رجل عمره ٤٦ سنة عنده حصوة ٧ ملم في الحالب الأيمن، ورجع بعد يومين بحرارة ٣٩٫٤ ورجفة، والضغط ٨٨/٥٢، والنبض ١٢٨، ومشوش قليلاً. الأشعة تظهر تضخم الكلية اليمنى. ما الإجراء المتوقع بشكل عاجل؟

A 46-year-old man with a 7 mm right ureteric stone returns two days later with fever 39.4 °C and rigors; BP 88/52, HR 128, mildly confused. Imaging shows right hydronephrosis. What urgent intervention is expected?

1. Shock-wave lithotripsy two weeks from now
2. Oral analgesia and waiting for the stone to pass alone
3. Fluids, antibiotics and urgent drainage of the obstructed kidney
4. Drinking large volumes of water to push the stone out

Answer: C) Fluids, antibiotics and urgent drainage of the obstructed kidney. An infected obstructed kidney with sepsis is an emergency needing fluids, antibiotics and urgent decompression (ureteric stent or nephrostomy), with definitive stone treatment later.