Rosh Pediatrics Practice Exam

If a pediatric patient has a high-riding left scrotum, what is the most likely clinical concern?

1. Inguinal hernia

2. Testicular torsion

3. Epididymitis

4. Hydrocele

The correct answer is: Testicular torsion

A high-riding left scrotum in a pediatric patient is often associated with testicular torsion. This condition occurs when the spermatic cord becomes twisted, compromising the blood supply to the testicle. The presenting features include an acutely painful, swollen, and often retracted or high-riding testicle in the scrotum. This anatomical change is a critical indicator that demands immediate medical evaluation, as testicular torsion can lead to necrosis of the testicle if left untreated. Recognizing the clinical presentation of a high-riding testicle is vital for timely intervention. If left untreated, testicular torsion can result in severe complications, including loss of the testicle. This is particularly concerning in pediatric populations, as preserving future reproductive function and normal anatomy is essential. In contrast, the other options—inguinal hernia, epididymitis, and hydrocele—while they can present with scrotal symptoms, typically do not feature a high-riding testicle as a common clinical finding. Inguinal hernias usually present with a palpable mass and are less likely to lead to an abnormal position of the testicle without torsion. Epididymitis is characterized by pain and swelling but the testicle typically remains