hallachi
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Topics: 11
Posts: 63
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1) A 5-year-old girl is brought to the physician
because of a 2-day
history of temperatures to 39.5 C (103.1 F) and pain
in the right side.
She has had two episodes of vomiting during this
period but no diarrhea
or symptoms of upper respiratory tract infection. She
has
vesicoureteral reflux and a history of recurrent
urinary tract infections. She
appears ill. Her temperature is 39.8 C (103.6 F),
blood pressure is
110/60 mm Hg, pulse is 150/min, and respirations are
25/min. Examination
shows right-sided costovertebral angle tenderness. In
addition to
obtaining urine cultures, which of the following is
the most appropriate next
step in management?
A ) Intravenous pyelography
B ) Renal ultrasonography
C ) Voiding cystourethrography
D ) Intramuscular antibiotic therapy and
reexamination in 24 hours
E) Intravenous antibiotic therapy
I know this q was discussed in the forum but i am confused...patient is already diagnosed vesicoureteral reflux so we dont have to do cystoureterogram to diagnose the reflux ...right
then next thing is that she has costovertebral angle tenderness this means infection ascend to kidney for which we have to choose renal u/s or pylerogram to check obstruction or scarring...but in the senerio pt presentation is acute for which we have to go with IV antibiotics.
so what we have to choose give antibiotics before culture reports or do u/s?
please answer
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