04-08-2009, 10:34 AM
45. 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