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Old 08-11-2012
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Question Painful Tender Testes!

A 22-year-old male notices a painful testicular mass while showering. It persists and begins to worry him. At the time of exam by his primary care doctor, the mass is 2 centimeters, firm, and tender. He also complains of a cough that has been persistent for 2 weeks.
The next step in the workup of this patient should include:
A) Antibiotic treatment for epididymitis
B) CT-guided biopsy of the mass
C) Measurement of a-fetoprotein and HCG
D) Ultrasound of the scrotum
E) CT scan of the abdomen
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Old 08-11-2012
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D) Ultrasound of the scrotum since it could be a pathology (torsion) of on of those vestigial remnants (appendix of the testes) but they are usually not that large i.e. 2 cm.

Painful goes against testicular cancer so C & E are out.
B is out since you never do that is a testicular swelling.
A-there is not enough info to make a diagnosis of epididymitis

However, I am unable to account for the cough and there could be two possibilities:

1. Testiular Ca with lung Mets (but the pain goes against it)
2. An indirect hernia due to cough ( but short duration and examination findings goes against it)
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Step-2-Questions, Surgery-, Urology-

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