NBME 24 Renal calculi in the left ureter (NBME Answers)

NBME 24 Answers

nbme24/Block 4/Question#22 (reveal difficulty score)
A 45-year-old man is brought to the emergency ...
Renal calculi in the left ureter 🔍 / 📺 / 🌳 / 📖
tags: renal hy

+9 upvote downvote
submitted by ∗sajaqua1(607)

get full access to all content ⋅ pick a username

The keys to this answer are that it is fairly sudden in onset, and migrates. None of the other answers could explain the movement of pain from flank to LLQ to scrotum. While the kidney stone does not actually enter the scrotum, the pain can be referred to the testicles.

get full access to all content ⋅ pick a username

+3 upvote downvote
submitted by ∗sweetmed(157)

get full access to all content ⋅ pick a username

Testicular torsion mostly happens in young boys, rarely in adults. Also the pain started at the flanks, which is not how torsion pain starts.

get full access to all content ⋅ pick a username

j44n I actually had testicular torsion and my pain started in my appendix area and by the time I got to the hospital it localized to my testicle +3

+0 upvote downvote
submitted by ∗madamestep(17)

get full access to all content ⋅ pick a username

Also I'm pretty sure that you're getting the referred pain from irritation of the genitofemoral nerve which is right next to the ureter. Correct me if I'm wrong.

get full access to all content ⋅ pick a username

+0 upvote downvote
submitted by ∗lispectedwumbologist(122)

get full access to all content ⋅ pick a username

How do you distinguish this from testicular torsion? Is it just because it started in the left flank?

get full access to all content ⋅ pick a username

neels11 and there's no mass in the scrotum, whereas testicular torsion will have that "bag of worms" feel (along with a lack of cremaster reflex) testicular torsion usually happens in a younger age group +12

medpsychosis @neels11 I would like to clarify a piece of information. I believe you are confusing Varicocele with Testicular Torsion. Varicocele will present with "bag of worms" feeling. While the absence of cremasteric reflex is a sign of testicular torsion. +22

johnson This is the classic "loin to groin pain" of nephrolithiasis. +9

suckitnbme Testicular torsion would also tend to have a unilateral high-riding testicle. +

an1 testicular torsion has high riding testis, that would have been a prevalent finding to push this towards TT +

+0 upvote downvote
submitted by ∗namesthegame22(13)

get full access to all content ⋅ pick a username

Classic "loin to groin" pain of nephrolithiasis.

Vs. pain starting in the balls = testicular torsion.

get full access to all content ⋅ pick a username

-2 upvote downvote
submitted by ∗youssefa(162)

get full access to all content ⋅ pick a username

I mean why would a testicle turn around itself when someone's sleeping. This typically occurs after sports/ bicycle riding etc..

get full access to all content ⋅ pick a username

brotherimodu People can move in their sleep? +2

prolific_pygophilic Actually in highschool this happened to a couple of my friends in their sleep, woke up with the sack all twisted +1

Must-See Comments from nbme24

seagull on Intestinal mucosa
tissue creep on Ask the roommate not to smoke in the apartment
drdoom on Adenosine
seagull on Increased serum testosterone concentration
atstillisafraud on Lamins
niboonsh on Only cookies are independently associated ...
atstillisafraud on Scar formation
lamhtu on Decreased adherence
drachenx on Damage to the rectovaginal septum
drdoom on Intestinal mucosa
azibird on Coronavirus
lsmarshall on Organic acid metabolism disorder
sympathetikey on Inhalant abuse
tea-cats-biscuits on Eosinophils