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Suspected testicular torsion — MSRA MCQ

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HardUrologySuspected testicular torsionMSRA

A 19-year-old man presents to a GP urgent-care service with 3 hours of severe left testicular pain that woke him from sleep. He has vomited twice. He reports a new sexual partner 2 weeks ago and mild urethral discomfort yesterday, but has no urethral discharge, dysuria, urinary frequency, fever or recent trauma. Urine dipstick shows trace leucocytes and is negative for nitrites. The left hemiscrotum is swollen; the left testis is diffusely tender, lies high and transversely, and the epididymis is not separately enlarged or tender. The right testis is normal. What is the most appropriate immediate management plan?

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

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Correct answer: B — Make the patient nil by mouth, give analgesia, and arrange immediate emergency assessment by on-call urology without awaiting imaging

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

This presentation should be managed as testicular torsion until proven otherwise. The decisive features are sudden severe unilateral pain waking him from sleep, vomiting, and an abnormally high transverse lie of the testis. These features outweigh the potentially distracting history of a new sexual partner, mild urethral discomfort and trace urine leucocytes. Epididymo-orchitis more typically has epididymal swelling or tenderness and may be accompanied by discharge, urinary symptoms or pyrexia; none is sufficiently convincing here to safely deprioritise torsion. Testicular torsion is a time-critical surgical emergency, with testicular salvage declining rapidly after around 6 hours. He therefore requires immediate urological assessment, analgesia and nil-by-mouth status in anticipation of possible exploration. Imaging must not delay referral when clinical suspicion is high. A and C inappropriately prioritise possible sexually transmitted epididymo-orchitis. B is unsafe because a Doppler ultrasound should not be used to delay urgent urological review in suspected torsion. E is inappropriate because outpatient investigation and observation risk irreversible ischaemic testicular injury.

Reference: Scrotal conditions — NHS Greater Glasgow and Clyde Primary Care (Reviewed 1 April 2026) — https://www.rightdecisions.scot.nhs.uk/ggc-primary-care/urology/scrotal-conditions/ Acute Testicular Pain Pathway — Glasgow Royal Infirmary Urology (2025) — https://rightdecisions.scot.nhs.uk/media/yhdhtxqp/acute-testicular-pain-pathway.pdf Epididymo-orchitis — Clinical features (Reviewed 28 January 2024) — https://www.rightdecisions.scot.nhs.uk/nhs-dumfries-galloway-refhelp/sexual-health/other-sexual-health-guidelines/epididymo-orchitis/clinical-features/