COMSAE Form 110 – Complete Exam: 33-Year-
Old Female with Acute Flank Pain | 50
Questions with Answer Key & Step-by-Step
Rationales | Ideal for COMLEX Level 1 / NRNP
Exam Prep
Question 1
A 33-year-old woman presents with acute right-sided flank pain radiating to the groin, associated
with dysuria and nausea. Vital signs are stable. Which of the following is the most likely
diagnosis?
A. Pyelonephritis
B. Urolithiasis (Kidney Stone)
C. Musculoskeletal back pain
D. Ovarian cyst
E. Renal infarction
Answer: B. Urolithiasis (Kidney Stone)
Explanation:
• Colicky flank pain radiating to the groin, hematuria, and CVA tenderness are classic for
kidney stones.
• Pyelonephritis usually presents with fever and systemic symptoms.
• Musculoskeletal pain is usually associated with movement or trauma.
• Ovarian cyst would cause lower abdominal/pelvic pain rather than flank radiation.
• Renal infarction is rare and presents with sudden, severe flank pain with hematuria.
Question 2
Which imaging modality is considered first-line to confirm a ureteral stone in this patient?
,A. Ultrasound of the kidney
B. Non-contrast CT scan of kidneys, ureters, bladder (CT KUB)
C. MRI of the abdomen
D. X-ray KUB
E. Intravenous pyelogram (IVP)
Answer: B. Non-contrast CT scan of kidneys, ureters, bladder (CT KUB)
Explanation:
• Non-contrast CT KUB is the gold standard for detecting kidney stones due to high
sensitivity and specificity.
• Ultrasound is useful in pregnant patients or when radiation is contraindicated.
• X-ray may miss small stones.
• MRI and IVP are rarely used first-line.
Question 3
Which of the following labs would you expect in a patient with an uncomplicated distal ureteral
stone?
A. Elevated creatinine and BUN
B. Leukocytosis, hematuria, mild leukocyte esterase on urinalysis
C. Positive nitrites and pyuria
D. Hyperkalemia
E. Severe metabolic acidosis
Answer: B. Leukocytosis, hematuria, mild leukocyte esterase on urinalysis
Explanation:
• Stones often cause microscopic hematuria and mild inflammatory response.
• Nitrites are more specific for bacterial UTI.
• Severe metabolic or electrolyte derangements are not expected in uncomplicated stones.
Question 4
Which medication is used to facilitate stone passage in patients with distal ureteral stones?
A. Furosemide
B. Tamsulosin
C. Acetaminophen
, D. Ciprofloxacin
E. Hydrochlorothiazide
Answer: B. Tamsulosin
Explanation:
• Alpha-blockers like tamsulosin relax ureteral smooth muscle and increase stone passage
rates.
• Furosemide and hydrochlorothiazide are diuretics, not indicated acutely.
• Acetaminophen is analgesic only.
• Ciprofloxacin is for infection, not stone passage.
Question 5
Which of the following is the most important patient instruction for conservative management
of a 5 mm distal ureteral stone?
A. Restrict fluids to prevent overhydration
B. Increase oral fluid intake to 2–3 L/day
C. Bed rest for 2 weeks
D. Avoid NSAIDs to prevent kidney damage
E. Limit urination to once every 4 hours
Answer: B. Increase oral fluid intake to 2–3 L/day
Explanation:
• Adequate hydration promotes stone passage.
• NSAIDs are indicated for pain unless contraindicated.
• Bed rest or fluid restriction is not beneficial.
• Frequent urination helps flush the urinary system.
Question 6
The patient calls the clinic reporting fever of 101.5°F and worsening flank pain. What is the
most appropriate next step?
A. Continue conservative management at home
B. Urgent referral to the emergency department
C. Prescribe oral analgesics only
Old Female with Acute Flank Pain | 50
Questions with Answer Key & Step-by-Step
Rationales | Ideal for COMLEX Level 1 / NRNP
Exam Prep
Question 1
A 33-year-old woman presents with acute right-sided flank pain radiating to the groin, associated
with dysuria and nausea. Vital signs are stable. Which of the following is the most likely
diagnosis?
A. Pyelonephritis
B. Urolithiasis (Kidney Stone)
C. Musculoskeletal back pain
D. Ovarian cyst
E. Renal infarction
Answer: B. Urolithiasis (Kidney Stone)
Explanation:
• Colicky flank pain radiating to the groin, hematuria, and CVA tenderness are classic for
kidney stones.
• Pyelonephritis usually presents with fever and systemic symptoms.
• Musculoskeletal pain is usually associated with movement or trauma.
• Ovarian cyst would cause lower abdominal/pelvic pain rather than flank radiation.
• Renal infarction is rare and presents with sudden, severe flank pain with hematuria.
Question 2
Which imaging modality is considered first-line to confirm a ureteral stone in this patient?
,A. Ultrasound of the kidney
B. Non-contrast CT scan of kidneys, ureters, bladder (CT KUB)
C. MRI of the abdomen
D. X-ray KUB
E. Intravenous pyelogram (IVP)
Answer: B. Non-contrast CT scan of kidneys, ureters, bladder (CT KUB)
Explanation:
• Non-contrast CT KUB is the gold standard for detecting kidney stones due to high
sensitivity and specificity.
• Ultrasound is useful in pregnant patients or when radiation is contraindicated.
• X-ray may miss small stones.
• MRI and IVP are rarely used first-line.
Question 3
Which of the following labs would you expect in a patient with an uncomplicated distal ureteral
stone?
A. Elevated creatinine and BUN
B. Leukocytosis, hematuria, mild leukocyte esterase on urinalysis
C. Positive nitrites and pyuria
D. Hyperkalemia
E. Severe metabolic acidosis
Answer: B. Leukocytosis, hematuria, mild leukocyte esterase on urinalysis
Explanation:
• Stones often cause microscopic hematuria and mild inflammatory response.
• Nitrites are more specific for bacterial UTI.
• Severe metabolic or electrolyte derangements are not expected in uncomplicated stones.
Question 4
Which medication is used to facilitate stone passage in patients with distal ureteral stones?
A. Furosemide
B. Tamsulosin
C. Acetaminophen
, D. Ciprofloxacin
E. Hydrochlorothiazide
Answer: B. Tamsulosin
Explanation:
• Alpha-blockers like tamsulosin relax ureteral smooth muscle and increase stone passage
rates.
• Furosemide and hydrochlorothiazide are diuretics, not indicated acutely.
• Acetaminophen is analgesic only.
• Ciprofloxacin is for infection, not stone passage.
Question 5
Which of the following is the most important patient instruction for conservative management
of a 5 mm distal ureteral stone?
A. Restrict fluids to prevent overhydration
B. Increase oral fluid intake to 2–3 L/day
C. Bed rest for 2 weeks
D. Avoid NSAIDs to prevent kidney damage
E. Limit urination to once every 4 hours
Answer: B. Increase oral fluid intake to 2–3 L/day
Explanation:
• Adequate hydration promotes stone passage.
• NSAIDs are indicated for pain unless contraindicated.
• Bed rest or fluid restriction is not beneficial.
• Frequent urination helps flush the urinary system.
Question 6
The patient calls the clinic reporting fever of 101.5°F and worsening flank pain. What is the
most appropriate next step?
A. Continue conservative management at home
B. Urgent referral to the emergency department
C. Prescribe oral analgesics only
