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Urosepsis with shock — USMLE Step 3 MCQ

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HardEmergency MedicineUrosepsis with shockUSMLE Step 3

A 66-year-old woman is brought from home because of fever, dysuria, flank pain, and confusion. Temperature is 39.1°C, blood pressure is 86/50 mm Hg, pulse is 124/min, and respiratory rate is 28/min. Lactate is 4.2 mmol/L. Urinalysis shows pyuria and nitrites. Blood cultures are drawn. Which of the following is the most appropriate next step in management?

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Correct answer: B — IV fluids and broad-spectrum IV antibiotics

Septic shock from pyelonephritis requires immediate IV crystalloid resuscitation and broad-spectrum antibiotics after cultures if this does not delay therapy. Imaging can follow if obstruction or poor response is suspected.

Reference: Surviving Sepsis Campaign Guidelines 2021