A 19-Year-Old Man Comes to the Emergency Department Due to Intense

question 18

Multiple Choice

A 19-year-old man comes to the emergency department due to intense scrotal pain over the past 6 hours.  The pain started shortly after participating in a soccer game; he does not recall any specific trauma.  The patient took ibuprofen at home with minimal relief.  He is sexually active and has been treated twice in the past for Neisseria gonorrhoeae.  Temperature is 36.9 C (98.5 F) , blood pressure is 110/86 mm Hg, and pulse is 92/min.  On examination, there is no inguinal adenopathy.  There is significant discomfort with scrotal examination primarily on the right where a high-riding swollen mass is palpated within the hemiscrotum.  The left testicle is palpated lower in the scrotum.  Which of the following additional physical examination findings is most likely present in this patient?

• A)Absent elevation of the right testicle with stroking of the ipsilateral thigh
• B)Enlargement of the mass when the patient coughs or bears down
• C)Increase in the size of the mass when standing relative to laying
• D)Reduction in pain with manual elevation of the right testicle
• E)Transillumination of the mass when a flashlight is placed behind the scrotum

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