Acute ISCE station

You are working in A & E when a 19-year-old male, Gethin Granger, comes in. Please take a focused
history from him. You have 4 minutes and then the examiner will ask you some questions.

History

 PC: I’ve got really bad pain down below

 HPC: Started 2 hours ago, came on suddenly when playing football. Left testicle. No injury.
Sharp pain, constant, 10/10 severity. Also feel sick. Think it’s a bit swollen and red. No
urinary sx.
 PMHx: normal, no meds no allergies
 FHx: nil
 SHx: drinks socially, no smoking, no other drugs
Question

 Please summarise
 What is your differential diagnosis
o Testicular torsion, testicular appendix torsion, epididymitis (orchitis), inguinal hernia,
hydrocoele/ varicocele, (abscess, gangrene, infarct)
 What investigations would you like to do?
o Urinalysis, FBC, CRP, Ultrasound and doppler
 Please interpret the result of this investigation
o Ultrasound, Left testis is enlarged, hypoechoic without any mass lesion. There is no
flow in left testis. Twisted intrascrotal spermatic cord present. Right testis is normal.
 How would you manage this patient?
o Immediate urological referral & surgery (NBM, IV access, group and save)
o Supportive- morphine and antiemetic
 What is the window in which treatment should be provided?
o 6 hours
 What is the major complication of this condition?
o Subfertility/ infertility
 What findings would you expect on examination?
o Acutely tender, firm, absent cremasteric reflex, abnormal lie, bell-clapper deformity
 Please could you explain to a patient how to do a mid stream urine and talk through how
you would do a urine dip
30/4/19

09:30

Gethin granger

21/2/2000