ABIM Exam Review Practice Question of the Week: 27 y.o. male with testicular pain and scrotal redness
This week’s sample ABIM Exam Review Question comes directly from the Knowmedge QVault which covers topics listed on the ABIM Board Exam blueprint
Question
27-year-old male presents with acute onset of left testicular pain that started this morning. He admits to having unprotected sexual intercourse with multiple partners over the course of the past week. On physical examination, you notice that the patient’s scrotal sac is warm, red and tender to touch. He undergoes a testicular ultrasound that is read as normal. Based on the patient’s history, which of the following is likely for this patient?
A. Infection with Escherichia coli B. Infection with Enterobacter C. Negative Prehn’s test D. Positive Prehn’s test E. Infection with herpes simplex virus
Explanation
From his history and clinical presentation, this patient likely has epididymitis. This condition results in acute testicular pain with overlying redness, warmth and tenderness of the scrotal sac. Patients less than 35 years of age are usually infected with Chlamydia or Neisseria. Patients older than 35 years old are usually infected with E. coli or enterobacter.
Since this patient is 27 years old, Choice A (Infection with E. coli) and Choice B (Infection with enterobacteria) are not likely. Herpes simplex virus (HSV) also doesn’t usually cause epididymitis so Choice E (Infection with herpes simplex virus) is incorrect.
Prehn’s test is not specific but can help differentiate between testicular torsion and epididymitis. A patient infected with epididymitis is likely to feel relief of testicular pain when his testicle is elevated, which corresponds to Choice D (Positive Prehn’s test).
If there is no relief of pain with elevation of the testicle, this is a negative Prehn’s test, indicative of testicular torsion. Remember this important distinction through this mnemonic: elevation starts with “E”, as does epididymitis. Lifting the testicle will relieve the pain and leave patient “E”lated or happy.
You can see all the previous ABIM Exam Review Questions of the Week at the Knowmedge Blog. You can also find additional topics and questions directly from the Knowmedge Internal Medicine ABIM Board Exam Review Questions QVault.
