1. Vital signs. Evaluate for fever, tachycardia, or hypotension, which suggest upper tract involvement and, in the case of hypotension, urosepsis.
2. Abdomen and back. Examine for abdominal or flank masses, suprapubic tenderness, or costovertebral angle tenderness.
3. Genitalia. Inspect skin and perineum for evidence of rashes, redness, or irritation. Look for evidence of discharge. Perform pelvic exam in sexually active adolescent girls who present with dysuria and discharge to rule out vaginitis, cervicitis, and pelvic inflammatory disease.
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