NREMT Paramedic Cognitive ExamMedicalMedium
A 40-year-old male presents with sudden-onset severe right flank pain radiating to his groin, accompanied by nausea and vomiting. He denies fever or dysuria. His vital signs are stable. On examination, he is restless and unable to find a comfortable position. His abdomen is soft and non-tender to palpation. What is the most likely diagnosis?
- ANephrolithiasis
- BCholecystitis
- CDiverticulitis
- DAppendicitis
Show answer & explanationAnswer & explanation
Correct answer: A. Nephrolithiasis
The sudden onset of severe, colicky flank pain radiating to the groin, accompanied by nausea/vomiting, and the patient's restlessness (renal colic) are classic signs of nephrolithiasis (kidney stones). The absence of fever and non-tender abdomen further differentiate it from infections or inflammatory conditions.
Why the other options are wrong
- B. Cholecystitis (gallbladder inflammation) causes right upper quadrant pain, often radiating to the shoulder, and typically associated with fatty meals and fever.
- C. Diverticulitis usually causes left lower quadrant pain, often with fever, and localized tenderness.
- D. Appendicitis typically causes periumbilical pain migrating to the right lower quadrant, often with fever and localized tenderness.
Nephrolithiasis (Kidney Stones)
Formation of mineral deposits in the kidneys that can cause severe, colicky pain when they obstruct the ureter.
- Pain is typically sudden, severe, and radiates from flank to groin.
- Patients are often restless and unable to find a comfortable position.
- May be accompanied by nausea, vomiting, and hematuria (blood in urine).
Memory trick: FLANK-GROIN-NAUSEA-RESTLESS = KIDNEY STONE CRUSH!