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i-Human Molly Howard Case Study: Acute Right Flank
Pain (Ureteral Calculus) | 2026/2027 Ultimate Guide
to Pass First Try
Case Overview: Molly Howard
Demographic Details
Patient Name Molly Howard
Age 33 years old
Gender Female
Chief Complaint "Severe right-sided flank pain"
This case challenges you to differentiate between renal colic (kidney stone),
pyelonephritis, and other causes of acute abdominal/flank pain. The key is recognizing
the classic presentation of ureteral calculus (nephrolithiasis) and ruling out life-
threatening alternatives.
Part 1: History Taking (Subjective)
The history is the most critical part of this case. A thorough HPI will point you toward
the correct diagnosis.
History of Present Illness (HPI) - Use OLD CARTS
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Attribute Finding Clinical Significance
Sudden, started approximately 2-3 days Sudden onset is classic for renal colic, unlik
Onset
ago after breakfast the gradual onset of infection
Right flank, under the ribs, radiating to Radiation to groin is pathognomonic for
Location
the groin ureteral stone migration
Renal colic is often constant if stone is lodg
Duration Constant pain lasting for 2 days
versus intermittent with movement
Severe, colicky (wavelike cramping), Colicky pain = smooth muscle spasm from
Character
rated 8/10 ureteral obstruction
Movement, possibly drinking orange Movement worsens pain; OJ is high in oxal
Aggravating
juice (stone risk factor)
Nothing provides relief; Tylenol Tylenol is ineffective for colicky pain; NSAID
Relieving
ineffective are first-line
Suggests complete obstruction vs. passing
Timing Constant over 2 days, no fluctuation
stone
Severity 8/10 - debilitating Severe pain is hallmark of acute obstructio
Associated Symptoms (Pertinent Positives & Negatives)
System Pertinent Positives Pertinent Negatives
No high fever or chills (would suggest
General Low-grade fever (100.2°F) reported
pyelonephritis)
Nausea, vomiting, decreased appetite No hematemesis, no diarrhea, normal bowe
GI
for 2 days movements
i-Human Molly Howard Case Study: Acute Right Flank
Pain (Ureteral Calculus) | 2026/2027 Ultimate Guide
to Pass First Try
Case Overview: Molly Howard
Demographic Details
Patient Name Molly Howard
Age 33 years old
Gender Female
Chief Complaint "Severe right-sided flank pain"
This case challenges you to differentiate between renal colic (kidney stone),
pyelonephritis, and other causes of acute abdominal/flank pain. The key is recognizing
the classic presentation of ureteral calculus (nephrolithiasis) and ruling out life-
threatening alternatives.
Part 1: History Taking (Subjective)
The history is the most critical part of this case. A thorough HPI will point you toward
the correct diagnosis.
History of Present Illness (HPI) - Use OLD CARTS
, 2|Page
Attribute Finding Clinical Significance
Sudden, started approximately 2-3 days Sudden onset is classic for renal colic, unlik
Onset
ago after breakfast the gradual onset of infection
Right flank, under the ribs, radiating to Radiation to groin is pathognomonic for
Location
the groin ureteral stone migration
Renal colic is often constant if stone is lodg
Duration Constant pain lasting for 2 days
versus intermittent with movement
Severe, colicky (wavelike cramping), Colicky pain = smooth muscle spasm from
Character
rated 8/10 ureteral obstruction
Movement, possibly drinking orange Movement worsens pain; OJ is high in oxal
Aggravating
juice (stone risk factor)
Nothing provides relief; Tylenol Tylenol is ineffective for colicky pain; NSAID
Relieving
ineffective are first-line
Suggests complete obstruction vs. passing
Timing Constant over 2 days, no fluctuation
stone
Severity 8/10 - debilitating Severe pain is hallmark of acute obstructio
Associated Symptoms (Pertinent Positives & Negatives)
System Pertinent Positives Pertinent Negatives
No high fever or chills (would suggest
General Low-grade fever (100.2°F) reported
pyelonephritis)
Nausea, vomiting, decreased appetite No hematemesis, no diarrhea, normal bowe
GI
for 2 days movements
