OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is pyelonephritis. While this may seem a odd practice, it is useful to see multiple examples of how pyelonephritis will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
QUESTION EXAMPLES
Question # 1
A 89 year old woman is with dementia is brought to the hospital because she is experiencing fever, chills, lethargy, and agitation for the past 3 days. Her temperature is 101.4°F. A physical exam reveals tenderness of the lower abdomen and the left costovertebral angle. Labs are collected and the results are shown below:
- Leukocyte count: 19,000/mm³
- Segmented neutrophils: 60%
- Bands: 20%
- Lymphocytes: 20%
- Urine
- RBC :20/hpf
- WBC: 40/hpf
- Granular casts: positive
- Bacteria: few
What is the likely diagnosis?
Explanation: fever + CVA tenderness = pyelonephritis
Question # 2
A 25 year old woman comes to the clinic because she has been experiencing a fever, chills, and flank pain for the past few days. She also explains that she has nausea and has vomited twice yesterday. Her temperature is 102.3°F, push is 110/min, and blood pressure is 85/65 mm Hg. A physical exam reveals tenderness to percussion over the right flank. The rest of the physical exam is unremarkable. Lab studies are shown below:
- Hemoglobin: 14.0 g/dL
- WBC count (serum): 18,000/mm3
- Urine RBCs: 10-15/hpf
- Urine WBCs: 30-45/hpf
What is the likely diagnosis in this patient?
Explanation: flank tendereness + fever + WBC/RBC in urine = pyelonephritis
Page Updated: 12.23.2016