Emergency Medicine

Explanation

Testicular torsion occurs when the spermatic cord (from which the testicle is suspended) twists, cutting off the testicle's blood supply resulting in ischemia. The principal symptom is rapid onset of testicular pain.

Explanation

Answer:Absent cremasteric reflex.

The B) cremasteric reflex is a superficial reflex observed in human males and is elicited by lightly stroking the superior and medial part of the thigh. The normal response is an immediate contraction of the cremaster muscle that pulls up the testis on the side stroked (and only on that side).

The reflex utilizes sensory and motor fibres of the genitofemoral nerve, formed by fibres from the L1 and L2 spinal nerves.

When the inner thigh is stroked, sensory fibres of the femoral branch of the genitofemoral nerve and the ilioinguinal nerve are stimulated.

These synapse in the spinal cord and activate the motor fibres of the genital branch of the genitofemoral nerve, which causes the cremaster muscle to contract and elevate the testis. In boys, this reflex may be exaggerated, which can occasionally lead to a misdiagnosis of cryptorchidism.

The cremasteric reflex may be absent with testicular torsion, upper and lower motor neuron disorders, as well as a spine injury of L1-L2. It can also occur if the ilioinguinal nerve has accidentally been cut during a hernia repair. The cremasteric reflex can be helpful in recognizing testicular emergencies.

The presence of the cremasteric reflex does not eliminate testicular torsion from a differential diagnosis, but it does broaden the possibilities to include epididymitis or other causes of scrotal and testicular pain. It is important to note that the pain is not always centred on the scrotum but may be in the groin or lower abdomen.

A) Prehn's sign, the physical lifting of the affected testicle relieves the pain of epididymitis (Positive Prehn's sign) but not pain caused by testicular torsion. Negative Prehn's sign indicates no pain relief with lifting the affected testicle, which points towards testicular torsion, which is a surgical emergency and must be relieved within six hours.

Prehn's sign is a medical diagnostic indicator that may help to determine whether the presenting testicular pain is caused by acute epididymitis or from testicular torsion. Although elevation of the scrotum when differentiating epididymitis from testicular torsion is of clinical value, Prehn's sign has been shown to be inferior to Doppler ultrasound to rule out testicular torsion.

C) Transillumination (or the passage of light through body tissues, in this case the testis) is positive (=present) when there is a hydrocele. Hydroceles usually are asymptomatic scrotal swellings, often bilateral and sometimes with a bluish discoloration. They may be tense or lax but are non-tender and transilluminate. A patent processus vaginalis, which is sufficiently narrow to prevent the formation of an inguinal hernia, may still allow peritoneal fluid to track down around the testis to form a hydrocele.

D) Blue dot sign may be found in hydatid of Morgagni torsion = torsion of the testicular appendage. A hydatid of Morgagni is an embruological remnant found on the upper pole of the testis. Torsion of this appendage characteristically affects boys just prior to puberty. This may be because of rapid enlargement of the hydatid in response to gonadotrophins. The pain may increase over one-to-two days and occasionally the torted hydatid can be felt or seen on the upper pole (the blue dot sign). Treatment is generally conservative, however, surgical exploration and excision of the appendage leads to rapid resolution of the symptoms.

Scrotal swelling and edema (E) may be found in acute idiopathic scrotal edema, a self-limiting, non-tender, acute scrotal edema and erythema in a pre-school child that resolves without sequelae. Involvement can be unilateral or, predominantly, bilateral. There is no primary source of scrotal, perineal or perianal infection. The most common findings are mild or no scrotal discomfort or tenderness, with scrotal, perineal and inguinal swelling and erythema. Laboratory and ancillary examinations are usually not indicated, and findings are normal except for the occasional eosinophilia.

Characteristic ultrasonographic findings may be found, such as marked thickening of the scrotal wall, with heterogeneous and edematous appearance, increased peritesticular blood flow, mild reactive hydrocele and enlarged inguinal lymph nodes. Treatment is conservative. Resolution of all episodes occur within one-to-four days.

Viral or bacterial epididymo–orchitis or epididymitis may cause an acute scrotum in infants and toddlers. Scrotal exploration may be indicated to confirm the diagnosis. On examination, there is usually tender scrotal swelling (unilateral or bilateral) and erythema. If an associated urinary tract infection is present, antibiotic treatment and full investigation of the urinary tract will be required. Incarcerated inguinal hernia is another important differential diagnosis in acutely swollen, tender erythematous testes.

Explanation

The correct answer is Pre-pubertal

Explanation

The correct answer is Pre-pubertal

Explanation

The correct answer is Infant.

Explanation

Explorative surgical intervention is mandatory unless torsion can be excluded clinically or radiologically in order to prevent possible loss of the testicle to necrosis.

Torsion of the testis is a surgical emergency and must be relieved within six-to-twelve hours of onset of the symptoms for there to be a good chance of testicular viability. Irreversible ischemia begins around six hours after onset and emergency diagnosis and treatment is required within this time to minimise necrosis and improve the chance of salvaging the testicle.

Fixation of the contralateral testis is essential because there may be an anatomical predisposition to torsion (e.g the Bell clapper testis). The most common underlying cause for testicular torsion is a congenital malformation known as a bell-clapper deformity, wherein the testis is inadequately affixed to the scrotum, allowing it to move freely on its axis and susceptible to induced twisting of the cord and its vessels.

An undescended testis is at increased risk of torsion.