NursingCase studyDifferential diagnosis

D.G. right scrotal pain case study guide: full chart

A full chart case with two problems hiding in one groin: acute right scrotal pain in a sexually active 34-year-old, plus a months-old scaly rash — differentials ruled on data, diagnoses confirmed, and a guideline-cited plan.

Aug 12, 2026

Editorial process

Last reviewed · August 12, 2026

Written by

Aaron Bishop

MA, Education

assignment interpretation and research-methods coaching across disciplines

Reviewed by

Dr. Nathan Cole

PhD, Rhetoric & Composition

Argumentation and thesis development

On this page

Interpret the task
Assignment instructions
Deliverables
Proposed outline
Research plan
Reference shortlist
Final review

What separates epididymitis from torsion on this exam?

The chart plants a classic acute-scrotum discrimination and then grades whether you argue it from the exam. D.G.'s right testis is red, tender, and twice normal size after 24 hours of constant nagging pain — and the two findings doing the heaviest work are that raising the testis decreases the pain and the cremasteric reflex is positive. Those findings lean the argument toward epididymitis and away from testicular torsion, and the rule-out portion expects you to say so explicitly: torsion presents with abrupt severe pain, a lost cremasteric reflex, and no relief on elevation, and it is discharged with urgency language because missing it costs the organ. The history's risk context — a new partner, no condoms, no prior STI history — points the etiology toward the sexually transmitted organisms his age bracket makes likely, while negative transillumination and the hernia-free exam discharge hydrocele and inguinal hernia on named data.

The chart's second problem is deliberately easy to overlook: a dull red rash in both groin folds with scaly plaques and distinct margins, months old, self-treated with an over-the-counter cream that only chases the itch. Distinct-margined scaly plaques in the crural folds read as tinea cruris, and it earns a place in your secondary diagnoses with its own treatment line rather than a passing mention — the assignment asks for medications for each diagnosis, primary and secondary, and a fungal rash managed with a named topical antifungal and hygiene education is exactly the kind of completeness the structure rewards. The allergy line matters just as much: he is penicillin-allergic, which any antibiotic selection must visibly respect in writing, and the ten-drinks-a-week pattern and absent condom use both belong in the education section with specific counseling attached.

The plan portion runs on the same sourcing discipline as the assessment: guideline-based medications for each diagnosis with the guidelines listed on the reference page, non-pharmacologic measures — scrotal elevation, rest, analgesia, partner treatment and abstinence until therapy completes — and testing justified line by line. This case's testing argument writes itself: urinalysis, and nucleic acid testing for gonorrhea and chlamydia given his age and new partner, each with its one-sentence why; an ultrasound earns its order if any torsion doubt survives the exam. Close with the referral logic the asterisked note describes — urology if symptoms fail to resolve on treatment — and the one-week follow-up to assess response. A cleaning note: this record circulated with a student's completed write-up ahead of the chart; the brief above is the case and assignment only.

Likely learning objectives

Inferred from the brief — check these against your own rubric.

01
Argue the acute-scrotum discrimination from the exam: elevation relief and positive cremasteric reflex against torsion's picture, with torsion discharged urgently and explicitly.
02
Use the sexual history to drive etiologic reasoning and the testing it implies.
03
Catch the second diagnosis — the distinct-margined scaly groin rash — and treat it as a full secondary with its own plan line.
04
Select antibiotics that visibly respect the documented penicillin allergy, from named guidelines.
05
Justify each test ordered and set the referral trigger and follow-up interval.

Assignment instructionsQuoted verbatim

Read the full question

Review every instruction before using the planning guidance that follows.

CC: “I am having pain in my right scrotum.” HPI: D.G. is a 34-year-old male who presents with c/o pain in the right scrotum for the past 24 hours. Reports that pain has been “getting worse” and rates as 7 on pain scale. Reports that the pain is constant and nagging. He denies trauma to the area, penile discharge or burning. He denies any h/o UTI, prostatitis or kidney stones. He is sexually active with a new female partner for the past 2 ½ months and does not use condoms. PMH: Last physical 1 year ago. UTD on immunizations. Medication: None Allergies: Penicillin – causes rash PSH: Denies SH: Divorced for 2 years. Has 3 children. Works as an electrical engineer. Nonsmoker. Denies illicit drug use. Drinks 10 drinks per week. FH: Mother – deceased Father – HTN and Hyperlipidemia Sister – Alive and well Brother – COPD Review of Systems: Cardiovascular: Denies chest pain, dyspnea or edema. Respiratory: Denies SOB, wheezing, cough, allergies. Gastrointestinal: Denies abdominal pain, nausea, vomiting, diarrhea, constipation or change in bowel pattern. Genitourinary: Denies h/o STI or undescended testicles; denies h/o of kidney or urinary problems; reports rash to the groin area for the past several months; applies OTC cream when it begins to itch and stops when the itch goes away. Physical examination: VS: 98.4-74-16-110/74; BMI:26 General: A&OX3; NAD Heart – RRR with murmur, gallops, rubs Lungs: CTA bilaterally Abdominal: soft, flat, non-distended with ABSX4; no HSM; no CVA or suprapubic tenderness; no inguinal nodes or lymphadenopathy noted Genitourinary: Right testis red, tender and swollen twice the normal size; raising the testes decreases the pain; positive cremasteric reflex; negative to transillumination; no varicocele, hydrocele, epididymal cyst or spermatocele noted. Left testis is not red, tender or swollen. No inguinal or femoral hernias. Dull, faint red rash noted in the left and right groin area with scaly plaques and distinct margins covering a small area of the groin. Lower extremities: no lesions or rashes. Assignment: For the assessment portion of the assignment: 1. identify potential differentials and specify the subjective and/or objective data that rules the differential out as the primary diagnosis 2. identify primary diagnoses and specify the subjective and/or objective data that confirms the diagnoses 3. identify secondary diagnoses and specify the subjective and/or objective data that confirms the diagnoses. For the treatment plan portion of the assignment: 1. identify appropriate medications based on evidence-based guidelines for each diagnosis (primary and secondary) and list the medication as if you were writing a prescription or escribing (medication name, dose, how to take, number to dispense and if refills will be provided) 2. identify appropriate non-pharmacological therapies and patient education based on evidence-based guidelines 3. identify if additional diagnostic testing or referrals are warranted and justify why the labs and or is warranted 4. identify when the patient is to return for follow-up *If you feel that the patient needs to be referred for the diagnosis, develop the treatment plan based on evidence-based pharmacological and non-pharmacological therapies that would be utilized by the specialist. *Remember to list the evidence-based guidelines that you utilized to develop the treatment plan on a reference page.

Turn the brief into deliverables

01
An assessment: differentials with rule-out data, primary and secondary diagnoses with confirming data.
02
A treatment plan: guideline-based medications for each diagnosis, non-pharmacological therapies, and education.
03
Justified testing and referrals, the follow-up plan, and the guidelines listed on a reference page.

How should both groin problems be assessed and treated?

The acute scrotum, argued

Present the 24-hour picture and decide it on the exam: elevation relief and intact cremasteric reflex toward epididymitis, torsion discharged explicitly with its contrasting findings and urgency.

Rule-outs and the second problem

Discharge hydrocele on transillumination and hernia on the exam, then elevate the distinct-margined scaly rash to a secondary diagnosis with its own reasoning.

The guideline-cited plan

Medications per diagnosis honoring the penicillin allergy, topical antifungal for the rash, scrotal elevation and analgesia, partner treatment, and education matched to his documented behaviors.

Testing, referral, and follow-up

Justify urinalysis and gonorrhea/chlamydia NAAT from age and history, state the ultrasound trigger, the urology referral condition, and the one-week response check.

Where are the workup and treatment standards documented?

Recommended databases

MedlinePlus

Search sequence

1.
Review the testicular-disorders overview for the acute-scrotum discrimination the exam findings decide.
2.
Check the tinea material for the crural-fold presentation and topical treatment the secondary diagnosis needs.
3.
Confirm the epididymitis workup and treatment elements before writing the plan.
4.
Draft assessment then plan, pinning every claim to its chart line and naming the guidelines.

Reference shortlist

These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.

Nothing here is cleared for citation until you have read it.

01
Testicular Disorders
MedlinePlus, U.S. National Library of Medicine · 2024
The frame for the acute-scrotum differential — epididymitis, torsion, hydrocele — behind the assessment's discrimination argument.
02
Epididymitis
MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine · 2024
The condition-level detail — causes by age group, exam findings, and treatment course — that the primary diagnosis and plan draw on.
03
Tinea infections
MedlinePlus, U.S. National Library of Medicine · 2024
The second diagnosis's evidence: the crural-fold presentation and topical antifungal management the secondary plan line needs.

Review before submission

Common mistakes

Dismissing torsion casually — it must be ruled out on the named exam findings with the urgency it deserves.
Missing the tinea cruris entirely, when the months-old scaly rash is planted as the second diagnosis.
Prescribing an antibiotic family the chart's penicillin allergy forbids.
Ordering tests without the per-test rationale the instructions require.
Leaving partner treatment and condom counseling out of a plan for a sexually transmitted etiology.
Forgetting the reference page of named guidelines the assignment grades.

Submission checklist

Torsion, hernia, and hydrocele each ruled out on named exam data.
Primary diagnosis confirmed on the elevation-relief and cremasteric findings plus history.
Tinea cruris carried as a secondary with its own treatment.
Antibiotic selection respects the penicillin allergy; guidelines named.
Testing justified line by line; referral trigger and one-week follow-up stated.
Education covers partner treatment, condoms, and the alcohol pattern.

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