This patient has a testicular mass. Let's examine a few differentials as we go through the answer choices.

Germinal Cell Tumor (Testicular Tumor)

• Usually painless but dull/achy/heavy sensation; palpation of SOLID mass
• No change in size when supine
• No transillumination

Dilated pampiniform venous plexus (Varicocele)

• Usually painless; "Bag of worms"
• Reduced swelling when supine
• No transillumination

Cystic Dilation of the effect ductules (Spermatocele)

• Typically painless; fluctuant swelling of upper testicular pole
• No change in size when supine
• Does transilluminate

Fluid accumulation within the tunica vaginalis testis (Hydrocele)

• Often painless; fluctuant swelling of scrotum
• May/May not change in size wrt position
• Does transilluminate

Vascular Trauma (Hematocele/Ruptured Testis)

• Extremely painful & tender; visible hematoma
• May/May not change in size wrt position
• No transillumination

This question is tricky. I used to always miss this presentation. This is laterally medullary syndrome- which most of us have memorizes is a PICA infarct. Fun fact, PICA comes off the vertebral artery.

This is how I remember the sx. If this helps at least one person I will be glad I am exposing my twisted brain.

3+5=8 & 9-11 & B-P.

3: Horner's syndrome 5:spinal trigeminal- ipsi face pain and temp loss 8: vestibular signs, vertigo diplopia

9-11: Nucleus ambiguous, diminshed gag, dysphagia B: Cerebellar - inferior cerebellar peduncle, ipsi ataxia P: Contra pain and temp, cuz this shit was so painful to memorize I throw it to the other side.

sclera injection and munchies

In the words of afroman. I was gonnna go to work....but then I got high...

Warmest welcome back to Step 1 by NBME lol