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Pyelonephritis with obstruction — SCE Acute Medicine MCQ

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HardSepsis and Infectious EmergenciesPyelonephritis with obstructionSCE Acute Medicine

A 63-year-old woman is assessed on the acute medical unit. She has flank pain, fever and hypotension. CT KUB shows an obstructing ureteric stone with hydronephrosis. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: C — Request urgent urological source control

Request urgent urological source control is the best answer because infected obstructed kidney is a source-control emergency requiring urgent decompression plus antibiotics. Perform synchronised direct-current cardioversion is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Antibiotics alone may fail when obstruction prevents drainage.

Reference: EAU urological infection guideline; NICE NG253