Approach to dysuria Quiz: Ace Your Exams
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A 74-year-old woman is brought to the emergency department from a nursing home for evaluation of fever and dysuria for two days. She has become progressively more confused. The patient has a past medical history of type 2 diabetes mellitus and hypertension. Temperature is 102.6℉ (39.2°C), pulse is 115/min, blood pressure is 104/86 mmHg, respiratory rate is 22/min, and oxygen saturation is 99% on room air. The patient is minimally interactive on examination. Physical examination reveals a normal cardiopulmonary exam and mild suprapubic tenderness to palpation. Results of the urinalysis are shown below. Which of the following is the best next step in the management of this patient?
| Urinalysis | |
| Color | Yellow, hazy |
| pH | 6.8 |
| Ketones | Negative |
| Glucose | Negative |
| Bilirubin | Negative |
| Leukocyte esterase | Positive |
| Nitrites | Positive |
| Urine Microscopy | |
| RBCs | 2-3/HPF |
| WBCs | >50/HPF |
| Epithelial cells | 1-2/HPF |
| Bacteria | Many |
| Casts | None |
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