gilbert
Forum Junior
Topics: 16
Posts: 45
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25. A previously healthy 2-year-old boy is brought to the physician because of fever and abdominal pain for 24 hours. His developmental milestones are appropriate for age. He is fully alert and responsive. His temperature is 38.6°C (101.5°F), blood pressure is 85/60 mm Hg, pulse is 100/min, and respirations are 20/min. Examination shows suprapubic tenderness to deep palpation but no guarding or rebound. There are no palpable abdominal masses or costovertebral angle tenderness. The penis is circumcised; there is no urethral discharge. Urinalysis shows 20–30 leukocytes/hpf, 5–6 erythrocytes/hpf, and nitrites. A urine culture grows 100,000 colonies/mL of Escherichia coli sensitive to all tested antibiotics. Amoxicillin therapy is initiated. Five days later, he is afebrile and asymptomatic. Ultrasonography of the kidneys shows no abnormalities. Which of the following is the most appropriate next step in management?
A ) Discontinue the antibiotic in 2 days and reexamine only if symptoms recur
B ) Voiding cystourethrography
C ) Intravenous pyelography
D ) Cystoscopy
E ) No further testing
A or B?
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| webjeee
Forum Guru
Topics: 99
Posts: 350
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b for sure
you can't do it with infection, but afterwards you should do it
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| nadiabarati
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B
look for posterior valves
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| gilbert
Forum Junior
Topics: 16
Posts: 45
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Since he is having infection, VCUG should not be performed.
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| nadiabarati
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but the infection has resolved!
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| prathapdoctor
Forum Elite
Topics: 12
Posts: 406
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yes, the answer is B.
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| Akeen
Forum Newbie
Topics: 1
Posts: 37
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Thinks answer is A.
Emedicine says:
Which children should undergo VCUG after a first febrile UTI?
Those in whom treatment fails after 48-72 hours
Patients with an abnormal voiding pattern (dribbling of urine)
Infants and children in whom good follow-up is not assured
Those with an abdominal mass
Infants and children with recurrence of a febrile UTI
Which pediatric patients do not need imaging studies after a first UTI?
Infants and children with a first febrile UTI who are assured follow-up, who respond promptly to treatment (afebrile within 72 h), and who have a normal voiding pattern (no dribbling) and no abdominal mass
Infants and children with cystitis: Those with an abnormal voiding pattern after receiving effective treatment of the UTI may need to undergo an evaluation for voiding dysfunction; this may include standard VCUG.
This child both responded to therapy and is likely to be followed up and so will not require VCUG
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| nadiabarati
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but this child is a BOY. never forget that boys don't get UTI wihout an important usually anatomic defect.
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| sera
Forum Senior
Topics: 14
Posts: 141
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B
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syra
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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I think even if the infection subsides, there will be a bit of reflux and VCUG is indicated only after 1-2 months after infection.
Moreover, PUV should have been seen as hydronephrosis in USG done in the patient, though late manifestation of PUV is possible.
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| ram3
Forum Guru
Topics: 48
Posts: 525
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I believe you are all wrong the anwer is e no further treatment because after treatment with the antibiotic he is afebrile and asymptomatic also an ultrasound of the kidneys showed no abnormality the best thing would be just observation not an invasive test
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| arlete
Intern in 2009!!!!!
Topics: 41
Posts: 2,918
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Boys with UTI must ALWAYS be tested!
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Que sera sera, whatever will be will be.
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| alosh_2
Forum Junior
Topics: 22
Posts: 53
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It's either A or B......... jus kidding... I think it's B, because boys with UTI, rare unless some sort of anatomic defect, so must be ruled out.
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| arlete
Intern in 2009!!!!!
Topics: 41
Posts: 2,918
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B
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Que sera sera, whatever will be will be.
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| alosh_2
Forum Junior
Topics: 22
Posts: 53
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BTW... wanted to mention... was reviewing the UW Qs jus now,,, and it said if the kid is between 2 months and 24 months, and it is his first UTI, then you have to do a VCUG or radionuclide VCG... so B is the answer for sure.. the kid is 2 yrs old.
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| whiterabbit
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b
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| elitoki
Forum Guru
Topics: 54
Posts: 508
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B
this boy has no more sign of infection and VCUG should be done after USG.
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| dr in trouble
Forum Guru
Topics: 62
Posts: 602
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B
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| cirus
Forum Guru
Topics: 108
Posts: 740
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UTI in child:
Male is investigated from the 1st time with voiding cust-ureth G
Female is investigated in case of recurrence..
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