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Disclosure: Most pearls I am posting here are with permission from and using freely available content on Archer blogs and I have not violated any copyrights. Since there is a thread discussing UWOrld Qbank pearls, I would like to post pearls from Archer Q-banks which are very good and additive to UWorld concepts. More questions equates better learning and retention!
Pearl 1:
Testicular Torsion questions:
Recognize that clinical probability of testicular ultrasound can be estimated by history and physical examination ( see the predictive clinical score below). Ultrasound should only be done if the clinical diagnosis is uncertain and if the performance of imaging does not significatntly delay the treatment.
Rapid diagnosis is important in order to salvage a viable testis with prompt surgery. The testicular salvage rate is more than 80% if surgery is performed within 6 hours, but the rate decreases to approximately 20% if surgery is done after 12 hours after the onset of symptoms.
Testicular Torsion: Clinical features include acute onset pain, absence of cremasteric reflex, negative prehn’s sign, tender testicle on palpation and a an elevated or horizontal lie of testis ( changed position of testis). Absent cremasteric reflex is the most sensitive physical finding for diagnosing testicular torsion. Three features in the history can serve as predictors of pre-test clinical probability of Testicular Torsion: 1. Onset of pain less than six hours 2. Absence of Cremasteric reflex 3. Diffuse Testicular Tenderness. Presence of all the three features ( score:3) is assocaited with 87% probability (high probability) of having Testicular Torsion as per a large study. These patients should undergo direct surgical exploration. A score of 1 or 2 indicates moderate to low clinical probabilty and should first undergo diagnostic ultrasound. A score of 0 favors an alternative diagnosis for acute scrotum rather than Testicular Torsion.
Key Concept : Recognize “Testicular Torsion” clinical score and determine the next step as follows : : 1. Onset of pain less than six hours 2. Absence of Cremasteric reflex 3. Diffuse Testicular Tenderness. Presence of all the three features ( score:3) is assocaited high probability of having Testicular Torsion as per a large study –> Next step, direct surgical exploration. A score of 1 or 2 indicates moderate to low clinical probabilty –> next step, diagnostic ultrasound. A score of 0 favors an alternative diagnosis for acute scrotum rather than Testicular Torsion.
Pearl 1:
Testicular Torsion questions:
Recognize that clinical probability of testicular ultrasound can be estimated by history and physical examination ( see the predictive clinical score below). Ultrasound should only be done if the clinical diagnosis is uncertain and if the performance of imaging does not significatntly delay the treatment.
Rapid diagnosis is important in order to salvage a viable testis with prompt surgery. The testicular salvage rate is more than 80% if surgery is performed within 6 hours, but the rate decreases to approximately 20% if surgery is done after 12 hours after the onset of symptoms.
Testicular Torsion: Clinical features include acute onset pain, absence of cremasteric reflex, negative prehn’s sign, tender testicle on palpation and a an elevated or horizontal lie of testis ( changed position of testis). Absent cremasteric reflex is the most sensitive physical finding for diagnosing testicular torsion. Three features in the history can serve as predictors of pre-test clinical probability of Testicular Torsion: 1. Onset of pain less than six hours 2. Absence of Cremasteric reflex 3. Diffuse Testicular Tenderness. Presence of all the three features ( score:3) is assocaited with 87% probability (high probability) of having Testicular Torsion as per a large study. These patients should undergo direct surgical exploration. A score of 1 or 2 indicates moderate to low clinical probabilty and should first undergo diagnostic ultrasound. A score of 0 favors an alternative diagnosis for acute scrotum rather than Testicular Torsion.
Key Concept : Recognize “Testicular Torsion” clinical score and determine the next step as follows : : 1. Onset of pain less than six hours 2. Absence of Cremasteric reflex 3. Diffuse Testicular Tenderness. Presence of all the three features ( score:3) is assocaited high probability of having Testicular Torsion as per a large study –> Next step, direct surgical exploration. A score of 1 or 2 indicates moderate to low clinical probabilty –> next step, diagnostic ultrasound. A score of 0 favors an alternative diagnosis for acute scrotum rather than Testicular Torsion.