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Clinical Medicine II > Renal: UTI, Cystitis, Pylo > Flashcards

Renal: UTI, Cystitis, Pylo Flashcards

(61 cards)

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1
Q

Pylo or GN?

WBC casts

A

pylo

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2
Q

Do negative LE/nitrite r/o UTI in symptomatic patients?

A

no

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3
Q

what are 2 reasons for false negative for nitrite on urine dipstick?

A

non-nitrate redox bacteria

frequent urination

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4
Q

what 2 things can cause false positive LE on urine dipstick>

A

vaginal contamination

trichomonas

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5
Q

Pylonephritis is a UTI of which tract?

A

upper tract

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6
Q

Cystitis, prostatitis, urethritis are UTIs of..

A

lower tract

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7
Q

Men or women?

More common (50x)
cystitis, pylo
A

women

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8
Q

Men are prone to which UTIs?

A

urethritis

prostatitis

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9
Q

Ascending bacterial infx is responsible for ___% of UTI

A

95%

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10
Q

most common pathogen responsible for UTI?

A

E. Coli (75-95%)

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11
Q

The following are causes of what UTI risk factor?

  • urine outflow obstruction
  • inadequate fluid intake
  • neurogenic bladder
A

reduced flow

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12
Q

The following are causes of what UTI risk factor?

  • sexual activity
  • spermicide use
  • fecal incontinence
A

promote colonization

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13
Q

The following are causes of what UTI risk factor?

catheterization
urinary incontinenze
fecal incontinence

A

facilitate ascent

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14
Q

What type of UTI?

  • confined to bladder
  • non-pregnant
  • no s/s of upper tract or systemic infx
A

acute simple cystitis

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15
Q

What type of UTI?

-Acute UTI + extension beyond badder

  • fever, chills
  • signs of systemic illness
  • flank pain
  • CVA tenderness
  • Pelvic/perineal pain in men
A

acute complicated UTI

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16
Q

What are 5 special populations at risk for complicated UTI?

A

pregnant women

men

immunocompromised

urologic abnormalities

comorbid contitions

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17
Q

A patient presents with:

dysuria
frequency
urgency

+/- hematuria, suprapubic discomfort

What are you concerned for, what needs to be ruled out?

A

concerned for acute simple cystitis

r/o pylo
flank pain, hesitancy, pruritus, perineal pain, NV, fever

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18
Q

Who can have an atypical presentation in acute simple cystitis?

A

elderly

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19
Q

PE for acute simple cystitis usually reveals…

A

grossly normal

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20
Q

You suspect acute simple cystitis so you order a UA. What findings on dipstick and microscopy might confirm your Dx?

A

dipstick: (+) LE and Nitrites
micro: pyuria, bacteriuria

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21
Q

the following presentations warrant ordering what test?

  • atypical presentation, uncertain dx
  • complicated UTI (flank pain, etc)
  • unresolving sxs
  • resistance
  • special populations
A

urine culture

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22
Q

What number of CFU on urine culture is diagnostic for acute simple cystitis?

A

10^3 +

10^2 in women with typical sxs

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23
Q

What OTC analgesic can be recommended for acute simple cystitis tx? How long of course?

A

Pyridium (AZO) 200 mg TID PRN x 2 days

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24
Q

You’ve diagnosed acute simple cystitis in a non-pregnant individual. What are the two options for abx?

A

macrobid 100mg PO BID x 5 days

Bactrim 160/800mg PO BID x 3 days

fosfomycin 3gm mixed in water PO single dose

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25
in early pylonephritis you have to avoid macrobin and fosfo because of ...
low renal conc.
26
If issues of allergy, interaction, resistance, cost, compliance, what other abx can you prescribe in acute simple cystitis of non-pregnant pt?
Beta lactam: augmentin fluoroquinolones: cipro, levaquin
27
What can you prescribe for acute simple cystitis in pregnant women?
augmentin, cefpodoxime, fosfomycin
28
What should you avoid in pregnant pts with acute simple cystitis?
fluoroquinolones
29
Men with acute simple cystitis can be prescribed the normal abx, but describe the duration of tx...
7 days (longer duration)
30
Which patient populations should receive the primary therapies for 1-2 weeks in acute simple cystitis?
comorbidities, immunocompromise, urologic abnormality
31
5 points of patient edu in acute simple cystitis
``` increase fluids void when need hygeine complete ABx ER precaution pylo ```
32
For whom are f/u urine cultures needed for acute simple cystitis if sxs resolve on abx?
pregnant women
33
An infection of the kidney is called...
acute pylonephritis
34
Ascent of bacteria up the ureters can lead to...
acute pylo
35
A sick appearing patient presents with the following hx: - frequency - urgency - dysuria - flank pain - systemic sxs - GI sxs
acute pylonephritis
36
A sick appearing patient presents with the following PE: - fever - tachy - hypotension - CVA tenderness
acute pylonephritis
37
What diagnostics should be ordered for acute pyelonephritis?
- UA - Urine C and S +/- GC/Chlamydia, CBC/BMP, Imaging
38
You receive the following results from UA and culture. What does this indicate? ``` (+) LE (+) Nitrites Pyuria (10+) Bacteriuria WBC casts ```
Acute Pyelonephritis
39
CBC and BMP are only necessary if a patient with acute pyelonephritis is hospitalized. What might they show?
left shift leukocytosis BMP for renal fxn, hydration, lytes
40
The following presentations of acute pyelonephritis indicate what diagnostic may be necessary? - severe illness - sxs after 48-72 hours of abx - suspicion for obstruction - recurrent sxs w/in weeks of tx
Imaging: CT A/P Renal US MRI
41
how long after starting tx should simple cystitis sxs be relieved?
48 hrs
42
Describe the tx of acute pyelonephritis for mild-moderate outpatient illness...
fluoroquinolones: - cipro 500mg PO BID x 5-7 - Levofloxacin 750mg PO QD x 5-7 days
43
If FLQ prevalence in E. Coli > 10%, what can be an alternative tx of acute pyelonephritis?
Ceftriaxone 1g IV/IM + FLQ
44
If you know the pathogen is susceptible to TMP-SMZ, what therapy can be used?
Bactrim 160/800mg PO BID x 7-10 days
45
When must follow up occur in mild/moderate outpatient acute pyelonephritis?
48-72 hours
46
The following are indications for what intervention in the tx of acute pyelonephritis: - hemodynamic instability - persistant fever > 101 - persistent pain/debility - suspected obstruction - metabolic dysfunction - NPO - compliance issues
hospitalization
47
This condition is defined by... bladder pain, pressure and discomfort for more than six weeks in absence of infx or other causes -can be relieved with voiding, worse with filling
interstitial cystitis
48
What is the most important part of assessment for IC?
careful hx | duration, triggers, # of voids
49
The components to the physical exam for IC...
abd, pelvic (females), rectal (males)
50
What labs can help r/o other causes to lead you to IC? (5)
UA and Culture Urine cytology if TOBB STI testing post-void residual volume cystoscopy
51
What may be identified on cystoscopy to support dx of IC?
altered urothelium - glomerulations - hunner lesions
52
What is 1st line tx for IC?
supportive and behavioral modification
53
What is the 2nd line for IC?
amitryiptyline, elmiron, hydroxyzine PO intravesical lido PT
54
How long may it take for elmiron to start acting?
3-6 mo
55
Urinary urgency +/- incontinence with nocturia and frequency. Caused by overactive detrusor
overactive bladder
56
The following are risk factors for what? ``` > 65 yo obesity parity prolapse DM neuro dz ```
OAB
57
The physical exam for OAB should target...
pelvic floor muscles, vaginal atrophy, pelvic masses
58
What labs may be helpful in OAB?
UA, culture
59
1st line tx for OAB is...
kegel, lifestyle mod, bladder training
60
2nd line meds for OAB...
antimuscarinics beta 3 agonist
61
What is a caution for tx of OAB with antimuscarinics?
anticholinergic sfx

Clinical Medicine II (31 decks)

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