Testicular torsion (pediatrics) Quiz: Ace Your Exams

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A 16-year-old boy is brought to the emergency department for evaluation of sudden onset severe left testicular pain that started three hours ago while he was asleep. He reports associated nausea and vomiting following the start of the pain. He does not have dysuria. 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 is in distress due to pain. The left testicle is high-riding with a transverse lie. There is marked scrotal erythema and swelling. Cremasteric reflex is absent on the left. Which of the following is the most appropriate next step in management?

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Order Doppler ultrasonography

Obtain emergent urology consultation and perform manual detorsion

Apply ice packs, scrotal support, and reassess in 24 hours

Advise bed rest and observe for spontaneous resolution of symptoms

Prescribe antibiotics, analgesia, and schedule follow-up in one week