UTI Flashcards

Question

acute cystitis duration of tx

Answer 1

-Gauge treatment duration on duration of symptoms -3-5 days: short duration of symptoms - 5 days: pregnant -5-7 days: anomaly of urinary tract -7 days: male patient -Antibiotic should be chosen based on local resistance status -Healthy young females may be treated empirically

Answer 2

Nitrofurantoin x 5-7 days (pregnant) Quinolones -Levofloxacin x 3 day -Ofloxacin x 3 days -Ciprofloxin x 3 days TMP/SMX x 3 days Special situations: -If previous medications are contraindicated: Cephalexin 5-7 days (pregnant) -enterococcus: Amoxicillin x 5-7 days (pregnant)

Answer 3

-Treatment is 5 days -*Eradication must be confirmed! -Antibiotic: -Nitrofurantoin 75mg PO BID -Amoxicillin 500mg PO TID -First generation cephalosporin: -Cefadoxil 500mg PO BID -Cephalexin 500mg PO TID

Answer 4

-May be managed as outpatient Hospitalize if: -Intractable vomiting -Evidence of shock -Severe dehydration -Initiate treatment in the hospital for pregnant females -Treatment should last at least10 days -Follow-up 3-5 days after treatment completion -Obtain urine culture prior to treating -However, do not wait for culture report prior to treating… -You can modify the treatment later if needed

Answer 5

**Quinolones x 10 days** -Levofloxacin -Norfloxacin -Ciprofloxacin Cefuroxime IV: -If unable to tolerate PO -May be changed to a PO med when able TMP/SMX 160/800mg PO daily x 14 days -Only after sensitivity known (high rate of resistance)

Answer 6

acute: - + bacterial culture - tx: 2-4 wks (quinolones preferred) chronic: - negative bacterial culture - positive culture of prostatic secretions - tx: 4-6 wks (quinolones preferred)

Answer 7

-Initiate treatment with IV or IM in **hospital** -IV hydration may be required Abx: -Cefuroxime IV -Ceftriaxone 1mg IM daily may be used - afebrile patient: take oral meds x 10 days -Ensure eradication of organism with repeat Urine culture** 5 days post tx**

Answer 8

-High levels of resistance seen -Use urine culture and sensitivity -Local hospitals may report an antibiogram -Treat using narrow spectrum antibiotics -Pseudomonas, enterococci, staphylcocci, and candida species are more common than in the outside population… -E. coli is seen in 50% (however tend to be resistant strains)

Answer 9

Prostatic hyperplasia should be evaluated -Digital rectal exam -Ultrasound: prostate and residual bladder volume measured -PSA Obtain urine culture (and blood culture if considering prostatitis) prior to treatment If febrile, **quinolones** are the drug of choice -> This class attains the best concentration in prostate

Answer 10

-Antibiotic options -Quinolones -Ciprofloxacin or norfloxacin -Treatment of choice if not contraindicated -TMP/SMX (Check sensitivities prior due to resistance) -Duration of treatment -Acute infection: 2-4 weeks -Chronic infection: 4-6 weeks

Answer 11

-70% of cases have sterile urine -Culture urine and treat initially -If there is pyuria “without bacteria”- Test for Chlamydia

Answer 12

Complication that affects patients that have: -Indwelling urinary catheter (long term) -ICU patient treated with broad spectrum Abx -Comorbidity of DM or immune suppression Tx - Remove catheter (resolves 1/3 of cases) -Fluconazole 200-400mg/day for 14 days -Flucytosine and Amphotericin B (if resistant) -Untreated may lead to sepsis

Answer 13

-Frequent bladder emptying -Post coital voiding -Every 3-4 hours during day -Good hygiene -Manage constipation -Think of the overall picture with your patient

Answer 14

Symptoms: -Fever -Painful Voiding Symptoms -enlargement of epididymis -very painful to touch -tenderness in the posterolateral aspect Causes: -Sexually transmitted: -Chlamydia -Gonorrhea -Non-sexual caused: -Associated with prostatitis and gram negative organisms Treatment: -Bed rest -Scrotal elevation -Treat the underlying pathogen

Answer 15

-MC benign tumor -over 80 years of age -> >90% chance -Symptoms are based on progression of disease -Endocrine relation with genetic and race connections likely -Hyperplastic process Nodular growth pattern -Treatment likely works with or against the components affected -Alpha-blocker- smooth muscle component -5-alpha-reductase inhibitors- epithelium component

Answer 16

Findings may include: -Distension of urinary bladder -Enlarged palpable prostate -**Hydronephrosis** -enlarged, boggy prostate -no nodules or odd feeling IF THERE IS PROSTATE CANCER- enlarged, nodular, firm prostate IF THERE IS PROSTATISTIS- hot, enlarged, tender

Answer 17

Stress -Pelvic floor is unable to prevent passage of urine -Occurs with coughing, sneezing, laughing Urge -Involuntary loss of urine with sudden sensation to urinate Overflow -Constant ‘dribbling’ of urine at all times or for a time period after urinating Structural -Typically related to fistulas in women

Answer 18

-Delirium -Infection -Atrophic urethritis/vaginitis -Pharmaceuticals -Psychological disorders (depression) -Excessive urine output -Restricted mobility -Stool impaction

Answer 19

-Definition: the inability to achieve or maintain an erection sufficient for satisfactory sexual performance -May be a marker of cardiovascular disease -Risk factors include: -Age -CV disease -Smoking -DM -Pelvic surgery/radiation -Drugs/Alcohol

Answer 20

-Medications -Phosphodiesterase Type 5 Inhibitors -> Sildenafil, Tadalafil, Vardenafil (oral); Alprostadil (Injected) -Testosterone replacement- sex drive not ED -Evaluate for current medications as a side effect causing ED -surgical -non-surgical- vacuum therapy

Answer 21

-Prior fertility? -STD history -Steroid/testosterone use -Surgeries -Injuries -Physical activity -Birth history (if known) -Secondary sexual characteristics present -Gynecomastia -Eunuchoid habitus Male genital exam: -Urethral meatus position -Testicular size -Epididymis -Pampiniform plexus -Vas deferens

Answer 22

etiology: -Abnormal Sperm production Obstruction of ductal outflow tract semen analysis: -count -motility -morphology -serologic testing: -horomones- testosterone, FSH -genetic testing

Answer 23

PAINFUL -testicular torsion- ER -epididymitis -inguinal hernia -trauma -tumor non-painful causes -varicocele: bag of worms -hydrocele: positive transillumination -spermatocele -inguinal hernia -tumor

Answer 24

Varicocele -running athletes -bilateral varicocele: surgery to prevent infertility -unilateral- is fine!!!! -tortuous mass -veins that contain inadequate valves Hydrocele: positive transilluminates

Answer 25

-Genetic disorder -Fluid filled cysts cause: -Kidney enlargement that displaces normal structure -Reduced kidney function then occurs -1/3 of patients with polycystic kidney disease progress to end-stage renal disease and require renal replacement -“Simple” cysts in kidneys or liver does not equal PKD absolutely -autosomal recessive PKD is less common (10%)- born with it, high mortality, HTN -autosomal dominant PKD is MC (90%)- 20s, HTN

Answer 26

DOMINANT -90% of PKD -Onset: age 30-40 -Cysts may start in childhood but progress to clinical significance in adulthood -HTN is commonly found in late 20s -Imaging will make dx RECESSIVE -10% of PKD -Onset: during fetal development -HTN and UTIs in childhood -Growth failure -Liver failure -May need both liver and kidney transplantation -30% neonatal mortality rate

Answer 27

-Usually clinically silent – incidental finding -Patient may present with: HTN, hematuria, proteinuria, renal insufficiency -May lead to Chronic Renal Failure- Most common genetic cause of CRF

Answer 28

-Treatment options -Control of HTN- First line ACE-inhibitors or ARBs to decrease RAS system activity -Limit sodium in diet -Aggressive treatment of hypercholesterolemia -Renal replacement

Answer 29

-Solid crystal or concretion developed in kidneys -Classified by location or composition -Most will pass (usually without any symptoms) -Pain occurs when stones are not able to pass and cause obstruction or if spasm of ureter occurs

Answer 30

Calcium oxalate and -Calcium phosphate- Starts with calcium phosphate concentrations that cause a ‘Randall’s Plaque’ that leads to calcium oxalate depositions and stone formation Uric acid- Solubility pattern leads to deposition with persistently acidic urine Struvite -Proteus mirabilis urease cleavage making urine alkaline leading to ‘staghorn calculus’ Cystine- Genetically caused by abnormal recessive gene for cystine transport

Answer 31

-Urease producing organisms cleave urea to make NH4 and make urine alkaline, leading to phosphate deposition -The deposition then becomes a site for continued growth of bacteria -staghorn calculus

Answer 32

-Flank pain -Cramping, colic-like pain -Moderate to severe intensity -Nausea and Vomiting -Absence of fever -Labs: -+ blood (whole cells present) -+ protein -+/- WBCs/infection -CT: See the stones/obstruction -Ultrasound: Hydronephrosis if obstruction -Cystoscopy

Answer 33

-Non-contrast CT Abd/Pelvis -Gold standard -Finds the stone in 96% of cases -Positive predictive value is 100% -Negative predictive value is 97% -Ultrasound -1st imaging test in pregnant female but inferior to CT

Answer 34

-Dietary: -Increase fluid intake -Limit calcium intake -Increase citrate-rick drinks -Limit Vitamin C -Limit protein -Allopurinol (if uric acid) -Analgesia- Opiate based is often needed -Expulsion assistance- Alpha-blockers -Lithotripsy -Surgical options

Answer 35

-Condition in which the testis has not descended into the scrotum by 4 months old -Absent or undescended -Most common congenital abnormality of the GU tract in males -Can be bilateral (10%) or unilateral -Increased risk with premature births -30% versus 2-5% in normal births -Other risk factors: -Low birth weight -Prenatal exposure to hormonal disruptors

Answer 36

-If not corrected leads to increased risk for: -Testicular torsion -Testicular trauma -Infertility -Increased risk for malignancy

Answer 37

-Physical finding -Ultrasonography vs exploratory surgery -US less sensitive but used initially (r/o DSD)

Answer 38

-Management -If bilateral – assess for genetic/chromosomal abnormality and refer to a multidisciplinary team if DSD identified -If no hormonal/chromosomal abnormality- Refer to pediatric urologist for exploratory surgery and orchiopexy -Long term care -Monthly self testicular examination and evaluation clinically due to increased lifetime risk of testicular cancer

Answer 39

-Retrograde flow of urine from bladder to upper urinary tract -Increases risk for pyelonephritis -Primary VUR -Caused by incompetent closure of the ureterovesical junction -Usually related to a congenital short ureter -Secondary VUR -Caused by high pressure in bladder (neurologic or obstructive)

Answer 40

Dx: -Start with US following initial UTI in children to assess for renal abnormalities -Voiding cystourethrogram Treatment: -Antibiotic prophylaxis -If neuropathic cause, attempt treatment of cause or catheterization to decrease bladder pressure -Referral to urologist for surgical correction if continuing past 2-3 years old -Surgical procedure is reimplantation of ureters to normal position resulting in decreased reflux -Goals of Treatment: -Decrease infection rates -Limit injury to the kidneys

UTI Flashcards

(64 cards)