Code Status case · Beginner · Premium
Flank pain in a 36-year-old man
“I can't get comfortable, no matter how I move.”
“Sudden left flank pain for about three hours. Restless, can't get comfortable. Nauseated and vomited once. He's in a lot of pain.”
Your challenge
Robert cannot keep still. His left side has hurt for three hours, he has vomited once, and no position helps. Appendicitis, a kidney stone, a kidney infection, a twisted testicle and a pulled muscle can all start like this. Pain relief comes first, but the real decisions are which scan to order, what makes this an emergency instead of a bad day, and when it is safe to send him home.
After the case, Attending’s Notes explains the decisions that mattered, backed by 10 sources.
Ready to make the call?
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Spoiler: the diagnosis and what this case teaches
Diagnosis
Renal Colic
Lesson 1
Flank Pain and Blood in Urine Suggest a Stone
A classic pattern can strongly suggest a stone. It does not prove one.
- Sudden flank pain in waves suggests renal colic
- Blood in urine supports a stone but does not prove it
- Broaden workup for fever or abnormal abdominal exam
Lesson 2
Obstruction Plus Infection Is the Emergency
Antibiotics alone may not control infection behind a blockage.
- Hydronephrosis means urine is backing up
- Infection plus obstruction needs urgent drainage
- No single test excludes infection with obstruction
- Involve urology early when kidney function is threatened
Lesson 3
Use CT When Stone Details or Alternatives Matter
Ultrasound may answer the immediate question with no radiation.
- CT shows stone size, location, and other causes
- Ultrasound can show hydronephrosis
- Abdominal X-rays cannot reliably exclude a stone
- Not every stone patient needs a scan today
Lesson 4
Discharge Needs Symptom Control and Kidney Safety
Pain control matters but discharge depends on the whole reassessment.
- Start an NSAID if kidney and bleeding risks allow
- Give fluids for dehydration, not to flush the stone
- Smaller stones near the bladder pass more often
- Control symptoms and confirm kidney safety
In the app, every line above opens into the detail behind it: doses, pitfalls and the evidence, with 10 sources linked to the originals.
Robert is a fictional patient. Code Status is for training only and is not intended for real-world patient care, diagnosis, treatment, or clinical decision-making.