A 25-year-old man presents with severe testicular pain and swelling. He is febrile, and Prehn’s sign is negative. Examination reveals an absent cremasteric reflex. What is the most likely diagnosis? A) Testicular torsion B) Epididymo-orchitis C) Inguinal hernia D) Fournier’s gangrene E) Hydrocele Correct Answer: A) Testicular torsion Explanation: Testicular torsion is a surgical emergency causing acute scrotal pain, absent cremasteric reflex, and a negative Prehn’s sign (lifting the testicle does not relieve pain). B) Epididymo-orchitis → Incorrect. Typically has a positive Prehn’s sign (pain relief on lifting the testicle) and is infective. C) Inguinal hernia → Incorrect. May cause swelling but not acute severe testicular pain. D) Fournier’s gangrene → Incorrect. A necrotising soft tissue infection, usually in diabetics, causing rapid sepsis. E) Hydrocele → Incorrect. Painless fluid collection around the testicle, transilluminates. Key Tips for PLAB 1: ✅ Testicular torsion = Absent cremasteric reflex + negative Prehn’s sign. ✅ Diagnosis = Urgent Doppler ultrasound. ✅ Treatment = Immediate surgical exploration & orchidopexy.
