flank pain

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

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 man with a history of smoking, hypertension, and dyslipidaemia presents for investigation of intermittent flank pain. Physical examination is unremarkable. Routine blood tests are normal. A CT scan of the abdomen is performed. Considering the findings demonstrated in the image, what is the most appropriate next step in the management of this patient?

A. Surveillance with abdominal ultrasound in 12 months

B. Urgent referral for surgical assessment and repair planning

C. Referral for immediate endovascular aneurysm repair

D. No specific follow-up imaging required, focus on risk factor modification

E. Repeat CT scan of the abdomen in 3 months

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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?

A. Prescribe tamsulosin and arrange outpatient follow-up.

B. Repeat the renal ultrasound in 24 hours.

C. Perform a retrograde pyelogram.

D. Arrange a non-contrast CT scan of the kidneys, ureters, and bladder.

E. Obtain a plain abdominal X-ray (KUB).

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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?

A. Intravenous fluids only

B. Observation and repeat urinalysis

C. Pain management with NSAIDs

D. Intravenous antibiotics

E. Oral antibiotics

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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?

A. Referral to vascular surgery for elective repair

B. Order a renal ultrasound to evaluate for hydronephrosis

C. Prescribe analgesics and schedule a repeat CT scan in 6 months

D. Start oral antibiotics for suspected pyelonephritis

E. Initiate intravenous heparin and consult vascular surgery for urgent repair

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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?

A. Prescribe oral tamsulosin and discharge home

B. Insert an indwelling urinary catheter

C. Consult urology for emergent stent placement

D. Order a non-contrast CT scan of the abdomen and pelvis

E. Administer intravenous ketorolac

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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, which of the following developments would most strongly necessitate urgent urological intervention?

A. Discovery of bilateral hydronephrosis on repeat imaging.

B. Passage of a small stone fragment.

C. Persistence of severe pain despite adequate analgesia.

D. Development of fever and rigors.

E. Increase in serum creatinine to 150 µmol/L.

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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?

A. Spasm of the renal artery

B. Increased pressure within the renal pelvis and collecting system

C. Ischaemia of the renal medulla

D. Distension of the renal capsule due to oedema

E. Inflammation of the renal parenchyma

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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?

A. Discharge with analgesia and follow-up

B. Increase oral fluid intake and reassess in 24 hours

C. Refer for immediate nephrectomy

D. Non-contrast CT of the abdomen and pelvis

E. Administer intravenous antibiotics

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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?

A. Administer intravenous ketorolac and discharge with outpatient urology follow-up

B. Consult nephrology for possible percutaneous nephrostomy

C. Order a non-contrast CT scan of the abdomen and pelvis

D. Insert a Foley catheter to monitor urine output

E. Start intravenous antibiotics for presumed pyelonephritis

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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?

A. Cholecystitis with referred pain

B. Appendicitis with atypical presentation

C. Musculoskeletal strain

D. Pyelonephritis secondary to ascending urinary tract infection

E. Diverticulitis of the ascending colon

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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?

A. Admit for observation, serial renal function tests, and pain management.

B. Arrange urgent non-contrast CT scan of the kidneys, ureters, and bladder.

C. Arrange urgent flexible cystoscopy and retrograde pyelography.

D. Administer intravenous fluids, opioid analgesia, and prescribe tamsulosin for medical expulsive therapy.

E. Urgent urology consultation for consideration of upper tract decompression.

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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?

A. Consult urology for emergent ureteroscopy

B. Start intravenous fluids at 250 mL/hr

C. Order a non-contrast CT scan of the abdomen and pelvis

D. Discharge home with tamsulosin and analgesics

E. Administer intravenous ketorolac

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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?

A. Discharge with analgesics and follow-up with urology

B. Administer IV antibiotics

C. Non-contrast CT of the abdomen and pelvis

D. Increase oral fluid intake and reassess in 2 hours

E. Refer for immediate surgical intervention

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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?

A. Non-contrast CT of the abdomen and pelvis

B. Refer for immediate nephrostomy tube placement

C. Repeat ultrasound in 24 hours

D. Discharge with analgesics and follow-up with urology

E. Administer IV antibiotics

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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?

A. Stretching of the renal capsule due to rapid kidney enlargement from a mass.

B. Direct irritation of nerve endings in the bladder wall.

C. Ischaemia of the renal cortex due to vascular compromise.

D. Inflammation of the renal parenchyma due to infection.

E. Increased pressure within the renal pelvis and ureter proximal to an obstruction.

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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?

A. Consult nephrology for possible percutaneous nephrostomy

B. Insert a Foley catheter to monitor urine output

C. Prescribe oral antibiotics for presumed pyelonephritis

D. Order a non-contrast CT scan of the abdomen and pelvis

E. Administer intravenous ketorolac and discharge with outpatient urology follow-up

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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?

A. Polycystic kidney disease

B. Pyelonephritis

C. Glomerulonephritis

D. Ureterolithiasis

E. Renal cell carcinoma

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A. Non-contrast CT of the abdomen and pelvis

B. Perform intravenous pyelogram

C. Insert a Foley catheter

D. Administer intravenous antibiotics

E. Discharge with analgesics and follow-up with urology

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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?

A. Polycystic kidney disease

B. Renal cell carcinoma

C. Acute pyelonephritis

D. Ureteral obstruction

E. Renal vein thrombosis

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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?

A. X-ray of the abdomen

B. Intravenous pyelogram (IVP)

C. Abdominal ultrasound

D. MRI of the abdomen

E. Non-contrast CT scan of the abdomen and pelvis

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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?

A. Initiate empirical broad-spectrum intravenous antibiotics.

B. Prescribe oral tamsulosin and diclofenac and discharge home.

C. Urgent urology consultation for potential decompression.

D. Administer intravenous fluids and opioid analgesia and observe for spontaneous stone passage.

E. Arrange a non-contrast CT KUB as the definitive imaging modality.

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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?

A. Perform a cystoscopy

B. Discharge with analgesics and follow-up with urology

C. Non-contrast CT of the abdomen and pelvis

D. Order serum lipase and amylase

E. Administer intravenous antibiotics

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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. Considering the patient's presentation and the findings demonstrated in the provided image, the most likely primary mechanism responsible for the severe pain experienced by this patient is:

A. Ischaemic injury to the renal tubules resulting from compromised blood flow.

B. Increased hydrostatic pressure leading to distension of the renal pelvis and collecting system.

C. Reflex spasm of the psoas muscle due to ureteral irritation.

D. Direct irritation of sensory nerve endings in the ureteral wall by the obstructing object.

E. Inflammatory response within the renal parenchyma secondary to bacterial invasion.

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flank pain

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