Rosh Emergency Medicine Practice Test

What would be expected on physical examination in a patient with left-sided scrotal pain, considering relief of pain upon elevation of the scrotum?

1. No contraction of the cremasteric muscle when the upper thigh is gently pinched or stroked

2. Presence of a large, soft, left-sided scrotal mass that decompresses and disappears in the recumbent position

3. Presence of clear fluid surrounding the testicle upon placing a light source at the base of the scrotum

4. Relief of pain upon elevation of the scrotum

The correct answer is: Relief of pain upon elevation of the scrotum

In a patient experiencing left-sided scrotal pain, the relief of pain upon elevation of the scrotum is indicative of a condition known as a hernia or possibly epididymitis. This phenomenon is often referred to as the "Prehn's sign," which is commonly associated with epididymitis, where elevating the scrotum alleviates the discomfort. This response occurs due to changes in tension on the structures within the scrotum and the alleviation of pressure and pain originating from the underlying pathology affecting the epididymis. In situations such as a testicular torsion, elevation of the scrotum doesn't typically relieve pain, and in cases of testicular trauma, there may be other findings, such as swelling or bruising. The presence of significant fluid around the testicle would suggest a hydrocele or another fluid collection, while the absence of cremasteric reflex might be more involved in cases of torsion or severe trauma. Therefore, noting that the patient experiences relief of pain upon elevation strongly indicates that the underlying issue is likely not a critical emergency (like torsion) but rather something that correlates with factors like inflammation of the epididymis or perhaps a minor hernia, both of which