Surgery MCQs Q10

A 4-month-old boy presents with irritability and unilateral testicular swelling. Examination reveals:

Temperature: 38°C
Testis: Enlarged, red, firm, tender
Urine analysis: Protein, nitrites, leukocytes

What is the most probable diagnosis?

A. Direct inguinal hernia

B. Epididymo-orchitis

C. Hydrocele

D. Testicular torsion

E. Undescended testis

🔍 Decoding the Stem

• • Acute swelling + Tender/Red: Indicates an inflammatory or infective process.
• • Fever (38°C) + Irritability: Signifies a systemic response to infection.
• • Nitrites/Leukocytes: Strongly suggests a concurrent Urinary Tract Infection (UTI).

✅ Correct Answer:

B. Epididymo-orchitis

Explanation of Correct Answer

Epididymo-orchitis is inflammation of the epididymis and testis, usually due to bacterial infection. In infants, it is often associated with urinary tract infection or congenital urinary tract anomalies.

Explanation of Wrong Options

A. Direct inguinal hernia: May present as swelling, but usually painless, reducible, and not associated with erythema or systemic symptoms.

C. Hydrocele: Presents as a painless, cystic, transilluminant swelling. It is not tender or red and is not associated with fever.

D. Testicular torsion: Presents with sudden onset pain. While the testis is tender and high-riding, urine analysis is typically normal and fever is less common.

E. Undescended testis: A congenital anomaly where the testis is non-palpable in the scrotum; not an acute inflammatory presentation.

🧠 High-Yield Points

Differential: Acute scrotal swelling in infants requires distinguishing epididymo-orchitis from torsion.
Clinical clues: Gradual onset, fever, and abnormal urine point toward epididymo-orchitis.
Management: Antibiotics and investigation for underlying urinary tract anomalies (e.g., PUV or ectopic ureter).

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💡 Quick Clinical Challenge:

What clinical sign is typically absent in testicular torsion but may be preserved in epididymo-orchitis?

Show Answer

✅ Answer:

The Cremasteric Reflex. It is almost always absent in torsion but usually present in epididymo-orchitis.