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ABD > Male A & P > Flashcards

Male A & P Flashcards

1
Q

Normal testis echoetxture

A

homogeneous medium-level echotexture

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2
Q

Testicle is surrounded by a fibrous capsule called the

A

tunica albuginea

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3
Q

multiple septations (septula) arise from the tunica albuginea to form the _____________ __________

A

mediastinum testis

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4
Q

Sonographic appearance of the mediastinum

A

echogenic linear band extending longitudinally within the testis

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5
Q

The ______ forms wedge-shaped compartments that contain the _________ _________, which converge to form the _____ ______, which connects the semineferous tubule to the _______ ______.

A

septula
seminiferous tubules
tubuli recti
rete testis

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6
Q

What is the rete testis?

A

Anastomosing network of delicate tubules located in the hilum of the testicle (mediastinumvtestis) that carries sperm to the epididymis.

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7
Q

The efferent ductules carry seminal fluid from where to where?

A

rete testis to the epididymis

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8
Q

Parts of the epididymis and anatomical position

A

head (globus major) adjacent to superior pole of testis, largest part of epi, where efferent ductules converge to form a single convuluted dut (ductus epididymis)
body (post/medial along tetsicle)
tail (globus minor) forms an acute angle and courses cephlad as the vas deferens (ductus deferens)
Epi is parallel to the testicle

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9
Q

Echotexture of the epi?

A

normally isoechogenic or slightly hyperechoic than the testis

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10
Q

Appendix testis

A

remnant of Mullerian duct

small ovid structure located beneath the head of the epididymis

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11
Q

Risks assocaited with an appendix testis

A

torsion of the appendage can occur in boys 7-12 years, resulting in a blue dot sign

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12
Q

appendix epididymis

A

derived from the Wolffian duct
detached efferent duct
small stalk porojecting off

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13
Q

Dartos

A

layer of muscle beneath the scrotal skin, diving the scrotum into chambers

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14
Q

The dividion of the two scrotal chamber is called the ______ _______.

A

scrotal pahie

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15
Q

Tunica vaginalis

A

saccular extension of the peritoneum into the scrotal chambers

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16
Q

Which layer of the tunica vaginalis covers the testis and epididymis?

A

The inner or visceral layer, the outer or parietal layer lines the scrotal chamber

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17
Q

Testicular blood flow is supplied by the (3)

A

deferential arerty
cremasteric (external spermatic) artery
testicular artery

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18
Q

What are the branches of the teticular artery?

A

divides into the capsular and centripetal (intratesticular) branches
the capsular comes down and encapsulates entire testicle, right under the surface
the centripetal arteries course along the septula converging on the mediastinum testis

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19
Q

What does the spermatic cord consist of?

A 
vas deferens
crenasteric, deferential, testicular arteries
pampiniform plexus of veins
lymphatics
nerves
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20
Q

The ______ zone comprises the majority of the prostate.

A

peripheral zone

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21
Q

the bell-clapper deformity is strongly associated with the development of what abnormality?

A

testicular torsion

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22
Q

the area where the urethra and the ejaculatory ducts join in the prostate is referred to as the _________.

A

verumontanum

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23
Q

Corpora amylacea are best defined as:

A

Macrocalcifications associated with chronic prostatitis

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24
Q

Approximately 70% of prostate malignancies are identified in the:

A

perioheral zone

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25
Q

Hyperemic flow during a scrotal exam would suggest which of the following conditions?

A

orchitis

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26
Q

The most common malignancy of the testicle is of what tissue origin?

A

germ cell

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27
Q

Sonographic evaluation of the scrotum for suspected testicular torsion requires optimization of the color Doppler to determine perfusion. How should the equipment be set in order to optimize the sensitivity to this abnormality?

A

Low PRF, high gain, and low filter

the testicle want blood flow at all times so not going to resist, low RI, but doesn’t deman a lot so slow flow velocity…..scale down, no wall filters, gain up, multiple focal zones, light pressure, high frquency

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28
Q

Cryptorchidism is defined as:

A

A congenital anomaly which is identified as an abnormally positioned testis which leads to an increased risk of testicular malignancy

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29
Q

The most common cause for scrotal swelling is:

A

hydrocele

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30
Q

The location of the rete testis is best described as:

A

Mediastinum of the testicle

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31
Q

The function of the pampiniform plexus is to:

A

Provide venous drainage from the testicles and scrotum (RT into IVC and LT in renal vein)

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32
Q

The epididymis receives the majority of its blood supply from what vessel?

A

deferential artery

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33
Q

The presence of a ________ demonstrates fluid between the tunica vaginalis parietal and visceral layers

A

hydrocele

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34
Q

The RT and LT hemiscrotum are divided by a fibrous septum called the _____ ______.

A

median raphe

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35
Q

Encases everything that has to go to and from the pelvi cavity

A

cremamaster muscle

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36
Q

Where does spermatogenisis occur?

A

seminiferous tubules

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37
Q

In the case of a hydrocele, is there fluid next to the testis?

A

No

may see in patients with ascites (peritoneal cavity)

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38
Q

T/F - venous first to go in torsion becasue muscel wall not as thick

A

T

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39
Q

Most _______ masses are benign, but the majority of ______ lesions are malignant.

A

extratesticular

intratesticular

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40
Q

Most malignant tetsicular neoplasms are _______ compared to the normal testicular parenchyma.

A

hypoechoic

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41
Q

Testiclar neoplasms are the most common malignancy in men ____to ______ years of age.

A

15-35

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42
Q

Most common testicular cancers.

A

germ cell tumors, either seminoma or nonseminoma

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43
Q

_______ is the most common germ cell type found in both pure seminoma and mixed germ cell testicular masses.

A

Seminoma

-they are radiosensitive and chemosensitive resulting in the most favorable prognosis of all testicular tumros

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44
Q

Risk factors for seminoma testicular ca (7)

A 
cryptorchidism (undescended testicles)
family Hx of test ca
infertility
Klinefelter syndrome (XXY0
Down Syndrome
smoking
white race
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45
Q

When an intratesticular mass is found, what area should be evaluated for lymph nodes mets

A

paraaortic region in the retroperitoneum

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46
Q

Tumor markers for seminoma test tumors

A

beta-hCG
AFP
LDH

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47
Q

Nonseminomas are masses that are not pure seminomas and consist of other cell types such as (4)

A

embryonal carcinomas
teratomas
yols sak tumors (endodermal sinus tumors)
chriocarcinomas
-when a mixture of these tumors exists, the tumor is referred to as a mixed tumor
-a tumor with both seminomatous with nonseminomatous elements is considered a nonemninomatous germ cell tumor

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48
Q

Treatment for nonseminomatous germ cell test tumors

A

radical (inguinal) orchiectomy

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49
Q

What lab is associatied with nonseminomas?

A

AFP

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50
Q

ascending lymphatic Mets from nonseminoma test tumors occurs in the retroperitoenal nodes and _____ renal hilar lymphadenopathy and _____ retro-caval lymphadenopathy is frequently seen

A

left

right

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51
Q

Most common testicular tumor in infants and young children.

A

Yolk sac tumors (endodermal sinus tumor)

52
Q

What lab value is assocated with Yolk Sac Tumors?

A

AFP

53
Q

Rare stromal (non-germ cell) testicular tumor occuring in boys (5-10) and men (30-60)

A

Leydig Cell Tumors

54
Q

Leydig cell tumors may be _____ ________ or ______.

A

pure non-germ

mixed

55
Q

T/F - Leydig cell tumors are always malignant in children.

A

F - always benign in children, maligant variations reported in adults

56
Q

Type of testiuclar tumor that is also found in the ovaries and is typically malignant?

A

Ovarian Leydig cell tumors

57
Q

Leydig cell tumors produce ______ resulting precocious puberty and they produce _____ resulting in feminizing symtptoms.

A

testosterone

estrogen

58
Q

AFP, beta-hCG, and LDH are normal in ____ _____ ____ ___

A

pure leydig cell tumors

59
Q

Elevation of beta-hCG and AFP cab be associated with many conditions but their elevation in conjucion with a _______ mass suggest _______ cancer.

A

testicular

testicular

60
Q

Which testicular cancer is suggested if AFP is elevated?

A

nonseminomatous

61
Q

If there is the presence of high levels of tumor markers, what is the prognosis?

A

Increased liklihood of metastatic disease and poor prognosis

62
Q

What is recommended inorder to determine the histology of a possible testicluar cancer?

A

inguinal orchiectomy, not Bx, inorder to prevent teh spread of cellular components

63
Q

What are the 2 types of benign testiular cysts and where are they usually located?

A

cysts of the tunica albuginea

intratesticular cysts - normally found near the mediastinum testis, probably originate from the rete testis

64
Q

Epidermoid cysts

A

benign soild tumor
germ cell origin
well-circumscribed
beneath the tunica albuginea

65
Q

Sonographic appearance of epidermoid cysts

A 
well-defined
solid
hypoechoic with
echogenic capsule or onion ring patter formed by multiple layers of keratin (cheesey-white)
or bow-tie central echogenic pattern
66
Q

what are absecsses usually a complication of?

A

epididymo-orchitis (epididymitis, orchitis)

67
Q

Sonographic appearance of tetsicular abscess?

A

enlarged testicle containing a predominantly fluid-filled mass with hypoechoic or mixed echogenic areas

68
Q

where are scrotal calcifications (scrotal pearls) typically located?

A

may be located within the testicle or between the layers of the tunica albuginea

69
Q

T/F - Testicular microlithiasis in an asymptomatic healthy man shoudl be considered to confer a definite but minimal risk of testicular germ cell tumor

A

T

70
Q

Is testicular infarct a common event?

A

No, it is uncommon typically with an undetermined cause

71
Q

How do segmental testicular infarcts typically present?

A

As a triangular-shaped avascular intratesticular lesion.
but the appearance depends on the age of the infarction.
Initially - focal or diffuse hypoechoic testicle
Progresses - testicle decreases size and devlops areas of increased echogenicity representing fibrosis or calcifications

72
Q

Fluid that accumulates within the tunica vaginalis, visceral and parietal

A

hydrocele

73
Q

Most hydroceles are ______ and are noted in boys ____-____ years.

A

congenital
1-2
-caused by failed closure of teh processus vaginalisi at the internal ring

74
Q

chornically acquired or secondary hydroceles usually occur in men older than ____ years.

A

40 years

75
Q

Whay are th epossible causes of hydroceles in adults?

A 
idiopathic
trauma
torsion
neoplasms
epididymitis
orchitis
76
Q

___-____ echoes from ____ or _____ crystals may be visulaized within the hydrocele.

A

low-level

fibrin or cholesterol

77
Q

Similar to a hydrocele but seen when blood fills the scrotal chamber from trauma.

A

hematocele

78
Q

Varicocele

A

dilatation of the pampiniform venous plexus of the testicular veins which drain the testicle

79
Q

_____ of varicoceles are on the _____ side.

A

90%
left
-becasue of the length of the left testicular vein, which drains into the left renal vein

80
Q

What should happen to the varicoceles with standing, valsalva, or abdominal compression?

A

They should distend

-may produce aching pain after a patient has been standing for extended time or with heavy lifting

81
Q

Is there as association between varicoceles and infertility?

A

Yes, but difficult to know for certain if the varicocele is directly to blame

82
Q

What is the most correctable cause of male infertility?

A

varicocels

83
Q

If a patient present with unilateral scrotal pain, what are some the possible Dx (3)

A

testicular torsion
epididymitis
varicocele thrombosis

84
Q

What criteria is set for varicoceles.

A

mutliple >2mm diameter

enlargement with valsalva and increased color Doppler

85
Q

What kind of hernias involve the scrotum?

A

indirect inguinal hernia

86
Q

What cause an indirect scrotal inguinal hernia?

A

results from bowel protruding through the inguinal canal into the tunica vaginalis of the scrotum

87
Q

What may be seen sonographically if there is an indirect inguinal scrotal hernia?

A

presence of peristalsis confirms the Dx
bowel may contain air, producing shadows
small hernias can be visualized by using valsalva

88
Q

Benign extratesticular tumors usulaly involve the ______.

A

epididymis

89
Q

Most common extratesticular tumor?

A

adenomatoid turmor

90
Q

What are spermatoceles?

A

Cystic masses that result from dilatation of the epididymal tubules

91
Q

Which are more common, spermatoceles or epididymal cysts?

A

spermatoceles

92
Q

Difference between spermatoceles and epididymal cysts?

A

spermatoceles are filled with thick mailk fluid containing spermatoza while epididymal cysts are composed and clear fluid
-both result from prior episodes of epididymitis

93
Q

Where do spermatoceles usually occur?

A

at the epididymal head

94
Q

What is tubular ectasia of the rete testis

A

a rare cystic dilatation of the mediastinal tubules

95
Q

What causes tubular ectasis of the rete testis?

A

Thought to result from partial or complete obliteration of the effernet ducts

96
Q

Tubular ectasia of the rete testis is a _____ condition that is often ______ and frequently associated with ______. Also it is more common in men over the age of ____.

A

benign
bilateral
spermatoceles
55

97
Q

Sonographic appearance of tubular ectasia of the rete testis

A

cluster of small anechoic structures adjacent to the mediastinum testis.

98
Q

2 most common causes of acute scrotal pain.

A

epididymitis* and torsion of the spermatic cord

99
Q

Possible DDx of acute scrotal pain (6)

A 
testicular torsion
trauma
epididymitis/orchitis
incarcerated hernia
torison of the appendix testis
varicocele thrombosis
100
Q

Sonographic findings of epididymitis

A 
enlarged epididymis
hypoechoic
increased blood flow (hyepremia)
reactive hydrocele
scrotal wall thickening
101
Q

Epididymitis may extend into the testicle causing ______.

A

orchitis

102
Q

Sonographic findings of orchitis

A

enlarged hypoechoic tetsicle
hyepremia
decreased arterial resistance (low-reistance waveform)

103
Q

The testicle is attached to the tunica vaginalis and w/o it or w/ a high attachment, the testicle can rotate freely on the spermatic cord which is known as the _____ ____ ______.

A

Bell clapper deformity

104
Q

Testicular torsion leads to ______ and ______ occlusion.

A

venous

arterial

105
Q

If testicular ischemia, what happens to the torsed testical in comparison to the contralateral testicle after 6 hrs?

A

it becomes enlarged and hypoechoic

106
Q

Who primarily suffers from testicular torsion, what ages?

A

adolescents and neonates

younger than 30, most 12-18

107
Q

What is associated with testicular torsion with pain for <6hrs?

A 
fever
nausea
vomiting
hx of trauma or activity
absence fo cremasteric reflex
high position of testicle
horizontal lie of testicle
108
Q

Torsion varies between 180-540 degrees. Partial vs torsion-detorsion syndrome or intermittent torsion is challenging to diagnose because the changes in the arterial waveforms are subtle. A partial or incomplete may be associated with a RI _______ or ______ waveform.

A

> .75 or

biphasic (to and fro)

109
Q

Time between onset of pain and performance of detorsion and the corresponding salvage rate:

A 
<6hrs = 90 to 100% salvage rate
12-24hrs = 20 to 50%
>24hrs = 0-10%
110
Q

What should the sonographer do to optimize for slow blood flow in the testicle to rule out a complete torsion?

A

decrease PRF

111
Q

Type of torsion that is exclusive to newborns?

A

Extravaginal testicular torsion - occuring oustide the vaginalis, when the testis and gubernaculum can rotate freely

112
Q

Symptoms of extravaginal testicular torsion

A

scrotal swelling
discoloration
firm mass in scrotum
-these are usually necrotic from brith and must be surgically removed

113
Q

HIdden testicle or undescended testicle

A

crytorchidism

114
Q

When do the testicles usually descend?

A

before birth but may occur spontaneously in eth first year so orchiplexy is usually reserved for age 2-10 years

115
Q

Key structure that guides testicular descent out of the abdomin to the scrotum

A

gubernaculum

116
Q

Complications assoicated with cryptorchidism

A

inferitility and cancer (increased risk for malignancy in both undescended testis and the contralateral testis

117
Q

Most common location of the cryptochid testis

A

inguinal canal

118
Q

Anorchia

A

congenital absence of testis

rare and accounts for 4% of PTs that present with crytorchidism

119
Q

Polyorchia

A

congenital duplication of the testes

imaging posterior to a filled bladder may aid in locating an abdominal testicle

120
Q

describe the anatomical position of the penis for scanning

A

erect and pointing upward so dorsal side is posterior and touching the belly while the ventral/anterior side is the scanning side

121
Q

What is directly under the TDx when scanning the anteriro surface of the penis?

A

corpus spongiosum and urethra

122
Q

Priaprism

A

erection that lasts for more than 4hrs and is painful

blood can get trapped in the erection chambers casuing ischemic priaprism

123
Q

Often no clear cause for priprism but is associated with

A

sickle0cell disease, 42%
leukemia
malaria
drugs for depression, mental illnesses, erectile dysfunction, marijuana, cocaine

124
Q

Peyronie’s disease

A

bent, rather than straight erect penis that result from scar tissue (plaque) that forms inside the penis
-some believe it result from trauma that cause bleeding in the penis

125
Q

Peyronie’s disease is associated with connective tissue and autoimmune disorders such as:

A 
Dupuytren's disease (trigger finger)
plantar fascitis
scleroderma
systemic lupus erythenatosus
Sjogren's sudnrome
Behcet's syndrome
126
Q

Why is ultrasound used to eval for Peyronie’s disease?

A

used to pinpoint the location of the plauqe buildup on the anterior or posterior aspect

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