doc_clotaire
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A 33 yo woman come to the ER due to 4 days hist of left sided flank pain , nausea , vominting , fever and chills . Temp 39 C , BP 100 . 60 . PE shows left costovertebral angle tenderness . Urinalisis shows + nitrites , many WBC and bact . LAB shows WBC 17000
What is the nest step in management +
a . IV pyelogram
b. IV antibiotic
c. Blood culture
d . CT scan
e . USG abdomen
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| usmle12
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I THINKS ITS BLOOD CULTURE BEFORE ANTIBIOTICS/..............
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| Justice
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Clinical picture is suggestive of pyelonephritis. We can use urine to develop bac. diagnosis., i.e. no need for a blood culture, which most likely will be growth-negative... But to confirm PN, or rule out other focal pathology, we do (E)
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| arlete
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I'd say B.
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| Justice
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arlete wrote:
I'd say B.
IV AB therapy is indicated only in children... Adults do well with AB per os
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| doyoudig
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actually IV is also done in elderly as they have more SE of oral therapy
my guess would also be to do Blood Culture before Ab, but her cases seem pretty forward esp w/ UA, so may B is better?
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| sprint123
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I am going for B.
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| nadiabarati
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B
NO oral antibiotics! because she has nausea and vomiting.
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| doc_clotaire
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This is from UW , 80 % screwed it up ( invluding myself  )
The answer is :
C : Blood Cluture
EXPLANATION :
Acute pyelonephritis can potentially result in Gram neg sepsis . Urine and Blood Culture should be routinely obtained prior to administering antibiotics
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| arlete
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Interesting!
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| doyoudig
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good one thx for sharing n providing an answer
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