Human Anatomy Quiz: Male Reproductive System

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Questions and Answers

Which structure is responsible for the exocrine function of the testes?

Seminiferous tubules (correct)

Tunica vaginalis

Mediastinum testis

Tunica albuginea

What is the approximate size of an adult testis?

3-5 x 2-4 x 3 cm (correct)

10-12 x 8-10 x 9 cm

6-8 x 5-7 x 6 cm

1-2 x 1-3 x 1 cm

What is the name of the structure formed by the convergence of seminiferous tubules at the apex of each lobule?

Ductus epididymis

Tunica dartos

Efferent ductules

Rete testis (correct)

In which part of the epididymis do the efferent ductules from the rete testis converge?

Head Signup and view all the answers

Which part of the epididymis is described as being positioned posterior to the lower pole of the testis?

Tail Signup and view all the answers

The tunica albuginea extends posteriorly into the testicle to help form which structure?

Mediastinum testis Signup and view all the answers

What is the sonographic appearance of the normal mediastinum testis?

Bright hyperechoic line Signup and view all the answers

Which layer of the tunica vaginalis surrounds the testis and epididymis?

Visceral layer Signup and view all the answers

What is the small bare area of the testicle where it is against the scrotal wall designed to prevent?

Torsion Signup and view all the answers

Where do hydroceles typically form in relation to the tunica vaginalis?

Between the layers of the tunica vaginalis Signup and view all the answers

Which structure is a continuation of the ductus epididymis?

Vas deferens Signup and view all the answers

What structure does the vas deferens join to form the ejaculatory duct?

Duct of seminal vesicles Signup and view all the answers

The spermatic cord suspends the testis within the scrotum and travels through which anatomical structure?

Inguinal canal Signup and view all the answers

Which of the following does NOT travel within the spermatic cord?

External iliac artery Signup and view all the answers

The cremasteric artery arises from which artery?

Inferior epigastric artery Signup and view all the answers

Which artery primarily supplies the epididymis and vas deferens?

Deferential artery Signup and view all the answers

The cremasteric artery provides blood flow to which structure?

Cremaster muscle and peritesticular tissue Signup and view all the answers

Which of these arterial branches has anastomoses with the testicular artery within the spermatic cord?

Cremasteric and deferential arteries Signup and view all the answers

The pampiniform plexus is a network of veins responsible for the venous drainage of which structure?

Scrotum Signup and view all the answers

Which vein does NOT contribute to the drainage of the scrotum?

Femoral Vein Signup and view all the answers

The right testicular vein drains directly into the:

Inferior Vena Cava Signup and view all the answers

During sonography of the scrotum, what is the typical recommended position of the patient?

Supine position with the legs close together Signup and view all the answers

Which of the following is the best frequency range to use for sonographic examination of the scrotum?

10 to 14 MHz Signup and view all the answers

In scrotal sonography, why should the asymptomatic side be used as a comparison?

To establish a baseline and notice any abnormal variations Signup and view all the answers

When assessing the testicular parenchyma, it should ideally appear:

Uniform, with equal echogenicity between sides Signup and view all the answers

During a scrotal ultrasound, a patient says they have a palpable mass. Where should the ultrasound probe be placed?

Directly over the palpable mass Signup and view all the answers

What measurements should be included in the sagittal view of the testis?

Longitudinal and AP measurements Signup and view all the answers

What is the primary purpose of using color and power Doppler in a testicular ultrasound?

To document arterial and venous flow Signup and view all the answers

What is the suggested approach when a varicocele is suspected during a testicular ultrasound?

Perform a Valsalva maneuver Signup and view all the answers

In cases of suspected testicular torsion, what adjustment to the color Doppler settings is recommended?

Sensitize color Doppler for slow flow Signup and view all the answers

Where do the testes initially develop during embryonic growth?

Near the kidneys in the retroperitoneum Signup and view all the answers

What is the typical location of an undescended testicle in cryptorchidism?

The inguinal canal Signup and view all the answers

What is a sonographic characteristic of an undescended testicle compared to a normal testicle?

Smaller and less echogenic Signup and view all the answers

How should the epididymal head be imaged?

With both color Doppler and in association with the superior pole of the testis Signup and view all the answers

What is the typical salvage rate for a testicle when surgery is performed between 6-12 hours after the onset of pain?

70% Signup and view all the answers

Which of the following is a typical clinical sign or symptom associated with testicular torsion?

Malposition of the testicle. Signup and view all the answers

What is the most common cause of acute scrotal pain in prepubertal boys?

Torsion of a testicular appendage Signup and view all the answers

What sonographic appearance is NOT typically associated with testicular torsion?

Increased intratesticular blood flow Signup and view all the answers

A collection of pus in the potential space between the visceral and parietal layers of the tunica vaginalis is best described as what?

Pyocele Signup and view all the answers

What is the most common location for an ectopic testicle to reside?

Superficial inguinal pouch Signup and view all the answers

Which of the following is a condition where a testicle is absent unilaterally?

Anorchia Signup and view all the answers

What is a common cause of unilateral anorchia?

Intrauterine testicular torsion Signup and view all the answers

Polyorchidism is characterized by which of the following?

Presence of more than two testicles Signup and view all the answers

Which of these conditions is most associated with testicular duplication?

Cryptorchidism Signup and view all the answers

What is the primary cause of testicular torsion?

Twisting of the spermatic cord Signup and view all the answers

Why is a 360-degree torsion considered more severe than less severe cases of torsion?

It obstructs both arterial and venous flow. Signup and view all the answers

What is the most significant reason why testicular torsion is considered a surgical emergency?

To restore blood flow to the testicle Signup and view all the answers

Study Notes

Scrotum Anatomy

The scrotum is a sac that houses the testicles.
It regulates temperature for optimal sperm production.
Two halves separated externally by median raphe.
Internally separated by tunica dartos.

Testicle Anatomy

Symmetric, oval-shaped glands.
Produce testosterone (endocrine function).
Produce sperm (spermatogenesis, exocrine function).
Adult testicle measures approximately 3-5 cm x 2-4 cm x 3 cm.
Divided into over 250-400 conical lobules containing seminiferous tubules.
Tubules converge to form rete testis in mediastinum.
Rete testis drains into the head of epididymis through efferent ductules.

Spermatogenesis Pathway

Sperm pathway: seminiferous tubules, tubuli recti, rete testis, efferent ductules, ductus epididymis, vas deferens.

Epididymis

Tubular structure (6-7 cm) that begins superiorly and courses posterolaterally to the testicle.
Contains 10-15 efferent ductules that converge to form a single duct in the body and tail.
Divided into head, body, and tail.
The head is the largest part, superior to the testicle's upper pole, and 10-12 mm wide.
The body is smaller than the head, following the testicle's posterolateral aspect from upper to lower pole.
The tail is slightly larger and positioned posterior to the lower pole of the testicle.
Normal epididymis appears isoechoic or hypoechoic to the testicle, with a coarser echo texture.

Mediastinum Testis

Dense, fibrous tissue covering each testicle.
The tunica albuginea extends posteriorly to form the mediastinum.
Helps form the mediastinum testis which contains multiple septa.
Separates the testis into lobules.
Supports vessels and ducts within the testis.
Appears as a bright hyperechoic line on sonography.

Tunica Vaginalis

Lines the inner walls of the scrotum.
Covers the testes and epididymis.
Consists of two layers: parietal (inner lining of scrotal wall) and visceral (surrounds testes and epididymis).
A potential space between these layers.

Scrotum Imaging

Supine patient position with penis on abdomen, covered with towel, legs close together.
Use rolled towel between legs to support scrotum.
Apply warmed gel.
Use high-frequency probes (10-14 MHz).
Bilateral examination, comparing symptomatic and asymptomatic sides.
Image in sagittal and transverse views.
Evaluate size, echogenicity, and structure.
Observe for uniform testicular parenchyma and equal echogenicity between sides.

Patient History

Palpable mass, scrotal pain, swollen scrotum, or other reason?
Pain description, location, duration?
Any injury or trauma? When did it occur?
Any prior surgical procedures? When?

Clinical Questions

Is the testicular parenchyma homogeneous or heterogeneous?
Is there a mass (cystic or solid)?
Is the mass intratesticular or extratesticular?
Is one testicle larger than the other, or is one side swollen or shrunken?
Is the epididymis normal or thickened?
Assess flow (absence or hyperemia) using color Doppler.
Compare flow between testicle sides with Doppler.

Scanning Protocol (Sagittal)

Long axis of the testicle measured with the long and AP measurements.
Color and PW Doppler for venous and arterial flow documented.
Lateral to medial sweeps across the epididymal head and superior testis.

Scanning Protocol (Transverse)

Mid-testicle measurements taken from superior to inferior.
Transverse views including both testes and epididymal heads.
Color Doppler of the epididymal head utilized.

Sonography Tips

Explain procedures and preparation to the patient.
Have patient get ready privately.
Image both testes together for comparison (gray scale and color Doppler).
Perform Valsalva maneuver where possible (varicocele suspected).
Color Doppler sensitivity adjustment for slow blood flow for potential torsion evaluation.

Cryptorchidism

Undescended testes.
Present often in the inguinal canal at birth, but may be found near the kidneys in the retroperitoneum.
Can be unilateral (one side) or bilateral (both sides).
Undescended testes often smaller and hypoechoic than normal testes, and with more variable texture.

Testicular Ectopia

Very rare condition where the testicle is in an abnormal (ectopic) location.
It cannot be moved into proper scrotal location.
Most common site is superficial inguinal pouch, but may also be in the perineum, femoral canal, suprapubic area, penis, diaphragm, or other scrotal compartments.

Anorchia

Unilateral or total absence of a testicle (monorchidism/anorchia).
Usually 4% prevalence, more common on the left side.
Definitive diagnosis depends on surgical exploration.
Causes include intrauterine testicular torsion, other forms of decreased vascular supply to the testicle in utero.

Polyorchidism

Very rare disorder; bilateral cases are 5% of total cases.
More common on the left side(75% cases).
Associated with Cryptorchidism, malignancy, inguinal hernia, torsion, or supernumerary (extra) small testicle.

Scrotal Pathology

Torsion, appendage torsion, fluid collections (hydrocele, pyocele, hematocele).
Inflammation (epididymitis, orchitis, epididymo-orchitis).
Microlithiasis.
Mass formation.

Torsion

Interruption of testicular blood supply due to twisting of the spermatic cord.
Typically occurs in adolescence (12-18 years).
Common cause is Bell clapper deformity (tunica vaginalis completely surrounds the testicle and distal spermatic cord, allowing movement/rotation).
Venous flow affected initially (swelling on one side), then arterial flow affected causing ischemia and pain.
360° torsion affects all vessels.
Surgical emergency. 80-100% success of salvage with intervention within 6 hours. Between 6 and 12 hours success rate drops to 70%. After 12 hours, only 20% of cases will be salvagable. After 24 hours, testicular salvage is typically impossible.

Sonographic Appearances of Torsion

Enlarged spermatic cord, epididymis, and testicle.
Absent or decreased intratesticular flow.
Heterogeneous, hypoechoic testicle.
Hydrocele (+).
Thickened scrotal wall (+).

Appendages

Small remnants of embryonic tissues originating from testis or epididymis.
Typically a benign finding but can become torsed (twisted).
Torsion may cause acute scrotal pain, especially in prepubertal boys.
"Blue-dot" sign (seen on ultrasound)

Fluid Collections

Potential space between visceral and parietal layers of tunica vaginalis.
Fluid collections include hydrocele (serous), pyocele (pus), and hematocele (blood).

Hydrocele

Collection of serous fluid in the scrotal space.
Most common cause of painless scrotal swelling.
Can be idiopathic (no known cause), but often associated with epididymo-orchitis or torsion.

Pyocele

Collection of pus in the scrotal space.
Occurs with untreated infection or when an abscess ruptures into the scrotal space.

Hematocele

Collection of blood in the scrotal space.
Secondary to trauma.
Sonographic appearance varies with the age of injury (mostly highly visible and mobile echoes initially).

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Description

Test your knowledge on the male reproductive system with this quiz focusing on the testes, epididymis, and associated structures. From the exocrine functions to the formation of the ejaculatory duct, this quiz covers essential concepts in human anatomy.