The correct answer is "pyelonephritis." This is the correct answer because the patient's presentation with dysuria that progresses to include fever, chills, and lower back pain, is a very classic presentation of pyelonephritis. Pyelonephritis is an infection of the renal parenchyma, most commonly due to an ascending urinary tract infection. In this patient, who is a female (which places her at a greater risk for UTI's as compared to males due to females having shorter urethras than males) who initially has dysuria, this is a convincing story for a UTI. Further, the fact that the symptoms of fever, chills, and lower back pain are not present initially with the dysuria, but develop over the next day, is further evidence that pyelonephritis is the likely diagnosis. The physical exam finding of unilateral costovertebral angle tenderness also is highly suggestive of pyelonephritis.

The other choices are incorrect. Spinal stenosis is not a common diagnosis in young, otherwise healthy patients, and would not account for dysuria and unilteral costovertebral angle tenderness. A pneumothorax would not cause dysuria and would likely present with shortness of breath. Primary syphilis and genital herpes would not account for dysuria, lower back pain, or costovertebral angle tenderness.

The most common cause of renal failure in the US is diabetic nephropathy due to diabetes mellitus. Diabetic nephropathy can include multiple complications including arteriosclerosis, glomerulosclerosis, pyelonephritis and renal failure.

The correct answer is "primary syphilis." This is the correct answer as the classic presentation of primary syphilis is a painless chancre found on the base, shaft, or glans of the penis. The other choices are incorrect. A urinary tract infection would not present with a chancre, and would typically present with dysuria. Chlamydia or gonorrhea would typically present with penile discharge in males, not a painless chancre. Genital herpes would typically present with one or multiple painful ulcers on the penis, not a single painless chancre.

Changes in baseline cognition and functioning of older adults may be due to infection. Urinary tract infections frequently cause confusion. Evaluate for an underlying condition before testing for rare diseases or dementia.

A sickle cell crisis will require interventions to control the client's pain due to widespread tissue ischemia. Oxygen is needed to treat hypoxia and control the amount of red bood cell sickling. Blood transfusions are usually not first line treatment in a crisis.

Nystatin is an anti fungal medication, not effective in treating viral infections such HSV. Antiviral medications such as acyclovir, famciclovir, and valacyclovir would be prescribed to control symptoms and shorten episodes. These drugs are not curative.

The terms outbreak and epidemic are very similar, except an outbreak is confined to a smaller place. Both indicate an increase in incidence of disease. An endemic disease is always present in the community in a low level. An example is the common cold. A pandemic is an epidemic that occurs across multiple continents. A sporadic disease disease occurs randomly or in scattered incidence.

The first-line treatment for uncomplicated urinary tract infection with Proteus mirabilis is a 3 day course of either oral quinolone or trimethoprim/sulfamethoxazole (TMP/SMZ). 10-21 day courses are only appropriate in patients with complicated UTI or co-infections. Ampicillin and cefalexin are poor choices for initial treatment due to a 10-20% rate of resistance in Proteus species.

The risk for cervical spine injury is high due to electrical workers being subjected to having to work on utility poles that upon electrocution may lead to falls from tall heights. This possibility puts the person at risk for spinal and long bone fractures. Electrical burns often lead to damage below the surface of the skin and may not be fully appreciated on visual inspection. Chemical burns can lead to continual damage over 3 days, myoglobin in the blood stream from muscle damage puts the kidneys at risk for damage and the patient is usually at risk for metabolic acidosis not alkalosis.

Rheumatic fever presents with a red rash over the trunk and extremities, fever, and a sore throat. It is caused by an untreated Streptococcus infection in the previous 2-6 weeks, such as strep throat, and can be confirmed with a positive antistreptolysin O titer.