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Testicular torsion — USMLE Step 2 CK MCQ

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ModerateSurgeryTesticular torsionUSMLE Step 2 CK

A 57-year-old African American man comes to the hospital because of progressive symptoms. History and focused examination are notable for acute unilateral testicular pain with high-riding testis and absent cremasteric reflex. Temperature is 98.6°F (37.0°C), blood pressure is 126/78 mmHg, pulse is 84/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Focused laboratory studies and imaging support an acute surgical process without suggesting a safer outpatient approach. Which of the following is the most likely diagnosis?

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Correct answer: B — Testicular torsion

The vignette describes Testicular torsion, supported by acute unilateral testicular pain with high-riding testis and absent cremasteric reflex. Testicular torsion is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: https://www.ncbi.nlm.nih.gov/books/#stage-9-order-42