1. Abrupt / sudden onset 2. Severe localised unilateral testicular pain 3. Nausea and vomiting or NO history of trauma 4. Exquisitely tender testis 5. Swollen testis 5. Abnormal position of affected testis– high riding and horizontal 6. Absent cremasteric reflex / no relief on scrotal elevation Or Discolouration scrotum

 History of trauma – needs to be NO history of trauma  Phx torsion - surgical repair is usually bilateral orchidopexy and so would be less likely ( although not excluded )  Did not give 2 points for abnormal noting high riding and horizontal as separate points  “Absent infective features” or speed of onset or abnormal lie – these are too non specific

1. Torsion appendix testis / epipidymus 2. Epididymitis or orchitis 3. Trauma 4. Others – ◦ idiopathic scrotal oedema ◦ Henoch schonhein ◦ Tumour – can have rapid painful growth/ infarction / hrrge ◦ Incarcerated inguinal hernia NOT appendicitis, hydrocoele ( may be present with torsion ), varicoele, which are not usually painful NOT UTI And NOT TORSION as this is the diagnosis

 2 possible answers – ◦ No use or role –as delays theatre, clinical diagnosis, should proceed to OT ◦ Or ◦ In equivocal cases where performance of US WILL NOT DELAY theatre or interfere with treatment ◦ Needed to mention some remark about US utility / role / application

 Pass mark 8 /12 with 32 out 45 pass