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℉, 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

Reference
 Color  Yellow, hazy  
 pH  6.8  5.0-7.0 
Ketones  Negative  Negative 
 Glucose  Negative  Negative 
 Bilirubin  Negative  Negative 
Leukocyte esterase  Positive  Negative 
 Nitrites  Positive  Negative
Urine Microscopy


 RBCs  2-3/HPF  0-3/HPF 
 WBCs  >50/HPF  0-4/HPF 
Epithelial cells  1-2/HPF  0-3/HPF 
 Bacteria  Many  None 
Casts  None  None 

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