Nokea
A 15 year old high school football player is in your clinic, c/o severe testicular pain since 8 am this morning. Denies sexual activity. Unable to urinate due to pain. He is nauseated and is vomiting. He is lying on the exam table, uncomfortably shifting his position. His BP is 150/100, pulse is 110, respirations are 24. There are no lesions on the penis and no discharge from the meatus. The scrotal skin is tense and red. Palpation of the left testicle causes severe pain and the patient begins to cry. Prostate exam is normal. His cremasteric reflex is absent on the left but is normal on the right. Urine sample (by catheter) is normal. You send him to the emergency room. What is the most likely diagnosis?
Correct Answer: C
Rationale: The correct diagnosis is torsion of the spermatic cord. This condition presents with sudden severe testicular pain, nausea, vomiting, high blood pressure, tachycardia, and absence of cremasteric reflex. The key findings include red, tense scrotal skin, severe pain on palpation, and crying. The absence of discharge and normal prostate exam rule out prostatitis. Acute orchitis typically presents with fever and urinary symptoms, which are absent here. Acute epididymitis usually presents with gradual onset and urinary symptoms. Torsion of the spermatic cord is a surgical emergency requiring immediate intervention to prevent testicular ischemia and necrosis.