Scrotum Flashcards
1
Q
The normal testis has what level or echo texture
A
Homogogenous
2
Q
The testicle is surrounded by a fibrous capsule called
A
Tunica albuginea
3
Q
Sonographically this is seen as an echogenic linear band extending longitudinally within the testis
A
Mediastinum testis
4
Q
The septula forms wedge-shaped compartments that contain the
A
Seminiferous tubules
5
Q
The seminiferous tubules converge to form the
A
Tubuli recti
6
Q
The tubuli recti enter the mediastinum testis forming a network of channels called the
A
Rete testis
7
Q
What carries the seminal fluid from the rete testis to the epididymis
A
Efferent ductules
8
Q
The epididymis is composted of what 3 things
A
1) head
2) body
3) tail
9
Q
Where is the epididymis located to the testicle
A
Parallel to the testicle
10
Q
What part of the epididymis is located ajdacent to the superior pole of the testis and is the largest part of the epididymis
A
Head
11
Q
What is another name for the head of the epididymis
A
Globus major
12
Q
What is another name for the tail of the epididymis
A
globus minor
13
Q
What is another name for the vas deferens
A
Ductus deferens
14
Q
Sonographically how does the epididymis normally appear
A
Isoechoic or slightly hyperechoic
15
Q
What is a small ovoid structure located beneath the head of the epididymis that is a remnant of the Mullerian duct
A
Appendix testis
16
Q
What is a small stalk projecting off the epididymis that represents a detached efferent duct
A
Appendix epididymis
17
Q
This is a layer of muscle fibers that lie beneath the scrotal skin dividing the scrotum into 2 chambers
A
Dartos
18
Q
The division of the 2 scrotal chambers is called the
A
Scrotal raphe
19
Q
What is a saccular extension of the peritoneum into the scrotal chambers
A
Tunica vaginalis
20
Q
What does the inner or visceral layer of the tunica vaginalis cover
A
Testis and epididymis
21
Q
What does the outer or parietal layer of the tunica vaginalis line
A
scrotal chamber
22
Q
Name 3 things the testicular blood flow is supplied by
A
1) deferential artery
2) cremasteric artery
3) testicular artery
23
Q
What is another name for the cremasteric artery
A
External spermatic artery
24
Q
Name 2 things the testicular artery divides into
A
1) capsular
2) centripetal
25
What 5 things does the spermatic cord consist of
1) vas deferns
2) cremasteric, deferential, testicular arteries
3) pampiniform plexus of veins
4) lymphatics
5) nerves
26
What is the most common solid tumor in men and what is the age range
Testicular neoplasms age 15-35
27
Germ cell tumors account for what percent of testicular tumors
95%
28
Name 4 testicular tumors
1) seminoma #1
2) teratoms
3) choriocarcinomas
4) mixed tumors
29
what is the most common germ cell tumor in adults
Seminoma
30
Where does seminoma initially spread to
draining lymph nodes in the retroperitoneum
31
When an intratesticular mass is discovered what area should be evaluated for lymph nodes
Paraortic region
32
The most common prepubertal testicular tumor is the
Yolk sac tumor (endodermal sinus tumor)
33
A yolk sac tumor is considered what type of tumor
germ cell
34
What lab value is increased with yolk sac tumors
alpha-fetoprotein (ALP)
35
What is the most common gonadal stromal tumor in children and adults
Leydig cell tumor
36
Leydig tumors occur most frequently in boys aged
4-5 years
37
Teratomas consist of 3 different germinal layers including
1) endoderm
2) mesoderm
3) ectoderm
38
What is the second most common testicular tumor in children that are usually benign
Teratomas
39
What tumor appears as a well defined mass containing cystic and solid components
Teratomas
40
Name the 2 lab values that are associated with testicular tumors
1) Beta-human chorionic gonadotropin (B-HCG)
- choriocarcinoma
-embryonal carcionma
2) alpha-fetoprotein (ALP)
-Yolk sac tumor
41
What is the most common lethal and least common form or germ cell tumors
Choriocarcinoma
42
Choriocarcinoma is associated with an increase in
B-HCG
43
What is the second most common testicular malignancy after seminoma
Mixed germ cell tumors
44
What is the most common mixed germ cell tumor and what is another name for it
Combo of teratoma and embryonal cell tumor
AKA- teratocarcinoma
45
What are the 2 most common malignancies to affect the testis secondarily
1) leukemia
2) lymphoma
46
What are the 2 types of benign cysts
1) cysts of the tunica albuginea
2) intratesticular cysts
47
What type of cyst is a benign tumor of germ cell origin and are well circumscribed solid tumors lying beneath the tunica albuginea
Epidermoid cyts
48
What type of cyst is filled with cheesy-white keratin and are well defined, solid, hypoechoic masses with an echogenic capsule or onion ring pattern formed by multiple layers of keratin
Epidermoid cysts
49
Sonographically what presents with an enlarged testicle containing a predominantly fluid filled mass with hypoechoic or mixed echogenic areas
Testicular abscess
50
What is the most common location for a spermatocele
a) head of epididymis
b) body of epididymis
c) tail of epididymis
d) tunica vaginalis
e) mediastinum testis
a) head of epididymis
51
A 15 y/o boy presents with sudden intense right scrotal pain, nausea, and vomiting. A sonogram is performed, and en enlarged hypoechoic right scrotum with decreased arterial flow is documented. The left scrotum is normal. This is most consistent with which of the following?
a) testicular rupture
b) varicocele
c) spermatocele
d) torsion
e) hydrocele
d) torsion
52
Which of the following statements is true in patients with uncomplicated acute epididymitis?
a) there is enlargement of the scrotum with focal or generalized thickening of the epididymis
b) the epididymis is uniformly enlarged and more anechoic than usual
c) the epididymis is small with areas of calcifications
d) there is decreased blood flow to the epididymis
e) the epididymis is too tender to be touched and cannot be scanned
b) the epididymis is uniformly enlarged and more anechoic than usual
53
On a longitudinal scan of the scrotum, which of the following is the most superior portion
a) ductus deferens
b) rete testis
c) head of the epididymis
d) tunica albuginea
e) spermatic cord
c) head of the epididymis
54
Which of the following is true concerning the seminal vesicles
a) they produce sperm and are located within the prostate
b) they produce sperm and are located posterior to the urinary bladder
c) they are the reservoir for sperm and are located posterior to the urinary bladder
d) they are the reservoir for sperm and are located between the mediastinum testes and the pampiniform plexus
e) they are the reservoir for sperm and are located in the peripheral zone of the prostate
c) they are the reservoir for sperm and are located posterior to the urinary bladder
55
On a sonographic examination, which of the following describes the appearance of a seminoma of the testicle
a) solid, homogeneous mass
b) large, multilocular cystic mass
c) small, simple cyst
d) diffuse, enlargement of the testicle
e) small, complex mass
a) solid, homogeneous mass
56
Which of the following may be the presenting symptom of a testicular malignant tumor
a) para-aortic lymphadenopathy
b) acute scrotal pain
c) leukemia
d) retroperiotneal lymphadenopathy
e) all of the above
e) all of the above
57
The left testicular vein drains into which of the following veins
a) IVC
b) Left internal iliac vein
c) common internal iliac vein
d) left renal vein
e) prostatic vein
d) left renal vein
58
In the subacute phase of testicular torsion, which of the following describes the appearance of the testes
a) anechoic areas in testes with decreased blood flow
b) small and echogenic
c) enlarged with increased blood flow
d) at normal size with a decrease in size of the epididymis
a) anechoic areas in testes with decreased blood flow
59
What is the most common congenital cause of urinary tract obstruction in males?
a) UPJ
b) posterior urethral valve
c) infantile polycystic kidney disease
d) undescended testis
e) duplex collecting system
b) posterior urethral valve
60
Approximately, what is the normal scrotal wall thickness
2-8 mm
61
The head of the epididymis measures up to how many mm in the AP diameter
10-12 mm
62
What is the primary function of the testes
Production of sperm and testosterone
63
What is the primary sex hormone respsonsible for the development of male reproductive tissues
Testosterone
64
What is an echogenic band extending from the caudal end of the testis to the scrotal wall
Scrotal ligament
65
Dilatation of the seminiferous tubules is referred to as
Tubular ectasia of the rete testis
66
What is the normal adult testis measurement in transverse and long
3-5 cm in length
2-3 cm in transverse
67
What artery provides the major blood supply to the testis
Testicular artery
68
What vein drains into the IVC
The right testicular vein
69
What vein drains into the left renal vein
The left testicular vein
70
The spectral waveform of which artery has a low-resistance, high flow pattern, with a mean RI of 0.62
Testicular artery
71
The spectral waveform of which artery has a low-resistance, high-flow waveform, and a RI ranging from 0.46-0.68
Epididymal artery
72
The sonographic appearance of what is an oval or elongated well-circumscribed hypoechoic homogenous soft tissue structure, smaller than the normal descended instrascrotal testis
Undescended testis
73
What is another name for calcifications
Scrotal Pearls
74
Testicular infarction commonly results in what
Torsion or Trauma
75
What is a serious fluid that accumulates within the tunica vaginalis or between the layers of the tunica vaginalis
Hydrocele
76
What is seen when blood fills the scrotal chamber and is associated with trauma
Hematocele
77
What is a dilitation of the pampiniform venous plexus of the testicular veins which drain the testicle
Varicocele
78
What results from bowel protruding through the inguinal canal into the tunica vaginalis of the scrotum
Scrotal Hernia
79
What is the most common extratesticular tumor
Adenomatoid tumor
80
Extratesticular tumors usually involve the
Epididymis
81
Name the 2 most common causes of acute scrotal pain
1) epididymitis
2) epididymo-orchitis
82
Name the 2 types of testicular torsion
1) intravaginal
2) extravaginal
83
What type of testicular torsion is the most frequent type and is seen in 80% of cases
Intravaginal torsion
84
What are cystic masses of the epididymis that result from dilatation of the epididymal tubules
Spermatoceles
85
This type of cyst is composed of clear fluid
Epididymal cyst
86
This type of cyst is filled with thick milky fluid containing spermatozoa
Spermatoceles
87
Where do spermatoceles usually occur
At the epididymal head
88
Name the 2 most common causes of acute scrotal pain
1) epdidymitis/ orchitis
2) torsion of the spermatic cord
89
What is the most common condition that causes acute scrotal pain
Acute epididymitis
90
Name 2 things acute epididymitis is usually caused by
1) sexually transmitted diseases
2) UTI
91
Sonographically, epididymitis is associated with
1) enlarged hypoechoic epdidymis
2) hypoechoic testicle
3) increased blood flow
4) reactive hydrocele
5) scrotal wall thickening
92
What is sonographically seen as an enlarged and hypoechioc testicle with increased blood flow
orchitis
93
Typically, what is the testicle attached to
Tunica vaginalis
94
What is it called when the testicle can rotate freely on the spermatic cord
Bell clapper deformity
95
What age group is testicular torsion obsereved in
Men younger than 30 between 12-18
96
Sonographically, what is seen as enlarged, inhomogenous and hypoechoic compared to the contralateral testicle
Testicular torsion
97
The degree of torsion may vary between how many degrees
180-580
98
Cryptorchidism literally means
HIdden testicle and generally refers to undescended testicle
99
Name 2 complications of cryptorchidism
1) infertility
2) cancer
100
What is the most common location of the cryptorchid testis
Inguinal canal
101
What is the most common correctable cause of infertility
Varicocles
102
What is it called when the superior mesenteric artery compresses the left renal vein, resulting in stasis and thrombosis
Nutcracker phenomenon
103
An extratesticular anechoic, cystic structure is seen adjacent to the superior pole of the testis most likely represents
a) urachal cyst
b) epididymal cyst
c) tunica albuginea cyst
d) seminoma
b) epididymal cyst
104
What is the second most common primary benign neoplasm of the epididymis
Leiomyoma
105
What is the most common extratesticular neoplasm that involve on the spermatic cord
Lipoma
106
What is the most common bilateral testicular tumor
Lymphoma
107
A sexually active male with right testicular pain is sent to your department, what can you expect to find on his scrotal exam?
a) testicular torsion
b) enlarged hyperemic epididymis
c) testicular tumor
d) none of the above
B) enlarged hyperemic epididymis
108
Which of the following sonographic findings are associated with hematoceles
a) a cyst along the course of the vas deferns
b) a blood-filled sac that surrounds the testicle, secondary to trauma or surgery
c) dilated veins caused by obstruction of the venous return
d) a condition in which the testicles have not descended
e) a solid mass outside the testes
b) a blood-filled sac that surrounds the testicle, secondary to trauma or surgery
109
Which scrotal artery encircles the testicular periphery
a) cremasteric
b) capsular
c) deferential
d) centripetal
b) capsular
110
What presents as small calcifications in the liver and spleen
Granulomas
111
Granulomas are caused by what 2 thing
1) histoplasmosis
2) tuberculosis infection
112
Liver inflammation due to viruses to toxins is called
Hepatitis
113
What is a nonobstructive hepatocellular cause of jaundice
Hepatitis
114
A hypoechoic liver parenchyma, liver enlargement, and hyperechoic portal vein walls describes
Acute hepatitis
115
A hyperechioc liver parenchyma, small liver, and decreased echogenicity of portal vein walls describes
Chronic hepatitis
116
A pyogenic mass commonly occurs in what part of the liver
Right lobe
117
Name the 5 differential diagnosis of pyogenic abscess
1) amebic abcess
2) echinococcal cyst
3) hemorrhagic cyst
4) hematoma
5) cystic neoplasm
118
Name 4 symptoms of an amebic abscess
1) RUQ pain
2) leukocytosis
3) fever
4) elevated liver function tests
119
What type of abscess occurs when a parasite from the intestines reaches the liver via the portal vein.
Amebic abscess
120
What type of abscess in the liver is the most common extraintestinal complication of amoebic dysentery
Amebic abscess
121
Name the 6 symptoms and findings of an amebic abscess
1) RUQ pain
2) diarrhea
3) fever
4) leukocytosis
5) elevated lover function tests
6) elevated right dome of diaphragm by X-ray
122
Name 3 sonographic features of an amebic abscess
1) round hypoechoic/ complex mass
2) typically occurs in right lobe
3) continguous with the liver capsule
123
What is another name for echinococcal cyst
Hydatid disease
124
Name the tests used to diagnose hydatid disease
1) casoni skin test (70% sensitivity)
2) detection of antibodies
- indirect hemagglutination
- indirect florescent antibody test
125
An echinococcal cyst is associated with
Anaphalatic shock
126
What is one of the most common parasitic infections in humans
Schistosomiasis
127
Schistosomiasis is a major cause of _________ world wide
Portal hypertension
128
Name 2 sonographic findings of schistosomiasis
1) occluded intrahepatic portal veins
2) thickening and increased echogenicity of the portal vein walls
129
Secondary signs of portal hypertension include
1) splenomegaly
2) ascites
3) esophageal variceal bleeding
4) portosystemic collaterals
130
Name 9 sonographic findings associated with AIDS
1) pneumocystis carnii
2) fatty liver infiltration
3) hepatomegaly
4) hepatitis
5) non-hodgkins lymphoma
6) candidiasis
7) cholangitis
8) acalculous cholecystitis
9) kaposis sarcoma
131
What is the most common organism causing infection in AIDs patients
Pneumocystic carinii
132
What is the accumulation of triglycerides within the hepatocytes
Fatty liver
133
Name the 2 leading causes of hepatic fatty infiltration
1) Alcohol abuse
2) obesity
134
What are the 2 patterns of fatty infiltration
1) focal fatty infiltration
2) focal fatty sparing
135
Focal regions of increased echogenicity within normal liver parenchyma describes
Focal fatty infiltration
136
Focal fatty commonly occurs where
at the porta hepatis
137
Focal regions of normal liver parenchyma within a fatty infiltrated liver is
Focal fatty sparing
138
Sparing commonly occurs where
Adjacent to the gallbladder, in the porta hepatis, in the caudate lobe at the liver margins
139
Differential diagnosis of hyperechoic masses within the liver include
1) focal fatty infiltration
2) cavernous hemangiomas
3) echogenic metastasis
4) haptic lipoma
140
What is a diffuse process of fibrosis and distortion of normal liver architecture
Cirrhosis
141
The 2 most common causes of cirrhosis are
1) alcohol abuse
2) viral hepatitis
142
Pathologic mechanisms of cirrhosis are
1) cell death
2) fibrosis
3) regeneration
143
Clinical presentation of cirrhosis is
1) hepatomegaly
2) jaundice
3) ascites
144
Abnormal liver functions of cirrhosis include
1) AST
2) ALT
3) LDH
4) conjugated bilirubin
145
Name the 8 sonographic findings of cirrhosis
1) hepatomegaly
2) small liver
3) caudate lobe atrophy
4) surface nodularity
5) fatty infiltration
6) regenerative nodules
7) changes related to portal hypertension
8) increased incidence of hepatocellular
146
Increased pressure in the portal venous system describes
Portal hypertension
147
What is the normal portal pressure
5-10 mm Hg
148
Portal vein diameter greater than ____ mm is suggestive of portal hypertension
13 mm
149
What are the 2 major causes of portal hypertension
1) cirrhosis
2) schistosomiasis
150
Name the 4 types of portal hypertension
1) extrahepatic presinusoidal
2) intrahepatic presinusoidal
3) intrahepatic (most common)
4) intrahepatic postsinusoidal
151
Sonographic findings of portal hypertension include the secondary signs of
1) splenomegaly
2) ascites
3) portal systemic venous collaterals
152
Name the 2 surgical techniques to lower portal pressure
1) portacaval shunt
2) TIPS
153
Which of the following lines the inside of the scrotal sac
a) tunica albuginea
b) visceral tunica vaginalis
c) rete testis
d) parietal tunica vaginalis
d) parietal tunica vaginalis
154
The development of scar tissue and fibrous plaque formation involving the tunica albuginea of the penis describes
a) priapism
b) squamous cell carcinoma of the penis
c) penile fracture
d) peyronie disease
d) peyronie disease
155
Which of the following arteries are evaluated during a penile duplex exam for erectile dysfunction
a) ventral
b) dorsal
c) urethral
d) cavernosal
d) cavernosal
156
Which scrotal artery encircles the testicular periphery?
a) capsular
b) deferential
c) centripetal
d) cremasteric
a) capsular
-The capsular artery courses along the testicle periphery and produces branches called centripetal arteries which course through the parenchyma. The deferential artery supplies vas deferens and epididymis with blood. The cremasteric artery supplies scrotal sac with blood
157
Which scrotal artery supplies the epididymis
a) deferential
b) capsular
c) centripetal
d) cremasteric
a) deferential
-Capsular artery courses along the testicle periphery and produces branches called centripetal arteries which course through the parenchyma. The deferential artery supplies vas deferens and epididymis with blood. The cremasteric artery supplies scrotal sac with blood
158
Which of the following lines the inside of the scrotal sac
a) visceral tunica vaginalis
b) rete testis
c) tunica albuginea
d) parietal tunica vaginalis
d) parietal tunica vaginalis
159
Which of the following structures is not included in the spermatic cord?
a) gonadal artery
b) cremasteric artery
c) vas deferns
d) centripetal artery
d) centripetal artery
- centripetal arteries are small branches of the capsular artery surronding the testicle. These branches penetrate the testicular tissue
160
Which of the following Doppler findings is most suggestive of partial testicular torsion
a) antegrade flow throughout the cardiac cycle
b) asymmetric resistive indices on the intratesticular Doppler evaluations
c) increased diastolic flow velocities with a very low resistive index on the affected side
d) increased diastolic flow velocities with a very high resistive index on the affected side
b) asymmetric resistive indices on the intratesticular Doppler evaluations
161
Which of the following is most suggestive of Ormond disease
a) pedal edema and scrotal swelling
b) aortic arch aneurysm formation
c) extrinsic compression of the celiac artery
d) bilateral staghorn calculi and posterior urethral valves
a) pedal edema and scrotal swelling
162
Which of the following statements is correct regarding testicular seminoma
a) associated with cryptorchidism, trisomy 21, klinefelter syndrome and smoking
b) most common in African american males
c) spreads to liver first with metastasis
d) unresponsive to radiation and chemotherapy
a) associated with cryptorchidism, trisomy 21, klinefelter syndrome and smoking
163
A scrotal pearl refers to
a) testicular prosthesis
b) a large intra-testicular calcification
c) a large extra-testciular calcification
d) microlithiasis formation only in the central portion of the test adjacent to the rete testes
c) a large extra-testciular calcification
164
A patient presents with mid scrotal pain and swelling on the left side that started 2-3 days ago. The patient awoke this morning with a slight fever and increased swelling. All of the following should be suspected cause for symptoms except
a) orchitis
b) epididymitis
c) hydrocele
d) testicular infarct
d) testicular infarct
