Caleb Metz 13 yo male Testicular Pain

Caleb Metz 13 yo male Testicular Pain Observations Warm, mildly diaphoretic History 1. How can I help you today? 2. When did your testicular pain start? 3. How severs (1-10) is your testicular pain? 4. What does your testicular pain feel like? 5. Does your testicular pain come and go? 6. What are the events surrounding the start of your testicular pain? 7. Have you been having fevers? 8. Do you have any pain in your abdomen? 9. Do you have any pain in your back? 10. Do you have any pain in your leg(s)? 11. Any change in the frequency of your bowel movements? 12. Are you sexually active? 13. Do you have pain/discomfort when you urinate? 14. Is your urine pink or red in color? 15. Do you have any problems with movement? 16. Have you had any trauma to your groin? 17. How is your appetite? Any recent change? 18. Do you have any other symptoms or concerns we should discuss? 19. Gen ROS 20. HTN ROS 21. Skin ROS 22. Cardiac ROS 23. Resp ROS 24. Endo ROS 25. Neuro ROS 26. Psych ROS 27. Heme ROS 28. Do you have any allergies? 29. Are you taking any prescription medications? 30. Are you taking any OTC or herbal medications? 31. Have you ever been diagnosed with a hernia? 32. Are there any diseases that run in your family? 33. How is your family and family life? 34. How is your overall health? Physical Exam ● Auscultate lungs ○ CTA b/l, normal effort ● Auscultate heart: ○ RRR, no m/r/g ● Visual inspection of abdomen ● Auscultate abdomen ● Palpate abdomen ● Percuss abdomen ● GU male exam ● Palpate all lymph nodes Assessment ● Sudden onset left scrotal/testicular pain and swelling in a 13 yo male- MSAP ● Related ○ Nausea with 1 episode of vomiting ○ Tachycardia ○ Diaphoresis ○ Left scrotal swelling per exam ○ Left scrotal erythema per exam ○ Left testicular pain to palpation ○ Absent cremasteric reflex ● Resolved ○ History of tympanostomy tubes as a young child Differential Diagnosis and Tests ● Testicular torsion - MnM ○ Scrotal US, doppler - absent blood flow to the affected left testicle ● Epididymitis - MnM ○ Urinalysis - normal ● Hernia, inguinal - MnM ○ CT abdomen/pelvis without contrast -- negative ● Urolithiasis ○ Urinalysis ○ CT abdomen/pelvis without contrast ● Torsion of testicular appendage ○ Scrotal ultrasound, doppler ● Appen