A 36-Year-Old Primigravida at 26 Weeks Gestation Comes to the Office

question 60

Multiple Choice

A 36-year-old primigravida at 26 weeks gestation comes to the office for evaluation of painful urination.  She has had urinary frequency since her first month of pregnancy, but a week ago she developed dysuria.  The patient has also had chills and fatigue for the past 2 days.  She has intermittent, nonpainful contractions but no vaginal bleeding or leakage of fluid.  Fetal movement is normal.  Three years ago, the patient was treated for pyelonephritis.  She has no chronic medical conditions and has had no surgeries.  Temperature is 100.4 F (38 C) , blood pressure is 110/60 mm Hg, and pulse is 110/min.  Fundal height is 26 cm and fetal heart tones are 170/min.  There is tenderness over the right costovertebral angle.  The uterus is nontender and the cervix is closed.  Urinalysis is positive for leukocyte esterase and blood; a urine culture is collected.  Which of the following is the best next step in management of this patient?

• A)CT scan of the abdomen and pelvis
• B)Inpatient intravenous antibiotics
• C)Oral antibiotics and follow-up in 2 days
• D)Renal ultrasound
• E)Voiding cystourethrogram

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