fandarast
Forum Junior
Topics: 15
Posts: 55
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An 18-year-old woman, gravida 3, para 2 at 28 weeks of gestation has been hospitalized because she presented with right-sided back pain, fever, chills, and severe nausea. Her physical examination was remarkable for bilateral costovertebral angle tenderness, with greater discomfort on the right side. Her temperature on admissions was 102.6°F, and the results of her CBC and Chemistry were unremarkable. However, her urinalysis was significantly abnormal. Her urine culture is still pending. She has been in the hospital for the last 3 days on intravenous antibiotics; however, despite initial improvement, her temperature is now 103°F. What is the next best step in management?
A. Repeat urine culture
B. Repeat CBC
C. Change antibiotics
D. Perform an ultrasound
E. Perform an intravenous pyelogram (IVP)
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| nyimalay
Forum Elite
Topics: 11
Posts: 297
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D
Failure to respond to IV antibiotics can be due to obstruction or drug-resistance.
Should exclude obstruction by USG while waiting sensitivity result/ before making decision to change antibiotics.
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| Ivonne
Find a way or make one
Topics: 58
Posts: 1,654
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 D
___________________
"Believe you can and you're half way there."
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| kpmle2
Forum Guru
Topics: 95
Posts: 512
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D. Perform an ultrasound
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| fandarast
Forum Junior
Topics: 15
Posts: 55
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You're right guys, the answer is D
Here is the actual explanation: the clinical scenario presented is that of pyelonephritis that is not responding to treatment. This finding should always prompt radiologic evaluation to rule out an abscess or a renal calculi. The least invasive initial procedure is a renal ultrasound, not an intravenous pyelogram. There is no need to repeat the urine culture or to change her antibiotics until results of her initial urine culture and sensitivity returns. Repeating CBC is fine, but it will not tell you why there is lack of response to treatment.
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