Appendix testis torsion: find the tender nub

Question 1Where does a twisted appendix testis usually sit?

1. aAt the lower pole of the testis
2. bAt the upper pole, between the testis and the head of the epididymis
3. cIn the inguinal canal
4. dInside the testis

Question 2Which pattern suggests torsion of the appendix testis rather than testicular torsion?

1. aNormal testicular flow with a small avascular nodule at the upper pole
2. bAn enlarged, uneven testis
3. cA whirlpool sign in the spermatic cord
4. dAbsent flow in the whole testis

Question 3A 13-year-old has sudden severe pain, vomiting and a high-riding testis. The scan shows normal testicular flow. What next?

1. aRepeat the scan next week
2. bDischarge with analgesia
3. cDiagnose appendix testis torsion and send home
4. dUrgent urology review, because normal flow does not exclude torsion

Question 4Why can the painful side look dramatic in torsion of the appendix testis?

1. aThe testis infarcts
2. bA reactive hydrocele and scrotal wall thickening surround a tiny appendage
3. cThe epididymis ruptures
4. dThe cord is twisted

Question 5Why start on the painless side?

1. aBecause the appendix is always on the left
2. bTo set the grey-scale and colour settings for a fair comparison
3. cBecause the painful side cannot be scanned
4. dTo save time