Mastering Acute Testicular Pain Guidelines for PLAB 2 Success

Acute testicular pain is a high-yield emergency presentation in PLAB 2 OSCEs, requiring rapid assessment to rule out testicular torsion – a urological emergency that can lead to permanent testicular damage within 6 hours.

Key Clinical Approach

History (SAMPLE & OPQRST)

• Onset: Sudden vs gradual – sudden onset suggests torsion

• Pain Radiation: To groin/abdomen

• Associated Symptoms: Nausea, vomiting, fever, dysuria, discharge

• Previous Episodes: History of similar pain

• Sexual History: Relevant for epididymo-orchitis

• Trauma History

Examination

• Inspection: Scrotal swelling, erythema, position of testes

• Palpation: Tenderness, swelling, consistency of testes

• Elevated Testis Sign: Pain relief with elevation (Prehn's sign) suggests epididymitis

• ** Cremasteric Reflex**: Absent in torsion

• Systemic Examination: Fever, abdominal tenderness

Differential Diagnoses

Investigations

• Doppler Ultrasound: First-line imaging – assess blood flow

• Urine Analysis: For infection

• Blood Tests: CBC, CRP

Management Guidelines

Testicular Torsion

1. Immediate analgesia

2. Urgent surgical detorsion within 6 hours

3. If viable: Bilateral orchidopexy

4. If non-viable: Orchidectomy

Epididymo-orchitis

• Antibiotics: According to guidelines (consider sexually transmitted pathogens in young patients)

• Analgesia: NSAIDs

• Scrotal support

• Follow-up

PLAB 2 OSCE Tips

• Time Management: Assess, examine, and formulate plan within 5-7 minutes

• Communication: Explain emergency nature clearly to patient

• Documentation: Clear documentation of examination findings

• Differential: Always consider torsion first in acute scrotal pain

Key Takeaway

In acute testicular pain, time is testis – always rule out torsion first with Doppler ultrasound and urgent surgical consultation if suspected.

This guide follows current UK guidelines and is essential for PLAB 2 success.