Name two lower UTI differentials
two Upper UTI differentials
What is the most common UTI causing organism in women?
What is the most common UTI organism in men?
What is the first test you would order in a man who had BPH symptom complaints?
UA because UTI has some of the same sypmtoms at BPH
The presence of nitrates by dipstick is a very specific but not very sensitive test for bacteruria.
So it shows better that they don't have it than if they do have it.
Esterase detection is very sensitive for UTI, that means if it is positive________.
If it is very sensitive it means if it is positive, most likely they do have a UTI.
What are two commonly used agents for treatment of UTI?
bactrim or cipro
What agent is used for UTI in pregnancy?
Amoxicillin and nitrofurantoin
How many days of abx therapy does a pregnant woman get for UTI?
a full 10 day course
What are symptoms of pylonephritis?
*mental status changes in the elderly
(plus UTI symptoms)
What are common agents to treat upper UTI infection?
short course of gentamicin
When using bactrim or cipro to treat pylonephritis, how does the medication regimen change?
the duration changes, it is long, 14 days to 6 weeks
Sudden change, BUN out of proportion to creatinine, often due to obsruction, acute tubular necrosis, or contrast media.
acute renal failure
Is acute renal failure reversible?
Name three causes of acute renal failure
Steady increase in BUN/creatinine, progressive over time from months to years, intrinsic kidney damage, not reversable but we can slow the progression
chronic renal failure
What is the normal BUN/cr ratio?
How would you categorize a patient with 10% or less of functioning nephrons, with complete loss of kidney function >3 months, who requires dialysis?
end stage renal disease
If you had a patient with 75% nephron loss and a double in the baseline creatinine, how would you classify their renal function?
According to the RIFLE criteria, to classify a patient with acute kidney injury (AKI) they must have:
1. serum cr 2-3 times their baseline OR GFR decrease >50%
2. UOP <0.5ml/kg/hr for >12 hours
What are the AEIOU indications for dialysis?
E: electrolyte disturbances
O: overload (fluid overload)/oliguria
U: uremia (urine in the blood)
How do we treat acute renal failure?
determine and Treat the underlying cause
How do we treat chronic renal failure?
slow progression of the chronic renal failure by:
treating HTN and DM if applicable
low protein diet
modify medications that maybe contributing to renal failure
How do you treat azotemia?
with renal replacement therapy (dialysis)
What type of HTN medication would you consider for a patient with chronic renal failure?
Three catagories of causes of acute renal failure
According to Barkley, what catagory of cause of acute renal failure is reversible by treating the underlying cause?
Name three causes of prerenal failure?
What are two causes of intrarenal (or intrinsic) renal failure?
The use of nephrotoxic drugs (i.e. gentamicin)
mismatched blood transfusions
allergic reactions (contrast media)
What are causes of post-renal failure?
mechanical and functiononal causes
If a patient has BUN/Cr ratio >10:1, what type of renal failure would you consider?
If a patient has BUN/cr ratio 10:1, what two types of renal failure would you consider?
Would the urine specific gravity of a patient in prerenal failure be high or low?
In prerenal failure what is the FENA (fractional excretion of sodium)?
In intra and post renal failure what is the FENA (fractional excretion of sodium)?
How do we treat prerenal failure?
volume, increase BP if necessary
How do we treat intrarenal failure?
decrease use of nephrotoxic drugs
renal replacement therapy if needed (dialysis)
How do we treat post-renal failure?
remove the obstruction
What is the most common type of kidney stone?
What are the four types of kidney stone?
uric acid (more common in men)
struvite (more common in women)
cysteine (difficult to treat)
What is Prehn's test and what is it used to do distinguish?
Prehn's test is done by elevating the scrotum
to distinguish epidydimitis from testicular torsion
According to Prehn's sign, the physical lifting of the testicles relieves the pain of epididymitis but not pain caused by testicular torsion
Negative Prehn's sign indicates no pain relief with lifting the affected testicle, which points towards the diagnosis of ____________ which is a surgical emergency and must be relieved within 6 hours.
What are three causes of an abnormal PSA?
What is an abnormal PSA level?
They are based on age
>4 is abnormal
Management of BPH includes avoiding medications that make symptoms worse including:
OTC for common cold and allergies
The medication class that is the standard of care for BPH:
PSA for prostate cancer is not a very sensitive test,
40% of men who actually have prostate CA may have a normal PSA
The 5 alpha reductase inhibitors treat BPH by:
actually shrinking the prostate
example: finasteride (proscar)
If a patient has BPH symptoms refractory to the -osins and 5 alpha reductase inhibitors they may consider:
If a woman comes in with green vaginal discharge consider:
Gonerrhea is a bacterial infection that can be asymptomatic or associated with discharge/dysurea and can be treated with
ceftriaxone/rocephin 250mg IM
Name 5 conditions that have to be reported to the health department in most states:
What type of bacterial STD presents with a painless indurated chancre 4 weeks after exposure?
Stages of syphilis
1. painless chancre
2. flulike prodrome with macropapular rash on palms hands and soles feet
3. tertiary syphilis: cardiac or CNS involement (neurosyphilis)
*latent syphilis = asymptomatic
What is the treatment for syphilis?
What is treatment for syphilis in a patient who is allergic to PCN?
What bacterial STD can be asymptomatic or cause dysurea and dyspareunia in women, dull testicular pain, is the most common in the US?
Name 4 differentials for dyspareunia:
What is the medication for treatment of chlamydia?
azithromycin 1g PO x1
What viral recurrent STD hurts, has a painful prodrome, has no treatment to cure?
What drug is used to suppress herpes outbreaks and is used to decrease asymptomatic transmission of herpes?
About 10% of people with this incurable virus is shed intermittantly all the time and therefore can be spread even when the patient is asymptomatic
Malodorous frothy vaginal discharge, dyspareunia, STD, strawberry patches on the cervix and vagina
strong vaginal odor, Fish like odor, watery grey discharge, vaginal spotting (not an STD)
thick white curd like discharge, vulvovaginal erythema and pruritis, not an STD
Clue cells are found in:
bacterial vaginosis (BV)
Both trich and BV can be treated with:
Pharmacologic treatment of vaginal candida
Name three normal physiologic renal changes as people age
diminished renal blood flow (up to 10% per decade after age 30-40)
kidneys decrease in size
GFR decreases 10% per decade after 30
impaired ability to retain sodium which leads to dehydration
bladder tone/elasticity decreased
decreased drug clearance---> increased risk for adverse drug reaction/increase drug clearance
Incontinence is never normal at any age, in an older patient with new incontinence consider:
Serum cr is the best indicator of renal function in all patients, but in elderly consider
creatinine clearance, as it takes into consideration age
The most common clinical illness of adults over the age 65 is:
In the elderly who present with weakness, lethary, confusion, urinary urgency, frequency, incontinence, consider this diagnosis