A 43-Year-Old Man Seeks Care for a Painful Testicle

question 862

Multiple Choice

A 43-year-old man seeks care for a painful testicle.  The discomfort started 2-3 days ago and has progressed to sharp left testicular pain every time he steps down with his left foot.  He has no fever, chills, or dysuria.  He has been in a stable monogamous relationship for 20 years and denies anal sexual intercourse.  He has not had this problem previously.  There is no history of trauma to the area.  He considers himself in good health and takes no medications.
His temperature is 37.4 C (99.4 F) , blood pressure is 130/80 mm Hg, and pulse is 84/min.  Cremasteric reflexes are normal bilaterally.  He has no skin lesions involving the genitalia and no palpable inguinal lymph nodes.  The scrotum is warm, and the left testicle feels slightly swollen with severe tenderness to palpation, especially over its posterior aspect.  There are no inguinal hernias.  There is no urethral discharge.
A urinalysis is normal.
Which of the following is the most likely diagnosis?

• A)Epididymitis
• B)Germ cell tumor
• C)Testicular torsion
• D)Varicocele
• E)Viral orchitis

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