Answer 5

5. Choice D is the correct answer.  This patient has pyelonephritis.  Patients with pyelonephritis need 10-14 days worth of antibiotics.  This patients vitals are normal, labs are reassuring, and pain is under control and likely does not need to be admitted to the hospital.  The other antibiotic choices are acceptable but are not long enough to treat pyelonephritis.

Question 5

5.  Your patient is a 21 year old female that presents with right flank pain, fever 102, dysuria, polyuria, with nausea and vomiting.  Lab values are as follows WBC 11.4, and remainder of CBC is normal.  BMP is normal.  Urine reveals WBC 75-100, many bacteria, nitrite positive.  Vitals are Temp 101, HR 97, BP 124/76, RR 20, Sat 100.  The patient is comfortable and pain is under control.  You have just given the patient Cipro 400 mg IV Piggy Back.  Which of the following regimens is most appropriate for this patient.?

A.  Continue Cipro 400 mg IV Piggy Back BID in Hospital awaiting cultures
B.  Bactrim DS one PO BID for 7 days
C.  Cipro 500 mg BID for 7 days
D.  Cipro 500 mg BID for 14 days

Answer 4

4.  Choice D is the correct answer.  All men with epididymitis should be covered for gonorrhea and chlamydia.  Rocephin provides excellent coverage for gonorrhea.  Chlamydia is best covered in this situation with doxycycline 100 mg BID.  While chlamydia is sensitive to Zithromax, ideally it should be give 1000 mg times one dose.  There is a lot of resistance to cipro in terms of chlamydia.  Flagyl is for trichomonas, not chlamydia.

Question 4

4.  Your patient is a 30 year old male that has had left testicle pain for 2 weeks.  The pain is alleviated when sitting and worse with standing.  His urinalysis is essentially negative.  Ultrasound of scrotum reveals left sided epididymitis.  Which of the following is the most appropriate antibiotic regimen?

A.  Rocephin 250 mg x1, plus Zithromax 500 mg PO daily for 10 days
B.  Rocephin 250 mg x 1, plus cipro 500 mg BID for 10 days
C.  Rocephin 250 mg x 1, plus flagyl 500 mg BID for 7 days
D.  Rocephin 250 mg x 1, plus Doxycycline 100 mg BID for 10 days

Answer 3

3.  Choice A is the correct answer.  Macrobid is safe and category B.  Bactrim and Cipro are category C.  Doxycyline is actually category D

Question 3

3.  Your patient is a 24 year old 12 week pregnant female that presents with dysuria and polyuria.  Your patients urinalysis show the following WBC 50-75, Many Bacteria, and Nitrite positive.  Which of the following treatment options is the most appropriate?

A.  Macrobid 100 mg BID
B.  Bactrim DS one PO BID
C.  Cipro 500 mg BID
D.  Doxycycline 100 mg BID

Answer 2

2.  Choice B is the correct answer.  The onset of the pain was two hours ago.  Testis necrosis starts to happen about 4-6 hours after the onset of pain.  Time is testicle.  There can be fertility issues reported in those that have to undergo an orchiectomy.  The turn around time on a 3 dose oral contrast would be 2 hours minimum and would not rule out a torsion.  This patient may need this at some point but it is not the first appropriate test to order.  Abdominal ultrasound may be appropriate to order if the patient does not have testicle pain.  A 3 view abdomen x rays would be low yield in this case.

Question 2

2.  Your patient is a 15 year old male that presents with right lower quadrant tenderness that radiates to his testicles.   He does has pain in the lower abdomen as well as in his right testicle.  His pain started two hours ago after running a race in track.  He also has nausea and vomiting.  Which of the following is the best first test to order on this patient?

A.  Abdominal ultrasound
B.  Scrotal ultrasound
C.  CT scan of abdomen and pelvis with 3 dose oral and IV contrast
D.  3 view abdomen x ray

Answer 1

1.  Choice C is the correct answer.  Uric Acid Stones are radiolucent.  Another concerning possible cause would be a GU malignancy not seen on CT scan.  If this patient does not pass a kidney stone, this patient needs a cystoscopy.  Pyelonephritis produces perinephric stranding around the kidney on CT Scan.  Calcium struvite and oxalate stones are radio-opaque on CT scan.

Question 1

1.  Your patient is a 45 year old male that present with right side flank pain, hematuria with nausea and vomiting.  He states his pain radiates to his right testicle.  His scrotal exam is unremarkable.  His urinalysis reveals >200 RBC and no white cells or bacteria.  His CT scan of his abdomen and pelvis reveals hydroureter and hydronephrosis without kidney stones seen.   Which of the following is the most likely diagnosis?

A.  Pyelonephritis
B.  Calcium Struvite Kidney Stone
C.  Uric Acid Kidney Stone
D.  Calcium Oxalate Kidney Stone