What is the classic clinical presentation of testicular torsion?

• A. Gradual dull ache over weeks
• B. Painless lump in the scrotum
• C. Recurrent scrotal swelling relieved by elevation
• D. Sudden severe unilateral testicular pain with nausea and vomiting; high-riding testis and absent cremasteric reflex

Answer: (D)

Testicular torsion is an emergency where the spermatic cord twists, cutting off the testis’s blood supply. The hallmark is a sudden, severe unilateral testicular pain that starts abruptly and is often accompanied by nausea or vomiting. On examination the affected testis is typically high-riding within the scrotum, and the cremasteric reflex on that side is absent. These signs together strongly point to torsion and signal the need for urgent intervention to try to save the testis, since viability diminishes quickly with time. Signs like a gradual dull ache, a painless lump, or swelling relieved by elevation point to other conditions such as epididymo-orchitis or a scrotal mass, not torsion.