NREMT Paramedic Cognitive ExamMedicalMedium
A 22-year-old male presents with acute onset of severe testicular pain, swelling, and redness. He denies any recent trauma or fever. On examination, the affected testis is elevated, and the cremasteric reflex is absent on the affected side. What is the most likely diagnosis?
- AEpididymitis
- BHydrocele
- CTesticular torsion
- DOrchitis
Show answer & explanationAnswer & explanation
Correct answer: C. Testicular torsion
Acute onset of severe testicular pain, swelling, and redness, especially with an elevated testis and an absent cremasteric reflex, are classic signs of testicular torsion. This is a surgical emergency requiring rapid intervention to save the testicle. Epididymitis and orchitis typically have a slower onset, often with fever, and usually a present cremasteric reflex.
Why the other options are wrong
- A. Epididymitis usually has a slower onset, often with dysuria, fever, and a positive Prehn's sign (pain relief with scrotal elevation), and a present cremasteric reflex.
- B. A hydrocele is a fluid collection around the testis, usually painless or causing dull ache, not acute severe pain or an absent cremasteric reflex.
- D. Orchitis is inflammation of the testis, often viral (e.g., mumps), causing pain and swelling, but typically with fever and a present cremasteric reflex.
Testicular Torsion
A urological emergency where the spermatic cord twists, cutting off blood supply to the testicle, causing sudden severe pain and requiring immediate surgical correction.
- Sudden onset of severe, unilateral testicular pain.
- Absent cremasteric reflex on the affected side is a key diagnostic sign.
- Testis may be elevated and horizontal; requires surgery within 6 hours to prevent necrosis.
Memory trick: TORSION: 'T'wisted cord, 'O'ut of reflex, 'R'apid onset, 'S'evere pain, 'I'mmediate surgery, 'O'ut of position testis, 'N'o time to waste.