Ch 24 The Scrotum Critical Thinking & Quiz Questions

A 10-year-old boy is referred for scrotal sonography because on clinical examination only one of
his testicles was palpable within the scrotal sac. A homogeneous ovoid mass is identified within
the left inguinal canal. Surgical repair is recommended because this condition is associated with
an increased risk for which of the following?
a. Testicular rupture
b. Testicular torsion
c. Orchitis
d. Cancer

d. Cancer

A 52-year-old man is diagnosed with epididymo-orchitis after a sonographic evaluation. His clinic
signs and symptoms most likely included which of the following?
a. Painless palpable testicular mass
b. Painless scrotal enlargement
c. Painful enlargement of the scrotum
d. Small, hard mass palpable near the testicular surface

c. Painful enlargement of the scrotum

A 25-year-old man has a sudden onset of scrotal pain during a soccer game. During examination
in the emergency department, the right side is still painful. A sonogram reveals slight
enlargement of the right testicle, and on color Doppler examination, no blood flow can be found
in the right testicle. What is the most likely diagnosis?
a. Epididymo-orchitis
b. Varicocele
c. Abscess
d. Testicular torsion

d. Testicular torsion

A 43-year-old man is seen with a mobile painless mass at the upper pole of his right testis.
Sonographic examination reveals a 1.5 cm, round anechoic lesion that demonstrates acoustic
enhancement. No other abnormalities are apparent. This probably represents a:
a. Varicocele
b. Spermatocele
c. Focal epididymitis
d. Teratoma

b. Spermatocele

A 30-year-old man undergoes sonographic examination for a painless mass in the right side. The
sonogram reveals multiple punctate hyperechoic non-shadowing foci and a hypoechoic mass
within the right testis. What is the most likely diagnosis?
a. Seminoma with microlithiasis
b. Orchitis with microlithiasis
c. Leydig cell tumor
d. Varicocele with clotted blood

a. Seminoma with microlithiasis

A 32-year-old man undergoes evaluation for infertility, and his physician orders a sonogram. The
exam shows a collection of vessels measuring 2.0 to 2.5 mm in the left side. What Doppler
findings within this collection of vessels would suggest a primary varicocele?
a. Substantial decrease in flow velocity with and without Valsalva maneuver
b. Further dilation and increase blood flow during Valsalva maneuver
c. Increased resistance and velocity while standing
d. Decreased resistance and tardus parvus waveform

b. Further dilation and increase blood flow during Valsalva maneuver

A 15-year-old boy is seen in the emergency department after falling and straddling a bicycle
cross-bar. He has pain and swelling of the scrotum. The sonogram demonstrates heterogeneity
of the right testicle and hypervascularity on color Doppler exam. An area of echogenic material
is seen just outside the upper margin of the right testicle. What is the most likely diagnosis?
a. Testicular torsion
b. Scrotal hernia
c. Testicular rupture
d. Complicated hydrocele

c. Testicular rupture

A 28-year-old man undergoes clinical evaluation for a palpable mass in the left testicle. A
sonogram reveals a solid, mostly hypoechoic mass including a shadowing calcification within the
left testicle. A small amount of fluid also surrounds the left testicle. These findings are most
suggestive of:
a. Scrotal hernia
b. Epididymitis
c. Embryonal cell carcinoma
d. Epididymal cyst
e. Teratoma

c. Embryonal cell carcinoma

A 61-year-old man is seen with intermittent pain and swelling of the right scrotum, radiating to
the right inguinal canal. A sonogram is ordered because a scrotal hernia is suspected. Which of
the following sonographic findings is suggestive of a scrotal hernia?
a. Inguinal mass
b. Hypoechoic areas within the testicles
c. Increase peritesticular vascularity
d. Tubular structures that demonstrate peristalsis within the scrotum

d. Tubular structures that demonstrate peristalsis within the scrotum

A 30-year-old man with gynecomastia, elevated hCG, and no palpable scrotal mass present for a
sonogram. The most significant sonographic findings include a 1.5 cm heterogeneous mass
within the right testicle. After orchiectomy, the prognosis remains poor because this type of
cancer does not respond well to radiation and chemotherapy. The clinic and sonographic
findings suggest which type of cancer?
a. Choriocarcinoma
b. Seminoma
c. Embryonal cell tumor
d. Lymphoma

a. Choriocarcinoma

Microlithiasis of the testis is associated with a(n):

malignant neoplasm

Intratesticular cysts have an association with:

spermatoceles

Which one of the following statements about varicoceles is FALSE?

a. Primary varicoceles result from incompetent valves in the spermatic vein.

b. Varicoceles are more common on the right side of the scrotum

c. Secondary varicoceles develop from compression of the spermatic vein

d. Varicoceles refer to dilated, serpiginous, and elongated veins of the pampiniform plexus

b. Varicoceles are more common on the right side of the scrotum

Sonographic characteristics of the normal testis include a(n):

homogenous pattern with medium-level echoes

The diameter of a varicocele measures more than ____ mm.

2

Compared with the testis, the epididymis typically appears:

hypoechoic

A seminoma of the testicle generally appears on ultrasound as a(n) _____ mass.

hypoechoic