Good.
The correct answer is E. This adolescent boy is most likely having nocturnal emissions ("wet dreams"), which are a normal part of puberty. A nocturnal emission is when the penis becomes erect during sleep and ejaculates. If the boy or his mother do not know about nocturnal emissions before they occur, they may think that he urinated. He should be reassured that this is normal. It is also important to discuss it with his mother so she does not make him feel uncomfortable about it in the future.
It is not necessary to advise him to stop drinking water at 8 pm and urinate before bed (choice A) because he is having a nocturnal emission, which is not related to urination.
It is inappropriate to begin a 3-day treatment regimen with trimethoprim-sulfamethoxazole (choice B) because this boy is most likely having nocturnal emissions, not a urinary tract infection. Nocturnal emissions are normal and do not require treatment.
It is not necessary to obtain a urine sample for culture and sensitivity (choice C) or a renal ultrasound (choice D) because this boy is most likely having nocturnal emissions, which are not related to urinary tract infections (UTI). He does not have the symptoms of a UTI, which include frequency, dysuria, and nocturia. The nighttime "wetness and stickiness" that he describes is most likely due to semen, not urine.
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