What might indicate a severe case of testicular torsion during a physical examination?

Severe testicular torsion is characterized by specific physical examination findings. The presence of testicular swelling and severe pain is a hallmark indication of this condition. Testicular torsion occurs when the spermatic cord twists, cutting off the blood supply to the testis. This leads to acute pain, often described as severe, and significant swelling may develop as the condition progresses. The acute onset of severe pain, usually localized to one testicle, along with swelling, is critical in diagnosing testicular torsion and differentiating it from other conditions such as epididymitis or trauma, which may present with different symptoms.

Furthermore, while lower abdominal tenderness may occur in various situations involving abdominal or pelvic pain, it is less specific for testicular torsion. Rhinorrhea and fever and chills do not typically correlate with testicular torsion; they are more associated with respiratory infections or other systemic inflammatory processes rather than an acute scrotal pathology. Thus, the combination of testicular swelling and severe pain strongly indicates a severe case of testicular torsion, making it the correct answer in identifying this medical emergency.