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Pyelonephritis — MCCQE Part 1 MCQ

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ModerateDysuriaPyelonephritisMCCQE Part 1

35-year-old woman presents with fever, dysuria and flank pain. She has costovertebral angle tenderness and nausea. Which of the following is the most appropriate next step?

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Correct answer: C — Start antibiotics for pyelonephritis and assess need for IV therapy/admission

Start antibiotics for pyelonephritis and assess need for IV therapy/admission is best because fever and flank pain indicate upper urinary tract infection. Discharge with reassurance and routine follow-up only is suboptimal because it underestimates acute or progressive risk; Treat symptomatically and defer definitive assessment is suboptimal because symptom control alone does not address the likely underlying diagnosis; Arrange non-urgent outpatient imaging in several months is suboptimal because delayed imaging is unsafe when the presentation has red flags; Start long-term corticosteroids without confirming the diagnosis is suboptimal because empiric steroids can obscure infection, malignancy or other diagnoses. Urine culture is important in pyelonephritis.

Reference: AMMI Canada urinary tract infection guidance