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