A 22-year-old woman with severe right lower quadrant (RLQ) pain accompanied by dysuria, fever, shaking chills, and frequency.
She is sexually active with one partner and always uses condoms. Her last menstrual period was 5 days ago.
On physical examination, her temperature is 39°C and her heart rate is 120/min. Blood pressure and respirations are normal.
Abdominal examination reveals suprapubic tenderness with palpation. The patient complains of pain when percussion is performed with the ulnar surface of the fist over the right costovertebral angle (CVA). Pelvic examination is normal.
Which of the following is the most likely diagnosis?
b. Acute cystitis
c. Renal calculi
for each alternative that you choose its better to explain, one case will have 2 winners one first correct answer and one other best explained answer