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Testicular torsion — MCCQE Part 1 MCQ

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HardScrotal PainTesticular torsionMCCQE Part 1

A 17-year-old boy presents with sudden severe left testicular pain and vomiting that began 3 hours ago. The left testis lies high and transverse, and the cremasteric reflex is absent. Urinalysis is normal. What is the most appropriate next step in management?

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Correct answer: E — Urgent surgical exploration without delaying for ultrasound

This is testicular torsion until proven otherwise; salvage depends on immediate detorsion and surgical fixation, so ultrasound should not delay surgery when clinical findings are strong. Epididymitis usually has urinary symptoms or inflammatory urinalysis and a less abrupt onset. Torsed appendix testis is usually less severe and often has a blue-dot sign. Tumour markers are irrelevant in the acute scrotum.

Reference: Canadian Urological Association acute scrotum guidance