Rosh Emergency Medicine Practice Test

When assessing a patient with acute testicular pain, what examination element is essential for ruling out torsion?

1. Temperature measurement

2. Medial thigh stimulation

3. Palpation of the abdomen

4. Assessment of respiratory rate

The correct answer is: Medial thigh stimulation

In the evaluation of acute testicular pain, medial thigh stimulation, specifically the cremasteric reflex, is crucial for assessing the possibility of testicular torsion. The cremasteric reflex involves the contraction of the cremaster muscle and elevation of the testis when the inner thigh is stroked. In cases of testicular torsion, the cremasteric reflex is often absent because the blood supply and nerve innervation to the testis are compromised. Therefore, if this reflex is not elicited during the examination, it raises a significant suspicion for torsion. The other examination elements, while they can provide some contextual information about the patient's overall condition, do not specifically rule out testicular torsion. Temperature measurement may indicate signs of systemic infection or inflammation but is not directly related to the evaluation of torsion. Palpating the abdomen can assess for other abdominal issues but does not directly assess the testis or torsion. Respiratory rate provides insights into the patient's respiratory status but does not contribute to the evaluation of testicular conditions. Thus, medial thigh stimulation serves as a targeted and essential component of the physical exam for this urgent scenario.