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Suspected renal colic — MSRA MCQ

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ModerateNephrolithiasisSuspected renal colicMSRA

A 38-year-old woman presents to her GP with 5 hours of abrupt right-sided colicky flank pain radiating to the groin, associated with vomiting. She had a ureteric stone 9 years ago. Temperature is 36.8°C, pulse 88 beats/minute and BP 124/76 mmHg. She has right renal-angle tenderness. Urine dipstick shows blood 3+ but nitrites and leucocytes are negative. Serum creatinine is at baseline. Her last menstrual period was 9 days ago and a urine pregnancy test is negative. Which is the most appropriate next diagnostic investigation?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Refer for urgent low-dose non-contrast CT within 24 hours of presentation

Explanation lettering: D = shown as C · E = shown as D · C = shown as E

This adult has suspected renal colic: acute colicky flank-to-groin pain, vomiting, renal-angle tenderness and haematuria support the diagnosis, while normal observations, preserved renal function and a negative dipstick for infection make an infected obstructed system less likely. She is not pregnant. NICE recommends urgent low-dose non-contrast CT within 24 hours for adults with suspected renal colic. This identifies both stones and important alternative diagnoses, and defines stone size and location to guide subsequent management. A and D are inappropriate because ultrasound is not first-line imaging for non-pregnant adults with suspected renal colic; it is first-line in pregnancy and in children and young people. B is inappropriate because intravenous contrast is not required for initial stone detection and may obscure calculi. C introduces an unnecessary ultrasound-first sequence that delays the recommended definitive investigation. Although previous stone disease increases the likelihood of recurrence, it does not remove the need for CT confirmation in this new acute presentation.

Reference: NICE NG118: Renal and ureteric stones: assessment and management — Recommendations (Published 8 January 2019; current NICE guidance checked August 2026) — https://www.nice.org.uk/guidance/ng118/chapter/Recommendations NICE Quality Standard QS195: Quality statement 1 — Diagnostic imaging (29 July 2020) — https://www.nice.org.uk/guidance/qs195/chapter/Quality-statement-1-Diagnostic-imaging