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Testicular torsion — RACGP Fellowship MCQ

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HardEmergency presentations in general practiceTesticular torsionRACGP Fellowship

A 14-year-old boy presents with acute scrotal pain for three hours, nausea and a high-riding tender testis. Urinalysis is normal and he is afebrile. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: BArrange immediate emergency referral for suspected testicular torsion

Explanation lettering: B = shown as A · D = shown as B · A = shown as D

Testicular torsion is a surgical emergency requiring immediate referral. The clinical presentation is classic: adolescent boy with acute scrotal pain, nausea, and a high-riding tender testis. Normal urinalysis excludes epididymitis. The patient is within the critical 6-hour window for salvage—the most important determinant of outcome. Salvage rates decline sharply beyond 6 hours, and delays in diagnosis and referral result in preventable testicular loss. All distractors represent dangerous delays or misdiagnosis: outpatient ultrasound (A) wastes critical time; antibiotics alone (B) fail to address torsion; reassurance based on urinalysis (C) ignores the clinical diagnosis; and rest with review (E) allows ischaemia to progress irreversibly.

Reference: RACGP Australian Family Physician, 'Acute scrotal pain' (2013); supported by systematic review of testicular torsion management emphasizing urgent exploration within six hours (Cureus 2025, PMC12535219), https://www.racgp.org.au/afp/2013/november/acute-scrotal-pain