An 18-Year-Old Man Comes to the Office Due to 3

question 498

Multiple Choice

An 18-year-old man comes to the office due to 3 days of progressive left testicular pain.  The pain began gradually and is dull and achy.  The patient has had no trauma to that area and has never had similar symptoms.  He has no fever, chills, urinary frequency, dysuria, urethral discharge, or penile ulcerations.  The patient is sexually active.  Vital signs are normal.  The left testicle is lower in the scrotum than the right.  The area posterior to the left testis is swollen and very tender.  The pain improves with elevation of the testis, and the cremasteric reflex is normal.  Urinalysis shows 4-5 white blood cells/hpf.  Which of the following is the best next step in management of this patient?

• A)Analgesics and observation
• B)Antibiotic therapy
• C)Emergency orchiectomy
• D)Incision and drainage of scrotal mass
• E)Renal and bladder ultrasound

---

Definitions:

Perception of Pain

The subjective interpretation and experience of pain, which can be influenced by physical, emotional, and cognitive factors.

Descending Neural Pathway

Neural pathways that carry signals from the brain down the spinal cord to control movements or functions in the body.

Midbrain

An area of the brainstem that plays a role in vision, hearing, motor control, sleep/wake, arousal (alertness), and temperature regulation.

Medulla

The inner region of an organ or tissue, especially the medulla oblongata which is part of the brainstem controlling vital autonomic functions, such as heartbeat and breathing.