i-HUMAN GRADUATE PREMIUM CASE WEEK 7 — FLANK PAIN33-Year-Old Female Patient COMPLETE CLINICAL NOTE & RATIONALES Patient: Tamika Brayton / Christine Smith 2026

Age / Sex 33-year-old Female Height / Weight 5'6" (168 cm) / 130 lb (59.1 kg) Chief Complaint Flank Pain Confidential — For Educational Purposes Only Page N i-Human Week 7: Flank Pain Case | 33-Year-Old Female | Expert Level Clinical Note | 2026 Case Week Week 7 Target Score 100% — Expert Level Prepared by: Graduate Nursing Student 2026 — Updated Questions Confidential — For Educational Purposes Only Page N i-Human Week 7: Flank Pain Case | 33-Year-Old Female | Expert Level Clinical Note | 2026 Table of Contents 1. Patient Information & Case Overview 2. History of Present Illness (HPI) 3. Past Medical History (PMH) 4. Family History 5. Social History 6. Review of Systems (ROS) 7. Physical Examination 8. Differential Diagnosis with Rationales 9. Diagnostic Workup & Interpretation 10. Assessment 11. Plan / Management 12. Patient Education 13. Follow-Up Plan 14. Expert Score Rationale & Key Takeaways 3 4 6 7 7 8 10 13 16 19 20 23 24 25 Confidential — For Educational Purposes Only Page N i-Human Week 7: Flank Pain Case | 33-Year-Old Female | Expert Level Clinical Note | 2026 1. Patient Information & Case Overview Patient Demographics Field Details Patient Name Tamika Brayton / Christine Smith Age 33 years old Sex Female Height 5'6" (168 cm) Weight 130 lb (59.1 kg) BMI 21.0 kg/m² (Normal) Chief Complaint Flank pain Case i-Human Week 7 — Graduate Premium Case Overview & Learning Objectives This case presents a 33-year-old female with acute flank pain, a clinical presentation that requires systematic evaluation to distinguish between urologic emergencies, infections, and musculoskeletal conditions. The advanced practice nursing student must demonstrate expert-level clinical reasoning through a comprehensive history, targeted physical examination, appropriate diagnostic ordering, and evidence-based management planning. Primary Learning Objectives: • Conduct a thorough and organized history of present illness using OLDCARTS framework • Apply clinical reasoning to differentiate nephrolithiasis, pyelonephritis, and other causes of flank pain • Select and interpret targeted diagnostic tests based on clinical suspicion • Develop an evidence-based, patient-centered management plan • Provide appropriate patient education and follow-up instructions Confidential — For Educational Purposes Only Page N i-Human Week 7: Flank Pain Case | 33-Year-Old Female | Expert Level Clinical Note | 2026 2. History of Present Illness (HPI) The history of present illness is obtained using the OLDCARTS mnemonic and supplemented by targeted questions relevant to flank pain etiology. The patient should be questioned in a systematic, empathetic manner. OLDCARTS Framework Onset Ask: 'When did the pain start? Did it come on suddenly or gradually?' Presentation Clinical Significance Sudden, severe onset Highly suggestive of nephrolithiasis (renal colic) — stone obstructing ureter causes acute spasm Gradual onset over hours More consistent with pyelonephritis, musculoskeletal strain, or renal abscess Patient Response: The patient reports sudden onset of sharp flank pain that began approximately 6 hours ago while she was at work, with no prodromal symptoms. Location Ask: 'Where exactly is the pain located? Can you point to it? Does it stay in one place or move?' • Right flank pain: May indicate right kidney or right ureter pathology • Left flank pain: May indicate left kidney or left ureter pathology • Bilateral flank pain: Consider bilateral process, musculoskeletal, or systemic illness • Costovertebral angle (CVA) tenderness: Classic for renal pathology Patient Response: Right-sided flank pain, located in the posterior costovertebral angle area, non-radiating at rest.