Discussion – Men’s Health

Discussion – Men’s Health

History of Present Illness (HPI) Questions

For the purpose of creating an accurate HPI for the patient, specific information about the testicular pain and its underlying circumstances is pertinent. Key questions include:

1. Onset and Duration: “When did the pain start, and is it continuous or intermittent?”
2. Pain Characteristics: “Can you describe the nature of the pain (sharp, dull, throbbing)?”
3. Severity: “On a scale of 1 to 10, how would you rate the pain?”
4. Location and Radiation: “Is the pain localized to one testicle or both? Does it radiate to any other areas, such as the abdomen or groin?”
5. Associated Symptoms: “Have you noticed any other symptoms, such as swelling, redness, fever, or nausea?”
6. Alleviating and Aggravating Factors: “Does anything relieve or worsen the pain (position changes, physical activity)?”
7. Recent Activities: “Have there been any instances where the area has been traumatized or injured in some way? Did you perform any vigorous physical activity or sexual intercourse in the last 24 hours?” (Nichol et al., 2023).
8. Urinary Symptoms: “Have you experienced any changes in urination, such as frequency, urgency, or discomfort?”
9. Past Medical History: “Do you have a history of similar episodes or any known medical conditions affecting the testicles?”

Physical Assessment

To address the testicular pain, a detailed physical examination is important for the assessment of the patient. Steps include:

1. Inspection: Examine the scrotum for any swelling, redness, or asymmetry.
2. Palpation: Gently palpate each testicle to assess for tenderness, masses, or differences in size and consistency.
3. Cremasteric Reflex: Check for cremasteric reflex by running your finger lightly over the inner aspect of his thigh and observing whether the testicle on that side rises or not.
4. Transillumination: Examine using ambient light and apply lateral transillumination to aid in distinguishing a solid mass from a cystic structure filled with fluid (Ugboma & Aburoma, 2011).
5. Abdominal and Inguinal Examination: Evaluate for signs of hernia, lymphadenopathy, or abdominal tenderness.

Top Three Differential Diagnoses

1. Testicular Torsion

Acute and severe pain confined to one side of the scrotum almost invariably signifies testicular torsion, which is a surgical emergency (Kapp et al., 2021).

2. Epididymitis

Inflammation of the epididymis that ebbs distinctly from infection may lead to acute or subacute testicular pain, which is always characterized by swelling and tenderness (Bonner et al., 2021).

3. Orchitis

Orchitis, caused by viruses and bacteria, has the primary symptoms of pain and swelling and possibly results in fever.

Diagnostic Plan

Real-time scrotal sonography can assist in distinguishing testicular torsion from epididymitis and other scrotal disorders, as it offers various degrees of detail when viewing the testes and surrounding tissue. Second, urinalysis and urine culture are vital so as to check for signs of infection or inflammation. Third, a complete blood count (CBC) is important to assess for systemic infection or inflammation. Lastly, STI screening is vital to rule out sexually transmitted infections, particularly if there is a history of unprotected sexual activity.

Initial Treatment Plan for Testicular Torsion

Emergency surgical management is indicated for testicular torsion. In view of this positive clinical assessment and ultrasound features with high suspicion of testicular torsion, the patient should be directed to urology for surgical exploration and detorsion (Thaker & Nelson, 2020). If not addressed quickly, that is, within the first six hours of developing the symptoms, destruction of the testicle is inevitable.

References

Bonner, M., Sheele, J. M., Cantillo-Campos, S., & Elkins, J. M. (2021). A descriptive analysis of men diagnosed with epididymitis, orchitis, or both in the emergency department. Cureus, 13(6), e15800. https://doi.org/10.7759/cureus.15800

Kapp, A., Troxler, D., Prüfer, F., Holland-Cunz, S., Frech, M., & Gros, S. J. (2021). Testicular torsion in the absence of severe pain: Considerations for the pediatric surgeon. Children, 8(6), 429. https://doi.org/10.3390/children8060429

Nichol, J. R., Nelson, G., & Sundjaja, J. H. (2023, April 30). Medical history. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK534249/

Thaker, H., & Nelson, C. P. (2020). Adjuvant pharmacological and surgical therapy for testicular torsion: Current state of the art. Journal of Pediatric Urology, 16(6), 807–814. https://doi.org/10.1016/j.jpurol.2020.08.005

Ugboma, H. A. A., & Aburoma, H. L. S. (2011). Public awareness of testicular cancer and testicular self-examination in academic environments: A lost opportunity. Clinics, 66(7), 1125–1128. https://doi.org/10.1590/S1807-59322011000700001

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We’ll write everything from scratch

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A 32-year-old male arrives at the clinic complaining of acute onset of testicular pain for the past 2 days.
1. What questions would you ask this patient to develop a thorough HPI?

2. How would you conduct your physical assessment?
3. List and provide rationales for your top three differential diagnoses
4. Explain your diagnostic plan
5. Choose one of the differentials and explain your initial treatment plan
All questions must be answered with supporting evidence from at least one current clinical practice guideline or evidence-based study.

Expectations
• Length: A minimum of 250 words, not including references
• Citations: At least one high-level scholarly reference in APA from within the last 5 years

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