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21-year-old college student presents to the ED with acute onset abdominal pain pain. He states it started higher up, in his flank, but has since became a stabbing, constant pain near his groin. Abdominal exam is benign. Urinalysis is positive for blood but negative for nitrites and leukesterases. Which of the following modalities is most appropriate for diagnosis?
1. Intravenous pyelogram
2. Plain radiogram of kidneys, ureters, bladder
3. CT abdomen and pelvis with IV contrast
4. CT abdomen and pelvis without IV contrast
5. Renal ultrasound
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yeah agree pawan if you are in USA and CT is in ER, 4 is the best answer, however if you are iin the area CT is expensive KUB first.
Ultrasound is fast, easy, safe, and relatively inexpensive to perform but has some limit, cannot be used to find small stones (<5 mm) and does not help in the evaluation of kidney function.
so maybe 4 
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you r right answer is 4, This patient's clinical presentation is strongly suggestive of renal calculi (nephrolithiasis). The presence of hematuria without infection, his age, and male sex weigh in favor of this diagnosis as well. Although controversial, most clinicians agree that CT abdomen/pelvis without IV contrast is the current gold standard for diagnosis of nephrolithiasis. While KUB will likely reveal any kidney stones present, 20% of renal calculi are radioopaque. These radioopaque stones, however, will show up on CT. IV contrast is contraindicated because it will white out the kidneys, thereby hiding any stones.
The other advantage of CT abdomen over KUB is the ability to demonstrate renal obstruction.
Renal ultrasound can also make the diagnosis, but cannot detect stones <5mm and is operator dependent.
IVP is the gold function for determining renal function. It can also show stones, but is time intensive (~6 hours) and requires the use of potentially nephrotoxic contrast.
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okt3 your knowledge is simply great :-)
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nice explanation thanks a lot guys... 
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thnx pawan, u r doing better good going and kola tnx for Q&A
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