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Acute severe testicular pain

Clinical Discipline(s)/Organ System(s)
Genitourinary System, Urology, General Surgery, Anatomical Pathology, Infectious Diseases
Progress Test Topic(s)
A 16 year old NZ European boy presents with severe pain in his left testis associated with some swelling. It started an hour ago and is excruciating. He has otherwise been well in the past.
Progress Test-Type Questions:   Question 1 | Question 2 | Question 3 | Question 4
Applied Science for Medicine 
   - Structure, function and common pathologies of the scrotal contents and male urethra
   - Blood supply and lymphatic drainage of the testes and scrotum
   - Pathophysiology and microbiology of inflammatory conditions of the male urogenital tract, including epididymo-orchitis
   - Histopathology of testicular tumours and their metastases
Clinical and Communication Skills 
   - Elicit a history from a patient with testicular pain and swelling
   - Interviewing adolescents by themselves and communicating with adolescent and caregivers together
   - Perform an abdominal and genital examination (including the cremasteric reflex)
   - Recognise the characteristic signs of testicular torsion
   - Recognise a testicular lump suggestive of cancer
   - Differential diagnoses and complications of scrotal problems: pain-predominant vs swelling-predominant
   - Indications for ultrasound
   - Interpret midstream urine
   - Management of acute testicular torsion and most common causes of epididymo-orchitis
   - Outline the management of testicular cancer: staging, role of chemotherapy, tumour markers, prognosis
Personal and Professional Skills 
   - Intimate examination and use of chaperone
   - Demonstrate sensitive communication for embarrassing symptoms
   - Communicate effectively with youth on sensitive topic of sexual health
   - Reflect on own embarrassment when performing sensitive examinations
   - Reflect on one's own sexual health
Population Health 
   - Epidemiology of mumps: likelihood of testicular involvement (age, gender, prevalence)
   - Epidemiology of testicular torsion, epididymitis and cancer (age, gender, prevalence, likelihood of presentation)
   - Prevention of mumps (MMR vaccination)
   - Prevention of sexually transmitted infections (safer sex)
Conditions to be considered relating to this scenario
testicular torsion, inguinal hernia, sexually transmitted infections, renal calculi, urinary tract infection, testicular trauma, torsion of testicular appendage, varicocele, hydrocoele, epididymitis
Less common but 'important not to miss'
testicular seminoma, testicular teratoma
orchitis (especially mumps)