questions 3

Testicular Torsion

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Topic updated on 06/14/15 2:30pm

Introduction
  • Twisting of the testicle on its vasular stalk resulting in ischemia 
  • Usually peripubertal patient
  • Urological emergency
Presentation
  • Symptoms
    • acute onset of testicular pain and edema
    • nausea and vomiting
  • Physical exam
    • tender swollen testicles with transverse lie 
    • abscent cremasteric reflex on affected side 
Evaluation
  • Doppler ultrasound to assess testicular artery flow
Treatment
  • Surgical 
    • emergent surgical exploration  
      • decompression with excision of testicle if it infrarcts

 



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Qbank (3 Questions)

TAG
(M3.RL.25) A 15-year-old boy presents to the emergency room with severe lower abdominal pain that awoke him from sleep about 3 hours ago. The pain is sharp and radiates to the left thigh. While in the emergency room, the patient experiences one episode of vomiting. He denies any fever, dysuria or chills. Physical examination reveals normal vitals with blood pressure 100/60 and temperature of 98.6F. Abdominal examination is relatively benign. Scrotal examination reveals an elevated left testis that is diffusely tender. The cremasteric reflex is absent. What is the next step in the management of this patient? Topic Review Topic

1. CT scan of abdomen and pelvis
2. Testicular doppler ultrasound
3. Surgical exploration
4. IV antibiotics
5. KUB x-ray

PREFERRED RESPONSE ▶
TAG
(M2.RL.4) A 16-year-old male presents to the emergency room with a 6-hour history of scrotal pain of sudden onset. The patient’s past medical history is insignificant, though upon questioning he reports sleeping with several women in the prior three month period. On physical examination the testes appear to have a horizontal lie and the scrotum is neither swollen nor discolored. Doppler ultrasonography shows decreased blood flow to the affected testicle. Which of the following is the most likely diagnosis: Topic Review Topic

1. Testicular torsion
2. Epididymitis
3. Seminoma
4. Orchitis
5. Traumatic urethral injury

PREFERRED RESPONSE ▶
TAG
(M2.RL.54) A 25-year-old male comes into the emergency department complaining excruciating testicular pain. The patient states that he was at the park playing basketball with his friends when the pain "hit me like a freight train". He denies any trauma to the groin, fevers, or chills but has been nauseous and had a few episodes of vomiting since the pain started. On physical examination he is noted to have an edematous scrotum with the testes found high in the scrotum. What is the most appropriate course of action to take with this individual? Topic Review Topic

1. Pelvic radiograph
2. Ultrasonography
3. Magnetic resonance imaging
4. Computed tomography scan
5. Emergent surgical exploration

PREFERRED RESPONSE ▶


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