Two Parts: Case Study A 42-year-old male comes into the clinic stating that

   
Two Parts:
Case Study
A 42-year-old male comes into the clinic stating that he has noticed a “lump” in one of his testicles. It is not painful. He says it is behind the right testicle and just slightly above it. His ROS is negative. He has no history of testicular cancer in the family. He has tried manipulating it to see if anything changes but it does not help. He tried ice but it did not go away. He says for a couple of days it hurt a little and he tried elevating the scrotum and that seemed to make the pain go away. He says, “it is kind of like I have a third testicle!”
 
Upon examination, his vital signs are stable and his assessment is unremarkable. You note a painless mass just superior and inferior to the right testicle. You are able to move it and it is freely movable.

 
Part 1- 
Use the Focused SOAP Note Template to address the following:
· Subjective: What details are provided regarding the patient’s personal and medical history?
· Objective: What observations did you make during the physical assessment? Include pertinent positive and negative physical assessment findings. Describe whether the patient presented with any morbidities or psychosocial issues.
· Assessment: Explain your differential diagnoses, providing a minimum of three. List them from highest priority to lowest priority and include their CPT and ICD-10 codes for the diagnosis. What would your primary diagnosis be and why?
· Plan: Explain your plan for diagnostics and primary diagnosis. What would your plan be for treatment and management? Include pharmacologic and non-pharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan.
· Reflection notes: Describe your “aha!” moments from analyzing this case.
Part 2-
Review question below and answer them
List three      differentials for this mass. List your top differential first and explain      why it is your top differential.

 
When examining      the patient, you examine the scrotum carefully. You note asymmetry with      the left hemiscrotum lower than the right. Is this typical?

 
Typically,      scrotal pain only affects one side and is not typically bilateral. True or      false?
When palpating,      the normal epididymis is more firm than the testis. True or false?
One of the      things you can do is transilluminate the testis. For your top dd, will the      testis typically transilluminate?

 
For this      patient, is it extremely important to get a semen analysis?

 
Name 10      testicular disorders that are important to consider when evaluating a      testicular mass.

 
If the patient      is having no pain, what is the desired treatment?

 
If the mass is      painful, what is the preferred treatment?
 
If a patient      had to have an orchiectomy, why might counseling be an important      intervention?

 
How often      should testicular self-assessment be performed?

 
Why is it best      to perform the testicular self-assessment after a warm bath or shower?

 
The      differential diagnosis for any testicular disorder should first exclude      the possibility of a ________________.

 
Explain the      difference between a spermatocele and a hydrocele.

 
Testicular      malignant neoplasms are very common in the general population.

 
Testicular      cancer is the most common form of cancer in men between the ages of      _______.

 
When      documenting the results of the testicular assessment, what should it      include?
18. Which of the following require immediate referral?
Torsion of the spermatic cord
Hydrocele
Incarcerated scrotal hernia

 
Why can      varicoceles cause infertility?

 
If there is      torsion of the spermatic cord, what are two things that can happen if      treatment is delayed?
Testicular      tumors have been associated with scrotal trauma. True or false?
21. What are two things that can result from surgical intervention for testicular tumors?

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