Genitourinary Question

22yo male presents to emergency department with a 2-hour history of increasingly intense testicular pain.  He reports being sexually active with multiple partners and intermittent condom use.  He is a very active person and completed a triathlon the day before presentation.  He denies dysuria, urethral discharge, or flank pain, but did have an episode of vomiting prior to arrival.  He is in visible distress and can not seem to get comfortable.  Evaluation of the scrotum reveals a tender, swollen left testicle.


  1. What are some bedside maneuvers you can perform to help with the differential?
  2. What should be the initial management of this patient?



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