10-21-2008, 04:53 AM
A 56-year-old man comes to the emergency department with severe right flank pain for the past 5 days. He says that the pain started after he returned from a long hiking trip in the Grand Canyon, and despite taking some ibuprofen, it has not improved. Infact, he came to the hospital today because the pain has increased and he now has new onset of nausea and chills. He tells you that he had similar pain several years ago that was diagnosed as uric acid stones. He was treated conservatively and eventually passed all the stones spontaneously. His temperature is 38.1 C (100.6 F), blood pressure is 130/80 mm Hg, and pulse is 115/min. On examination, the patient is unable to lie still because of the pain and has significant right costovertebral tenderness radiating to his right testicle. Leukocyte count is 16,000/mm3 and his creatinine is 2.1 mg/dL. The most appropriate study after starting the patient on intravenous hydration and antibiotics is
A. a CT scan of the abdomen and pelvis
B. a DMSA renal scan
C. an intravenous pyelogram
D. a radiograph of the kidneys, ureters, and bladder
E. a renal ultrasound
A. a CT scan of the abdomen and pelvis
B. a DMSA renal scan
C. an intravenous pyelogram
D. a radiograph of the kidneys, ureters, and bladder
E. a renal ultrasound