94.A 51-year-old man describes 1 week of gradually worsening scrotal
pain and dysuria. He is sexually active with his wife. His temperature is
100.1°F, HR 81 beats per minute, BP 140/75 mm Hg, and oxygen satura-
tion is 99% on room air. On physical examination, his scrotal skin is warm
and erythematous. A cremasteric reflex is present. The posterior left testi-
cle is swollen and tender to touch. Color Doppler ultrasonography demon-
strates increased testicular blood flow. Urinalysis is positive for leukocyte
esterase. What is the most likely diagnosis?
a. Epididymitis
b. Testicular torsion
c. UTI
d. Testicular tumor
e. Varicocele
95.A 22-year-old man presents to the ED complaining of dysuria for 3 days.
He states that he has never had this feeling before. He is currently sexually
active and uses a condom most of the time. He denies hematuria but notes
a yellowish discharge from his urethra. His BP is 120/75 mm Hg, HR is
60 beatsper minute, and temperature is 98.9°F. You send a clean catch
urinalysis to the laboratory that returns positive for leukocyte esterase and
15 white blood cells per high power field (WBCs/hpf). Which of the follow-
ing is the most appropriate next step in management?
a. Send a urethral swab for culture and administer 125-mg ceftriaxone intramus-
cularly and 1-g azithromycin orally.
b. Send urine for culture and administer SMX/TMP orally.
c. Discharge the patient with strict instructions to return if his symptoms worsen.
d. Order a CT scan to evaluate for a kidney stone.
e. Have him follow-up immediately with a urologist to evaluate for testicular cancer.
Abdominal and Pelvic Pain 89