NREMT Paramedic Cognitive ExamMedicalMedium
A 22-year-old male presents with sudden onset of severe, excruciating pain in his right testicle. He reports the pain started abruptly an hour ago and is accompanied by nausea and mild swelling of the scrotum. On examination, the right testicle is high-riding and exquisitely tender to touch. What is the MOST likely diagnosis?
- AEpididymitis
- BOrchitis
- CTesticular torsion
- DInguinal hernia
Show answer & explanationAnswer & explanation
Correct answer: C. Testicular torsion
The sudden onset of severe, excruciating unilateral testicular pain, especially when accompanied by a high-riding testicle and nausea, is highly indicative of testicular torsion. This is a surgical emergency requiring immediate intervention to save the testicle.
Why the other options are wrong
- A. Epididymitis typically has a more gradual onset of pain, often associated with dysuria or fever, and the testicle is usually in a normal position.
- B. Orchitis (inflammation of the testicle) usually presents with more generalized testicular pain, swelling, and systemic symptoms like fever, often secondary to a viral infection (e.g., mumps).
- D. An inguinal hernia typically presents as a bulge in the groin that may or may not be painful, and while it can involve the scrotum, it's less likely to cause such acute, excruciating testicular pain without a palpable mass in the groin.
Testicular Torsion
Testicular torsion is a surgical emergency where the spermatic cord twists, cutting off blood supply to the testicle. It presents with sudden, severe testicular pain and requires rapid diagnosis and intervention.
- Sudden, severe, unilateral testicular pain.
- High-riding testicle and absence of cremasteric reflex are classic signs.
- Time-sensitive: irreversible damage can occur within hours.
Memory trick: Twisted testicle? Time is tissue!