05-24-2007, 11:14 AM
A 78-year-old woman is admitted to the hospital because of fever, flank pain, and mental obtundation. On arrival to the hospital, she was minimally responsive and was found to have a white blood cell count of 43,000/mm3 with a profound left shift. Urinalysis revealed packed white cells. A renal ultrasound demonstrated a left hydronephrosis and hydroureter. A CT scan confirmed the presence of an obstructing stone. Her vital signs on admission showed a temperature of 39.5 C (103.1 F), blood pressure of 80/40 mm Hg, pulse of 112/min, and respirations of 18/min. Intravenous pressors were initiated. Three sets of blood cultures came back positive for Gram-negative rods within 2 hours. The most appropriate next step in management is to
A. administer antibiotics, intravenously, and observe
B. insert a nephrostomy tube, percutaneously
C. perform extracorporeal shock wave lithotripsy (ESWL)
D. schedule cystoscopy and ureteral stent placement
E. schedule a nephrectomy
A. administer antibiotics, intravenously, and observe
B. insert a nephrostomy tube, percutaneously
C. perform extracorporeal shock wave lithotripsy (ESWL)
D. schedule cystoscopy and ureteral stent placement
E. schedule a nephrectomy