A 32-year-old male arrives to the clinic complaining of acute onset testicular pain for the past 2 days.
What questions would you ask this patient to develop a thorough HPI?
How would you conduct your physical assessment?
List and provide rationales for your top three differential diagnoses
Explain your diagnostic plan
Choose one of the differentials and explain your initial treatment plan
Full Answer Section
- Past Medical History (PMH):Any history of sexually transmitted infections (STIs), sexually transmitted diseases (STDs), urinary tract infections (UTIs), testicular trauma, or surgery?
- Medications:Taking any medications currently?
- Sexual History:Any recent unprotected sexual intercourse?
Physical Assessment
The physical assessment should focus on the genitourinary system, including:
- Inspection:Look for swelling, redness, or bruising of the scrotum or testicles.
- Palpation:Gently palpate each testicle for tenderness, masses, or lumps. Assess for epididymal swelling (spermatocele) and inguinal hernias.
- Transillumination:In a darkened room, shine a light source behind the scrotum. A positive transillumination (light passing through) suggests a fluid collection (hydrocele) and is usually painless.
Differential Diagnoses
- Epididymitis: This is the most likely diagnosis given the acute onset of testicular pain. It's an inflammation of the epididymis, the tube that carries sperm from the testicles. It can be caused by a bacterial infection, often secondary to a sexually transmitted infection (STI) like chlamydia or gonorrhea.
- Testicular Torsion: This is a medical emergency where the spermatic cord twists, cutting off blood flow to the testicle. It causes severe, sudden testicular pain, often accompanied by nausea and vomiting. Prompt diagnosis and treatment are crucial to prevent testicular loss.
- Orchitis: This is an inflammation of the testicles themselves. It can be caused by viruses like mumps, bacteria (often alongside epididymitis), or rarely, autoimmune conditions. It typically presents with testicular pain, swelling, and fever.
Diagnostic Plan
- Urinalysis and Urine Culture:To rule out a urinary tract infection (UTI) which can sometimes cause testicular pain.
- Complete Blood Count (CBC):To assess for signs of infection (elevated white blood cells).
- Scrotal Ultrasound:This imaging test can help differentiate between epididymitis, testicular torsion, and orchitis. It can also visualize any masses or fluid collections.
Treatment Plan (Example: Epididymitis)
If epididymitis is suspected:
- Antibiotics:A course of antibiotics (e.g., azithromycin) will be prescribed to target the bacterial infection.
- Pain Management:Medications like ibuprofen or acetaminophen can help manage pain and inflammation.
- Scrotal Elevation:Using a supportive jockstrap or athletic supporter can elevate the scrotum and reduce discomfort.
- Rest:Avoid strenuous activity until symptoms improve.
Note: This is just a sample treatment plan for epididymitis. The specific treatment will depend on the confirmed diagnosis.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult a healthcare professional for diagnosis and treatment.