Quiz 2 review Flashcards
(131 cards)
1
Q
What is the ultrasound appearance of the testicle and epididymis?
A
Testes appear as smooth, medium gray structures with fine echo texture. Epididymis is iso-hypo echoic to testes, coarser.
2
Q
What is the rete testis?
A
Converges into mediastinum, drains epi head into efferent ductules.
3
Q
What are the parts of the epididymis?
A
Head (6-15 mm), body, tail.
4
Q
What part do we normally see?
A
Epi head.
5
Q
What is an appendix testis or appendix epididymis?
A
Accessory from mullerian duct remnant, seen on head with hydrocele.
6
Q
What are the layers covering the testicle?
A
Tunica albuginea then tunica vaginalis (parietal and visceral).
7
Q
Where do hydroceles form?
A
Between the visceral and parietal layers of the tunica vaginalis.
8
Q
Where do the testicular arteries originate from?
A
AO, IIA, IEA.
9
Q
Which vessel delivers blood to the cremasteric muscle?
A
Cremasteric.
10
Q
Which vessel delivers blood to the epididymis and vas deferens?
A
Deferential.
11
Q
Which vessel delivers blood to the scrotal wall?
A
Pudendal.
12
Q
Where do testicular veins drain to?
A
Right- IVC, Left- LRV.
13
Q
What is the purpose of the pampiniform plexus?
A
Regulate temperature of the scrotum.
14
Q
What is a hematocele?
A
Collection of blood in scrotal sac.
15
Q
What is epididymitis and what causes it?
A
Inflammation of epididymis and testis, usually from UTI spread from spermatic cord to epididymis to testis. Most common cause of scrotal pain in adults.
Epididymitis: Enlarged, hypoechoic, hyperemic (hyper vascularity), inhomogeneous, reactive hydrocele, skin thickening.
16
Q
What is orchitis and what can cause it?
A
Inflammation of testicle, often infection.
17
Q
If a patient has orchitis alone what is likely the cause?
A
UTI.
18
Q
What is epididymo-orchitis?
A
Inflammation of testicle and epididymis.
19
Q
What are the sonographic appearances of epididymo-orchitis?
A
Enlarged, hypoechoic, hyperemic (hyper vascularity), inhomogeneous, reactive hydrocele, skin thickening.
20
Q
What is the most common cause of scrotal pain in adults?
A
Epididymo-orchitis.
21
Q
What anomaly is associated with torsion?
A
Bell clapper anomaly.
22
Q
How long can a patient have torsion before the chance of saving the testicle drops below 80 %?
A
5-6 hours.
23
Q
How much rotation is required for true testicular torsion?
A
560 degrees.
24
Q
What is the ultrasound appearance of testicular torsion?
A
4-6 HRS – swelling and hypoechoic. After 6 HRS – heterogeneous. Doppler (differentiates from orchitis) power.
25
Why is torsion an emergency?
Blood flow and return is cut off.
26
What picture is key to diagnosing torsion?
No color flow.
27
How does the appearance of torsion change from initial onset over time?
Goes from enlarged, homogeneous, and hypoechoic to heterogeneous.
28
What is the blue dot sign an indication of?
Appendix testis torsion.
29
What is an epididymal cyst?
Small, clear cysts containing serous fluid located within the epididymis.
30
Where does a spermatocele occur and what does it contain?
Cystic dilations of efferent ductules in epididymal head. Contain proteinaceous fluid and spermatozoa.
31
What can trauma do to the testicle?
Rupture it, hematocele.
32
Are extratesticular masses usually benign or malignant?
Benign.
33
What is a varicocele?
Dilations of vein in pampiniform plexus in spermatic cord.
34
What is the measurement for a varicocele?
> 2mm.
35
What is the cause of primary varicocele?
Nonfunctioning venous valves.
36
What is the cause of secondary varicoceles?
Nutcracker syndrome, invaded LRV, hydronephrosis, cirrhosis.
37
Why would varicoceles decrease infertility?
Testicle cannot regulate temperature.
38
What maneuver is key to diagnosing varicoceles?
Valsalva.
39
What side are varicoceles more common on?
Left.
40
What syndrome is associated with varicoceles?
Nutcracker.
41
What vessel is compressed and what is compressing it?
LRV squished by SMA and AO.
42
What is a scrotal hernia?
Perfusion of bowel into scrotal wall- peristalsis.
43
What is a hydrocele?
Serous fluid collection in scrotum.
44
Sperm granuloma are associated with what?
Vasectomy, chronic inflammatory reaction.
45
In patients with microlithiasis, how often should they have follow-up ultrasounds?
Annually.
46
What is the dilation of the efferent ductules in the rete testis?
Tubular ectasia of rete testis.
47
What age group is testicular cancer usually found in?
15-35.
48
What are the two major types of tumors in the testicle?
Germ cell tumors- Seminoma and teratocarcinoma.
49
Which type of tumor is usually benign?
Non germ cell tumors; Sertoli-leydig, adenomatoid, juvenile granulosa cell tumor.
50
Which is usually malignant?
Germ cell tumors- seminoma, embryonal cell, choriocarcinoma, teratocarcinoma.
51
What lab values will often be elevated with testicular cancer?
AFP and HCG.
52
What type of testicular tumor is the most common testicular cancer?
Seminoma.
53
What is associated with this type of cancer?
Undescended testes.
54
What is the sonographic appearance of a seminoma?
Homogeneous, hypoechoic, smooth borders, no calcs.
55
What is the sonographic appearance of embryonal cell carcinoma?
Heterogeneous, not well circumcised, hyperechoic areas of hemorrhage, calcs, of fibrosis.
56
What is the appearance of teratocarcinoma?
Heterogeneous with calcs, hypoechoic.
57
What is the appearance of choriocarcinoma?
Heterogeneous with hemorrhagic central necrosis- mets to lung and brain.
58
Which testicular cancer is the most aggressive and has the worst prognosis?
Choriocarcinoma.
59
What lab values are increased with embryonal cell tumors?
AFP and HCG.
60
What age group is associated with embryonal cell cancer?
25-35.
61
What type of cancer is usually associated with increased hCG, gynecomastia and hyperthyroidism?
Choriocarcinoma.
62
Which is the most common testicular tumor of children?
Embryonal cell tumor- yolk sac.
63
Which testicular cancer is very aggressive and invasive and what age group is associated with this?
Embryonal cell carcinoma, children under 2.
64
Where can primary cancers metastasize to the testicle?
Prostate and kidney.
65
What is significant about mets to the testicles that differentiates it from a primary cancer?
N/A.
66
What is filariasis caused by?
Nematodes from mosquito bite.
67
What does it cause?
Obstructed and dilated lymphatic channels, edema, N/N, fever, chills, scrotal wall swelling.
68
What is cryptorchidism?
Undescended testes.
69
Where do testicles originate during fetal development?
Retroperitoneum near the kidneys.
70
Where are most undescended testicles found?
80% in inguinal canal.
71
What is the surgery called to fix cryptorchidism?
Orchiopexy.
72
What risks are related to cryptorchidism?
Increased chances of cancer, torsion, and infertility.
73
What is anorchia?
Absence of both testicles.
74
What is monorchidism?
Absence of one testicle.
75
What is polyorchidism?
Extra testicles.
76
Are the corpus cavernosa closer to the dorsal or ventral side of the penis?
Dorsal- top/back of penis when pointing up- corpus cavernosum. Ventral- bottom/front of penis when pointing up- corpus spongiosum.
77
What is the most common vascular cause of impotence?
An insufficient veno-occluded mechanism resulting in cavernosal 'venous leak'.
78
What is Peyronie's disease?
Acquired, unknown etiology, associated with diabetes, middle-aged men, painful deformity, shortening of penis, less rigidity, painful erection, curved/bent penis, erectile dysfunction, formation of fibrous plaques in tunica albuginea of penis causing scar tissue buildup.
79
What measurement in any direction would be considered enlarged in the prostate?
>5cm.
80
What is the name of the area where the ejaculatory ducts meet the urethra?
Verumontanum.
81
What sign is associated with this?
'Eiffel Tower' sign.
82
What is the purpose of the seminal vesicles?
Produces seminal fluid, which turns sperm into semen.
83
Where are the apex and base of the prostate?
Superior is the base and inferior is the apex.
84
What is superior to the prostate?
Urinary bladder and symphysis pubis.
85
What are the zones of the prostate?
Peripheral zone (Largest, 70%) *Most cancers in this zone! Homogeneous with medium-level echogenicity (slightly hyperechoic). Central zone (20%). Ejaculatory ducts. Transition zone (5%). Central and transitional zones are not distinctive, slightly hypoechoic to peripheral zone.
86
Which zone is not affected by cancer or BPH?
Fibromuscular stroma.
87
What is the largest portion of the prostate?
Peripheral zone.
88
In what part of the prostate do most cancers develop?
Peripheral zone.
89
What are the two sonographic approaches in which we can view the prostate?
Transrectal and transabdominal.
90
Which approach gives us a much more detailed view of the prostate?
Transrectal.
91
What do the seminal vesicles look like on ultrasound?
Hypoechoic clouds superior and posterior to prostate.
92
What PSA level would be most concerning for cancer?
Above 10x that of BPH.
93
What is BPH and what zone is affected?
Enlargement of the inner gland, 95% transitional zone and 5% periurethral glands.
94
What symptoms are associated with it?
Difficulty urinating.
95
What are some treatments for prostate cancer?
Hormone therapy, chemotherapy, radiation (seeds), prostatectomy.
96
What are some benefits of using ultrasound contrast over other modalities?
No radiation, safer for patient- rare allergies.
97
What was the first contrast used for?
Cardiac ultrasound.
98
What aspects of the ultrasound are enhanced with contrast?
Vessels, sometimes a mass will absorb it.
99
What size do microbubbles need to be?
Smaller than RBC.
100
Why do they need to be this size?
To make it through the entire circulatory system without rupturing, enhances reflectivity and echogenicity.
101
What are the three contrast agents approved by the FDA?
Albunex, Definity, Imagent, Lumason, Optison.
102
Which was approved for use in characterizing liver lesions?
Lumason.
103
Are grayscale, color or doppler images optimized with contrast?
Grey scale visualization of blood flow in vessels.
104
What were the first microbubbles made from?
Shaken saline.
105
How are tissue-specific contrast agents different from vascular contrast agents?
Specific agents are taken up by specific tissues from the vessels.
106
What movement of microbubbles allows for better views on ultrasound?
Oscillation.
107
Is the mosaic pattern in liver tissue evidence of normal or abnormal tissue?
Normal tissue.
108
How can oral contrast help with pancreas views?
Window through the stomach, rids of gas.
109
What ways do we use contrast with the liver?
TIPS- stent stenosis Dx, transplants, detection of hepatic blood flow, detect and characterize tumors, cirrhosis.
110
What are the three reasons we use contrast in the kidneys?
Detect RAS- renal artery stenosis, renal masses, transplants.
111
What vascular structures do we evaluate with contrast?
Hepatic artery, renal artery, portal vein.
112
What are some of the major procedures performed under ultrasound?
FNA, biopsy, paracentesis, thoracentesis, needle/catheter placement.
113
What is the most commonly biopsied organ?
Liver.
114
What is the main reason to perform a biopsy?
Distinguish malignant from infectious/inflammatory, recurrent cancer or scar tissue, benign vs malignant.
115
What is a reason to biopsy a kidney transplant?
Determine if it is rejecting.
116
What is the major advantage of using US guidance for procedures?
Continuous real time visualization of needle and ability for adjustment.
117
What are some reasons we could not do a procedure under ultrasound guidance?
N/A.
118
What is oocyte retrieval?
Retrieving an egg from the ovary.
119
What is a time-out and what information is verified?
Pausing before an exam to ensure right patient, DOB, name, procedure, and place.
120
What lab tests would be performed prior to a procedure? What do these tests indicate?
INR- <1.5 is good, PT- Prothrombin time, PTT- partial thromboplastin time.
121
What is FFP and how is it used?
Fresh frozen plasma, used to combat effects of anticoagulants.
122
What is the required discontinuation times for Heparin, Coumadin, and Aspirin?
Heparin- 4-6 hours, Coumadin- 3-4 days, Aspirin- 5-7 days.
123
What is an FNA? What needle sizes are used?
Fine needle aspiration. 20-25 gauge needle, obtaining cells.
124
What is a core biopsy? Is this needle smaller or larger than an FNA?
Core sample of tissue for histologic analysis- spring loaded. Larger than FNA.
125
What is the difference in tissue obtained in an FNA vs a core biopsy?
FNA is cells, core is tissue.
126
What are the major risks in any procedure?
Infection and internal bleeding.
127
What is a risk in a thoracentesis?
Pneumothorax.
128
What is a risk in a paracentesis?
Pancreatitis, biliary leak, peritonitis.
129
What is the difference between cytopathology and histology?
Cytology focuses on individual cells, histology focuses on tissue types.
130
What is the advantage of having a cytopathologist present for an FNA?
Increase the percentage of successful biopsies, helps to minimize the number of passes, and possibly reduces overall procedure time.
131
What is a vasovagal reaction?
Drop in BP and heart rate, fainting.
