I HUMAN CASE WEEK #10 13 Y/O BOY REASON FOR ENCOUNTER: TESTICULAR PAIN WITH SCREENSHOTS, Exams of Health sciences

Download I HUMAN CASE WEEK #10 13 Y/O BOY REASON FOR ENCOUNTER: TESTICULAR PAIN WITH SCREENSHOTS and more Exams Health sciences in PDF only on Docsity! I HUMAN CASE WEEK #10 13 YEAR OLD BOY REASON FOR ENCOUNTER: TESTICULAR PAIN COMPLETE CASE STUDY WITH SCREENSHOTS 2024 (CLASS 6512) a This case has a limit of 90 interactions. You have used 2. Choose a category: Press ENTER to see a final listo Interview Opening U [when ai > HPI: Constitutional Complaints How can | help you today? (previou What has been happening since yo! ; > HPI: Other Complaints (1 - Z) = ef > HPI: Other Compiaints (A - H) > HPI: Pain Complaints (A - H) lt = Do you have pain anywhere? If so, w What symptom is the most distressint Has anyone else you know developec HPI: Sensation & Movement nl Complaints Tell me how that makes you feel, > Past Medical History (PMH) How does this affect your life? > HPI: Pain Complaints (I - Z) > HPI: Psychological Complaints Family Medical History (FH) What is your name? > Social Hx (SH) Diet > Review of Systems (ROS) _ Aggravating Reliving Timing/Treatments @ Severity testicular pain? PMH, FH, SH as Needed @ Asked ® Not asked Graded Approach Question @ PMH ae re any prescription e PMH ave youeeh been diagnosed @ PMH Coumler or herbal modotions? ® PMH Do you have any allergies? ] SH fy is your family and family @ SH Are you sexually active? } FH Are there any diseases that run in your family? How severe (1-10 scale) is your Maybe a 9? | have never had anything like this before. Information Obtained Clinic Notes Response No, | don't take any pills. No, | don't think so. No. I'm pretty sure | don't. Pretty good, | guess. You're crazy. I'm a kid? That's a weird question. Dad takes something for his blood pressure, but that's it. Review of Systems (ROS) Select the major body systems that have not been touched on during the interview process for the HPI. @ Asked ® Not asked P Information Obtained Graded Question Response Clinic Notes Have you noticed any bruising, o bleeding gums, nose bleeds, or Nope. other sites of increased bleeding? Do you have problems with heat or e cold intolerance, increased thirst, Nope. increased sweating, frequent urination, or change in appetite? Do you have problems with dizziness, fainting, spinning room, seizures, weakness, numbness, tingling, or tremor? Nope. Do you have any problems with an itchy scalp, skin changes, moles, No, none of that stuff. thinning hair, or brittle nails? Do you have any problems with nervousness, depression, lack of interest, sadness, memory loss, or mood changes, or ever hear voices or see things that you know are not there? Nope. Do you have any problems with fatigue, difficulty sleeping, What does any of that have to do unintentional weight loss or gain, with why my privates hurt? fevers, or night sweats? Do you have any problems with headaches that don't go away with aspirin or Tylenol (acetaminophen), double or blurred vision, difficulty Kees with night vision, problems hearing, Pe: Do you experience chest pain discomfort or pressure; pain/pressure/dizziness with There's nothing wrong with my exertion or getting angry; chest. That's not where it hurts! palpitations; decreased exercise . ° tolerance; or blue/cold fingers and toes? Do you experience shortness of breath, wheezing, difficulty catching No your breath, chronic cough, or . sputum production? =xams Skin, Hair, Nails - inspect skin overall ¢ Mildly diaphoretic, skin warm e Acne noted on face and back e« Norash Exams HEENT - inspect/palpate head ¢ Normocephalic, atraumatic No deformities Facial feature symmetric Temporal arteries non-tender to palpation Frontal and maxillary sinuses non-tender MALE INGUINAL ANATOMY direct hernia Protrusion at the deep inguinal ring ough the inguinal canat fypically a congenital defect resulting failure of the processus vaginalis edial to the inferior vessels through an acquired in the abdominal wall ach’s triangle). May occur in Protrusion inferior to the inguinal ligament through an acquired eakness of the femoral.canal ‘common in women. HERNIATION TYPES Indirect inguinal Direct inguinal « Abdomen lean, muscular, nondistended ¢ No visible herniation Review the pathogenesis of the 3 demonstrated types of inguinal herniation: ¢ Indirect ¢ Direct « Femoral «ams bdomen - palpate abdomen ¢ Soft, nontender to palpation « No organomegaly; no abdominal or inguinal mass Exams Abdomen - percuss abdomen « Abdomen normal to percussion Exams Extremities - visual inspection extremities e There is no swelling or deformity. ¢ There is no cyanosis, clubbing or edema. Exams Lymphatic - palpate all lymph nodes e No inguinal adenopathy CREMASTERIC REFLEX Lightly stroke the superior-medial region of the thigh with the second and third fingers in an upward or downward direction. The normal response is an immediate contraction of the cremaster muscle that results in elevation of the ipsilateral testis. Expert Feedback Vitals Documentation: @ Pulse: Good, all correct. (FYI actual rate: 120) @ Respiration: Good, all correct. (FYI actual rate: 18) x BP: Incorrect assessment, correct is normal. (FYI actual BP: 130/70) @ Mental Status: Good, all correct. Exam Documentation: @ Lung Auscultation: Good, all correct. ®@ Cardiac Auscultation: Good, all correct. @ Eyes - Pupils: Good, all correct. Exams Performed: @ Correct Good job, you performed all appropriate : 1. Vitals: Temperature (provided) 2. Vitals: Skin (provided) 3. Vitals: Pulse 4. Vitals: BP 5. Chest Wall & Lungs: auscultate lungs 6. Heart: auscultate heart 7. Abdomen: auscultate abdomen 8. Abdomen: visual inspection abdomen 9. Abdomen: palpate abdomen 10. Abdomen: percuss abdomen 11. Lymphatic: palpate all lymph nodes 12. Genitourinary: genitourinary male exam You also performed additional exams that were not required, but are never inappropriate. 1. Vitals: SpO2 (provided) 2. Vitals: SpCO (provided) 3. Vitals: eTCO2 (provided) 4. Vitals: Respiration X Incorrect You performed 16 exams not required by expert. 1. Vitals: Mental Status 2. HEENT: examine pupils 3. Neck: auscultate carotid arteries 4. Abdomen: auscultate abdominal/femoral arteries Exam Performance: XIncorrect You made 2 errors performing some exams: 1. Did not auscultate the anterior in the correct order. 2. Did not auscultate the posterior in the correct order. Ramindar:  Gloria Problem Statement A 13-years-old male child has sudden onset of left testicular pain 2 hours ago. The pain started during the basketball match. He is also experiencing nausea and had one episode of vomiting. During physical assessment swelling is observed in let testicle and left cremasteric reflex is absent. Patient has tachycardia and diaphoresis. Test/Diagnosis Association Association of test with diagnosis: @ Correct X Incorrect ® Missing Other Tests testicular torsion X scrotal ultrasound ®@ scrotal ultrasound, doppler hernia, inguinal X abdomen CT @ CT abdomen/pelvis without contrast X CT abdomen/pelvis with IV contrast torsion of testicular appendage  Association of test with diagnosis: @ Correct X Incorrect ® Missing @ scrotal ultrasound, doppler X scrotal ultrasound appendicitis @ complete blood count (CBC) @ CT abdomen/pelvis without contrast X urinalysis (UA) urolithiasis @ urinalysis (UA) @ CT abdomen/pelvis without contrast epididymitis epididymitis @ urinalysis (UA) X scrotal ultrasound, doppler 1 of 1 Index of Tests Exercises Which of the following statements are true regarding the utility of ultrasound in cases of suspected epididymitis? Select all that apply. @ Correct ® Missing X Incorrect Yours Graded Choice oOo Oo Oo u@ oOo x Ultrasound may be normal Ultrasound may show increased blood flow Ultrasound may show decreased blood flow Ultrasound is necessary to make the diagnosis None of the above Scoring: Your score will be 0 if you select more than the number of correct choices. Diagnosis | of6 Index of Diagnosis Exercises What is the correct diagnosis ‘or this patient? @ Coroct @ Missing X Incorract Discussion Yours Graded Choice ooe000 Definitive diagnosis: Testicular torsion appendicitis ‘The sudden onset of testicular pain, along with physical findings of scrotal epididymitis erytnemayswelling and elevated testicle are highly suggestive of testicular hem i torsion. The absent cremasteric reflex is highly predictive of this diagnosis; me, nguinal and, the absent blood flow to the affectad testicle on ultrasound Doppler testicular torsion evaluation confirms the diagnosis. If history and physica’ excm alone are suspicious for testicular torsion, urgent urology consultation shauld not bo lorsion of lesliculer appendage delayad for imaging studies, urolithiasis Expert's Feedback “The tunica vaginalis isa fascial structure that ensheathes the testis (other than the posterior border), the ‘epididymis, andthe spermate-cord structures. has bath an inner visooral layer and an outer parietal layer. “Testicular torsion may occur within the tunica vaginalis (inravagina), o exterior to — and inclusive of — the tunica vaginalis (extravaginan. + xtravaginal testicular torsion mast commonly presents in neonates. * Iriavaginal testicular torsion most commanly occurs in adolosconts, but can be seen in Inwhat age groupe are these types of testicular torsion most common? (Short answer) ‘any age group, Testicular torsion commonly occurs among neonates and adolescents (12-18 years of age. Discussion  Plan Initially, medications for pain management will be given to the patient. Manual reduction can be considered as an initial management. As testicular torsion is a medical emergency, the patient will be referred to urologist for surgical correction. Pain and edema management after surgical procedure can be done. pLan Gloria Pain management will be the initial step. Nothing from mouth will be given to the patient. IV morphine can be given. Testicular torsion is a medical emergency therefore, the patient will be immediately referred to urologist. manual reduction and surgical correction are two processes. Manual reduction can be done however, surgical detorsion is required to prevent future testicular torsion. 1of4 Index of Plan Exercises Salvage rates for testicles in cases of testicular torsion drop off after how many hours? @ Correct ® Missing X Incorrect Yours Graded Choice oO @ 6 hours © x 12 hours © 24 hours oO 48 hours aod Expert's Feedback sion shou be cone byutasound prio tkng apt othe OR? Secon © correct @ MsingX Incoret idesunsian Yours Graded Choice ee ine Apter who ha a lasso presentation of estar trsion shoud go ot OR for exploration of he ° @ false ‘scrotum, as re-establishment of perfusion to the testicle may be delayed by obtaining an ultrasound. In. ‘equivocal cases o inthe situation in which the ultrasound can be obtained quickly while wating forthe Urologist to are, obtaining an ultrasound may be appropriate 4of4 Index of Plan Exercises At this point in the case, what is the most appropriate choice of analgesics? @ Correct ® Missing X Incorrect Yours Graded Choice Acetaminophen Oral oxycodone IV morphine Ibuprofen oOo0e00 e@ Analgesics may mask symptoms and should be avoided