A 15-Year-Old Boy Is Brought to the Emergency Department Because

A 15-year-old boy is brought to the emergency department because of severe pain in the right groin, nausea, and vomiting for 3 hours. The pain started shortly after participating in a soccer game; he does not recall any specific trauma.  He has never experienced similar symptoms before.  Temperature is 36.9 C (98.5 F) , blood pressure is 110/86 mm Hg, and pulse is 92/min.  On examination, there is no inguinal adenopathy.  Abdominal examination shows no abnormalities. The right scrotum appears mildly swollen. There is severe tenderness on palpation of the scrotum that persists with elevation of the testes. Which of the following additional physical examination findings is most likely present in this patient?

A) Absent elevation of the right testicle with stroking of the ipsilateral thigh
B) Enlargement of the mass when the patient coughs or bears down
C) Increase in the size of the mass when standing relative to laying
D) Reduction in pain with manual elevation of the right testicle
E) Transillumination of the mass when a flashlight is placed behind the scrotum

Correct Answer:

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