A 15 year-old with severe pain and swelling in the right testis would most likely have which examination finding?

In the scenario of a 15-year-old presenting with severe pain and swelling in the right testis, the finding of a high-lying testis suggests the likelihood of testicular torsion. Testicular torsion typically occurs with acute onset of symptoms, and one of the hallmark examination findings is a higher position of the affected testis due to the twisting of the spermatic cord, which affects the blood supply and can lead to necrosis if not treated promptly.

Testicular torsion is an emergency situation that requires immediate surgical intervention, and the high-lying position can help clinicians suspect this condition upon physical examination. Other findings might include absence of the cremasteric reflex on the affected side.

Other possible examination findings include a nodular mass within the testis, which could indicate a testicular tumor rather than an acute process; transilluminated fluid mass suggests the presence of a hydrocele or cyst, and palpation of a soft bag of worms refers to varicocele. None of these findings are as directly indicative of acute testicular pain and swelling as a high-lying testis.