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Acute pyelonephritis — MCCQE Part 1 MCQ

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ModerateDysuriaAcute pyelonephritisMCCQE Part 1

A 34-year-old woman has fever, rigors, flank pain, vomiting, dysuria and costovertebral angle tenderness. Which of the following is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Obtain urine culture and start empiric antibiotics, considering parenteral therapy

Obtain urine culture and start empiric antibiotics, considering parenteral therapy because she is vomiting is the single best answer because the age, timing, examination findings and investigations in the vignette fit Acute pyelonephritis better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to Canadian antimicrobial stewardship guidance, with attention to acuity, safety-netting and local provincial pathways.

Reference: https://mcc.ca/objectives/medical-experts/