Repeated USMLE Questions Step 2 CK- 435

A 26-year-old woman complains of left flank pain and fever for 2 days. She has a history of two episodes of urinary tract infections in the past three years treated with trimethoprim-sulfamethoxazole. She is married, sexually active and takes contraceptive pills. Her last menstrual period was 5 days ago. On physical examination, her pulse is 100/min., blood pressure is 120/80 and her temperature is 103 F. She has left costovertebral angle tenderness on palpation.

What is the best next step of management?

A-Admission to the intensive care unit (ICU)

B-Collection of urine and blood cultures

C-CT scan of abdomen and pelvis

D-MRI of the kidney

E-Administration of wide spectrum antibiotics


This patient history and clinical examination are consistent with acute pyelonephritis. Collection of urine and blood samples for culture should be done before administration of any antibiotics to achieve accurate results.. Culture is important for prescribing the most effective antibiotic and for the follow up. The patient is stable and so there is no need for the ICU. Diagnosis of acute pyelonephritis can be reached by history and physical examination only. Imaging studies are not necessary in this case as it is straight forward. In case of failure of medical treatment, imaging studies should be considered for further knowledge.

The correct answer is B

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