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ARDMS Abdominal Review > Scrotum > Flashcards

Scrotum Flashcards

1
Q

The normal testis has what level or echo texture

A

Homogogenous

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2
Q

The testicle is surrounded by a fibrous capsule called

A

Tunica albuginea

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3
Q

Sonographically this is seen as an echogenic linear band extending longitudinally within the testis

A

Mediastinum testis

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4
Q

The septula forms wedge-shaped compartments that contain the

A

Seminiferous tubules

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5
Q

The seminiferous tubules converge to form the

A

Tubuli recti

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6
Q

The tubuli recti enter the mediastinum testis forming a network of channels called the

A

Rete testis

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7
Q

What carries the seminal fluid from the rete testis to the epididymis

A

Efferent ductules

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8
Q

The epididymis is composted of what 3 things

A

1) head
2) body
3) tail

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9
Q

Where is the epididymis located to the testicle

A

Parallel to the testicle

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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

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11
Q

What is another name for the head of the epididymis

A

Globus major

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12
Q

What is another name for the tail of the epididymis

A

globus minor

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13
Q

What is another name for the vas deferens

A

Ductus deferens

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14
Q

Sonographically how does the epididymis normally appear

A

Isoechoic or slightly hyperechoic

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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

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16
Q

What is a small stalk projecting off the epididymis that represents a detached efferent duct

A

Appendix epididymis

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17
Q

This is a layer of muscle fibers that lie beneath the scrotal skin dividing the scrotum into 2 chambers

A

Dartos

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18
Q

The division of the 2 scrotal chambers is called the

A

Scrotal raphe

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19
Q

What is a saccular extension of the peritoneum into the scrotal chambers

A

Tunica vaginalis

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20
Q

What does the inner or visceral layer of the tunica vaginalis cover

A

Testis and epididymis

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21
Q

What does the outer or parietal layer of the tunica vaginalis line

A

scrotal chamber

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22
Q

Name 3 things the testicular blood flow is supplied by

A

1) deferential artery
2) cremasteric artery
3) testicular artery

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23
Q

What is another name for the cremasteric artery

A

External spermatic artery

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24
Q

Name 2 things the testicular artery divides into

A

1) capsular
2) centripetal

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25
Q

What 5 things does the spermatic cord consist of

A

1) vas deferns
2) cremasteric, deferential, testicular arteries
3) pampiniform plexus of veins
4) lymphatics
5) nerves

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26
Q

What is the most common solid tumor in men and what is the age range

A

Testicular neoplasms age 15-35

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27
Q

Germ cell tumors account for what percent of testicular tumors

A

95%

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28
Q

Name 4 testicular tumors

A

1) seminoma #1
2) teratoms
3) choriocarcinomas
4) mixed tumors

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29
Q

what is the most common germ cell tumor in adults

A

Seminoma

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30
Q

Where does seminoma initially spread to

A

draining lymph nodes in the retroperitoneum

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31
Q

When an intratesticular mass is discovered what area should be evaluated for lymph nodes

A

Paraortic region

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32
Q

The most common prepubertal testicular tumor is the

A

Yolk sac tumor (endodermal sinus tumor)

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33
Q

A yolk sac tumor is considered what type of tumor

A

germ cell

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34
Q

What lab value is increased with yolk sac tumors

A

alpha-fetoprotein (ALP)

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35
Q

What is the most common gonadal stromal tumor in children and adults

A

Leydig cell tumor

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36
Q

Leydig tumors occur most frequently in boys aged

A

4-5 years

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37
Q

Teratomas consist of 3 different germinal layers including

A

1) endoderm
2) mesoderm
3) ectoderm

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38
Q

What is the second most common testicular tumor in children that are usually benign

A

Teratomas

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39
Q

What tumor appears as a well defined mass containing cystic and solid components

A

Teratomas

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40
Q

Name the 2 lab values that are associated with testicular tumors

A

1) Beta-human chorionic gonadotropin (B-HCG)
- choriocarcinoma
-embryonal carcionma

2) alpha-fetoprotein (ALP)
-Yolk sac tumor

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41
Q

What is the most common lethal and least common form or germ cell tumors

A

Choriocarcinoma

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42
Q

Choriocarcinoma is associated with an increase in

A

B-HCG

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43
Q

What is the second most common testicular malignancy after seminoma

A

Mixed germ cell tumors

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44
Q

What is the most common mixed germ cell tumor and what is another name for it

A

Combo of teratoma and embryonal cell tumor
AKA- teratocarcinoma

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45
Q

What are the 2 most common malignancies to affect the testis secondarily

A

1) leukemia
2) lymphoma

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46
Q

What are the 2 types of benign cysts

A

1) cysts of the tunica albuginea
2) intratesticular cysts

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47
Q

What type of cyst is a benign tumor of germ cell origin and are well circumscribed solid tumors lying beneath the tunica albuginea

A

Epidermoid cyts

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48
Q

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

A

Epidermoid cysts

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49
Q

Sonographically what presents with an enlarged testicle containing a predominantly fluid filled mass with hypoechoic or mixed echogenic areas

A

Testicular abscess

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50
Q

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

a) head of epididymis

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51
Q

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

A

d) torsion

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52
Q

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

A

b) the epididymis is uniformly enlarged and more anechoic than usual

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53
Q

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

A

c) head of the epididymis

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54
Q

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

A

c) they are the reservoir for sperm and are located posterior to the urinary bladder

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55
Q

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

a) solid, homogeneous mass

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56
Q

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

A

e) all of the above

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57
Q

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

A

d) left renal vein

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58
Q

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

a) anechoic areas in testes with decreased blood flow

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59
Q

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

A

b) posterior urethral valve

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60
Q

Approximately, what is the normal scrotal wall thickness

A

2-8 mm

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61
Q

The head of the epididymis measures up to how many mm in the AP diameter

A

10-12 mm

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62
Q

What is the primary function of the testes

A

Production of sperm and testosterone

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63
Q

What is the primary sex hormone respsonsible for the development of male reproductive tissues

A

Testosterone

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64
Q

What is an echogenic band extending from the caudal end of the testis to the scrotal wall

A

Scrotal ligament

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65
Q

Dilatation of the seminiferous tubules is referred to as

A

Tubular ectasia of the rete testis

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66
Q

What is the normal adult testis measurement in transverse and long

A

3-5 cm in length
2-3 cm in transverse

67
Q

What artery provides the major blood supply to the testis

A

Testicular artery

68
Q

What vein drains into the IVC

A

The right testicular vein

69
Q

What vein drains into the left renal vein

A

The left testicular vein

70
Q

The spectral waveform of which artery has a low-resistance, high flow pattern, with a mean RI of 0.62

A

Testicular artery

71
Q

The spectral waveform of which artery has a low-resistance, high-flow waveform, and a RI ranging from 0.46-0.68

A

Epididymal artery

72
Q

The sonographic appearance of what is an oval or elongated well-circumscribed hypoechoic homogenous soft tissue structure, smaller than the normal descended instrascrotal testis

A

Undescended testis

73
Q

What is another name for calcifications

A

Scrotal Pearls

74
Q

Testicular infarction commonly results in what

A

Torsion or Trauma

75
Q

What is a serious fluid that accumulates within the tunica vaginalis or between the layers of the tunica vaginalis

A

Hydrocele

76
Q

What is seen when blood fills the scrotal chamber and is associated with trauma

A

Hematocele

77
Q

What is a dilitation of the pampiniform venous plexus of the testicular veins which drain the testicle

A

Varicocele

78
Q

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

A

Scrotal Hernia

79
Q

What is the most common extratesticular tumor

A

Adenomatoid tumor

80
Q

Extratesticular tumors usually involve the

A

Epididymis

81
Q

Name the 2 most common causes of acute scrotal pain

A

1) epididymitis
2) epididymo-orchitis

82
Q

Name the 2 types of testicular torsion

A

1) intravaginal
2) extravaginal

83
Q

What type of testicular torsion is the most frequent type and is seen in 80% of cases

A

Intravaginal torsion

84
Q

What are cystic masses of the epididymis that result from dilatation of the epididymal tubules

A

Spermatoceles

85
Q

This type of cyst is composed of clear fluid

A

Epididymal cyst

86
Q

This type of cyst is filled with thick milky fluid containing spermatozoa

A

Spermatoceles

87
Q

Where do spermatoceles usually occur

A

At the epididymal head

88
Q

Name the 2 most common causes of acute scrotal pain

A

1) epdidymitis/ orchitis
2) torsion of the spermatic cord

89
Q

What is the most common condition that causes acute scrotal pain

A

Acute epididymitis

90
Q

Name 2 things acute epididymitis is usually caused by

A

1) sexually transmitted diseases
2) UTI

91
Q

Sonographically, epididymitis is associated with

A

1) enlarged hypoechoic epdidymis
2) hypoechoic testicle
3) increased blood flow
4) reactive hydrocele
5) scrotal wall thickening

92
Q

What is sonographically seen as an enlarged and hypoechioc testicle with increased blood flow

A

orchitis

93
Q

Typically, what is the testicle attached to

A

Tunica vaginalis

94
Q

What is it called when the testicle can rotate freely on the spermatic cord

A

Bell clapper deformity

95
Q

What age group is testicular torsion obsereved in

A

Men younger than 30 between 12-18

96
Q

Sonographically, what is seen as enlarged, inhomogenous and hypoechoic compared to the contralateral testicle

A

Testicular torsion

97
Q

The degree of torsion may vary between how many degrees

A

180-580

98
Q

Cryptorchidism literally means

A

HIdden testicle and generally refers to undescended testicle

99
Q

Name 2 complications of cryptorchidism

A

1) infertility
2) cancer

100
Q

What is the most common location of the cryptorchid testis

A

Inguinal canal

101
Q

What is the most common correctable cause of infertility

A

Varicocles

102
Q

What is it called when the superior mesenteric artery compresses the left renal vein, resulting in stasis and thrombosis

A

Nutcracker phenomenon

103
Q

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

A

b) epididymal cyst

104
Q

What is the second most common primary benign neoplasm of the epididymis

A

Leiomyoma

105
Q

What is the most common extratesticular neoplasm that involve on the spermatic cord

A

Lipoma

106
Q

What is the most common bilateral testicular tumor

A

Lymphoma

107
Q

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

A

B) enlarged hyperemic epididymis

108
Q

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

A

b) a blood-filled sac that surrounds the testicle, secondary to trauma or surgery

109
Q

Which scrotal artery encircles the testicular periphery
a) cremasteric
b) capsular
c) deferential
d) centripetal

A

b) capsular

110
Q

What presents as small calcifications in the liver and spleen

A

Granulomas

111
Q

Granulomas are caused by what 2 thing

A

1) histoplasmosis
2) tuberculosis infection

112
Q

Liver inflammation due to viruses to toxins is called

A

Hepatitis

113
Q

What is a nonobstructive hepatocellular cause of jaundice

A

Hepatitis

114
Q

A hypoechoic liver parenchyma, liver enlargement, and hyperechoic portal vein walls describes

A

Acute hepatitis

115
Q

A hyperechioc liver parenchyma, small liver, and decreased echogenicity of portal vein walls describes

A

Chronic hepatitis

116
Q

A pyogenic mass commonly occurs in what part of the liver

A

Right lobe

117
Q

Name the 5 differential diagnosis of pyogenic abscess

A

1) amebic abcess
2) echinococcal cyst
3) hemorrhagic cyst
4) hematoma
5) cystic neoplasm

118
Q

Name 4 symptoms of an amebic abscess

A

1) RUQ pain
2) leukocytosis
3) fever
4) elevated liver function tests

119
Q

What type of abscess occurs when a parasite from the intestines reaches the liver via the portal vein.

A

Amebic abscess

120
Q

What type of abscess in the liver is the most common extraintestinal complication of amoebic dysentery

A

Amebic abscess

121
Q

Name the 6 symptoms and findings of an amebic abscess

A

1) RUQ pain
2) diarrhea
3) fever
4) leukocytosis
5) elevated lover function tests
6) elevated right dome of diaphragm by X-ray

122
Q

Name 3 sonographic features of an amebic abscess

A

1) round hypoechoic/ complex mass
2) typically occurs in right lobe
3) continguous with the liver capsule

123
Q

What is another name for echinococcal cyst

A

Hydatid disease

124
Q

Name the tests used to diagnose hydatid disease

A

1) casoni skin test (70% sensitivity)
2) detection of antibodies
- indirect hemagglutination
- indirect florescent antibody test

125
Q

An echinococcal cyst is associated with

A

Anaphalatic shock

126
Q

What is one of the most common parasitic infections in humans

A

Schistosomiasis

127
Q

Schistosomiasis is a major cause of _________ world wide

A

Portal hypertension

128
Q

Name 2 sonographic findings of schistosomiasis

A

1) occluded intrahepatic portal veins
2) thickening and increased echogenicity of the portal vein walls

129
Q

Secondary signs of portal hypertension include

A

1) splenomegaly
2) ascites
3) esophageal variceal bleeding
4) portosystemic collaterals

130
Q

Name 9 sonographic findings associated with AIDS

A

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
Q

What is the most common organism causing infection in AIDs patients

A

Pneumocystic carinii

132
Q

What is the accumulation of triglycerides within the hepatocytes

A

Fatty liver

133
Q

Name the 2 leading causes of hepatic fatty infiltration

A

1) Alcohol abuse
2) obesity

134
Q

What are the 2 patterns of fatty infiltration

A

1) focal fatty infiltration
2) focal fatty sparing

135
Q

Focal regions of increased echogenicity within normal liver parenchyma describes

A

Focal fatty infiltration

136
Q

Focal fatty commonly occurs where

A

at the porta hepatis

137
Q

Focal regions of normal liver parenchyma within a fatty infiltrated liver is

A

Focal fatty sparing

138
Q

Sparing commonly occurs where

A

Adjacent to the gallbladder, in the porta hepatis, in the caudate lobe at the liver margins

139
Q

Differential diagnosis of hyperechoic masses within the liver include

A

1) focal fatty infiltration
2) cavernous hemangiomas
3) echogenic metastasis
4) haptic lipoma

140
Q

What is a diffuse process of fibrosis and distortion of normal liver architecture

A

Cirrhosis

141
Q

The 2 most common causes of cirrhosis are

A

1) alcohol abuse
2) viral hepatitis

142
Q

Pathologic mechanisms of cirrhosis are

A

1) cell death
2) fibrosis
3) regeneration

143
Q

Clinical presentation of cirrhosis is

A

1) hepatomegaly
2) jaundice
3) ascites

144
Q

Abnormal liver functions of cirrhosis include

A

1) AST
2) ALT
3) LDH
4) conjugated bilirubin

145
Q

Name the 8 sonographic findings of cirrhosis

A

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
Q

Increased pressure in the portal venous system describes

A

Portal hypertension

147
Q

What is the normal portal pressure

A

5-10 mm Hg

148
Q

Portal vein diameter greater than ____ mm is suggestive of portal hypertension

A

13 mm

149
Q

What are the 2 major causes of portal hypertension

A

1) cirrhosis
2) schistosomiasis

150
Q

Name the 4 types of portal hypertension

A

1) extrahepatic presinusoidal
2) intrahepatic presinusoidal
3) intrahepatic (most common)
4) intrahepatic postsinusoidal

151
Q

Sonographic findings of portal hypertension include the secondary signs of

A

1) splenomegaly
2) ascites
3) portal systemic venous collaterals

152
Q

Name the 2 surgical techniques to lower portal pressure

A

1) portacaval shunt
2) TIPS

153
Q

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

A

d) parietal tunica vaginalis

154
Q

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

A

d) peyronie disease

155
Q

Which of the following arteries are evaluated during a penile duplex exam for erectile dysfunction
a) ventral
b) dorsal
c) urethral
d) cavernosal

A

d) cavernosal

156
Q

Which scrotal artery encircles the testicular periphery?
a) capsular
b) deferential
c) centripetal
d) cremasteric

A

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
Q

Which scrotal artery supplies the epididymis
a) deferential
b) capsular
c) centripetal
d) cremasteric

A

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
Q

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

A

d) parietal tunica vaginalis

159
Q

Which of the following structures is not included in the spermatic cord?
a) gonadal artery
b) cremasteric artery
c) vas deferns
d) centripetal artery

A

d) centripetal artery
- centripetal arteries are small branches of the capsular artery surronding the testicle. These branches penetrate the testicular tissue

160
Q

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

A

b) asymmetric resistive indices on the intratesticular Doppler evaluations

161
Q

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

a) pedal edema and scrotal swelling

162
Q

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

a) associated with cryptorchidism, trisomy 21, klinefelter syndrome and smoking

163
Q

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

A

c) a large extra-testciular calcification

164
Q

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

A

d) testicular infarct

ARDMS Abdominal Review (14 decks)

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