Rosh Emergency Medicine Practice Test

What is the likely pathophysiology for a young man presenting with severe testicular pain and no elevation of the testes upon stimulation?

1. Compression of the testis against pubic bones

2. Defect of the abdominal wall in the groin area

3. Inadequate fixation of the lower pole of the testis

4. Infection with Neisseria gonorrhoeae

The correct answer is: Inadequate fixation of the lower pole of the testis

The scenario describes a young man experiencing severe testicular pain, accompanied by the observation of no elevation of the testes upon stimulation. This symptom is a classic indication of testicular torsion, a condition where the spermatic cord becomes twisted, cutting off the blood supply to the affected testis. The selected answer points to inadequate fixation of the lower pole of the testis, which directly relates to the condition known as an "inadequate fixation," or lack of normal structural support of the testis within the scrotum. Typically, the testis is anchored to the scrotal wall and the surrounding structures, but in cases of inadequate fixation, the testis is more mobile and susceptible to rotation, leading to torsion. This loose attachment allows the testis to become rotated freely around the spermatic cord, resulting in severe pain and the inability to elevate the affected testis during physical examination. In comparing with the other possible explanations, compression of the testis against the pubic bones may occur in various conditions but would not specifically account for the torsion or the lack of elevation observed. A defect of the abdominal wall in the groin area suggests an inguinal hernia, which typically presents differently and is not associated directly with test