06-02-2008, 06:43 PM
A 42-year-old woman comes to the physician
because of increasing
low back pain for 2 days. She is a daily intravenous
drug user. She
has a history of pyelonephritis, abscesses at
injection sites, and
pelvic inflammatory disease. Her temperature is 39 C
(102.2 F), blood
pressure is 130/70 mm Hg, pulse is 84/min, and
respirations are 20/min.
Examination shows warm, dry skin, a supple neck, and
no jugular venous
distention. There is tenderness over L4. Pelvic
examination shows mild
erythema around the cervical os and scant discharge;
there is no adnexal
or cervical motion tenderness. Her hematocrit is 30%,
leukocyte count
is 10,600/mm3, and serum glucose level is 110 mg/dL.
Urinalysis is
within normal limits. Which of the following is the
most appropriate next
step in management?
A) Echocardiography
B) Renal ultrasonography
C) MRI of the back
D) Colposcopy
E) Laparoscopy
because of increasing
low back pain for 2 days. She is a daily intravenous
drug user. She
has a history of pyelonephritis, abscesses at
injection sites, and
pelvic inflammatory disease. Her temperature is 39 C
(102.2 F), blood
pressure is 130/70 mm Hg, pulse is 84/min, and
respirations are 20/min.
Examination shows warm, dry skin, a supple neck, and
no jugular venous
distention. There is tenderness over L4. Pelvic
examination shows mild
erythema around the cervical os and scant discharge;
there is no adnexal
or cervical motion tenderness. Her hematocrit is 30%,
leukocyte count
is 10,600/mm3, and serum glucose level is 110 mg/dL.
Urinalysis is
within normal limits. Which of the following is the
most appropriate next
step in management?
A) Echocardiography
B) Renal ultrasonography
C) MRI of the back
D) Colposcopy
E) Laparoscopy