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NBME 24 Answers

nbme24/Block 4/Question#22

A 45-year-old man is brought to the emergency ...

Renal calculi in the left ureter

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 +2  upvote downvote
submitted by sajaqua1(258),

The keys to this answer are that it is fairly sudden in onset, and migrates. None of the other answers could explain the movement of pain from flank to LLQ to scrotum. While the kidney stone does not actually enter the scrotum, the pain can be referred to the testicles.

How do you distinguish this from testicular torsion? Is it just because it started in the left flank?

neels11  and there's no mass in the scrotum, whereas testicular torsion will have that "bag of worms" feel (along with a lack of cremaster reflex) testicular torsion usually happens in a younger age group +1  
medpsychosis  @neels11 I would like to clarify a piece of information. I believe you are confusing Varicocele with Testicular Torsion. Varicocele will present with "bag of worms" feeling. While the absence of cremasteric reflex is a sign of testicular torsion. +2  
johnson  This is the classic "loin to groin pain" of nephrolithiasis. +  

 +0  upvote downvote
submitted by youssefa(34),

I mean why would a testicle turn around itself when someone's sleeping. This typically occurs after sports/ bicycle riding etc..

 +0  upvote downvote
submitted by sweetmed(57),

Testicular torsion mostly happens in young boys, rarely in adults. Also the pain started at the flanks, which is not how torsion pain starts.