Testicular torsion

I​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​nstructions: The leading diagnosis for this patient is ****. As evidenced by presenting symptoms of ***** (citation of reference supporting findings). Supporting physical assessment findings include ****** (citation). Differential Diagnoses Differential diagnoses for this patient include *** and ***. (must have 2 differentials) Differential 1 (e.g. Influeza) The first differential in this case is **** supported by patient presentation of *** (citation). The differential is further supported by physical exam findings of **** (citation). *** is less likely however due (here you would present s/s, history physical exam findings that rule out differential) (citation). Differential 2 (e.g. Viral pharyngitis) *** is the second possible differential in this case. Differential is supported by patient’s presenting symptoms of **** (citation). Patient’s physical assessment findings of *** further support the differential however, differential is less likely due to *** (citation). Diagnostics Based on current practice guideline recommendations, *this would be any pertinent diagnostic test(s) or exam(s) indicated for diagnosis* (must include citation of a Clinical Practice Guideline or Problem Specific Peer Reviewed Reference). Brief statement regarding why the test(s) is/are being used, e.g. Positive RADT results are confirmatory for GAS in pediatric patients (Clinical Practice Guideline or Problem Specific Peer Reviewed Reference citation). Treatment Plan *** is the first line treatment for *** (Clinical Practice Guideline or Problem Specific Peer Reviewed Reference) Any medications should include name, route, dose, and duration (Clinical Practice Guideline or Problem Specific Peer Reviewed Reference citation). Supportive measures recommended, including * (citation). Follow up **** (citation) References Include references cited documented per APA 7 guidelineAndrew Hailey is a 17-year-old male who presents to the clinic today with a four-hour history of severe right groin pain radiating to the right scrotum and associated nausea but no vomiting, fever, or urinary symptoms. II. Prioritized Cues from Hx and PE. (Do not include lab, x-?ray, or other diagnostic test results here.) • Tier 1: The cues (may be positive or negative) that contribute most to the diagnosis of the active problem. • Tier 2: These are cues of intermediate importance (list only positive cues). • Tier 3: Of least importance (list only positive cues). Tier 1 Tier 2 Tier 3 Right sided groin pain that began 4 hours ago Previous episode of similar pain that resolved spontaneously Similar episode in the part that resolved spontaneously Swollen, tender, and erythematous right scrotum Sexually active but uses condoms Appendectomy at age 12 Associated nausea Denies vomiting, fever, urinary symptoms Denies injury or trauma No penile discharge III. Problem Statement Andrew, a sexually active 17-year-old boy, has a four-hour history of significant right groin pain with radiation to the right scrotum and nausea, but no vomiting, fever, or urinary symptoms. A similar event occurred six to nine months earlier and resolved spontaneously, according to the patient. A swollen, erythematous right scrotum with an excruciatingly sensitive right testicle, no masses, a negative Prehn sign, an absent cremasteric reflex on the right, no blue dot sign, and no transillumination of the scrotum are discovered on ph​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​ysical examination. IV. Differential Diagnosis Based on what you have learned from the history and physical examination, list up to 3 diagnoses that might explain this patient’s complaint(s). List your most likely diagnosis first, followed by two other reasonable possibilities. For some cases, fewer than 3 diagnoses will be appropriate. Then, enter the positive or negative findings from the history and the physical examination that support each diagnosis. Leading dx: Testicular torsion History Finding(s) Physical Exam Finding(s) Acute pain onset of 4 hours Vital signs are normal Severe right groin pain radiating to right scrotum Swollen, tender, and erythematous right scrotum Associated nausea without other symptoms Negative Prehn sign No pain reliving factors Absent blue dot sign Pain 10/10 No scrotal transillumination No history of groin injury or trauma Absent cremasteric reflex of right scrotum Alternative dx: Epididymitis This study source was downloaded by 100000820572760 from CourseHero.com on 07-27-2022 14:53:43 GMT -05:00 https://www.coursehero.com/file/143252481/CAT-FM27docx/ History Finding(s) Physical Exam Finding(s) Acute pain onset of 4 hours Vital signs are normal Severe right groin pain radiating to right scrotum Negative Prehn sign Associated nausea without other symptoms Swollen, tender, and erythematous right scrotum No pain reliving factors Absent cremasteric reflex of right scrotum Pain 10/10 No history of groin injury or trauma Alternative dx: Trauma History Finding(s) Physical Exam Finding(s) Severe right groin pain radiating to right scrotum Vital signs are normal Associated nausea without other symptoms Swollen, tender, and erythematous right scrotum No pain reliving factors Absent cremasteric reflex of right scrotum Pain 10/10 No history of groin injury or trauma Acute pain onset of 4 hours V. Explanation of Diagnostic Plan (including tests, labs, imaging studies, etc.) and Treatment Plan in prioritized order: Diagnostic Plan Rationale Color doppler sonography Color doppler sonography is extremely specific and sensitive in detecting torsion and other disorders that might affect the scrotum (Hyun, 2018). Radionuclide scintigraphy This test is used to determine testicular viability. Non-viable testis manifests as a photopenia in the testis region on radionuclide scrotal scintigraphy; in situations when infarction is due to undetected torsion, there may be a surrounding ring of hyper-perfusion around the photopenia (Krishnaraju et al., 2018). Complete blood count This is in order to get an idea of what is going on in the body. The leukocyte count is elevated in individuals with testis torsion, according to numerous research; it acts as a sign of the inflammatory response (Yucel & Ozlem Ilbey, 2019). Urinalysis UA is useful in ruling out other possible causes of scrotal discomfort, such as epididymitis or kidney stones, rather than diagnosing torsion (Hyun, 2018). Urine with culture and sensitivity A urine culture can be useful in ruling out the possibility of a urinary tract infection. Treatment Plan Rationale Manual detorsion of the testicle In patients with testicular torsion, preoperative manual detorsion was linked to better surgical salvage (Dias Filho et al., 2017). Orchidopexy Testicular torsion is a serious surgical emergency that necessitates immediate surgical intervention in order to save the patient's testicular viability (Hy​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​un, 2018). I