Urinary tract infection (pediatrics) Quiz: Ace Your Exams

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A 5 year-old girl is brought to the emergency department for evaluation of fever and irritability for two days. Her parent reports that the patient has had foul-smelling, dark urine. The patient has been given acetaminophen for fever control. She has a past medical history of an uncomplicated appendectomy at 4 months of age and was treated for otitis media two months ago with amoxicillin. She has a history of moderate developmental delay, and she is not yet toilet-trained. Temperature is 39°C (102°F), pulse is 124/min, respiratory rate is 28/min, blood pressure is 99/60 mmHg, and oxygen saturation is 99% on room air. On physical examination, the patient is crying. Mucous membranes appear moist. Cardiopulmonary and HEENT examinations are within normal limits. Suprapubic tenderness is present. Genitourinary examination shows normal-appearing female genitalia. Urinalysis is positive for leukocyte esterase. Which of the following is most likely to lead to misdiagnosis?  

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