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Calvin Moss Ihuman, 13-year-old Caucasian male, CC: Testicular Pain

HEAL100 Health Care — exam and revision material · Other

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Health Care exam material, 5 pages. Originally published on StudyMerit.

Pages
5
Academic year
2025/2026
Language
English

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Calvin Moss 13Y0 55" 120 Ibs. (54.5 kg) Reason for encounter: Testicular pain Denies being sexually active, denies dysuria. Denies any fever. Vomited on the way to clinic once. Still nauseous. Denies any numbness or tingling. Patient is circumcised. Ask: urine characteristics, color odor, frequency, family hx GU renal, hx uti, sexual abuse? GU hygiene? Hx of undescended testes in family? Do you strain (hernia-more on right)? Premature? Weight lift? HPI (OLDCARTS) Calvin is a 13-year-old Caucasian male who presents to the clinic with acute left testicular pain which started suddenly two hours ago while he was playing basketball. Calvin describes the pain as “punching” and constant. The pain radiates to his left groin, not relieved with any intervention, and is worse since it started per the patient. The patient denies taking any medication or supplements to relieve his symptoms. The patient also stated that he is nauseous and has had one episode of vomiting on his way to the clinic. His pain is 9/10. The patient denies any history of hernia, surgeries, dysuria, and denies being sexually active. The patient denies any history of cancer in the family. Objective findings include negative for fever. Left hemiscrotal swelling and mild erythema, high-hanging, exquisitely tender to touch, negative left cremasteric reflex and Prenh'’s sign. The right testicle is within normal limits. Negative for masses on palpation. The patient has mild leukocytosis without left shift. Normal urinalysis. Ultrasound of scrotum showed the absence of blood flow to the left testicle which highly suggests testicular torsion. Primary Dx: Testicular Torsion — Negative cremasteric and phren’s sign. n/V? Trauma? Blue dot sign? Elevated scrotum? Acute Epididymitis + phren’s and cremasteric signs? Orchitis Testicular Appendix Torsion/Torsion of the appendix — this is gradual onset*** Non high riding testes.

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DDx: Orchitis? Trauma (pain is better within the hour) Hernia? Hydrocele? Transillumination? Varicocele? Bag of worms that enlarges with Valsalva? Hernia? Are you straining? Hx in family? Pain down in the “nuts” on the left O-playing basketball and doing lay ups then suddenly developed pain L-left sided nut pain D-two hours C-Really bad as if punched, constant A-constant A-nothing helps R-groin T-none S-9/10 scale worsening 1. Therapeutic & Non-Therapeutic Modalities Evaluating the patient for testicular torsion is critical and time sensitive to prevent complications. The patient will have to be transferred to the hospital urgently by calling 911 for ambulance transfer. It is important not to let the patient or the parent travel by themselves to the hospital. It is also important to advise the patient with the parent to maintain a NPO status in anticipation of the surgery if found necessary in the emergency department. While waiting on ambulance, a call must be made to the nearest hospital and should request to speak with the triage nurse directly to give a report about the patient’s symptoms, history and physical findings, and possible testicular torsion. An emergent ultrasound of the scrotum should be anticipated as soon as patient arrives in the emergency department and to alert the on call surgical team for a possible testicular surgical exploration or orchiopexy. Furthermore, a complete blood count, clotting factors, and urinalysis may be ordered in the emergency center to prepare for surgery and identify the presence of an infection. Therapeutic modalities in the hospital might include analgesics, antianxiety medications, and anti-nausea medications.

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