Q

anomaly associated with testicular torsion

A

‘bell clapper’

*no bare area; testis free to rotate within the scrotum

195
Q

typical demographic for testicular torsion

A

12-18 y, neonates

196
Q

how soon does sx have to be performed to save a testicle with compromised blood supply due to torsion

A

<6 hours

197
Q

acite testicular pain, rapid swelling, nausea, vomiting, fever, increased white count and no cremasteric reflex

A

testicular torsion

+/- enlarged epi
+/- scrotal wall thickening
+/- hydrocele

198
Q

which acute testicular emergency can mimic an infection

A

torsion

199
Q

what Doppler findings would you expect with testicular torsion

A

no flow = torsion

decreased flow = probable torsion

increased flow = likely detorsion

200
Q

detorsion can mimic __

A

epididymo-orchitis

**use clinical hx

201
Q

spontaneous untwisting of torqued spermatic cord

A

detorsion

202
Q

49y male, no flow in affected testis, appendix testis seen inf to testis suggesting malrotation and small hydrocele seen with debris - likely dx?

A

testicular torsion

203
Q

what kind of vascularity would you expect in the extratesticular tissue with torsion

A

hyperemic

204
Q

testicular torsion >6 hours showing heterogeneity

A

infarcted, necrotizing

205
Q

sonographic feature of torsion knot

A

‘whirlpool sign’

*superior or inferior to testis, or in inguinal canal

206
Q

likely demographic for torsion of appendix testis

A

infant and pre-pubescent

*if accurately dx, not a surgical emergency (managed with NSAIDS and is self-limiting)

207
Q

acute vs. chronic testicular infarct

A

acute = focal, hypoechoic mass or diffuse hypochoic tissue, small testis

chronic = hyperechoic pattern secondary to fibrosis

208
Q

chromosomal syndrome associated with bilat small testes

A

Kleinfester syndrome

*3 sex chromosomes

209
Q

sono appearance of testicular prosthesis

A

sinilar to breast implant
* fibrous capsule

typically anechoic

+/- reverberative echoes

+/- SOS artifact

210
Q

wrinkle in prosthesis capsule called

A

contracture

211
Q

rare incidence of polyorchidism most commonly occuring on which side

A

left

212
Q

location and demographic of femoral hernias

A

more common in females

inferior to inguinal ligament

medial to sepheno-femoral function

213
Q

a hernia that can be manually returned to its normal compartment

A

reducible hernia

214
Q

complications of non reducible hernias

A

incarceration = maintains blood supply

strangulation = loss of blood supply

215
Q

common contents of hernia

A

bowel
fat (omental, mesenterc, properitoneal)

216
Q

hernia technique

A

large footprint linear array >/=12 MHz

217
Q

what type of artifact are you likely to see on a repaired hernia

A

twinkling

common to use mesh to correct weakened wall

218
Q

ligament that provides support to lower abdomen

A

inguinal ligament

219
Q

normal contents of inguinal canal (male; female)

A

male = spermatic cord, ilioinguinal nerve

female = uterine round ligament, ilioinguinal nerve

220
Q

Inguinal triangle aka

A

Hasselbach’s triangle

221
Q

why do we care where the epigastric vessels are

A

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
Q

why are the inferior epigastric vessels never obscured by gas?

A

they run anterior to the peritoneal cavity

223
Q

the inguinal triangle is the landmark for __ hernias

A

direct inguinal hernias

**medial to inferior epigastric artery

224
Q

direct inguinal hernias originate __

A

medially

225
Q

indirect inguinal hernias originate __

A

lateral and anterior to epi artery

at the inguinal ring

226
Q

why is it called ‘indirect’ inguinal hernia

A

bowel and peritoneum do not herniate directly through the weakness in the abd wall

227
Q

contents of an indirect inguinal hernia move through a patent __

A

processus vaginalis

  • courses anterior to inferior epigastric artery
228
Q

less common inguinal hernia, acquired, most likely in older and +BMI patients

A

direct inguinal hernia

229
Q

difference (direct, indirect) in hernia extension relating to the spermatic cord

A

indirect extends anterior to SC

direct extends posterior to SC

230
Q

which type of inguinal hernia can often extend into the scrotum and labium majorum?

A

indirect

231
Q

contents of femoral sheath

A

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
Q

key landmark when assessing a femoral hernia

A

sapheno-femoral junction

**canal is medial to CFV and superior to SFJ

233
Q

which side is more common for femoral hernias

A

right side

ABD & SMALL PARTS (16 decks)

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