A 15-year-old boy is brought to the emergency department because of severe pain in the right groin, nausea, and vomiting for 3 hours. The pain started shortly after participating in a soccer game; he does not recall any specific trauma. He has never experienced similar symptoms before. 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. Abdominal examination shows no abnormalities. The right scrotum appears mildly swollen. There is severe tenderness on palpation of the scrotum that persists with elevation of the testes. Which of the following additional physical examination findings is most likely present in this patient?

Question

A 15-year-old boy is brought to the emergency department because of severe pain in the right groin, nausea, and vomiting for 3 hours. The pain started shortly after participating in a soccer game; he does not recall any specific trauma.  He has never experienced similar symptoms before.  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.  Abdominal examination shows no abnormalities. The right scrotum appears mildly swollen. There is severe tenderness on palpation of the scrotum that persists with elevation of the testes. Which of the following additional physical examination findings is most likely present in this patient?

Quizplus · Accepted Answer

Eductional Objective: Testicular torsion presents with acute, severe, progressive unilateral scrotal pain.  Classic examination findings include scrotal edema and discoloration, a high-riding testicle, and an absent cremasteric reflex (ie, absence of testicular elevation when stroking the ipsilateral thigh). Twisting of the spermatic cord leads to venous engorgement, with consequent compromise of the testicular artery and irreversible damage if the torsion is not resolved in the first 6-12 hours

A 15-Year-Old Boy Is Brought to the Emergency Department Because