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GOGETA
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09/20/08 - 08:05 AM       #1

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 1001min, 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?
O A) Discontinue the antibiotic in 2 days and reexamine only if symptoms recur
O B) Voiding cystourethrography
O C) Intravenous pyelography
O D) Cystoscopy
O E) No further testing


E or B?

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RUDOLPH
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09/20/08 - 08:55 AM       #2

My 2 cents for 'B'.


kpmle2
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09/20/08 - 09:41 AM       #3

B) Voiding cystourethrography


nightflight1945
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09/20/08 - 12:50 PM       #4

B) Voiding cystourethrography

A typical case of UTI in a child which should always be followed by VCUG for Dx of reflux.

What is your doubt?


GOGETA
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09/21/08 - 08:49 AM       #5

It was his first time.
Are we suppose to wait for the second time to do the test?
someone told me that kids could actually get UTI and is no biggy, if is repetition then you do test.

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nightflight1945
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09/21/08 - 12:58 PM       #6

GOGETA wrote:
It was his first time.
Are we suppose to wait for the second time to do the test?
someone told me that kids could actually get UTI and is no biggy, if is repetition then you do test.


You'd better take a look at a pediatrics book rather than listening to rumors out there ,

VCUG is indicated after the first UTI in all children under 8 (or 5 in some books) and also in all boys with UTI , also some recommend it for upper UTI in adults ,

It is very high yield topic in every question ,






lampard
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10/14/08 - 02:37 PM       #7

Boys are not supposed to get UTI...

So in such a case make sure to r/u any genito urinary abnormality


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