Chapter 23 - Prostate and Scrotum

Apex

inferior portion of the prostate gland, which is located superior to the urogenital diaphragm

Base

superior portion of the prostate gland, which is located below the inferior margin of the urinary bladder

Corpora amylacea

calcifications commonly seen in the inner gland of the prostate

Eiffel Tower sign

is a shadowing artifact created in the area of the urethra and verumontanum

Ejaculatory duct

duct that passes through the central zone and empties into the urethra; originates from the combination of the vas deferens and the seminal vesicle

Endogenous calculi

developing or grown from within; calculi formation within the substance of the prostate

Exogenous calculi

calculi found within the urethra

Seminal vesicles

a pair of tubular glands which extend from out pouching of the vas deferens

Surgical capsule

Demarcation between the inner gland (central and transitional zones) and the outer gland (peripheral zone), which normally appear hypoechoic

Vas deferens

reproductive duct that extends from the epididymis to the ejaculatory duct

Verumontanum

a longitudinal ridge within the prostatic urethral wall where the orifices of the ejaculatory ducts are located on either side

A

Which structure travels within the central zone of the prostate gland and joins the urethra?

A. ejaculatory duct

B. seminal vesicle

C. vas deferens

D. verumontanum

B

Which of the following is not a zone within the glandular tissue of the prostate gland?

A. peripheral zone

B. epithelial zone

C. central zone

D. periurethral zone

A

Which of the glandular zones of the prostate is the largest?

A. peripheral zone

B. periurethral zone

C. central zone

D. transition zone

A

In which zone does prostate cancer and prostatitis most often occur?

A. peripheral zone

B. periurethral zone

C. central zone

D. transition zone

D

Your patient presents for a sonography examination to evaluate for benign prostatic hypertrophy. Which zone is most often affected by benign prostatic hyperplasia (BPH)?

A. peripheral zone

B. periurethral zone

C. central zone

D. transition zone

C

Which blood test is used to identify men at increased risk of prostate cancer?

A. AFP

B. CA-125

C. PSA

D. AST

A

The apex of the prostate is located inferior to the verumontanum and is made up predominantly of which zone

A. peripheral zone

B. periurethral zone

C. central zone

D. transition zone

C

The base of the prostate is located superior to the verumontanum and is made up predominantly of which zone?

A. peripheral zone

B. periurethral zone

C. central zone

D. transition zone

B

Which of the following cysts is associated with genital anomalies such as hypospadias?

A. mullerian duct cyst

B. utricle cyst

C. seminal vesicle cyst

D. prostatic cyst

C

Which of the following cysts will contain spermatozoa?

A. mullerian duct cyst

B. utricle cyst

C. seminal vesicle cyst

D. prostatic cyst

D

A diabetic patient presents with fever, urinary frequency, low back pain, and hematuria. While scanning the prostate the gland, you notice a focal complex area that has increased blood flow. What is the most likely diagnosis given the patient's history?

A. BPH

B. prostate CA

C. prostatic cyst

D. prostatic abscess

A

What is the most common symptomatic condition to affect the prostate gland?

A. BPH

B. prostate CA

C. prostatic cyst

D. prostatitis

D

Your patient states that he has had a transurethral resection or TURP procedure. What condition does this procedure treat?

A. prostate CA

B. prostatic abscess

C. prostatitis

D. BPH

C

Which of the following statements regarding BPH is false?

A. BPH is commonly seen in men over the age of 40 with a peak incidence around 60

B. BPH causes the prostate to appear more rounded than normal

C. BPH affects the central zone of the prostate

D. BPH causes urinary symptoms of frequency, nocturia, and difficulty starting stream

D

What is the sonographic appearance of the prostate gland in patients with benign prostatic hypertrophy?

A. hypoechoic

B. hyperechoic

C. heterogeneous

D. the appearance of BPH could include all of the above

C

Where does corpora amylacea occur most often?

A. superior segment of the prostate

B. inferior segment of the prostate

C. posterior segment of the prostate

D. anterior segment of the prostate

D

Patients with prostate cancer may present with which of the following symptoms?

A. an abnormal PSA level

B. an abnormal DRE

C. bladder outlet obstruction

D. patients may present with all of the above symptoms

C

A definitive diagnosis of prostate cancer can be made by which of the following procedures?

A. DRE

B. TRUS

C. ultrasound-guided biopsy

D. PSA level

A

What is the predictive value of TRUS alone for diagnosing prostate cancer diagnosis?

A. less than 10 percent

B. 25 percent

C. 50 percent

D. 75 percent

C

Which of the following statements regarding ultrasound guided prostate biopsy is true?

A. prostate biopsy is only performed if a discrete lesion can be identified with ultrasound

B. the method of choice is the transperineal approach

C. prostate biopsy is commonly done at known sites of anatomic weakness

D. prostate biopsy is routinely done from a transabdominal approach with a full urinary bladder

transrectal ultrasound

TRUS is an acronym for

malignancy; infertility; chronic pelvic pain syndrome; congenital; biopsy

TRUS of the prostate can be used to evaluate the prostate in cases of ________________,________________,________________ ________________ ________________ ________________, and ________________ abnormalities. It can also be used to guide ________________ and treatment procedures

mesonephric; paramesonephric

The ________________ ducts are responsible for development of the male reproductive system whereas the ________________ form the female reproductive system

funnel; 4 x 3 x 2 cm

The prostate is shapes like a ________________ and measures ________________ on average

base; apex; urethra

The cephalic portion of the gland is the ________________, whereas the caudal portion is the________________. The ________________ travels through the center of the prostate gland

homogenous; isoechoic; surgical capsule; greater

Sonographically, the peripheral zone tissue is ________________ and ________________. The ________________ ________________ separates the peripheral zone from the central zone. The echogenicity of the central zone is ________________ than the peripheral zone

echogenicity; asymmetry; capsule

Sonographic characteristics of prostate disease include changes in ________________, ________________ of the gland, and a distorted ________________

inverted; bottom; top; left; right

When performing an examination of the prostate, the image is typically ________________ with the near field at the ________________ of the image and the far field at the ________________ of the image. In the transverse plane, the right lobe of the gland is at the ________________ side of the image and the left lobe of the gland is on the ________________ side of the image

smooth; disruption

The capsule of the prostate gland should appear ________________ and without

mullerian; utricle

The most common of the pelvic cystic masses are the ________________ duct and cysts

endodermal; hypospadias; undescended; renal

A utricle cyst is ________________ in origin and is typically associated with genital anomalies such as ________________, ________________ testicles, and ________________ anomalies

renal agenesis

The majority of patients with seminal vesicle cyst also have ipsilateral ________________ ________________

transition

The most common cysts are typically the result of BPH and are seen in the ________________ zone of the prostate

endogenous; exogenous; endogenous; prostatic; exogenous; urine

Prostatic calculi are divided into ________________ calculi and ________________ calculi. ________________ calculi are found within the prostate gland and form from ________________ fluid. ________________ calculi are found within the urethra and are derived from ________________

periurethral

________________ calculi can produce what is known as the "Eiffel Tower" appearance

fever; low back; perineal; gram- negative bacteria

Patients with acute bacterial prostatitis present with a ________________, along with ________________ ________________ and ________________ pain. Large numbers of ________________ ________________ will be present within the urine

lower urethra; peripheral

The prostate is infected by organisms ascending from the ________________ ________________ . There is a greater incidence of prostatitis within the ________________ zone

hypoechoic halo; heterogeneous

The most common sonographic finding in patients with a history of prostatitis is a ________________ ________________ in the periurethral area. The peripheral zone may also have a ________________ echo pattern

adenocarcinoma; peripheral, multifocal

The most common type of prostate cancer is ________________ and occurs most commonly in the ________________ zone. Most are ________________, as opposed to solitary lesions

A

The diameter of a varicocele measures more than _____ millimeters (mm).

A) 2

B) 3

C) 4

D) 5

D

The testes measure:

A) 6 cm long, 3 cm in depth (anteroposterioroy [AP]), 3 cm wide

B) 4 cm long, 3 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

C

Sonographic characteristic 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

B

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

C

The most common cause of acute scrotal pain in the adolescent is:

A) a varicocele

B) epididymis

C) testicular torsion

D) an inguinal hernia

B

Which one of the following statements about varicoceles is false?

A) varicoceles refer to dilated, serpiginous, and elongated veins of the pampinform 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

A

Which one of the following almost always transpires secondary to epididymitis?

A) orchitis

B) hydrocele

C) spermatocele

D) varicocele

A

A seminoma of the testicle generally appears on Ultrasound as a(n) ______ mass.

A) hypoechic

B) complex

C) hyperechoic

D) anechoic

B

A clinical history of a vasectomy is associated with:

A) testicular torsion

B) sperm granulomas

C) microlithiasis

D) varicoceles

A

Intratesticular cysts have an association with:

A) spermatocele

B) germ cell tumors

C) hydroceles

D) microlithiasis

B

Follow-up examination of patients with microlithiasis is recommended:

A) semiannually

B) annually

C) every 5 years

D) follow-up is not recommended

C

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

A

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

A

Secondary varicoceles are associated with all of the following except:

a. Left-sided location

b. Right-sided location

c. Hepatomegaly

d. Renal mass

B

The most common location of benign prostatic hypertrophy is the:

a. Peripheral zone

b. Transitional zone

c. Central zone

d. Verumontanum

C

Enlargement of the prostate in older men is most often caused by:

a. Prostatitis

b. Prostate cancer

c. Benign prostatic hypertrophy

d. Klinefelter syndrome

C

Which of the following best describes a spermatocele?

a. The most common malignant neoplasm of the scrotum

b. A benign intratesticular cyst

c. A simple-appearing cyst, found within the head of the epididymis, that may contain debris

d. A dilated group of veins found within the scrotum

A

A dilated group of veins found within the scrotum is defined as a:

a. Varicocele

b. Spermatocele

c. Seminoma

d. Hydrocele

B

Primary varicoceles are associated with all of the following except:

a. left-sided location

b. retroperitoneal mass

c. infertility

d. palpable extratesticular mass

C

A common cyst most often seen in the head of the epididymis that contains nonviable sperm is the:

a. epididymal cyst

b. tunica albuginea cyst

c. spermatocele

d. seminoma

D

What scrotal abnormality is caused by incompetent valves within the pampiniform plexus?

a. testicular carcinoma

b. testicular microlithiasis

c. testicular torsion

d. varicocele

D

The blue dot sign is indicative of:

a. testicular torsion

b. epididymitis

c. orchitis

d. torsion of the testicular appendage

C

A 23-year old man presents to the ultrasound department with a history of infertility. Which of the following is associated with male infertility?

a. spermatocele

b. choriocarcinoma

c. varicocele

d. hydrocele

A

All of the following are sonographic findings consistent with torsion of the testicular appendage except:

a. no intratesticular flow

b. small hyperechoic mass adjacent to the testis

c. reactive hydrocele

d. scrotal wall thickening

A

What is the most common correctable cause of male infertility?

a. varicocele

b. chlamydia

c. hydrocele

d. testicular torsion

B

A simple fluid collection surrounding the testis is referred to as a:

a. hematocele

b. hydrocele

c. varicocele

d. spermatocele

D

The exocrine function of the testicles is to produce:

a. testosterone

b. human chorionic gonadotropin

c. alpha-fetoprotein

d. sperm

C

The most common location of a hydrocele is:

a. superior to the testis

b. within the scrotal wall

c. between the two layers of the tunica vaginalis

d. between the tunica vaginalis and tunica albuginea

D

Acute onset of testicular pain at rest is a common clinical finding with:

a. testicular carcinoma

b. hydrocele

c. testicular trauma

d. testicular torsion

C

A 7-year-old boy presents to the emergency department with acute testicular pain localized to the superior pole of his right testis. What is the most likely diagnosis?

a. testicular torsion

b. hydrocele

c. torsion of the testicular appendage

d. yolk sac tumor

D

Dilated veins of a varicocele will measure:

a. >8mm

b. >4mm

c. <2mm

d. >2mm

C

The lack of the normal fixation of the testis to the posterior scrotal wall is referred to as:

a. Klinefelter syndrome

b. blue dot sign

c. bell-clapper deformity

d. cryptorchidism

A

Which of the following techniques is useful at providing sonographic evidence of a varicocele?

a. Valsalva maneuver

b. sitting position

c. pulsed Doppler

d. right lateral decubitus position

A

The endocrine function of the testicles is to produce:

a. testosterone

b. human chorionic gonadotropin

c. alpha-fetoprotein

d. sperm

A

All of the following are sonographic findings consistent with the diagnosis of testicular torsion except:

a. hyperemic flow within the testis

b. hypoechoic testis

c. reactive hydrocele

d. decreased intratesticular flow (as compared with the asymptomatic testis)

D

Spermatogenesis occurs within the:

a. tunica albuginea

b. rete testis

c. mediastinum testis

d. seminiferous tubules

C

You have been asked to perform a study to rule out cryptorchidism. The term cryptorchidism denotes:

a. one or both of the testicles has a malignancy

b. the patient lacks the normal fixation of the testis to the posterior scrotal wall

c. one or both of the testicles has not descended into the scrotum

d. the patient has been kicked in the scrotum

C

The most common germ cell tumor of the testis is the:

a. yolk sac tumor

b. embryonal cell carcinoma

c. seminoma

d. teratoma

B

The most common location of a varicocele is:

a. the right side of the scrotum

b. the left side of the scrotum

c. the inguinal canal

d. within the testis

A

The most common location of prostatic cancer is the:

a. peripheral zone

b. transitional zone

c. central zone

d. verumontanum

D

What is the most common cancer found in men?

a. testicular cancer

b. lung cancer

c. liver cancer

d. prostate cancer

D

What is the most common sonographic appearance of a seminoma?

a. hyperechoic

b. anechoic

c. heterogeneous with calcifications

d. hypoechoic

A

The testes are covered by a fibrous capsule formed by the:

A) tunica albuginea

B) Cowper's fascia

B) cremaster muscle

D) dartos muscle

B

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

D

The epididymis is located ______ to the testis.

A) anterior and inferior

B) anterior and superior

C) posterior and inferior

D) posterior and superior

B

Common causes of hydrocele include all of the following except:

A) trauma

B) microlithiasis

C) epididymo-orchitis

D) testicular torsion

A

A spermatocele is always located in which portion of the epididymis?

A) head

B) neck

C) body

D) tail

B

A common cause of acute scrotal pain in adults is:

A) an epidermal cyst

B) epididymo-orchitis

C) a spermatocele

D) testicular torsion

C

Tubular ectasia of the rete testis is associated with a(n):

A) hydrocele

B) varicocele

C) epididymal cyst

D) inguinal hernia

C

Epididymo-orchitis most commonly results from a:

A) trauma

B) virus

C) bladder infection

D) sexually transmitted