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D&T3 Exam 1 > Dysuria-Petrany > Flashcards

Dysuria-Petrany Flashcards

(59 cards)

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1
Q

Urine Culture

Indications

A

Suspicion of complicated UTI

Atypical symptoms

Tx failure

Recurrent symptoms (<1 month after rx of previous UTI)

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2
Q

Cystitis

Prevention

A

Cranberry juice (contains tannins which can dec binding ability of E. Coli)
Void soon after sex
Avoid prolonged bath soaking
Wipe front to back
Void when urge-don’t hold it
Drink lots of water
Cotton underwear, loose fitting clothes, dec warmth and lessen colonization of perineum

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3
Q

Urethritis

Gonorrhea

Common pt

A

Indigent inner-city woman

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4
Q

UTI

Lower tract

Cystitis

Urinalysis

A

Pyuria (culture not need if uncomplicated)

Hemorrhagic cystitis if hematuria present

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5
Q

Vaginitis

Common causes

A

Candida vaginitis

Trichomonas vaginitis

Bacterial vaginosis

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6
Q

Urinalysis

UTI diagnosis sensitivities and specificities

A

Sensitivity. Specificity
Microscopic pyuria. >90. >50-75
Leukocyte esterase. 75-95. 94-98
Nitrite*. 35-85. 90-100

*only pos for enterobacteriaceae. Not staph, enterococcus, pseudomonas

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7
Q

You get a phone call…

A

Check for fever, N/V, comorbid conditions like pregnancy, DM, immunosuppression, possibility of STD (discharge)

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8
Q

Bacterial Vaginosis

A

Metronidazole

Clindamycin

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9
Q

Complicated UTI

Factors

A 
Pregnancy
Diabetes
Hx of acute pyelonephritis in last year
Relapsing UTI in past year
Hx of UTI in childhood
3 or mor UTIs in past year
Uropathogen with multiple resistance pattern
Hospital acquired UTI 
In-dwelling urinary catheter
An atomic of fxnal abnormality of urinary tract
Antibiotic tx within the last month
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10
Q

Urine Culture

Pos value if these symptoms

A

> 1000 CFU/mL

Diluted, washed out urine

Early infxn

On antibiotics

Men (contamination less likely)

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11
Q

UTI

Lower tract

Cystitis

What constitutes adequate diagnosis

A

UTI symptoms in presence of leukocytes

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12
Q

Urine sampling

Clean catch urine specimen

A

Woman must spread labia and whip with antiseptic wipe front to back and place cup in the midstream

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13
Q

Urethritis

Gonorrhea

Rx

A

Ceftriaxone (parenteral), ofloxacin

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14
Q

UTI Children

Rx

A

7-14 days of antibiotics

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15
Q

UTI

Lower tract

Cystitis

Involvement

A

Both bladder and urethra involved

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16
Q

Urethritis

Chlamydia

Risks

A

Sexually active, multiple partners, no barrier contraception

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17
Q

UTI

Lower tract

Cystitis

A

MC cause of dysuria in adult women

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18
Q

Indwelling bladder catheters

A

Avoid long term use if possible

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19
Q

UTI

Lower tract

Cystitis

Symptoms

A

Dysuria
Frequency
Urgency
Suprapubic pain

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20
Q

Dysuria

Symptomatic treatment

A

Phenazopyridine

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21
Q

Vaginitis

Urinalysis

A

Little to no pyuria

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22
Q

Vaginitis

Bacterial vaginosis

A

Thin off white fishy odor dishcharge

Ph>4.5

Clue cells

Pos whiff test

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23
Q

UTI

Lower tract

Cystitis

Exam

A

OK except Suprapubic tenderness

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24
Q

Urethritis

Gonorrhea

Gram stain

Study These Flashcards
A

Gram negative diplococci

25
UTI inpatient Therapy Pyelonephritis: when to admit
More severe illness, toxic appearing Complicated UTI (elderly, instrumented, diabetic, urologic abnormality) May be unable to take oral meds (N/V) Pregnancy Concerned about compliance
26
Urine sampling Urine handling
Bacteria still grow in warm urine so cool specimen if delay (OK overnight but WBCs may be affected
27
UTI Upper tract symptoms
Flank pain Fever Abdominal pain Nausea/vomiting
28
UTI Antibiotic Therapy (Adults) Uncomplicated cystitis
Short (1-3 days) TMP-SMX (or fluoroquinolone)
29
Urethritis Gonorrhea Gold standard
Urethral culture (calcium Latinate tip swab onto pre-warmed Thayer-Martin agar DNA probe OK but less sensitive
30
Vaginitis Symptoms
Dysuria with vaginal discharge or odor, itching, dyspareunia
31
Dysuria: Children Infectious causes
Lower UTI Pyelonephritis Urethritis Vaginitis
32
UTI Antibiotic Therapy (Adults) Complicated UTI
Longer course (7-14 days) Broader spectrum floroquinolones Don't use amox, nitrofurantoin, sulfa May need parenteral therapy Culture guided rx
33
Vaginitis Trichomoniasis
Copious yellow green malodorous discharge PH >4.5 Motile trichomonads, WBCs
34
Atrophied vaginitis
Post-menopausal, estrogen deficient women May have dysuria Urinalysis normal and no growth on culture Topical estrogen often effective
35
Urethritis in men
Dysuria alone is chlamydia Dysuria and discharge is gonorrhea
36
Vaginitis Candida
Thick, white cottage cheese discharge Normal pH (<4.5) Hyphae and budding yeast
37
Phenazopyridine Length of use
2 days only
38
Phenazopyridine Side effects
Turns urine red and leads to false pos dipstick (orange sweat) G6PD deficient pts can get hemolytic anemia
39
Candida vaginitis Rx
Fluconazole or itraconazole oral
40
Urine Culture Pos for proper clean catch urine
>100,000 CFU/mL
41
Trichomonas vaginitis Rx
Metronidazole TREAT SEX PARTNERS
42
UTI Women Risk factors
Sex Hx of UTI Diaphragm, spermicidal use Pregnancy Catheter Postmenopause
43
Urine sampling Suprapubic aspiration of bladder
Needle into bladder (rarely used, best)
44
UTI Men Risk factors
Prostatic hypertrophy Urethral catheterization
45
Urine sampling In children in diapers
Need minicath or Suprapubic tap
46
Dysuria: Children Noninfectious causes
Irritants Minor trauma Labial adhesions with small tears Psychogenic
47
Complicated UTI Procedure
Urine culture should be obtained with sensitivities Therapy may need to be adjusted (longer, different antibiotic) May require further evaluation
48
Phenazopyridine
Urinary analgesics can be used one diagnosis is made
49
Urethritis Chlamydia Testing and Rx
Test for DNA (NAAT) Rx: azythromycin, doxycycline
50
Uncomplicated UTI
Acute cystitis in an otherwise healthy non pregnant woman
51
UTI Common pathogens
``` E. Coli (90%) Enterococcus Pseudomonas (nursing homes, hospitalized) Proteus Klebsiella Staph saprophiticus ```
52
Irritant Dysuria
Rxn to local contact with irritant (contraceptive gel, tampon, condom, bubble baths, etc.)
53
Urethritis Chlamydia Urinalysis and culture
Pyuria without bacteriuria Urine culture neg
54
Acute dysuria In men...
Acute cystitis rare (anatomic problems) Urethritis more common in young sexually active men UTI more common in older men with prostatic hypertrophy
55
MC cause of dysuria in adult women
Cystitis (lower tract bacterial UTI)
56
Urine sampling Minicath urine sampling
Small sterile catheter inserted into bladder
57
UTI Lower tract symptoms
Dysuria Frequency Urgency Suprapubic pain
58
Acute dysuria Common Causes
Cystitis Urethritis Vaginitis
59
Uncomplicated UTI Cause
Almost always E. Coli or S. Saprophyticus

D&T3 Exam 1 (19 decks)

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