Testicular torsion (pediatrics) Quiz: Ace Your Exams

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A 17-year-old boy is brought to the emergency department with sudden onset severe right testicular pain that started one hour ago. He reports associated nausea and vomiting that started after the pain began. He was at soccer practice earlier that day, which he states was particularly strenuous. He is currently sexually active with two partners and uses protection inconsistently. He denies dysuria and penile discharge. Temperature is 37ºC (98.6°F), heart rate is 106/min, blood pressure is 135/90 mmHg, and respiratory rate is 20/min. The patient appears to be in distress due to pain. Urinalysis is negative. Which of the following physical examination findings would be expected given the likely underlying condition?

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Absent left-sided cremasteric reflex

Positive right-sided cremasteric reflex

Pain relief with elevation of the right scrotum

Marked diffuse swelling and tenderness of the right scrotum

Purulent urethral discharge