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Renal colic — MCCQE Part 1 MCQ

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EasyAbdominal PainRenal colicMCCQE Part 1

39-year-old man presents with sudden flank pain radiating to the groin. Urinalysis shows haematuria and he is afebrile with normal renal function. Which of the following is the most appropriate next step?

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Correct answer: E — Provide NSAID analgesia, hydration advice and imaging/follow-up based on stone risk

Provide NSAID analgesia, hydration advice and imaging/follow-up based on stone risk is best because classic renal colic without infection can be managed with analgesia and risk-based imaging. Discharge with reassurance and routine follow-up only is suboptimal because it underestimates acute or progressive risk; Treat symptomatically and defer definitive assessment is suboptimal because symptom control alone does not address the likely underlying diagnosis; Arrange non-urgent outpatient imaging in several months is suboptimal because delayed imaging is unsafe when the presentation has red flags; Start long-term corticosteroids without confirming the diagnosis is suboptimal because empiric steroids can obscure infection, malignancy or other diagnoses. Fever, solitary kidney or renal failure changes urgency.

Reference: Canadian Urological Association ureteral calculi guideline