مراهق عمره ١٥ سنة استيقظ من النوم بألم شديد مفاجئ في الخصية اليسرى مع غثيان وقيء منذ ساعتين. الخصية مرتفعة ومتورمة ومؤلمة جداً، ومنعكس المشمرة غائب. الحرارة ٣٧٫٢. ما الإجراء الأنسب؟

A 15-year-old woke with sudden severe left testicular pain, nausea and vomiting two hours ago. The testis is high-riding, swollen and very tender with an absent cremasteric reflex. T 37.2 °C. What is the most appropriate action?

1. Warm compresses, analgesia and home observation until tomorrow
2. Urgent surgical assessment for possible testicular torsion
3. Oral antibiotics and clinic follow-up in a week
4. A urine test only, waiting for results before acting

Answer: B) Urgent surgical assessment for possible testicular torsion. Sudden severe pain, a high-riding testis and absent cremasteric reflex mean torsion until proven otherwise; time is critical, ideally within 6 hours.