Pyelonephritis Quiz: Ace Your Exams

Get ready to dominate your medical and nursing exams by using our dynamic quizzes to elevate your knowledge and increase your confidence. Whether you're gearing up for the USMLE®, COMLEX®, or your next in-class assessment, Osmosis quizzes tackle key topics in pathology, diagnostics, and treatment approaches. By honing in on clinical readiness and decision-making, we make sure the knowledge you gain empowers you both in the classroom and in real-world practice. Jump in and supercharge your exam prep!

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A 62-year-old man presents to the emergency department with two days of fever, vomiting, and right flank pain. The pain is intermittent and has not responded to acetaminophen or ibuprofen. The patient also had burning urination that started around the same time, which he attributed to a new body soap. Temperature is 38.5 ºC (101.3 ºF), pulse is 108/min, blood pressure is 145/88 mmHg, respiratory rate is 18/min, and SpO₂ is 99% on room air. On physical examination, the patient has no periumbilical or suprapubic tenderness to palpation. The serum leukocyte count is 19,000/mm³. Urinalysis shows positive leukocyte esterase, moderate pyuria, and the presence of white blood cell casts. Which of the following physical exam maneuvers will most likely elicit pain in this patient?

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Flexion and internal rotation of the right hip while the patient is supine

Elevation of the patient’s right foot and striking the right heel while the patient is supine

Passive extension of the right hip while the patient lies on their left side

Palpation in the left lower quadrant and waiting for report of pain in the right lower quadrant

Palpation and percussion between the right 12^th rib and spine