Question 1

A young adult male reports a dull pain in the right scrotum and the provider notes a bluish color showing through the skin on the affected side. Palpation reveals a bag of worms on the proximal spermatic cord. What is an important next step in managing this patient?

A) Anti-infective therapy with ceftriaxone or doxycycline
B) Consideration of underlying causes of this finding
C) Reassurance that this is benign and may resolve spontaneously
D) Referral to an emergency department for surgical consultation

B

Accepted Answer

The description of a "bag of worms" on the proximal spermatic cord and a dull pain in the scrotum with a bluish color showing through the skin is indicative of a varicocele. It is important to consider underlying causes of this finding, such as renal tumors that may increase renal vein pressure and subsequently lead to varicocele formation, especially if the varicocele is sudden in onset, on the right side (most are left-sided due to anatomical reasons), or if the patient is older than the typical age range for varicocele occurrence.

Question 2

An adolescent male reports severe pain in one testicle. The examiner notes edema and erythema of the scrotum on that side with a swollen, tender spermatic cord and absence of the cremasteric reflex. What is the most important intervention?

A) Doppler ultrasound to assess testicular blood flow
B) Immediate referral to the emergency department
C) Prescribing anti-infective agents to treat the infection
D) Transillumination to assess for a "blue dot" sign

B

Accepted Answer

The presentation is consistent with testicular torsion, a medical emergency that requires immediate surgical intervention to prevent testicular ischemia and necrosis. Referral to the emergency department is crucial for prompt diagnosis and treatment. Doppler ultrasound may be used for confirmation of the diagnosis, but it is not the most important intervention. Anti-infective agents are not indicated unless there is evidence of infection, which is not the case here. Transillumination is not a reliable technique for diagnosing testicular torsion.

Question 3

A 3-month-old male infant has edema and painless swelling of the scrotum. On physical examination, the provider can transilluminate the scrotum. What will the provider recommend?&#10;A) A Doppler ultrasound to evaluate the scrotal structures&#10;B) A short course of empirical antibiotic therapy&#10;C) Immediate referral to a genitourinary surgeon for repair&#10;D) Observation and reassurance that spontaneous resolution may occur

Accepted Answer

The infant has likely developed a hydrocele, which is a collection of fluid around the testicle that can cause scrotal swelling. In infants, hydroceles often resolve on their own without any intervention. The transillumination of the scrotum helps to confirm the diagnosis of hydrocele. A Doppler ultrasound or referral to a surgeon would not be necessary at this time. Empirical antibiotics would not be effective as this is not an infection. Observation and reassurance are the appropriate course of action.

Deck 133: Testicular Disorders