Cystitis, Pyelonephritis, IC & OAB

Question 1

When is a urine dispstick most accurate in predicting a UTI?

Answer 1

If sxs AND + for leukocyte esterase/ nitrate

Question 2

Non-nitrate reducing organisms and frequent urination/ urine in bladder < 4 hrs can cause what?

Answer 2

False negative on urine dipstick

Question 3

Vaginal contamination and trichomonas infection can cause what?

Answer 3

False positive on urine dipstick

Question 4

Upper urinary tract infection is aka?

Answer 4

Pyelonephritis

Question 5

Lower tract infection is aka?

Answer 5

Cystitis (also prostatitis, urethritis)

Question 6

What is the majority cause of UTI’s?

Answer 6

Ascending bacterial infection (E. coli)

Question 7

↓ urine flow is a RF for UTI. What 3 things can cause this?

Answer 7

Urine outflow obstruction, inadequate fluid intake, neurogenic bladder

Question 8

Promotion of colonization is a RF for UTI. What 3 things can cause this?

Answer 8

Sexual activity, spermicide use, recent antimicrobial use

Question 9

Facilitated ascent is a RF for UTI. What 2 things can cause this?

Answer 9

Catheterization, urinary/ fecal incontinence

Question 10

Acute simple cystitis is confined to where? (although there may be an atypical presentation in elderly)

Answer 10

Bladder (lower urinary tract) (in non-pregnant individual)

Question 11

What are the most common sxs of a UTI? (3)

Answer 11

Dysuria, urinary frequency, urgency

Question 12

You note a normal PE and a UA with + leukocyte esterase & nitrates, microscopy w/ + pyuria, and bacteriuria. What should you be suspicious for?

Answer 12

UTI

Question 13

The following are indications for what? Atypical presentation, suspect complicated UTI, recurring/ non-resolving sx, ABX resistance, special populations (pregnant, men, IMC, underlying urogenital abn)

Answer 13

Culture (routine cultures not usually needed for women w acute simple cystitis)

Question 14

CFU of what for uropathogen is diagnostic for a UTI?

Answer 14

≥ 103 CFU

Question 15

CFU of what for women with presence of UTI symptoms is considered positive?

Answer 15

>102 CFU

Question 16

Typical tx for uncomplicated URI is what?

Answer 16

Urinary analgesic (Pyridium), limit to 2 day course

Question 17

What abx should be used in the tx of a UTI?

Answer 17

Nitrofurantoin, Bactrim, Fosfomycin

Question 18

What abx should be avoided in the tx of UTI if there is presence of early pyelonephritis?

Answer 18

Nitrofurantoin and Fosfomycin

Question 19

What abx should be avoided in pregnancy for the treatment of a UTI?

Answer 19

Fluoroquinolones

Question 20

Men with a UTI should be treated for longer duration of how long in order to r/o prostatitis?

Answer 20

7 days

Question 21

Pts who are IMC should be treated for longer duration of how long for a UTI?

Answer 21

1-2 weeks

Question 22

Pts with a UTI should experience relief in how long after initiation of abx treatment?

Answer 22

W/i 48 hrs

Question 23

What ER precautions should be given to a pt with a UTI?

Answer 23

Signs of pyelonephritis (fever, chills, flank pain)

Question 24

When should f/u urine cultures be taken in pts with a UTI?

Answer 24

Pregnant women

Question 25

What type of UTI is an extension of infection beyond the bladder?

Answer 25

Acute complicated UTI

Question 26

What is the term for infection of the kidney (upper urinary tract) usually from ascent of bacterial pathogen?

Answer 26

Pyelonephritis

Question 27

What sxs will you see on a pt with pyelonephritis? (7)

Answer 27

Dysuria, fever, chills, fatigue, flank pain, CVAT, GI sx

Question 28

What 3 tests will you order is you suspect a pt has pyelonephritis?

Answer 28

UA/culture, CBC, BMP

Question 29

What will you see on UA/ culture of a pt with pyelonephritis?

Answer 29

WBC casts (also + leukocyte esterase, + nitrites, pyuria (≥ 10 leukocytes/mL), bacteriuria)

Question 30

What is the imaging of choice for a pt with pyelonephritis?

Answer 30

CT A/P w/ & w/o contrast

Question 31

What is the treatment for outpatient pyelonephritis?

Answer 31

Fluoroquinolone (Ciprofloxacin, Levofloxacin)

Question 32

What is the treatment for outpatient pyelonephritis if the pt has a FLQ resistance?

Answer 32

IV or IM dose of Ceftriaxone followed by Cipro or Levofloxacin

Question 33

What is the treatment for inpatient pyelonephritis

Answer 33

IV ABX, supportive care

Question 34

How soon must a pt w/ pyelonephritis f/u if they are symptomatic (mild-mod illness) or out pt management?

Answer 34

48-72 hrs

Question 35

The following complications are associated with what condition? Sepsis w/ shock Renal failure Scarring/chronic pyelonephritis (if coexistent kidney disease) Renal abscess formation

Answer 35

Pyelonephritis

Question 36

What is prostatitis? (men)

Answer 36

Pelvic or perineal pain

Question 37

Bladder pain syndrome (BPS) and painful bladder syndrome (PBS) are aka what?

Answer 37

Interstitial cystitis (IC)

Question 38

Chronic debilitating condition characterized by bladder pain \> 6 wk is what condition?

Answer 38

Interstitial cystitis (IC)

Question 39

When is the bladder pain better/ worse with Interstitial cystitis (IC)?

Answer 39

Worse w/ bladder filling, relieved w/ voiding

Question 40

Men with Interstitial cystitis (IC) may present as having pelvic pain along with what other complaint?

Answer 40

Sexual dysfunction

Question 41

Interstitial cystitis (IC) is really a clinical dx of inclusion. This involves performing a UA and urine culture to exclude what?

Answer 41

Hematuria and infection

Question 42

Cystoscopy of a pt with Interstitial cystitis (IC) might show what, which is used to support the dx?

Answer 42

Altered urothelium (glomerulations and hunner lesions)

Question 43

Which condition has the potential to impacts psychosocial functioning and QOL?

Answer 43

Interstitial cystitis (IC)

Question 44

Is treatment of Interstitial cystitis (IC) curative?

Answer 44

No, goal is to provide symptomatic relief

Question 45

What is 1st line tx for Interstitial cystitis (IC)? (5)

Answer 45

Lifestyle changes, behavior modification, exercise, support groups, urinary analgesics

Question 46

What is 2nd line tx for Interstitial cystitis (IC)? (3)

Answer 46

Oral meds (Amitriptyline, Elminron, Hydroxyzine) Intravesical meds (Lidocaine) Pelvic PT

Question 47

Pt presents with a hx of urinary urgency +/- incontinence, often w/ nocturia and urinary frequency. They state their sxs are impacting their QOL. What should you be considered for?

Answer 47

Overactive Bladder (OAB)

Question 48

What is the etiology for Overactive Bladder (OAB)?

Answer 48

Detrusor muscle overactivity → involuntary bladder contraction → leakage

Question 49

What labs should you get if you are suspicious for Overactive Bladder (OAB)?

Answer 49

UA, + urine culture if UTI or hematuria

Question 50

What is 1st line tx for Overactive Bladder (OAB)? (3)

Answer 50

Pelvic floor muscle exercises, lifestyle/behavioral changes (weight loss, caffeine reduction), bladder training

Question 51

What is 1st line tx for Overactive Bladder (OAB)? (2)

Answer 51

Antimuscarinics (interfere w/ detrusor muscle) Mirabegron

Question 52

What cautions should you be aware of when treating Overactive Bladder (OAB)?

Answer 52

Cautions w/ anticholinergic side effects

Question 53

Pt presents w sharp, stabbing back pain of waxing and waning severity that radiates from flank to groin. What should you be concerned about?

Answer 53

Nephrolithiasis

Question 54

What are the most common associated sxs of nephrolithiasis? (3)

Answer 54

Pain (flank radiating to groin), hematuria, passage of stone/ gravel

Question 55

What is the pathogenesis of nephrolithiasis?

Answer 55

Supersaturation of urine = crystal formation

Question 56

What are the most common type of stones?

Answer 56

Calcium oxalate \> calcium phosphate

Question 57

What type of stones are typically radiolucent?

Answer 57

Uric acid

Question 58

What are RF's for nephrolithiasis? (5)

Answer 58

Hx of prior stone, FH, decreased fluid intake, malabsorption, hyperparathyroidism

Question 59

What is the gold standard for dx of nephrolithiasis? (check for both stone and obstruction)

Answer 59

Non-contrast low radiation CT (IV contrast decreases sensitivity for small stones) (can also use US)

Question 60

What happens to kidney stones ≤ 5mm?

Answer 60

Pass spontaneously

Question 61

Besides pain meds, hydration, and urine straining, what pharmacologic tx is used for nephrolithiasis in order to facilitate stone passage?

Answer 61

Tamsulosin 0.4mg qd (alpha blocker)

Question 62

Stones \>10mm, failure to pass stone w conservative management, and significant obstruction are indications for what?

Answer 62

Urology referral

Question 63

Urologic infection, AKI, anuria, and unyielding pain, n/v with respect to nephrolithiasis management are indications for what?

Answer 63

Urgent urology referral

Question 64

What are the 3 possible surgical removal options for tx of nephrolithiasis?

Answer 64

Shock wave lithotripsy Ureteroscopy Percutaneous nephrolithotomy

Question 65

What pt edu should be provided for the management of nephrolithiasis? (3)

Answer 65

Eval for underlying causes Diet +/- Allopurinol (gout), HCTZ

Question 66

If on eval of a non-contrast CT of a pt w possible nephrolithiasis you note perinephritic stranding. What does this indicate?

Answer 66

Signs of inflammation or obstruction

Question 67

What lifestyle habit is associated with increased risk of renal cell carcinoma?

Answer 67

Cigarette smoking

Question 68

What is the classic triad for renal cell carcinoma?

Answer 68

Hematuria, flank pain, palpable abd mass

Question 69

What is the test of choice for definitive dx of renal cell carcinoma?

Answer 69

Tissue bx (often found incidentally on CT or US)

Question 70

What is the tx for localized renal cell carcinoma?

Answer 70

Nephrectomy

Question 71

What sxs are typically associated with PKD? (3)

Answer 71

HTN, abd/ flank pain, hepatic cysts

Question 72

What gene is associated with autosomal recessive PKD?

Answer 72

PKHD1 gene

Question 73

What is the treatment for autosomal dominant PKD?

Answer 73

Tolvaptan (also dialysis, kidney transplant)

Question 74

The following pathogenesis ultimately causes what complication in pts with PKD? BIL: cysts → enlarge → compress parenchyma → compromise renal function/ BF →

Answer 74

ESRD (\> 50% by age 60)

Question 75

What systems are affected by recessive PKD?

Answer 75

Kidneys and hepatobiliary tract