American Board of Internal Medicine (ABIM) Certification Practice Exam

For which condition is drainage usually required if complications are seen in pyelonephritis?

1. Kidney stones

2. Small abscess collections

3. Perinephric or intrarenal abscess

4. Viral infections

The correct answer is: Perinephric or intrarenal abscess

Drainage is typically required for perinephric or intrarenal abscesses in the context of pyelonephritis due to the potential for significant complications arising from infected pus collections. Pyelonephritis, an infection of the kidney, can lead to the formation of abscesses, which represent localized collections of pus that can occur around the kidney (perinephric) or within the renal tissue itself (intrarenal). The presence of these abscesses not only indicates a more severe infection, but they can also lead to systemic complications such as sepsis if not addressed adequately. Adequate drainage allows for the relief of pressure from the abscess, facilitates the elimination of the infected material, and contributes to the overall management of the infection. In contrast, conditions such as kidney stones, small abscess collections, and viral infections typically do not require such invasive interventions. While kidney stones can lead to obstructive pyelonephritis, the primary treatment focuses on addressing the stone rather than immediate drainage unless complications arise, which are not as routinely seen as with significant abscesses. Small abscesses may sometimes resolve with antibiotic management and may not require drainage, depending on their size and associated symptoms. Viral