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 43-year-old woman is hospitalized for fever, nausea, vomiting, right flank pain, and dysuria. After an initial evaluation, acute pyelonephritis is diagnosed and the patient is started on intravenous ceftriaxone. The initial serum leukocyte count is 23,000/mm³. Urine culture grows >100,000 colony-forming units of E. coli, which are susceptible to ceftriaxone. On hospital day three, the patient develops a fever after being afebrile for 24 hours. Flank pain is still present. Current temperature is 38.5 ºC (101.3 ºF), pulse is 86/min, and blood pressure is 138/81 mmHg. Serum leukocyte count is 21,000/mm³ (4,500–11,000/mm³). Significant tenderness to palpation is still present at the right costovertebral angle. Which of the following is the best next step in management?

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Obtain abdominal MRI

Obtain a serum lactate level

Obtain a repeat urine culture

Obtain CT of the abdomen and pelvis

Change ceftriaxone to cefepime