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Suspected renal colic in the third trimester of pregnancy — MSRA MCQ

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HardUrologySuspected renal colic in the third trimester of pregnancyMSRA

A 31-year-old woman who is 33 weeks pregnant presents to an urgent GP service with 6 hours of severe right-sided loin pain radiating to the groin. She is restless and vomited once. Her temperature is 36.8°C, heart rate 92 beats/min and blood pressure 118/74 mmHg. She has right costovertebral-angle tenderness. Urine dipstick is positive for blood but negative for nitrites and leucocytes. Her creatinine is 63 micromol/L. She has no vaginal bleeding, uterine contractions or rupture of membranes. Renal colic is suspected. What is the most appropriate immediate management plan?

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

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Correct answer: E — Arrange same-day hospital assessment for urgent renal ultrasound and give intravenous paracetamol

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

This patient has a typical presentation of renal colic without features suggesting an infected obstructed system: she is afebrile, haemodynamically stable, has no pyuria or nitrituria, and renal function is normal. However, pregnancy changes both the imaging and analgesic sequence. NICE recommends urgent imaging within 24 hours for suspected renal colic; in pregnancy, ultrasound is used instead of CT because of fetal radiation exposure. NSAIDs are normally first-line analgesia for renal colic, but diclofenac is contraindicated in the third trimester. NICE therefore recommends intravenous paracetamol when NSAIDs are contraindicated or insufficient. A is incorrect because both non-contrast CT and diclofenac are inappropriate at 33 weeks' gestation. C is premature: alpha-blockers may be considered for confirmed distal ureteric stones under 10 mm, but should not substitute for urgent diagnostic imaging in this presentation. D provides appropriate analgesia but uses CT despite pregnancy. E risks delayed diagnosis and inadequate analgesia; suspected renal colic in pregnancy requires urgent ultrasound assessment rather than community observation alone.

Reference: NICE NG118: Renal and ureteric stones: assessment and management — Recommendations (2019) — https://www.nice.org.uk/guidance/ng118/chapter/Recommendations Diclofenac sodium Dexcel SR 75 mg Prolonged-release Tablets — Summary of Product Characteristics (2026) — https://www.medicines.org.uk/emc/product/2661/smpc NICE QS195: Renal and ureteric stones — Quality statement 1: Diagnostic imaging (2020) — https://www.nice.org.uk/guidance/qs195/chapter/Quality-statement-1-Diagnostic-imaging