AccessMedicine's Case of the Week: Emergency Medicine

From: Graber and Wilbur’s Family Medicine Examination and Board Review, 5th Edition
AccessMedicine's Case of the Week: Emergency Medicine


A 14-year-old otherwise healthy male presents to the ED with acute onset left testicular pain when running 1 hour prior to presentation. He denies any trauma to the region. He states that his pain is severe and only on the left. The pain is increased with ambulation and movement. He has had nausea and vomiting. He denies diarrhea, fever, chills, dysuria, hematuria, or penile discharge.

Vital signs: temperature 37°C, pulse 110 bpm, respirations 18, and BP 120/85 mm Hg. He is in distress secondary to pain. Abdomen: normal bowel sounds, nontender, soft, no masses. Genitourinary: circumcised male, no penile lesions, no discharge. The left testicle is tender to palpation and has a normal lay in the scrotum. The cremasteric reflex is normal bilaterally.

Question 1 of 3:

What is the significance of the normal lay and cremasteric reflex?

A - The cremasteric reflex should be abnormal in epididymitis

B - The presence of a cremasteric reflex effectively rules out testicular torsion

C - The normal lay of the testicle in the scrotum effectively rules out testicular torsion

D - The presence or absence of a cremasteric reflex is not helpful in ruling out testicular torsion

Click HERE to answer the question and complete the remaining questions in the case.

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