A 24-year-old woman comes to the physician because of a 24-hour history of right flank pain, burning micturition and high-grade fever with chills. Her temperature is 38.9° C (102° F), blood pressure is 90/60 mm Hg, pulse is 130/min, and respirations are 20/min. Physical examination shows costovertebral angle tenderness. Which of the following is the most likely urine dipstick finding in this patient?

Question

A 24-year-old woman comes to the physician because of a 24-hour history of right flank pain, burning micturition and high-grade fever with chills.  Her temperature is 38.9° C (102° F), blood pressure is 90/60 mm Hg, pulse is 130/min, and respirations are 20/min.  Physical examination shows costovertebral angle tenderness.  Which of the following is the most likely urine dipstick finding in this patient?

Quizplus · Accepted Answer

Dipsticks are commercially available kits that detect the presence of leukocyte esterase and nitrites in the urine of patients with suspected UTI. Leukocyte esterase in the urine indicates significant pyuria, whereas nitrites signify the presence of Enterobacteriaceae, which converts urinary nitrates to nitrites. (Remember that the most likely responsible organism of UTI is E.coli.) The advent of dipstick testing has significantly reduced the cost associated with urine culture; however, dipsticks are associated with a high false positive rate and high false negative rate. For this reason, a negative dipstick test in a patient with symptoms of UTI should still have urine cultures done. In this case, the patient's clinical presentation (i.e., pyuria, significant bacteriuria) is highly suggestive of acute pyelonephritis. The expected dipstick finding is positive for both nitrites and esterase. Educational objective: Dipsticks are commercially available kits that detect the presence of leukocyte esterase and nitrite in the urine of patients with suspected UTI. Positive leukocyte esterase signifies significant pyuria and positive nitrites indicate the presence of Enterobacteriaceae.

A 24-Year-Old Woman Comes to the Physician Because of a 24-Hour