A 5-year-old girl is brought to the physician because of a 2-day history of temperatures to 39.5 C (103.1 F) and pain in the right side. She has had two episodes of vomiting during this period but no diarrhea or symptoms of upper respiratory tract infection. She has vesicoureteral reflux and a history of recurrent urinary tract infections. She appears ill. Her temperature is 39.8 C (103.6 F), blood pressure is 110/60 mm Hg, pulse is 150/min, and respirations are 25/min. Examination shows right-sided costovertebral angle tenderness. In addition to obtaining urine cultures, which of the following is the most appropriate next step in management?
A) Intravenous pyelography
B) Renal ultrasonography
C) Voiding cystourethrography
D) Intramuscular antibiotic therapy and reexamination in 24 hours
E) Intravenous antibiotic therapy
Wed Jun 24, 2009 8:58 pm