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

Retired 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

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submitted by ∗sajaqua1(607)

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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.

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submitted by ∗sweetmed(157)

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

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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

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submitted by ∗madamestep(17)

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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.

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submitted by ∗lispectedwumbologist(122)

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

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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 +

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submitted by ∗namesthegame22(13)

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Classic "loin to groin" pain of nephrolithiasis.

Vs. pain starting in the balls = testicular torsion.

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submitted by ∗youssefa(162)

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

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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

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