American Board of Internal Medicine (ABIM) Certification Practice Exam

What condition is characterized by subacute pain in the superolateral testis, often associated with lower urinary tract symptoms, and relieved by testicular elevation?

1. Epididymitis

2. Orchitis

3. Testicular torsion

4. Hydrocele

The correct answer is: Epididymitis

The condition characterized by subacute pain in the superolateral testis, often accompanied by lower urinary tract symptoms, and alleviated by testicular elevation is epididymitis. Epididymitis typically presents with a gradual onset of pain and swelling in the scrotum due to inflammation of the epididymis, which is a structure located at the back of the testis. The pain often radiates to the lower abdomen or flank and can be associated with symptoms such as dysuria, urgency, and frequency, indicating a connection with lower urinary tract involvement. Relief of pain with elevation of the testis, known as the Prehn sign, is particularly indicative of epididymitis, which differentiates it from other acute scrotal conditions. In contrast, testicular torsion usually presents with sudden, severe pain and does not provide relief with elevation, while orchitis typically causes pain alongside fever and is often associated with viral infections. Hydrocele presents primarily with a mass effect rather than significant pain or urinary symptoms. Thus, the distinctive features of epididymitis make it the appropriate diagnosis in this case.