DIRECT RESIDENT CASE...

HPI HISTORY OF PRESENT ILLNESS: This is a 39-year-old African American male who says he has had a painful, swollen right testicle for the last month. The pain has slowly gotten worse, and was insidious in onset. This morning the pain has progressed such that it actually woke him up from sleep. He characterizes it as a "sharp" and constant. It is improved when laying down, and is aggravated by movement of the testicle. He has never experienced similar pain to this in the past. He denies dysuria, discharge, history of an STD, orchitis, varicocele or torsion. He has not taken any medication or seen any physician for this complaint as of yet.

ROS: No fevers, chills. He does have occasional back pain, but none today. No abdominal pain, nausea, vomiting, diarrhea. The rest of the review of systems is negative.

PMHx: Hypertension

Social Hx: 1 ppd smoker, remote etoh, drug use.

Exam

VITAL SIGNS: Temp 97.7, pulse 59, respirations 20, blood pressure
137/84.
GENERAL APPEARANCE: A well-developed, well-nourished African American
male, alert, oriented, appears nontoxic.
SKIN: Warm. No evidence of systemic rash or lesions.
ABDOMEN: Soft, nontender. Bowel sounds present in all 4 quadrants. No
organomegaly noted.
GU: Normal external male genitalia. No inguinal hernia. Palpable, hard mass on the right testicle; this is tender to palpation. No lesions seen on the genitalia. No pronounced lymphadenopathy in the inguinal region. No skin color changes about the GU area. No penile discharge noted. Contralateral testicle is without masses.
EXTREMITIES: Moving extremities x4 without difficulty. No clubbing,
cyanosis, or edema.

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