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flank pain

Practice targeted AMC-style multiple-choice questions on flank pain.

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Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k CC BY 2.5 · Source

A 48-year-old woman presents with acute onset severe left flank pain radiating to the groin, associated with nausea. She denies fever or dysuria. Vitals are stable. Urinalysis shows haematuria. Serum creatinine is 75 µmol/L. An ultrasound is performed. Considering the clinical presentation and the findings demonstrated in the provided image, which of the following is the most appropriate next diagnostic step?

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A 32-year-old woman presents to the emergency department with a 2-day history of fever, chills, and right flank pain. She has a history of recurrent urinary tract infections. On examination, she is febrile with a temperature of 38.5°C, her heart rate is 110 bpm, and her blood pressure is 110/70 mmHg. There is tenderness on palpation of the right costovertebral angle. Urinalysis shows pyuria and bacteriuria. What is the most appropriate initial management for this patient?

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A contrast enhanced CT scan demonstrating an abdominal aortic aneurysm of 4.8 * 3.8 cm
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 68-year-old male presents to the emergency department complaining of new onset left flank pain radiating to his groin. He reports a history of hypertension and hyperlipidemia, both managed with medications. He denies any recent trauma. His vital signs are stable: blood pressure 130/80 mmHg, heart rate 88 bpm, respiratory rate 16 breaths/min, and oxygen saturation 98% on room air. Physical examination reveals mild tenderness to palpation in the left flank, but no guarding or rebound tenderness. Peripheral pulses are normal and symmetric. A contrast-enhanced CT scan of the abdomen and pelvis is performed, the axial view is shown. Given the clinical context and the findings on the image, which of the following is the MOST appropriate next step in management?

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Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k CC BY 2.5 · Source

A 45-year-old male presents to the ED with left flank pain radiating to his groin. He reports nausea but denies fever or dysuria. Vitals are stable. A point-of-care ultrasound is performed, with the image shown. Assuming no contraindications, what is the MOST appropriate next step in management?

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Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k CC BY 2.5 · Source

A 38-year-old man presents with sudden onset severe left flank pain radiating to the groin, associated with nausea. He is afebrile, blood pressure 140/90 mmHg, heart rate 95 bpm. Urinalysis shows microscopic haematuria. Serum creatinine is 80 µmol/L. An ultrasound is performed. Considering the clinical presentation and the findings demonstrated in the provided image, which of the following best explains the mechanism of the patient's pain?

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Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k CC BY 2.5 · Source

A 35-year-old male presents with left flank pain and dysuria. An ultrasound is performed. What is the MOST appropriate next step in management?

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Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k CC BY 2.5 · Source

A 38-year-old male presents to the emergency department complaining of sudden onset, severe left flank pain that radiates to his groin. He reports associated nausea and vomiting. He denies any fever, dysuria, or hematuria. His vital signs are: Temperature 37.0°C, Heart Rate 88 bpm, Blood Pressure 130/80 mmHg, Respiratory Rate 16 breaths/min, and SpO2 98% on room air. A urine dipstick is positive for blood. An ultrasound is performed, and the image is shown. Given the clinical presentation and the ultrasound findings, what is the MOST appropriate next step in management?

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A 62-year-old male presents to the emergency department with a 2-day history of right flank pain, fever, and nausea. He reports a history of recurrent urinary tract infections. On examination, he has right costovertebral angle tenderness. Urinalysis reveals pyuria and leukocyte esterase. Which of the following is the most likely underlying condition related to the organ primarily affected in the right lumbar region?

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Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k CC BY 2.5 · Source

A 45-year-old male presents to the emergency department with sudden onset severe left flank pain radiating to the groin. He reports some nausea but no vomiting. His temperature is 37.5°C, pulse 88 bpm, BP 130/80 mmHg, respiratory rate 16/min, oxygen saturation 98% on room air. On examination, he has significant left costovertebral angle tenderness. Urinalysis shows microscopic haematuria and trace leukocytes. His creatinine is 90 µmol/L (baseline unknown). An ultrasound of the kidneys is performed, shown in the image. Based on the clinical presentation and the finding shown in the image, what is the most appropriate immediate next step in management?

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Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k CC BY 2.5 · Source

A 45-year-old male presents to the ED with left flank pain that started suddenly 6 hours ago. He describes the pain as a sharp, cramping sensation radiating to his groin. He also reports nausea and one episode of vomiting. His vital signs are stable: BP 120/80 mmHg, HR 78 bpm, RR 16 breaths/min, Temp 37.1°C. Urine dipstick shows 2+ blood. A renal ultrasound is performed, and the image is shown. Assuming the patient's pain is not controlled with oral analgesics, what is the MOST appropriate next step?

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Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k CC BY 2.5 · Source

A 45-year-old male presents to the ED with left flank pain radiating to his groin. He reports nausea but no vomiting. Vitals are stable. A focused ultrasound is performed, as shown. What is the MOST appropriate next step in management?

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Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k CC BY 2.5 · Source

A 38-year-old woman presents with acute onset left flank pain, radiating to the groin. She reports dysuria and hematuria. Vitals: HR 88, BP 130/80, Temp 37.1°C. A bedside ultrasound is performed, as shown. What is the MOST appropriate next step?

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Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k CC BY 2.5 · Source

A 38-year-old woman presents with sudden onset, severe left flank pain radiating to her groin. She reports associated nausea but denies fever or dysuria. On examination, she is afebrile, blood pressure 125/75 mmHg, heart rate 80 bpm. Urinalysis shows microscopic haematuria. Serum creatinine is 80 µmol/L. An ultrasound is performed. Considering the clinical presentation and the findings demonstrated in the provided image, which of the following is the most likely underlying mechanism causing the patient's pain?

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Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k CC BY 2.5 · Source

A 38-year-old male presents to the emergency department complaining of sudden onset, severe left flank pain that radiates to his groin. He reports associated nausea and vomiting. He denies any fever, dysuria, or hematuria. His vital signs are stable: blood pressure 120/80 mmHg, heart rate 88 bpm, respiratory rate 16 breaths/min, and temperature 37.0°C. A urinalysis reveals microscopic hematuria. A point-of-care ultrasound is performed, and the image is shown. Given the clinical presentation and ultrasound findings, what is the MOST appropriate next step in management?

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Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k CC BY 2.5 · Source

A 45-year-old male presents with left flank pain radiating to the groin. Urinalysis shows microscopic hematuria. What is the MOST likely diagnosis based on the image?

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Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k CC BY 2.5 · Source

A 45-year-old male presents to the ED with left flank pain radiating to his groin. He reports nausea but no vomiting. Vitals are stable. A focused ultrasound is performed, as shown. What is the MOST appropriate next step in management?

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Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k CC BY 2.5 · Source

A 40-year-old male presents with acute, severe left flank pain. An ultrasound is performed. What is the MOST likely underlying cause of the finding on the image?

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A 35-year-old man presents to the emergency department with severe right-sided flank pain that started suddenly and radiates to the groin. He describes the pain as sharp and colicky. He has had similar episodes in the past but never this severe. He denies fever, dysuria, or hematuria. On examination, he is in obvious distress, with a blood pressure of 140/90 mmHg, heart rate of 110 bpm, and respiratory rate of 22 breaths per minute. Abdominal examination reveals tenderness in the right flank but no guarding or rebound tenderness. Urinalysis shows microscopic hematuria. Which of the following is the most appropriate initial imaging study to confirm the diagnosis?

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Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k CC BY 2.5 · Source

A 55-year-old man presents to the emergency department with sudden onset, severe left flank pain radiating to his groin, associated with nausea. He is afebrile, blood pressure 130/80 mmHg, heart rate 85 bpm. Urinalysis shows 20-30 red blood cells per high-power field. Serum creatinine is within normal limits. An ultrasound is performed. Considering the clinical context and the findings demonstrated in the provided image, which of the following is the most appropriate immediate management step?

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Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k CC BY 2.5 · Source

A 45-year-old male presents to the ED with left flank pain radiating to his groin. He reports nausea but no vomiting. Vitals are stable. A focused assessment with sonography for trauma (FAST) exam is performed, with a view obtained as shown. What is the MOST appropriate next step in management?

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