Which feature would be least typical of testicular torsion?

• A. Fever
• B. Sudden onset severe pain
• C. Nausea
• D. High-riding, horizontal testis

Answer: (B)

Testicular torsion is an emergency caused by twisting of the spermatic cord, which abruptly cuts off blood supply to the testis. The most telling presentation is an abrupt, severe pain that starts suddenly and is often accompanied by nausea or vomiting. On exam, the affected testis typically lies higher than normal and sits more horizontally due to the twisting and the attendant muscular responses. The cremasteric reflex is usually diminished or absent.

Fever, by contrast, is not a typical feature of torsion. Fever points more toward an infectious process like epididymo-orchitis or epididitis, which usually has a more gradual onset and different exam findings. So among the given features, fever best stands out as least typical for torsion, while sudden onset severe pain, nausea, and a high-riding, horizontally oriented testis all align with torsion.