Study guide for breast/scrotal

Question 1

1. Three layers of the breast

Answer 1

mammary layer, retromammary layer, subcutaneous layer

Question 2

2. Functional portion of the breast consists of how many lobes

Answer 2

15 - 20

Question 3

3. What is the fibrosis skeletal muscle that maintains the breast

Answer 3

Coopers Ligament

Question 4

4. As a women ages glandular breast tissue is replaced with what

Answer 4

Fat (JL PG 553)

Question 5

5. Describe cooper ligaments what it looks like under US

Answer 5

Echogenic (JL p 552)

Question 6

6. Describe songoragphic of the retromamorary layer

Answer 6

thin and consist of fat surrounded by connective tissue septa

the fatty tissue appears hypoechoic and the ducts, glands, and supporting ligaments appear echogenic

(MW pg. 550)

Question 7

7. What are the most important signs that a lesion is cystic

Answer 7

smooth walls, anechoic, posterior enhancement good through transmission

(MW breast slide #6)

Question 8

8. If a patient has clinically findings of lumpy bumpy painful breasts with their monthly cycles

Answer 8

Fibrocystic condition (EG pg 574)

Question 9

9. What are the characteristics of a papilloma

Answer 9

• Bloody discharge from single duct
• Tiny papilloma may not be detected
• May cause dilatation of a single duct
• arise from lining of breast ducts, retroareolar area most common
• Intracystic papillomas- soft tissue mass growing into lumen of cystic lesion
• May cause skin dimpling and retraction

(MW breast slide #11)

Question 10

10. What is the most common solid benign tumor of the breast

Answer 10

fibroadenoma

Question 11

11. What is the sonographic characteristics of fibroadenoma?

Answer 11

Smooth, rounded margins
low level homogeneous internal echoes
posterior enhancement
typically hypoechoic but can be hyperechoic because of the fat within the breast 
(JL pg 5765)

Question 12

12. Lymphatic drainage usually flows to what lymph nodes

Answer 12

Axillary (JL pg 554)

Question 13

13. Most common malignant neoplasm Breast

Answer 13

Invasive Ductal Carcinoma (JL pg 578)

Question 14

14. Describe findings of the breast carcinoma

Answer 14

attenuation of sound
irregular borders
inhomogenous low level internal echo patterns with calcification

Question 15

15. Skin rippling what does that suggest

Answer 15

retraction of the tissue secondary to tumor infiltration

Question 16

17. Primary purpose of breast screening

Answer 16

provides early detection of breast carcinoma

Question 17

18. Know the clock face

Answer 17

Mid portion of rt medial and Lt lateral breast is annotated 3:00

Question 18

16. Most common of clinical signs of breast cancer is what

Answer 18

Palpable lump

Question 19

19. Normal extension of breast tissue into the axillary region

Answer 19

tail of spence

Question 20

20. According of ACS should began mamo screening at what age

Answer 20

40

Question 21

21. Which one of the following of the arteries responsible to supply more then half of the breast

Answer 21

anterior perforating branches of the internal mammary gland (JL pg 553) (internal mammary supplies have the blood supply to the breast)

Question 22

22. A condition when a male has breast?

Answer 22

gynecomastia (MW pg 556 and google)

Question 23

23. Appearance of breast cancer under US

Answer 23

Irregular margins and taller than wide

Question 24

24. US is often a benefit for procedures except what

Answer 24

large core needle biopsy of calcification

Question 25

25. Be able to answer/ ultrasound is exam of choice if your pregnant or at an younger age and have a family history/ not a mamogram

Answer 25

??

Question 26

26. Know other modalities that are used besides US for the breast and why would we use one of the other

Answer 26

Ultrasound of the breast is often performed as an adjunctive imaging tool in all of the following situations a. To assess a smooth mammographic mass as cystic or solid b. To further evaluate a palpable breast lump in a patient with very dense breast tissue and a negative mammogram c. To further evaluate a palpable breast lump in a patient with breast implants

Question 27

27. If you see a smooth mass on a mammogram and they want correlating images on US what do you think you’re going to see

Answer 27

Anechoic cyst with posterior acoustic enhancement

Question 28

28. What are advantages of breast US over mammography

Answer 28

Differentiation of cystic versus solid smooth masses More comfortable examination for the patient Better visualization of juxtathoracic deep tissues Can better evaluate those hard-to-reach places, such as parasternal tissues and axilla, not well seen on mammography.

Question 29

29. What is the diameter of a varicocele

Answer 29

> 2mm (MW pg 619)

Question 30

30. What is the fibrous capsule surrounding the testicle

Answer 30

tunica albuginea | MW pg 606

Question 31

31. Normal measurements

Answer 31

Testis 3-5 cm in length 2-4 cm in width 3 cm in height epididymis 6-7 cm (MW pg 604)

Question 32

32. Sonographic characteristics of a testicle

Answer 32

smooth, medium gray structures with fine echo texture (MW pg 605) Homogeneous pattern with medium level echos

Question 33

33. What is the linear strip that is echogenic that runs through the testies

Answer 33

MEDIASTINUM TESTIS | MW slide 10

Question 34

34. Normal location of the epidymsis

Answer 34

beginning superiorly and then coursing posterolateral to the testis (MW)

Question 35

35. What are the facts about undescended testies

Answer 35

- AKA cryptorchidism if bilateral in 10% to 25% of cases - testis has not descended into the scrotum and cannot be brought into the scrotum w/ external manipulation - may be located in the ABD, inguinal canal (80%), or other ectopic location - usually in premature babies cause balls descend in late pregnancy - 40% to 50% association with cancer - orchiopexy is surgical treatment - if orchiopexy is not performed more likely to cause: spermatogensis and result in infertility, testicular cancer because they are not easily palpated so the lump may not be detected soon enough, testicular torsion (MW pg 628)

Question 36

36. The most common of acute scrotal pain at an young age

Answer 36

Torsion (EG pg 617)

Question 37

37. Some common causes for hydro seals

Answer 37

- idiopathic but associated with epididymo-orchitis and torsion - may also be found in patients following trauma or development of a neoplasm (MW pg 621)

Question 38

38. Make sure you know about varicoceles

Answer 38

- tortuous dilated veins - increased size w/ valsalva maneuver or patient standing - dilated veins fill w/ color on valsalva - spectral doppler confirms venous flow - an abnormal dilatatation of the veins of the pampiniform plexus - usually caused by incompetent venous valves in the spermatic vein called primary varicoceles, more common in the left (MW, lots more info on pg 619)

Question 39

39. Know what part of the epydimisis the spermato seal is located

Answer 39

in the head (MW pg 614)

Question 40

40. Common cause for scrotal pain in adults

Answer 40

EPIDIDYMITIS | MW slide 38

Question 41

41. Almost always transpires with epdymsis The question I have is.....transpires 2nd to epididamitis (MW)

Answer 41

Orchitis (pg 615)

Question 42

42. Tuburlar ectastia

Answer 42

uncommon, benign condition associated with presence of spermatocele, epididymal or testicular cyst, or other epididymal obstruction on the same side of the dilated tubules more commonly seen in patients 45 or older appears as prominent hypoechic channels near the echogenic mediastinum testis (MW pg 624)

Question 43

43. What is seminoma what does it look like under US

Answer 43

hypoechoic lesion smooth well defined borders (MW pg 626)

Question 44

44. Epdydimal orchiatisis is most commonly results from what/ trauma bladder infection or STDs

Answer 44

most commonly results from the spread of a lower urinary tract infection via the spermatic cord less common: mumps, syphilis, tuberculosis, viruses, trauma, chemical causes (MW pg 615)

Question 45

45. Clinical history of vasectomy is associated with what

Answer 45

Sperm granuloma

Question 46

46. Primary blood supply to the testicals

Answer 46

``` testicular artery (primary source, arise from AO just below the renal arteries pg 606) capsular artery centripetal artery recurrent rami (MW ph 607) ```

Question 47

47. Intra testicular cyst have association with what

Answer 47

extratesticular spermatoceles (MW pg 624)

Question 48

48. Microthiliaiss is associated with what

Answer 48

testicular malignancy (MW pg 625)

Question 49

49. Follow up examination for patients with microlithiasis is

Answer 49

annual (MW pg 625)

Question 50

50. Attached at the superior pole of the testie between the epydimsis and testie is what structure/ we have an organ that is named this as well (APPENDIX)

Answer 50

appendix testis (MW pg 605)

Question 51

51. Hydro seal develops between what layers of the scrotum

Answer 51

Visceral and Parietal layers of the tunica vaginalis | MW pg 620

Question 52

52. What is the location of rete testies

Answer 52

hilum of the balls where the mediastinum resides | MW pg 623

Question 53

53. Be able describe the echogenicity difference between testies and epydymisis

Answer 53

balls- smooth, medium gray structures with fine echo texture epididymis- isoechoic or hypoechoic compared to the balls and the echo texture is coarser (MW pg 605)