Case 4 – Renal Colic

You are seeing Ms. Hamilton, a 64 year old man, for left sided back pain. She says it began three days ago and isn’t getting any better. Take a focused history of her complaint and perform a physical examination.


  • Onset and duration of pain
  • Progression of pain
  • Location of pain (unilateral)
  • Frequency of pain (intermittent)
  • Quality of pain (sharp)
  • Radiation (to abdomen and groin)
  • Flank pain (yes)
  • Changes in amount of urine
  • Dysuria
  • Urgency
  • Hematura (some darkening)
  • Post-void dribbling
  • Fever (recently)
  • Nausea/vomiting
  • Diarrhea (none)
  • Diaphoresis
  • Current Medications
  • Diet history (focusing on calcium and oxalate intake)
  • Personal history of renal stones
  • Personal history of urinary tract infections
  • Family history of renal stones
  • Past medical history

Physical Examination


  • Comments on general appearance of patient (uncomfortable, diaphoretic)
  • Measures heart rate (elevated) and states that temperature should also be measured

Renal Examination

  • Palpates location of back in which pain is located
  • Assesses for CVA percussion tenderness
  • Attempts to palpates for kidneys with patient supine
  • Auscultates for renal bruits bilaterally

Abdominal Examination

  • Inspects abdomen for masses, scars
  • Auscultates in all four quadrants of the abdomen
  • Palpates all quadrants for tenderness, commenting on absence/presence of guarding
  • Assesses for rebound tenderness in the left and right lower quadrants
  • States that they would perform a digital rectal examination as part of the abdominal examination

Special Maneuvers

  • Examines for signs of appendicitis: McBurney’s point tenderness, Rovsing’s sign, Psoas sign
Case 4 – Renal Colic