Case Study: Evaluation and Management of Acute Flank Pain
Assignment Instructions:
A 34-y.o. female presents with the complaint of a sudden excruciating pain in her back
and points to her flank area on the right side. She rates the pain as 10 on a scale of 1 to
10, with 10 being the worst. She also complains of nausea with the pain. She states that
she has never had anything like this before, and the pain is subsiding a little now.
1. What additional questions should you ask the patient and why?
2. What should be included in the physical examination at this visit?
3. What are the possible differential diagnoses at this time?
4. What tests should you order and why?
5. How should this patient be managed?
, When evaluating a 34-year-old female presenting with sudden, severe right-sided flank
pain rated as 10/10 and associated with nausea, a thorough clinical approach is essential
to arrive at an accurate diagnosis and provide appropriate management. The following
sections outline key additional questions, components of the physical examination,
differential diagnoses, diagnostic testing, and management strategies.
Additional Questions to Ask the Patient:
A detailed history is critical to clarify the nature of the pain and associated symptoms.
Important questions include:
- Onset, duration, and pattern: Did the pain come on suddenly or gradually? How long
has it lasted? Is it intermittent or constant?
- Character of pain: How does she describe the pain (sharp, cramping, burning)? Does it
radiate to the groin, abdomen, or elsewhere?
- Associated urinary symptoms: Any dysuria, hematuria (visible blood in urine),
frequency, or urgency?
- Gastrointestinal symptoms: Any vomiting, diarrhea, constipation, or abdominal
bloating?
- Gynecologic history: Last menstrual period, possibility of pregnancy, history of ovarian
cysts, or pelvic pain?
- Past medical history: Any known history of kidney stones, urinary tract infections,
gastrointestinal conditions, or surgeries?
- Risk factors: Fluid intake, dietary patterns, family history of nephrolithiasis, history of
trauma, or recent infections.
These questions help differentiate renal, gastrointestinal, musculoskeletal, and
gynecologic causes of flank pain.
Physical Examination:
The physical exam should be comprehensive, with emphasis on abdominal and
genitourinary systems:
- General appearance: Level of distress, hydration status, vital signs (including blood
pressure, heart rate, temperature).
- Abdominal exam: Inspection, auscultation, palpation, and percussion for tenderness,
Assignment Instructions:
A 34-y.o. female presents with the complaint of a sudden excruciating pain in her back
and points to her flank area on the right side. She rates the pain as 10 on a scale of 1 to
10, with 10 being the worst. She also complains of nausea with the pain. She states that
she has never had anything like this before, and the pain is subsiding a little now.
1. What additional questions should you ask the patient and why?
2. What should be included in the physical examination at this visit?
3. What are the possible differential diagnoses at this time?
4. What tests should you order and why?
5. How should this patient be managed?
, When evaluating a 34-year-old female presenting with sudden, severe right-sided flank
pain rated as 10/10 and associated with nausea, a thorough clinical approach is essential
to arrive at an accurate diagnosis and provide appropriate management. The following
sections outline key additional questions, components of the physical examination,
differential diagnoses, diagnostic testing, and management strategies.
Additional Questions to Ask the Patient:
A detailed history is critical to clarify the nature of the pain and associated symptoms.
Important questions include:
- Onset, duration, and pattern: Did the pain come on suddenly or gradually? How long
has it lasted? Is it intermittent or constant?
- Character of pain: How does she describe the pain (sharp, cramping, burning)? Does it
radiate to the groin, abdomen, or elsewhere?
- Associated urinary symptoms: Any dysuria, hematuria (visible blood in urine),
frequency, or urgency?
- Gastrointestinal symptoms: Any vomiting, diarrhea, constipation, or abdominal
bloating?
- Gynecologic history: Last menstrual period, possibility of pregnancy, history of ovarian
cysts, or pelvic pain?
- Past medical history: Any known history of kidney stones, urinary tract infections,
gastrointestinal conditions, or surgeries?
- Risk factors: Fluid intake, dietary patterns, family history of nephrolithiasis, history of
trauma, or recent infections.
These questions help differentiate renal, gastrointestinal, musculoskeletal, and
gynecologic causes of flank pain.
Physical Examination:
The physical exam should be comprehensive, with emphasis on abdominal and
genitourinary systems:
- General appearance: Level of distress, hydration status, vital signs (including blood
pressure, heart rate, temperature).
- Abdominal exam: Inspection, auscultation, palpation, and percussion for tenderness,
