Rosh Internal Medicine Boost Practice Exam

Which clinical feature would most likely suggest a diagnosis of varicocele?

1. Painless scrotal mass

2. Transillumination of the mass

3. Scrotal swelling associated with pain

4. Soft scrotal mass

The correct answer is: Scrotal swelling associated with pain

A diagnosis of varicocele is most commonly suggested by the presence of a soft scrotal mass that may be associated with discomfort or pain. Varicoceles are defined as the enlargement of the pampiniform plexus of veins within the scrotum and are often described as feeling like a "bag of worms." The key characteristic that aligns with this diagnosis is that the varicocele may cause symptoms of heaviness or discomfort in the scrotal area, especially with prolonged standing or physical activity. In contrast, other clinical features such as painless masses or transillumination findings would be more indicative of other conditions. For instance, a painless scrotal mass would suggest an entirely different etiology such as a hydrocele or testicular tumor, while transillumination is typically seen in cases of hydrocele where fluid is present, not in varicoceles that consist of engorged veins. Thus, the association between scrotal swelling and pain, along with the physical examination findings, helps lead to the diagnosis of varicocele in clinical practice.