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Nephrolithiasis — MCCQE Part 1 MCQ

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HardBlood in UrineNephrolithiasisMCCQE Part 1

A 45-year-old man has a first episode of severe colicky flank pain radiating to the groin and microscopic haematuria. He is afebrile, renal function is normal, pain is controlled and there is no known stone history. What is the most appropriate next step?

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Correct answer: B — Provide NSAID analgesia and obtain low-dose non-contrast CT to define stone size and location

NSAIDs are preferred initial analgesia when not contraindicated. In a first adult presentation, low-dose non-contrast CT is the most accurate test for stone size, position and obstruction and informs whether observation, medical expulsive therapy or urologic intervention is appropriate. Ultrasound is preferred in pregnancy and may be used in selected recurrent uncomplicated presentations, but a blanket discharge without risk assessment is unsafe.

Reference: https://pmc.ncbi.nlm.nih.gov/articles/PMC9245965/; https://www.cua.org/system/files/Guideline-Files/7581_v6.pdf