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MKSAP 17 Q & A
A 27-year-old man is evaluated in the emergency department for dull, throbbing, left testicular pain occurring over the past week. He also notes urinary frequency and dysuria, but no penile discharge. He reports no back pain, weight loss, or fever. Medical history is unremarkable. His only medication is ibuprofen, which he takes as needed for pain. He is sexually active with several different partners and uses barrier protection only intermittently. He reports no testicular trauma.
On physical examination, blood pressure is 126/64 mm Hg, and pulse rate is 90/min. BMI is 22. The penis appears normal without discharge at the meatus. The left testicle is boggy and exquisitely tender to palpation over the superior pole. The testicular pain lessens with elevation of the testis.
Laboratory studies reveal a normal complete blood count, and urinalysis with microscopy shows 2 leukocytes/hpf.
Which of the following is the most likely diagnosis?
B: Testicular torsion
C: Urinary tract infection