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Discussion Starter #1
Here's a question
A long typical case of Pyelonephritis in 21 year old female previously healthy
you started IV ceftriaxone and the patient fever still spiking and patient did not improve after 2 days of therapy
What's the next stap in management

a- Wait another 24 hours
b- Repeat blood and urine cultures, don't change AB until results
c- Repeat blood and urine cultures, give broader spectrum AB now
d- Do Ultrasound to look for abscess
e- Do CT scan to look for abscess
 

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The simple clinical rule
pus somewhere pus anywhere pus under the diaphragm

This girl must have developed abscess

So the question is what is the best investigation to detect perinephric abscess and the answer is CT scan
U/S is less sensitive and could be difficult if she's obese
 
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