Ch. 23 Scrotum

A seminoma of the testicle generally appears on ultrasound as a(n) _____________ mass. a. hypoechoic b. complex c. hyperechoic d. anechoic

ANS: A A seminoma tends to be a homogeneous, hypoechoic mass with smooth borders.

The diameter of a varicocele measures more than _____ millimeters (mm). a. 2 b. 3 c. 4 d. 5

ANS: A A varicocele measures more than 2 mm in diameter.

Intratesticular cysts have an association with: a. spermatoceles. b. germ cell tumors. c. hydroceles. d. microlithiasis.

ANS: A Intratesticular cysts are found in men older than 40 years of age and have an association with extratesticular spermatoceles.

Which one of the following almost always transpires secondary to epididymitis? a. Orchitis b. Hydrocele c. Spermatocele d. Varicocele

ANS: A Orchitis almost always transpires secondary to epididymitis.

A spermatocele is always located in which portion of the epididymis? a. Head b. Neck c. Body d. Tail

ANS: A Spermatoceles are cystic dilations of the efferent ductules of the epididymis and are always located in the epididymal head.

Which one of the following facts about an undescended testis is false? a. The testis originates in the retroperitoneum at the level of the fetal kidney. b. All undescended testes are found in the inguinal canal. c. An associated risk for testicular malignancy can develop. d. An increased incidence of infertility exists.

ANS: B Approximately 80% of undescended testes are located in the inguinal canal. They may also be found in the abdomen or in other ectopic locations.

Attached at the superior pole of the testis between the epididymis and the testis is which one of the following? a. Rete testis b. Mediastinum testis c. Appendix testis d. Spermatocele

ANS: C The appendix of the testis is attached at the superior pole of the testis between the epididymis and testis.

Compared with the testis, the epididymis typically appears: a. anechoic. b. hyperechoic. c. hypoechoic. d. homogenous.

ANS: C The epididymis appears isoechoic to hypoechoic, compared with the normal testis. It also displays a coarser texture than the testis.

The rete testis is located: a. at the hilum of the testis. b. in the epididymis. c. at the superior pole of the testis. d. at the inferior pole of the testis.

ANS: A The rete testis is located at the hilum of the testis where the mediastinum resides.

The testes are covered by a fibrous capsule formed by the: a. tunica albuginea. b. Cowper's fascia. c. cremaster muscle. d. dartos muscle.

ANS: A The testis is completely covered by a dense, fibrous tissue termed the tunica albuginea.

A common cause of acute scrotal pain in adults is: a. an epididymal cyst. b. epididymo-orchitis. c. a spermatocele. d. testicular torsion.

ANS: B Epididymo-orchitis represents the most common cause of acute scrotal pain in adults.

Follow-up examination of patients with microlithiasis is recommended: a. semiannually. b. annually. c. every 5 years. d. Follow-up is not recommended.

ANS: B Follow-up examination is recommended annually.

Common causes of a hydrocele include all of the following except: a. trauma. b. microlithiasis. c. epididymo-orchitis. d. testicular torsion.

ANS: B Hydroceles may by idiopathic but are commonly associated with epididymo-orchitis, testicular torsion, trauma, or the development of a neoplasm.

A clinical history of a vasectomy is associated with: a. testicular torsion. b. sperm granulomas. c. microlithiasis. d. varicoceles.

ANS: B Sperm granulomas are most frequently observed in patients with a history of a vasectomy.

A linear stripe of variable thickness and echogenicity running through the testis in a craniocaudal direction represents the: a. Cowper's fascia. b. mediastinum testis. c. epithelial layer. d. dartos muscle.

ANS: B The mediastinum testis appears as a bright hyperechoic line that courses craniocaudal within the testis.

Which one of the following statements about varicoceles is false? a. Varicoceles refer to dilated, serpiginous, and elongated veins of the pampiniform plexus. b. Varicoceles are more common on the right side of the scrotum. c. Primary varicoceles result from incompetent valves in the spermatic vein. d. Secondary varicoceles develop from compression of the spermatic vein.

ANS: B Varicoceles are more commonly found on the left side of the scrotum due to venous drainage into the left renal vein.

A hydrocele develops between the: a. visceral and parietal layers of the tunica albuginea. b. tunica albuginea and tunica vaginalis. c. parietal and visceral layers of the tunica vaginalis. d. scrotum and tunica albuginea.

ANS: C A hydrocele develops between the visceral and parietal layers of the tunica vaginalis.

Epididymo-orchitis most commonly results from a: a. trauma. b. virus. c. bladder infection. d. sexually transmitted disease.

ANS: C Epididymo-orchitis most commonly results from the spread of a lower urinary tract infection via the spermatic cord. Less common causes include mumps, syphilis, tuberculosis, viruses, trauma, and chemical causes.

The most common cause of acute scrotal pain in the adolescent is: a. a varicocele. b. epididymitis. c. testicular torsion. d. an inguinal hernia.

ANS: C Testicular torsion is the most common cause of acute scrotal pain in the adolescent.

The primary source of blood flow to the testicles is via the _____________ arteries. a. renal b. internal iliac c. testicular d. centripetal

ANS: C The testicular arteries are the primary source of blood flow to the testicles.

Sonographic characteristics of the normal testis include a(n): a. inhomogeneous pattern with dense internal echoes. b. homogeneous pattern with low-level internal echoes. c. homogeneous pattern with medium-level echoes. d. inhomogeneous pattern with medium-level echoes.

ANS: C The testis appears as a smooth, homogeneous, medium-gray structure with a fine echo texture.

Tubular ectasia of the rete testis is associated with a(n): a. hydrocele. b. varicocele. c. epididymal cyst. d. inguinal hernia.

ANS: C Tubular ectasia of the rete testis is associated with the presence of a spermatocele, an epididymal or testicular cyst orother epididymal obstruction on the ipsilateral side.

Microlithiasis of the testis is associated with a(n): a. hydrocele. b. inguinal hernia. c. spermatocele. d. malignant neoplasm.

ANS: D Microlithiasis is associated with malignancy, varicocele, undescended testis, Klinefelter syndrome, infertility, and testicular atrophy.

The testes measure: a. 6 cm long, 3 cm in diameter (anteroposteriorly [AP]), 3 cm wide. b. 5 cm long, 2 cm in diameter (AP), 2 cm wide. c. 2 cm long, 5 cm in diameter (AP), 5 cm wide. d. 4 cm long, 3 cm in diameter (AP), 3 cm wide.

ANS: D The adult testes measure 3 to 5 cm long, 2 to 4 cm in width, and 3 cm in diameter (AP).

The epididymis courses ________________ to the testis. a. anterior and inferior b. anterior and superior c. posterior and inferior d. superior and posterolaterally

ANS: D The epididymis is a 6- to 7-cm tubular structure beginning superiorly and coursing posterolaterally to the testis. It is divided into the head, body, and tail.