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Bulging of soft tissue through the inguinal canal
0%
0/46
Inflammation of the testicles due to a viral infection
85%
39/46
Malignant growth of germ cells at the testicle
Mutation of cystine-reabsorbing transporter at the proximal collecting tubule
Rotation of the spermatic cord
15%
7/46
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This patient is experiencing orchitis secondary to infection with the mumps virus (fever, severe testicular pain, and parotitis 1 week prior). He is, therefore, experiencing inflammation of the testicles due to a viral infection. Mumps is a contagious viral illness that is largely preventable via vaccination. It is highly infectious and is transmitted via respiratory droplets, direct contact, or fomites. Patients usually present with a few days of fever, headache, myalgia, fatigue, and salivary gland swelling within 48 hours of symptom onset. The disease is self-limited, and most individuals recover within a few weeks. In postpubertal males, orchitis is the most common complication of mumps infection and typically occurs 5-10 days after the onset of parotitis. Symptoms include abrupt onset of fever, and severe testicular pain with swelling and erythema of the scrotum. Management of patients is supportive. Figure A is a Doppler ultrasound demonstrating symmetrical blood flow to and from the testes (red indicates flow towards transducer while blue indicates flow away from transducer). Incorrect Answers: Answer 1: Bulging of soft tissue through the inguinal canal describes an inguinal hernia, which may present with severe groin pain secondary to tissue ischemia. However, a soft mass at the groin would be present on physical examination. Answer 3: Malignant growth of germ cells at the testicle describes testicular cancer, which most commonly presents with a painless, nodular mass at the testicle. Answer 4: Mutation of cystine-reabsorbing transporter at the proximal collecting tubule describes cystinuria, a hereditary condition that leads to recurrent cystine renal stones. Though this may present with acute groin pain, it would begin during childhood. Answer 5: Rotation of the spermatic cord describes testicular torsion, which is a medical emergency. However, this patient’s Doppler ultrasound demonstrates normal blood flow bilaterally. Bullet Summary: Mumps infection presents with parotitis and possibly orchitis 5-10 days following initial parotitis.
2.5
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