Fellowship Practice Exam Feedback 2015

Question 20

A 13 year old boy presents with a painful testisWhat 6 features on history and examination would raise your suspicion of testicular torsion?6 marks

1. Abrupt / sudden onset

2. Severe localised unilateral

testicular pain3. Nausea and vomiting or NO history of trauma

4. Exquisitely tender testis5. Swollen testis5. Abnormal position of affected testis– high riding and horizontal 6. Absent cremasteric reflex / no relief on scrotal elevation

Or Discolouration scrotum

History of trauma – needs to be NO history of trauma

Phx torsion - surgical repair is usually bilateral orchidopexy and so would be less likely ( although not excluded )

Did not give 2 points for abnormal noting high riding and horizontal as separate points

“Absent infective features” or speed of onset or abnormal lie – these are too non specific

Answers that did not gain points

1. Torsion appendix testis / epipidymus2. Epididymitis or orchitis3. Trauma4. Others –

◦ idiopathic scrotal oedema ◦ Henoch schonhein◦ Tumour – can have rapid painful growth/ infarction / hrrge◦ Incarcerated inguinal hernia

NOT appendicitis , hydrocoele ( may be present with torsion ) , varicoele, which are not usually painful NOT UTI

And NOT TORSION as this is the diagnosis

What are your 4 other most likely diagnoses? ( 4 marks )

2 possible answers –

◦ No use or role –as delays theatre , clinical diagnosis, should proceed to OT

◦ Or

◦ In equivocal cases where performance of US WILL NOT DELAY theatre or interfere with treatment

◦ Needed to mention some remark about US utility / role / application

What si the utility of ultrasound in the acute setting? (2 marks)

Pass mark 8 /12 with 32 out 45 pass Overall

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mark x/12