Quiz 3 - UTIs and Nephrolithiasis

Question 1

Adjunctive trick

Answer 1

Bromelain 300 mg TID to enhance tissue penetration

Question 2

Chronic urethritis causes

Answer 2

STIs, indwelling catheter, diapers, intercourse, diapers

Question 3

Bladder CA RFs

Answer 3

smoking
second-hand smoke
env exposure
high coffee intake
high animal protein/fat
radiation
schistosomiasis

Question 4

Cystitis Tx

if other tx not working within 24-48 hrs or signs of pyelo

Answer 4

nitrofuratoin or TMP-SMX

Question 5

If acute pyelo does not resolve after 5 days of tx

Answer 5

Renal abscess (or perinephric abscess)

Tx with abx!
Refer for percutaneous aspiration under CT or US
Surgery

Imaging = CT

Question 6

Bladder CA Dx

Answer 6

UA- hematuria

cytoscopy + biopsy

Question 7

UTI Urine collection

Answer 7

MSCC

Question 8

only radiolucent stone

Answer 8

Uric acid

Question 9

Acute urethritis in women

Answer 9

tetracyclines (eg doxycycline) and fluoroquinolones (eg Cipro) are contraindicated in pregnancy.

Question 10

Struvite stones etio

Answer 10

urea-splitting organisms Proteus, klebsiella, pseudomonas

Question 11

GCU ssxs in men

Answer 11

purulent dc, dysuria, itching

meatal edema, tenderness

Question 12

Dx Interstitial cystitis

Answer 12

dx of exclusion
Hunner’s ulcers
Glomerulations on cystoscopic exam
pain associated with the bladder OR urinary urgency

Question 13

Abx for pyelo

Answer 13

Cipro or

TMP-SMX

Question 14

Pyelo DDX

Answer 14

Emphysematous pyelo
Focal or multifocal bacterial nephritis
Pyonephrosis
Xanthogranulomatous pyelonephritis

Question 15

GCU complications

Answer 15

asymptomatic carriage, which may result in chronic infertility, chronic prostatitis, chronic epididymitis, recurrent acute infections, etc. (do cultures of urethra, pharynx, rectum as needed)

Question 16

Tx Spastic Bladder

Answer 16

anticholinergics
catheter
neurorestorative herbs

Question 17

NGU complications

Answer 17

epididymitis, prostatitis, proctitis, Reactive arthritis (reactive arthritis triad: arthritis, uveitis, urethritis), lymphogranuloma venereum

Question 18

Labs tests for male urethritis

Answer 18

Urine NAAT PCR

Question 19

Cystitis caused by E. coli…

Answer 19

D-mannose works (if type 1 pili)

Question 20

Tx stress incontinence

Answer 20

alpha adrenergic agonists, estrogen

Question 21

chronic stone former work-up

Answer 21

24-hour urine
PTH
Serum calcium and phosphorus

Question 22

UTIs in boys and men <50

Answer 22

abnormality of urinary tract

Question 23

Naturopathic Tx Cystitis

Answer 23

vit C, vit A, vit E, D-mannose
white undies
botanicals
alt sitz bath, COPs

Question 24

Ca oxalate stones etiology

Answer 24

(75% of stones)

Low water intake
Hyperoxaluria, hypercalciuria
Hyperuricosuria, hypocitriuria
hyperPTH

Question 25

Tx Flaccid Bladder

Answer 25

crede's acetylcholine derivatives catheter neurorestorative herbs

Question 26

IC Tx

Answer 26

``` prednisone LDN hydrodistension avoid bladder irritants anxiolytics antispasmodics ```

Question 27

Interstitial cystitis Complication

Answer 27

gradual ureteral stenosis or reflux --> hydronephrosis

Question 28

Cystitis Dx

Answer 28

UA.. if + then | Urine C&S (>100,000 to exclude contamination)

Question 29

minerals/molecules that increase risk of stones

Answer 29

calcium, oxalate, phosphate, uric acid

Question 30

Tx of Chlamydia

Answer 30

azithromycin (1gm) SD OR | doxycycline 100mg bid for 7d

Question 31

NGU

Answer 31

Dysuria, scant dc Less acute onset (longer incubation period) Meatal edema and erythema

Question 32

Pathognomonic for pyelo...

Answer 32

Glitter cells (neutrophils with cytoplasmic granules)

Question 33

recurrent cystitis

Answer 33

vesicoureteral reflex

Question 34

what (physiologically) causes non-colicky pain

Answer 34

distention of renal capsule

Question 35

Stone PE

Answer 35

Restlessness CVA tenderness Abdominal mass with obstruction and hydronephrosis

Question 36

sxs of staghorn stone

Answer 36

silent unless recurrent UTIs

Question 37

minerals/molecules that decrease risk of stones

Answer 37

sodium, citrate, mag, sulfate

Question 38

Tx of GCU

Answer 38

Ceftriaxone (250mg IM) PLUS Azirthomycin OR doxyclycline bid for 7 days

Question 39

Causes of Neurogenic bladder spastic + flaccid

Answer 39

MS, spinal cord injury, DM, ALS, Parkinson’s, spinal or pelvic surgery, degeneration from aging or inflammation

Question 40

Chronic pyelo

Answer 40

BL pyogenic kidney infection or congenital reflux nephropathy with renal parenchymal scarring and atrophy of the calyces. Course over 20+ yrs usu asx

Question 41

Strangury

Answer 41

painful frequent urination in small amounts | if stone blocks ureter

Question 42

what (physiologically) causes renal colic

Answer 42

stretching of ureter by obstruction of flow