scrotum

Question 1

At __ weeks of gestation female and male embryo appear identical

Answer 1

7-8

Question 2

•
Testes develop from area near where the ____ develop, and about the same time
•

Answer 2

kidneys

Question 3

____ month the testes descend through inguinal canal into the scrotum
•

Answer 3

8th – 9th

Question 4

________ is the condition when 1 or both testes don’t reach the scrotum. Occasionally a testicle may remain undescended and will need to be surgically brought down where it will be sutured into the scrotum.

This procedure is called_______.

Answer 4

Cryptorchidism

ORCHIOPEXY

Question 5

Between the 3rd and 9th month of pregnancy the testes descend from the____ area (medial to the mesonephros, remember this tissue? It is the second fetal kidney) into the future scrotum. The descend is due to a combination of ______________.

Answer 5

lumbar

growth processes and hormonal influences

Question 6

The_______ also plays a decisive role in testis descent. When does it develop?

Cranially it has its origin at the testis and inserts in the region of the genital swelling (future scrotum).
At the same time, at the inguinal canal along the lower gubernaculum, an evagination of the peritoneum arises, the vaginal process, on which the testes will slide through the inguinal canal.

Answer 6

gubernaculum testis

IT develops in the 7th week from the lower gubernaculum, after the mesonephros has atrophied.

Question 7

testicular development at 2 months. label.

Answer 7

1. Gubernaculum testis 2. Penis 3. Inguinal canal
2. Testis 5. Peritoneal cavity 6. Deferent duct

Question 8

what is the arrow pointing to?

Answer 8

parietal peritoneal lining. (it pulls the lining down as it descends)

In this diagram, the beginning of the formation of the vaginal process is visible. It enters with the testis into the inguinal canal. Shown in blue is the gubernaculum that becomes increasingly shorter.

Question 9

Between the____ and ____ month of pregnancy the testes remain near the inguinal canal in order to pass through it. The vaginal process lengthens while the gubernaculum shortens, thereby drawing the testis, the deferent duct and its vessels on both sides downwards

Answer 9

3rd and 7th

Question 10

In the____ month of pregnancy (but also sometimes only after birth) the testes reach the scrotum. The vaginal process forms now a serous bilaminar structure on the front side of the testis.

Answer 10

9th

Question 11

serous bilaminar

Answer 11

The parietal layer: lines the scrotal sac The visceral layer: surrounds the testicle

Question 12

serous memebrane

This type of tissue creates a____ in the scrotum or_____ within the abd. of pleural fluid within the thorax.

Answer 12

scrotum lining – a serous membrane (or serosa) is a smooth membrane consisting of a thin layer of cells which secrete serous fluid.

hydrocele, ascites

Question 13

process vaginalis

Answer 13

canal created by descent

Question 14

bare area

Answer 14

no visceral tunica vaginalis (lymphatics, nerves, veins and sperm exit this area)

Question 15

testes are _____ in fetal life.

Answer 15

retroperitoneal

Question 16

scrotum

Answer 16

sac of skin continuous w/ the abdomen

Question 17

•
_____muscles within scrotal wall; controls the contraction of the scrotal skin. The contraction of the skin will drawl the testes closer to the body.

Answer 17

Dartos

causes skin to pucker, regulating temperature. autosomal ( we can’t control it) but can be a problem (caused by nerves, temp) you get a lousy image then on US

Question 18

the scrotum sac is divided into 2 halves by the ____. ____ divides the scrotum into a rt and lt hemishere

Answer 18

septum

median raphe

Question 19

what does each hemiscrotum contain?

Answer 19

A testis
An epididymis
A portion of spermatic cord
A vas deferens (ductus deferens) (makes sperm)

Question 20

what can you see here? why?

Answer 20

Median Raphe
•
Scrotal wall is inflamed but the median raphe is clearly seen separating the two hemiscrotums.

Question 21

notice the lobules in the testes. what do they contain?

Answer 21

seminiferous tublues (place sperm is made)

Question 22

what is the testes endocrine function?

what type of cells are found here?

Answer 22

testosterone

Sertoli cells: provide nourishment to the sperm cells
–
Leydig Cells: These cells are in the intestinal space and secrete the male sex hormone testosterone
Cross section of a Seminiferous tubules

Question 23

what are the testes exocrine functions?

Answer 23

spermatozoa (germ cell) via- Seminiferous tubules
–
spermatogonium cells develop into sperm
–
primitive sperms cells are peripheral
–
immature sperm cells at the lumen
–
once in the lumen sperm travel to the epididymis to mature

Question 24

what is the tete testes

Answer 24

–
Within the mediastinum still beneath the tunica albuginea
–
Connects seminiferous tubules to epididymis

Question 25

what does the epididymis do? what parts does it have?

Answer 25

Store spermatozoa. acts as Transport conduit Head thickest portion, can be more echogenic than that body Body is the longest portion Tail smallest and most inferior

Question 26

what are teh vas deference aka? what doe they do?

Answer 26

Ductus Deference – The excretory duct of the testis Continuation of the epididymis Thin muscular tube which transports sperm from the testis to the prostatic urethra

Question 27

\_\_\_\_ serves as a conduit. contains arteries, veins (network called the pampiniform plexus), nerves, lymph vessels

Answer 27

spermatic cord

Question 28

the _____ muscle raises and lowers testes from body. It, along with the scrotal wall muscle the dartos help to control the temperature of the testes.

Answer 28

cremaster

Question 29

what is the out most layer of the testes?

Answer 29

fascia

Question 30

\_\_\_\_\_ is a vestigial remnant of the Müllerian duct (paramesonephric duct), present on the upper pole of the testis and attached to the tunica vaginalis. It is present about 90% of the time.

Answer 30

appendix testis

Question 31

• This structure is derived from the Wolffian duct (mesonephric duct) as opposed to the appendix testis which is derived from the Müllerian duct remnant.

Answer 31

Appendix testis / appendix epididymis

Question 32

\_\_\_\_ is The hilum of the testis • Linear fibrous structure, thicken area of the tunica albuginea (more echogenic fibrous surrounding that holds open the hilum) • Each testicle has one • Arteries, veins, nerves, lymphatics, and spermatic ducts enter and exit through the hilum

Answer 32

medistinum testes

Question 33

patient prep

Answer 33

Warm room and warm gel - Prevents dartos and cremaster muscles from contracting – Simple instructions Be relaxed and matter of fact/ nonchalant Patient will stop listening once you instruct them to remove their clothing from the waist down – Give patient privacy Leave the room Turn the lights down a little

Question 34

what's the difference here?

Answer 34

rt dartos muscle iscontracted, lt not contracted

Question 35

what do the testes look like on a sonogram?

Answer 35

(similar to thyroid) medium level echoes – homogenous – often vessels seen within parenchyma – mediastinum is only echogenic area within testes – post vasectomy/infection/trauma can alter appearance • tubular ectasia • calcification

Question 36

\_\_\_\_ is the dilation of the rete testis. Common to see in males the are post vasectomy

Answer 36

tubular ectasia

Question 37

sonographic appearance of the epididymis

Answer 37

– Shape: epididymal head can be triangular, crescent, teardrop or round in shape. – Echogenicity: usually homogeneous and isoechoic to testicle. Appearance can change after vasectomy. Not uncommon to see cystic structures in the head (head is usually a bit brighter than the rest) • Cysts • Spermatoceles - little hole happens in epididymis and sperm gets out, the body walls it off and you get little cysts. can't tell dif b/t this and epididymis cyst you are born with

Question 38

scanning techniques

Answer 38

Open towel-Covering abdomen – Rolled towel-hold penis ventral side up. Pt. can hold this – Open towel in a sling- to keep scrotum up and out from between the legs – Pt. legs crossed this will help testes to stay put –Sheet to cover pt. legs Some sonographers like to use a rolled up towel placed as a block between the legs to set the testes on. I have found this position inadequate to evaluate the testes thoroughly as the posterior approach is block by the towels.

Question 39

imaging techniques and Td selection

Answer 39

Linear transducers 8 MHz or higher Longer foot print is better Appropriate depth setting Gain settings Unaffected side 1st, if appropriate Do not readjust gain during scan if possible

Question 40

indications for scrotal eval

Answer 40

Size changes or discrepancy •Differentiating an intratesticular from an extratesticular palpable mass •Finding occult neoplasm: known CA elsewhere, suspect testes as primary •Etiology of acute scrotum: pain, swelling… •? Varicoceles: dilated pampiniform plexus •Undescended testes: aka cryptorchidism •Trauma •Fertility issues

Question 41

protocol (long)

Answer 41

(same as renal) Long with measurement – Long lateral portion – Long medial portion – Long head of epididymis with measurement – Long body of epididymis with measurement – Long tail of the epididymis (typically include with the epididymal body image)

Question 42

protocol trans

Answer 42

Superior – Mid with measurement – Inferior – Bilateral Transverse • Dual screen if needed – Epididymal head with measurements

Question 43

what plane is this?

Answer 43

trans and below

Question 44

Which images shows the mediastinum? Find the epididymal tail Which images shows the superior part of the testis? Find the median raphe

Answer 44

what plane?

Question 45

what is this?

Answer 45

Spermatic cord – Along inguinal canal – Sometimes we need to look at the cord (right over pubic bone) • Inguinal hernias • Localized pain in this area

Question 46

what images do you want if the pt has a history of pain/infection? mass or lump?

Answer 46

History of pain / infection Testes and all parts of the epididymis must be evaluated Doppler exam for flow to R/O torsion – Mass / Lump Sonographer must find the mass and determine its origin Hernias can cause enlarged scrotums

Question 47

what common findings are there in the epididymis?

Answer 47

spermatoceles and ipdidymal cysts

Question 48

the below are ____ of a testicular exam Getting testicle symmetric Scan through transversely and figure how testicle is laying Inaccurate measurements Not in the longest axis Not symmetric See the testicles but missing the scrotal pathology Large spermatocele / epididymal cyst mistaken for hydrocele Node vs. undescended testicle (the below is a dirty sperrmatocele, a collection of sperm outside of the epididymis, could be a hemorrhagic hydrocele an abscess.)

Answer 48

pitfalls

Question 49

Two images have a small air bubble between the transducer and skin can you find them?

Answer 49

what do you see?

Question 50

this common variant is when One or both testes fail to descend to normal position.

Answer 50

cryptorchidism

Question 51

this scrotal variant is when there is more than one testicle per hemiscrotum...

Answer 51

polyorchidism

Question 52

indications for a scrotal exam

Answer 52

– Pain – Enlargement – Palpable mass – Search for undescended testicle – Trauma – Male infertility

Question 53

\_\_\_\_\_ may be implatned in the case of erctile dysfunction.

Answer 53

erectile implants

Question 54

which chromosome determines gender?

Answer 54

Y

Question 55

the testis develop approx the same time and approx the same area as the \_\_\_\_.

Answer 55

kidneys

Question 56

The term undescended testis is used to describe what phenomena.

Answer 56

when one or both tesis fail to descend

Question 57

The descend of the testicles into the scrotum is trigger by a. increased fetal intrabdominal pressure. b. hormones. c. the fetus turning into the cephalic position. d. the scrotum becomes larger.

Answer 57

b

Question 58

The testes are retroperitoneal, when within the abdomen. Upon there descend through the canal a layer of ______ is pulled through the canal and into to scrotum along with the testes. The specific term used to describe the pouching of the peritoneum through which the testes travel through is the _____ \_\_\_\_\_.

Answer 58

pertoneum processus vaginalis

Question 59

A = B = Another term for scrotal septum is the ____ \_\_\_\_. Name the AREA within the circle. Note it is not covered by a layer of peritoneum.

Answer 59

tunica vaginalis tunica albuginea median raphe bare area

Question 60

The condition of an undescended testis is also known as Cryptorchidism. What do you believe the term Crypto means?

Answer 60

hidden or secret

Question 61

Image A is showing what? Image B is representative of normal. A patient with this anatomic defect is a risk for what primary testicular problem?

Answer 61

an open processus vaginalis torsion

Question 62

What does the term hemiscrotum mean? Each hemiscrotum contains a testis, epididymis, portion of the spermatic cord and vas deferens. What is the vas deferens?

Answer 62

1/2 of the scrotum the conduit duct for sperm betwee the tail of the ipididymis and the urethra

Question 63

10. What divides the Rt. hemiscrotum from the Lt. hemiscrotum? 11. The testes are both and endocrine and an exocrine gland. True / False

Answer 63

median raphe true

Question 64

12. Testosterone is produced from the exocrine portion of the testes. True / False 13. Spematozoa are produced from the exocrine or endocrine portion of the gland?

Answer 64

false exocrine

Question 65

14. What are the functions of the epididymis? 15. Name the parts of the epididymis. a. b. c.

Answer 65

storage of sperm and transport conduit head (globu major), body and tail (globus minor)

Question 66

16. The most proximal portion of the epididymis is the \_\_\_\_\_. 17. The testes are divided into lobes by septula. Each lobe contains tubules from which spermatozoa are produced. Name these tubules.

Answer 66

head seminiferous tubules

Question 67

18. Within the seminiferous tubules are spermatogonium from which sperm cells are derived and two other types of cells. Name these cells. 19. Testosterone is produce by which if these cells?

Answer 67

sertoli cells, leydig cells leydig cells

Question 68

20. A = 21. What is the dotted circle is surrounding? 22. What is the green circle is surrounding?

Answer 68

retes testis globus major body of the eipdidymis

Question 69

23. What portion of the testis is the large arrow pointing to? 24. What is the small arrow pointing to? 25. What is the most distal portion of the epididymis?

Answer 69

inferior vas deferens globus minor

Question 70

Starting with the seminiferous tubules and ending with the urethra name the path of flow for sperm. Include the retes tesis.

Answer 70

seminiferous tubules, retes testis, eipdidymal head, body, tial, vas deferens, urethra (prostatic portion)

Question 71

Name the muscle which controls the position of the testes from the body. 3. The spermatic cord contains all of the following EXCEPT. a. arteries / veins / lymphatic vessels b. vas deferens c. cremaster muscle d. head, body and tail of the epididymis

Answer 71

cmuscle d

Question 72

4. The area of the testicle in which arteries, veins, nerves, lymphatic vessels and spermatic ducts enter and leave the testis is called the _______ testis.

Answer 72

mediastinum testis

Question 73

Name the muscle within the scrotal wall which when contracted pulls the scrotal skin closer to the testes. When this happens during an US, what does it do to the image?

Answer 73

dartos muscles degrades the image, creates shadowing from the currugated folds of scrotal skin

Question 74

Dilation of the retes testis is not uncommon after this procedure. What is the name of this condition when seen with US?

Answer 74

vasectomy tubular ectasia (ectasia = dilation)

Question 75

What is the shape of the normal testicle? What are the normal dimensions of the adult testicle? Define spermatocele. Name the plexus of veins found within the spermatic cord which drain the testicles of blood.

Answer 75

oval length 3x5cm aP 2-4cm a cystic structure containing sperm (viable or dead) pampiniform plexus

Question 76

Name the TYPE of transducer which yields the BEST images of the testicles. Which MHz. range would best be suited for a testicular examination. a. 2-3 MHz. b. 4-6 MHz. c. 7-10 MHz.

Answer 76

linear c

Question 77

When preparing a patient for a scrotal examination, through instructions with details will insure the patient is properly prepared for the exam. True / False By using the sling method, where the scrotum is cradled on a towel draped over the patients thighs, the posterior aspect of the scrotum can be examined. True / False Having a warm room and gel will help prevent the patients’ scrotum from contracting. True / False

Answer 77

F T T

Question 78

During a examination of the scrotum, both testes are routinely examined. When beginning an exam on an acute scrotum it is advisable to set the gain settings using which testicle?

Answer 78

the unaffected side

Question 79

Which of the following probes is the better choice when doing a scrotal examination? Why? a. 8 MHz. linear 4cm footprint b. 8 MHz. linear 6cm foot print

Answer 79

b - lgr footprint willimage greater portion of the testis

Question 80

The testes can be thoroughly examined from the anterior surface of the scrotum. True / False Prior to beginning a scrotal examination, how can the penis be placed to be out of the way?

Answer 80

F lay the penis uon th ept's abd and lay a rolled towel across it

Question 81

List the 2-D testicular images taken during a routine scrotal examination. Assume that the entire testis can be seen in the longitudinal views. Don’t list the epididymal images. Hint: there will be an odd number of images.

Answer 81

long mid w/ measure long medial long lateral trans sup, mid inf tran bilateral

Question 82

All of the following are potential reasons for a scrotal US examination EXCEPT. a. infertility b. palpable mass c. pain d. difficulty urinating One of the most common mistakes new sonographer make when measuring the testes is to foreshorten them. Why do you think this is?

Answer 82

d failure to find the longest axis; settline fr the best guess

Question 83

What is the difference between the following? Testes Testis

Answer 83

testes - pleural testis - singular

Question 84

What plane was this image taken in? The asterisk is on which testicle?

Answer 84

trans right

Question 85

what plane?

Answer 85

long

Question 86

This image was taken in the transverse plane. At what level was it taken? Why did you choose this answer? a. superior b. mid c. inferior

Answer 86

b - mediastinum testis

Question 87

what is the arrow pointing to?

Answer 87

epididymal head

Question 88

wht is the arrow pointing to?

Answer 88

scrotal wall

Question 89

What is this image showing, why was it taken?

Answer 89

epididymal head, showing measurement

Question 90

what is the arrow pointing to?

Answer 90

mediastinum

Question 91

What is causing this image to appear this way.

Answer 91

dartos muscle contraction, skin of scrotum is corregated

Question 92

what is this condition?

Answer 92

tubular ectasia

Question 93

which image was taken in long?

Answer 93

a

Question 94

Why is this image part of the protocol, what is the image used for?

Answer 94

bilateral testes, shows echogenicity comparison

Question 95

what is the arrow pointing to?

Answer 95

median raphe

Question 96

What plane is this image taken in? Name the anatomy the yellow arrow is pointing to? Name the specific anatomy the green arrow is pointing to?

Answer 96

trans mediastinum epididymal body

Question 97

The following image shows contraction of the cremaster muscle. True / False

Answer 97

false - dartos muscle

Question 98

This image was taken from a patient with a history of oligospermia (low sperm count). What is displayed within the circle which could account for this history?

Answer 98

varicocele; dilated pampiniform plexus

Question 99

What specific anatomy is shown in this image? What plane was this image taken in?

Answer 99

epiddiymal body long

Question 100

what is the arrow pointing to?

Answer 100

epdidymal tail

Question 101

Name the structure from which the testicular arteries arise. Name the structures into which each of the testicular veins drain into. Be specific.

Answer 101

aorta rt to ivc, lt to renal vein

Question 102

Name this anatomic structure. Which testis would you use to set your gain setting? Rt. or Lt.

Answer 102

scrotal wall lt