A 68 year-old woman complains of fever, anorexia and right flank pain for 2 days. She vomited twice today


#1

A 68 year-old woman complains of fever, anorexia and right flank pain for 2 days. She vomited twice today. On physical examination, her temperature is 101.3 F and there is moderate tenderness on the right costovertebral angle. Her urinalysis shows leukocytes and pus cells.

What is the most appropriate next step of management?

A – Hospitalization and intravenous antibiotics

B – Outpatient wide spectrum antibiotics and schedule a visit after 3 days

C – Collect blood and urine samples for culture

D – Schedule MRI of the abdomen and pelvis

E – Schedule Intravenous pyelogram

Answer

Rule of thumb: any case of pyelonephritis, endocarditis or any expected sepsis, collect blood and urine samples for culture before administration of antibiotics. Very important repeated topic in all steps of USMLE. Collect for culture first….please don’t forget that……MRI and IVP could be done later if the case is complicated but history, examination and urinalysis are enough for diagnosis of most cases of acute pyelonephritis.

The correct answer is C