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Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
Patients typically complain of severe testicular pain, which may be relapsing and remitting, but often occurs abruptly. This is usually accompanied by nausea and vomiting. Patients may also less frequently complain of accompanying abdominal pain, fever and urinary frequency. Upon examination, there may be scrotal swelling and erythema, palpation is often exquisitely tender and there is no relief on elevating the scrotum. I would specifically look for a high-riding testicle, which would be elevated and may also have a horizontal lie compared to its normal, unaffected counterpart. Finally, I would examine for the cremasteric reflex, which is often absent in testicular torsion.
Considerations for the Focused Neuro-Urologic History and Physical Exam
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Laura L. Giusto, Patricia M. Zahner, Howard B. Goldman
Next, test the genital reflexes including the bulbocavernosus and anal reflex while the patient is in the lithotomy position, since the exam should flow from least to most invasive. In the male patient, we can also check the cremasteric reflex first. The bulbocavernosus reflex is important to assess since it is one of the first reflexes to return in patients with spinal shock after their injury (Table 19.9).8
Testicular lumps
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
Davoud Khodatars, Sarah Y. W. Tang
Is there an absent cremasteric reflex? A cremasteric reflex means that if you gently stroke the inside of the thigh, the testis rise within the scrotum – explain this test to the patient before doing it! (Testicular torsion)
Intravascular large B-cell lymphoma presenting as an isolated cauda equina–conus medullaris syndrome – A case report
Published in The Journal of Spinal Cord Medicine, 2020
In a month, he was wheelchair bound and dependent on ibuprofen for pain relief. The patient also experienced erectile dysfunction without nocturnal erections and 60 lbs of unintentional weight loss at presentation. At this time, neurological exam showed decreased muscle strength and tone in his bilateral lower extremities; ankle dorsiflexion and plantar flexion were 2/5 (MRC scale) bilaterally, foot inversion and eversion were also 2/5, knee flexion and extension were 3/5, hip flexion was 4/5, and hip extension, abduction and adduction were 3/5. Knee, ankle and plantar reflexes were absent bilaterally. There was loss of cremasteric reflex and rectal tone. Sensory exam revealed saddle anesthesia to pinprick. The remainder of the physical exam was normal.
Gonococcal epididymo-orchitis in an octogenarian
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Diagnosis is primarily clinical and based on history and physical examination. However, it is imperative to rule out urologic emergencies, such as testicular torsion, with ultrasonography. As opposed to gradual onset of pain seen in acute EO, testicular torsion typically presents with a sudden onset of severe pain with nausea and vomiting, in the absence of fevers and urinary symptoms [4]. Exam findings may reveal high-riding testis and absence of cremasteric reflex. Ultrasound findings are conclusive in the absence of blood flow on color Doppler [4].