NURS 6501: Final Exam:
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A college student presents with scrotal pain and dysuria. Examination reveals a swollen and tender right testicle. Which clinical finding is most suggestive of epididymitis rather than testicular torsion?
Group of answer choices
- Decreased pain with elevation of the testicle (Prehn's sign)
- Nausea and vomiting
- Absent cremasteric reflex
- High-riding testicle
The correct answer is: Decreased pain with elevation of the testicle (Prehn's sign)
Explanation:
Epididymitis and testicular torsion are both causes of scrotal pain, but they have distinct clinical features.
Prehn's sign: In epididymitis, the pain typically decreases when the scrotum is elevated, which is known as Prehn's sign. This is because epididymitis is usually an inflammatory condition, and elevating the testicle helps reduce the pressure and discomfort caused by inflammation.
In contrast, testicular torsion, which is a surgical emergency, does not usually relieve pain with testicular elevation. Instead, the pain worsens, and the testicle is often not reducible.
Other clinical findings:
Nausea and vomiting: These are more commonly associated with testicular torsion, which involves acute ischemia of the testicle and can trigger autonomic symptoms.
Absent cremasteric reflex: This is suggestive of testicular torsion, where the reflex is often absent due to the twist in the spermatic cord.
High-riding testicle: This is also more typical of testicular torsion, where the testicle may appear elevated or twisted, often with an abnormal position.
Thus, Prehn's sign (relief of pain with testicular elevation) is most suggestive of epididymitis and helps differentiate it from testicular torsion.
