A 34-year-old otherwise healthy woman presents to your prima…
A 34-year-old otherwise healthy woman presents to your primary care office with a 2-day history of dysuria, urinary urgency, and urinary frequency that has progressed to fever, chills, nausea, and left-sided flank pain. She is alert, well hydrated, and able to tolerate oral fluids. Vital signs are as follows: temperature 100.8°F, blood pressure 118/72 mmHg, heart rate 92 bpm, respiratory rate 16 breaths/min, and oxygen saturation 99% on room air. Physical examination demonstrates left costovertebral angle tenderness. Urinalysis reveals positive nitrites, positive leukocyte esterase, pyuria, bacteriuria, and WBC casts. A urine culture is obtained before initiating treatment. Which of the following is the most appropriate antibiotic selection?
Read DetailsA 69-year-old man with hypertension and stable coronary arte…
A 69-year-old man with hypertension and stable coronary artery disease is newly diagnosed with primary hypothyroidism. His calculated full replacement dose is approximately 120 mcg/day. Which initial levothyroxine prescription is most appropriate?
Read DetailsA 56-year-old man presents with a 3-day history of fatigue,…
A 56-year-old man presents with a 3-day history of fatigue, decreased urine output, and dark-colored urine. He denies dysuria, urinary frequency, urgency, or flank pain. Two weeks ago, he completed treatment for streptococcal pharyngitis. His blood pressure is 168/94 mmHg, and physical examination demonstrates bilateral lower extremity edema. Laboratory studies reveal: Urine dipstick: 3+ blood, 2+ protein, negative nitrites, negative leukocyte esterase Urine microscopy: Dysmorphic RBCs, numerous RBC casts, no bacteria Urine culture: No growth after 48 hours Serum creatinine: 2.6 mg/dL (baseline 0.9 mg/dL) eGFR: 29 mL/min/1.73 m² UACR: 620 mg/g Based on these findings, what is the most appropriate next step?
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