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  #1  
Old 04-12-2012
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Question Acute prostatitis and uretheral catheterization

A 46-year-old man comes to the physician because of a 2-day history of fever and chills. His fever was gradual in onset. He also complains of perineal and back pain, which is worse towards the sacral area. He has repeated urges to urinate, along with pain on micturition. Rectal examination shows a boggy, exquisitely tender prostate. Laboratory studies show:
Nitrite +++

WBC 50+

Protein +

Blood ++

Which of the following is the most appropriate next step in management?
A. Send culture of post-prostatic massage sample
B. Send culture of mid-stream urine sample
C. Administer alpha blocking agents
D. Start empirical treatment on an outpatient basis
E. Urethral catheterization

please support ur ans with expln
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Old 04-12-2012
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pt has acute bacterial pyelonephritis : dysuria and flan pain and Fever

ans is D. start emperical therapy on outpatient basis

culture will take time . pt can get in acute distress if results are awaited
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Old 04-12-2012
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so I just reread the question :P

I think answer is A. Send culture after prostatic massage. It's acute protatitis.
we'll send cultures then start antibiotic tm.
I think
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Old 04-12-2012
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I think B.
We don't do post-prostatic massage because it can lead to bacteremia.
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Quote:
Originally Posted by aiminghigh View Post
I think B.
We don't do post-prostatic massage because it can lead to bacteremia.
but i jus read that u do some massage before collecting the urine sample in case of prostatitis ( kinda weird lol) plus this patients prostae is redboggy n stuff.
but ya then again wen we are sure of infection. y go thru hassle giv the treamtment stargihtway
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Old 04-13-2012
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D.) start empiric treatment ; )
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Old 04-14-2012
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answer. B
dont do again and again prostate massage bcoz pt will go in bactremia it can lead to septic shock, do urine culture then start tx according to urine culture and sentitivity.
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Old 04-14-2012
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Ac Prostatitis.

Correct answer must be

D. Start empirical treatment on an outpatient basis

I rule out B and C here for the following reasons.

C is also an optional but empirical Abc therapy can provide timely help.

Midstream urine could be an option, but not when patient has got hematuria, boggy and tender prostate.
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Infectious-Diseases, Step-2-Questions, Urology-

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