A 17-year-old female presents with intermittent right ...
A 17-year-old female presents to the office with complaints of intermittent right flank pain, hematuria, urinary frequency, fever, chills, and myalgia. She has no significant past medical or surgical histories. Her temperature is 38.3(C (101(F). The remaining vital signs are within normal limits. Her abdomen is soft with mild right lower quadrant tenderness, and there is no guarding or rebound. Costovertebral angle tenderness to percussion is noted on the right with regional hypertonicity and tissue texture abnormalities at the thoracolumbar junction. Laboratory studies reveal:
|Test |Patient's Value |Reference Range |
|Leukocyte count |7.8 x 103/mcL |4.8-10.8 x 103/mcL |
|Neutrophils |65% |54-62% |
|Hemoglobin |12.8 g/dL |12.0-16.0 g/dL |
|Total bilirubin |1.2 mg/dL |0.2-1.2 mg/dL |
|BUN |43 mg/dL |6-20 mg/dL |
|Serum creatinine |0.7 mg/dL |0.6-1.1 mg/dL |
Urinalysis reveals 1+ blood. The most appropriate next test to order is a/an
A) 24-hour urine collection for protein
B) abdominal radiograph
C) cystoscopy
D) gallbladder ultrasound
E) noncontrast spiral CT scan
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