A 40-Year-Old Man Comes to the Emergency Department Due to Acute

question 276

Multiple Choice

A 40-year-old man comes to the emergency department due to acute flank pain and dysuria.  He has no associated fever, joint pain, or suprapubic pain.  The patient was discharged 5 days ago following hospitalization for central nervous system toxoplasmosis.  He has long-standing AIDS (most recent CD4 count: 150/mm³) and had not been compliant with either antiretroviral treatment or trimethoprim-sulfamethoxazole prophylaxis therapy for several months prior to admission.  While in the hospital, the patient was started on sulfadiazine and pyrimethamine, and antiretroviral treatment was reinstituted.
Temperature is 37 C (98.6 F) , blood pressure is 122/78 mm Hg, and pulse is 98/min.  Mucous membranes are dry.  The abdomen is soft, and bilateral costovertebral angle tenderness is present.  No rash is present.
Laboratory studies are as follows:
A urinary catheter is placed and produces 10 mL of urine during 6 hours of observation in the emergency department.
Which of the following is most likely to confirm the diagnosis in this patient?

• A)Cystoscopy
• B)Renal ultrasound
• C)Urine culture
• D)Urine sediment analysis for crystals
• E)Urine sediment analysis for eosinophils

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