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Generalist Exam Questions > Scrotum and Prostate > Flashcards

Scrotum and Prostate Flashcards

1
Q

What month GA do the testes lie in the scrotum?

A

8 mo

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2
Q

What structure is a fibrous sheath that covers the testis and is seen as a thin echogenic line on ultrasound?

A

Tunica albuginea

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3
Q

What is the normal thickness of the scrotal wall?

A

2-8mm

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4
Q

The scrotum is divided into two compartments by what structure?

A

Median Raphe

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5
Q

What three major structures are contained in the scrotum?

A

Testes, epi, spermatic cord

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6
Q

What structure is a continuation of the epididymis?

A

Vas deferens

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7
Q

The Rt testicular vein drains into what structure whereas the Lt testicular vein drains into what stucture?

A

Rt - IVC
Lt - Lt renal vein

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8
Q

What type of waveform will you see in testicular arteries?

A

Low-resistance and high flow

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9
Q

Spermatogenesis takes place where?

A

Seminiferous tubules

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10
Q

When undescended testes are located prior to what age, is fertility preserved?

A

2 years

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11
Q

Where are the majority of undescended testes located?

A

Inguinal canal

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12
Q

Between what ages does torsion typically occur?

A

12-18

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13
Q

When torsion is suspected, what can you expect to find sonographically and what should you do to confirm?

A

Whirpool sign / torsion knot

Use CD and pulsed doppler to confirm absence of blood flow

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14
Q

Of the types of torsion, what is the most common?

A

Intravaginal

Extravaginal - occurs ONLY in newborns

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15
Q

Clinical signs of torsion?

A
  1. Sudden onset of pain
  2. Nausea/vomiting
  3. Fever
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16
Q

What pathology represents 75% to 80% of all acute inflammatory processes in the scrotum?

A

Epididymitis

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17
Q

Men of what ages are typically affected by epididymitis?

A

20-30 yrs

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18
Q

What is meant by a “reactive” hydrocele?

A

A type of non-communicating hydrocele that is caused by trauma, infection, or torsion

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19
Q

What is the most common cause of painless scrotal swelling?

A

Hydrocele

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20
Q

What are the most common epididymal lesions?

A

Epididymal cysts
Spermatoceles

Usually occur post vasectomy or due to trauma and found most commonly in the head

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21
Q

What age of men typically present with tubular ectasia or rete testes?

A

50 yrs - often bilateral

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22
Q

To be a varicocele, the vein must measure what?

A

> 3mm - most commonly left sided

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23
Q

Clinical signs of varicoceles?

A

Abnormally warm scrotum
Infertility

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24
Q

Clinical signs of a patient with a scrotal hematoma?

A

Pain, swelling, skin discolouration

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25
Q

Hematoceles and pyoceles usually form between what two layers within the testes?

A

Parietal and visceral layer of tunica vaginalis

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26
Q

Granulomatous disease of the testis and epididymis results from retrograde spread of what illness?

A

TB

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27
Q

Granulomatous disease of the scrotum is seen in men between what ages?

A

20-50yrs

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28
Q

SF of granulomatous disease?

A
  1. Hypervascular
  2. Enalrged epididymus
  3. Wall thickening
  4. Hydrocele
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29
Q

Where are benign adenomatoid tumors typically found?

A

Epi tail - EXTRATESTICULAR

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30
Q

SF and age range of benign adenomatoid tumor?

A

Ages - 20-50’s
SF - well circumscribed solid mass with variable echogenicity

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31
Q

What is the SECOND m/c benign extratesticular neoplasm and where is it located (hint: epi)

A

Leiomyoma - epi tail

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32
Q

What is the most common non–germ cell neoplasm of the testis? What age of men are they typically found?

A

Leydig-cell tumour - 10-15% are actually malignant

Aged 20-50’s

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33
Q

What are the clinical features of Leydig cell tumors? (hint: gonadal stromal tumour)

A
  1. Impotence
  2. Gynecomastia
  3. Decreased libido
  4. Endocrine imbalance
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34
Q

What is the most common malignant tumor of the epididymis and spermatic cord?

A

Rhabdomyosarcoma - mostly in children and adolescents

35
Q

What are the SF of a rhabdomyosarcoma?

A
  1. Hypoechoic
  2. Not well-defined - hard to delineate borders
  3. 1-2cm
  4. No defined capsule
36
Q

What is the name for a benign teratoma of the testicle? What age does it typically present?

A

Epidermoid cyst - ages 20-40yrs

37
Q

Are epidermoid cysts painful or not?

A

NO - present as a PAINLESS scrotal mass -
“target or bulls eye” mass

38
Q

Patients with cryptorchidism/undescended testicle(s) have how much of an increased risk for developing testicular cancer?

A

2.5 to 8 times

39
Q

How do scrotal malignancies typically present?

A
  1. Unilateral, painless mass
  2. Hardened testes
  3. Unilateral enlargement
40
Q

What is the MOST common malignancy of the testicle in men over 60?

41
Q

SF and age range of a Seminoma in the testicle (malignancy) ?

A

Age - 40.5 yrs average

Hypoechoic
Vascular
Well-defined

42
Q

Embryonal cell carcinomas typically present in what age?

A

25-35 and often invade tunica albuginea

43
Q

25 year old patient presents with a scrotal mass and elevated b-HcG levels, what is the most likely diagnosis?

A

Choriocarcinoma

44
Q

Considering scrotal malignancies, which one is the MOST aggressive?

A) Lymphoma
B) Seminoma
C) Epidermoid cyst
D) Embryonal cell

A

Embryonal cell carcinoma

45
Q

SF of embryonal cell carcinoma?

A

Hypoechoic without well-defined borders

46
Q

What ducts are responsible for development of the male reproductive system?

A

Mesonephric ducts

47
Q

What three structures traverse the prostate gland?

A

The right and left ejaculatory ducts, and the urethra.

48
Q

What is the longitudinal ridge on the posterior wall of the prostatic urethra?

A

Verumontanum

49
Q

What structure accounts for the “Eiffel Tower” appearance on transverse images of the prostate gland?

50
Q

What arteries supply the prostate?

A

Internal iliacs

51
Q

What zone of the prostate makes up 70% ?

A

Peripheral zone

52
Q

What zone of the prostate is the most common location for carcinomas and prostatitis to occur?

A

Peripheral zone

53
Q

In what zone does BPH typically occur?

A

Transition zone

54
Q

Calculi in the prostate most commonly occur in what zone?

A

Peri-urethral

55
Q

Does the vas deferens lie medially or laterally to the seminal vesicles?

56
Q

What are the two most common type of male pelvic cyst? (think prostate)

A

Mullerian duct and utricle cysts

57
Q

What is the most common symptomatic tumor-like condition in the male population? What age does this typically occur and when does it peak?

A

BPH - occurs around age 40 and peaks at 60

58
Q

What symptoms typically occur with BPH?

A

Urinary symptoms

59
Q

What procedure is done to relieve the symptoms caused by compression of the prostatic urethra due to BPH?

A

TURP - transurethral resection of prostate

60
Q

The testes are surrounded by a fibrous connective tissue sheath known as what?

A

Tunica albuginea

61
Q

What tissue membrane in the scrotum covers the testes and epididymis?

A

Tunica vaginalis

62
Q

Between what layers of the scrotum do hydroceles form?

A) Between tunica vaginalis and albuginea
B) Between both layers of the tunica vaginalis
C) Between the two layers of tunica albuginea
D) Between the tunica albuginea and testes

63
Q

Where do the testicular arteries arise from?

64
Q

What does the testicular artery divide into to supply the periphery of the testicle?

A) Cremasteric
B) Capsular
C) Deferential
D) Centripetal

A

Capsular artery

65
Q

Which arteries pass through the testicular parenchyma and travel towards mediastinum testes?

A) Cremasteric
B) Capsular
C) Deferential
D) Centripetal

A

Centripetal

66
Q

What artery supplies the epididymis and vas deferens?

A) Cremasteric
B) Capsular
C) Deferential
D) Vesicular

A

Deferential - high resistance

67
Q

What artery supplies the scrotal wall and muscle?

A) Cremasteric
B) Capsular
C) Deferential
D) Vesicular

A

Cremasteric - high resistance

68
Q

The intra-testicular arteries that arise from the capsular artery are known as?

A) Cremasteric
B) Capsular
C) Deferential
D) Centripetal

69
Q

What arteries have high resistance?

A) Deferential and capsular
B) Cremasteric and capsular
C) Deferential and cremasteric
D) Deferential and centripetal

70
Q

The capsular artery is a branch of what artery?

A) Cremasteric
B) Capsular
C) Deferential
D) Testicular

71
Q

Most common findings associated with epididymo-orchitis?

A

Thickening scrotal wall and reactive hydrocele

72
Q

How to differentiate an epi cyst vs spermatocele?

A

Cyst = anechoic and thin walled
Spermatocele = contain low level echoes

73
Q

SF of a seminoma?

A

Well-defined, homogenous, hypoechoic mass

74
Q

What type of cyst of the prostate is associated with infertility?

A) Mullerian duct cyst
B) Utricle cyst
C) Ejaculatory duct cyst
D) Retention cyst

A

C - may be associated with low sperm count

75
Q

In a trans-rectal US, what structure is seen at the bottom of the screen?

76
Q

A large complex hydrocele is most commonly associated with which of the following?

A) Seminoma
B) Epididymal cyst
C) Varicocele
D) Orchitis

77
Q

What zone is most commonly affected by prostate cancer

A

Peripheral

78
Q

What SF is not typically seen with testicular cancer?

79
Q

Which SF is not likely seen in orchitis?

A) Thickened scrotal wall
B) Hyperemia
C) Hypoechoic testes
D) Microlithiasis

80
Q

In what patient position is typically used for transrectal US?

81
Q

Three main symptoms associated with prostatism?

A

Difficulty urinating, small stream, nocturia

82
Q

The prostate is supplied by what artery?

A

Internal iliac

83
Q

What zone surrounds the ejaculatory ducts?

Generalist Exam Questions (21 decks)

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