Patient presents with complaints consistent with ureteral calculus.  Symptoms include acute onset of severe flank pain, radiating to the groin or lower abdomen, described as sharp, stabbing, or colicky.  Associated symptoms may include hematuria, nausea, vomiting, urinary frequency, and urgency.  Patient reports pain onset  (duration).  Physical examination reveals (tenderness to palpation in the flank or costovertebral angle, restlessness).  Differential diagnosis includes pyelonephritis, renal colic, nephrolithiasis, ureteral obstruction, and appendicitis.  Urinalysis reveals (hematuria, pyuria).  Imaging studies, such as non-contrast CT scan of the abdomen and pelvis, are ordered to confirm the presence, size, and location of the ureteral stone.  Medical decision making considers stone size, location, and patient symptoms.  Treatment plan may include pain management with analgesics such as NSAIDs or opioids, medical expulsive therapy with alpha-blockers such as tamsulosin, and observation for spontaneous stone passage.  For larger stones or those causing obstruction, urological consultation may be warranted for interventions such as ureteroscopy, lithotripsy, or percutaneous nephrolithotomy.  Patient education provided regarding hydration, dietary modifications, and follow-up care.  ICD-10 code N20.0, ureteral calculus, is assigned.  Return precautions discussed with the patient, including worsening pain, fever, chills, or inability to urinate.