Case 1(surgery/ What is the significance of the normal lay and cremasteric reflex)

A 14-year-old white male presents to the ED with acute onset left testicular pain when running, 1 hour prior to presentation. His past medical history is negative, he is on no medications, and he has no allergies. He denies any trauma to the region. He states that his
pain is severe and only on the left. The pain is increased with ambulation and movement. He denies nausea, vomiting, diarrhea, fever, chills, dysuria, hematuria, or penile discharge.
His vital signs and physical exam are as follows: temperature 37.0°C, pulse 110, respirations 18, blood pressure 120/85. He is a well-nourished, well-developed male in distress secondary to pain.

Abdomen: Normal bowel sounds, non tender, soft, no masses.

Genitourinary: Circumcised male, no penile lesions, no discharge; left testicle tender to palpation but has a normal lay in the scrotum. The cremasteric reflex is normal bilaterally.
What is the significance of the normal lay and cremasteric reflex?
A) The cremasteric reflex should be abnormal in epididymitis.
B) The presence of a cremasteric reflex effectively rules out testicular torsion.
C) The normal lay of the testicle in the scrotum effectively rules out testicular torsion.
D) The presence or absence of a cremasteric reflex is not helpful in ruling out testicular torsion.

Discussion
The correct answer is D. The presence or absence of a cremasteric reflex is neither sensitive nor specific enough to confirm or rule out the presence of testicular torsion. Likewise, the lay of the testicle can be
normal in patients with testicular torsion. An abnormal testicular lay and absence of the cremasteric reflex may point towards testicular torsion. However, you cannot rely on these findings to rule out testicular
torsion.