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RDS Test 3 > B8.050 Male UTI > Flashcards

B8.050 Male UTI Flashcards

1
Q

what is a cremasteric reflex?

A

when you stroke the medial thigh, the testicle elevate

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2
Q

no cremasteric reflex + high riding testicle

A

testicular torsion

testicle will be fixed and hard

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3
Q

UA in the case of epididymitis

A

normal

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4
Q

epididymitis findings on scrotal US

A

increased blood flow (unlike torsion)
enlarged epididymal head
reactive hydrocele

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5
Q

do you need to do a scrotal US to evaluate epididymitis?

A

no
but if you’re unsure, you should do it
testicular torsion is an emergency, do not want to miss it

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6
Q

what is epididymitis

A

inflammation of the epididymis with or without infection

-can be due to chemical exposure

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7
Q

pathophys of epididymitis

A

retrograde ascent of pathogens along vas deferens to epididymis

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8
Q

2 most important factors in evaluating epididymitis

A
  1. patient age

2. patient sexual history

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9
Q

cause of epididymitis in individuals < 35 yrs

A

neisseria gonorrhea or chlamydia trachomatis

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10
Q

cause of epididymitis in individuals > 35 yrs

A

e.coli or other urinary tract pathogens

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11
Q

treatment of epididymitis in individuals < 35 yrs

A

ceftriaxone 250 mg IM & doxy 100 mg BID
10 days
OR
1 g azithromycin once

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12
Q

treatment of epididymitis in individuals > 35 yrs

A

levofloxacin 500 mg daily for 10 days

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13
Q

what questions should you always ask in a urological evaluation?

A 
flank pain?
hematuria?
history of stones or UTIs?
have you ever been unable to pee and had to get a catheter?
urinary tract instrumentation?
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14
Q

what do you need in a diagnosis of acute bacterial prostatitis?

A

URINE CULTURE

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15
Q

should you order a PSA in the setting of prostatitis?

A

no

will be falsely elevated in 70% of men and may persist for 1-2 months

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16
Q

epidemiology of acute bacterial prostatitis

A

peak incidence in men 20-40 and >70

17
Q

cause of acute bacterial prostatitis

A

ascending urethral infection or intraprostatic reflux

-the prostate is a sponge, ejaculate/urine can get into ducts and sit, there is a lot of stasis in the prostate

18
Q

risk factors for acute bacterial prostatitis

A 
BPH (number 1)
GU infections
high risk sexual behavior
history of STIs
immunocompromised
phimosis
prostate manipulation
urethral stricture
19
Q

common acute prostatitis pathogens

A 
e.coli (>50%)
pseudomonas
klebsiella
enterococcus
enterobacter
proteus
serratia
20
Q

presentation of ABP

A 
irritative symptoms
obstructive symptoms
rectal and perineal pain
painful ejaculation, hematospermia
fevers, chills, nausea
prostate boggy on rectal exam
post-void residual may be elevated
21
Q

ddx of ABP

A 
BPH
chronic BP
chronic pelvic pains syndrome
cystitis
diverticulitis
epididymitis
orchitis
proctitis
prostate cancer
22
Q

evaluation of ABP

A

midstream UA and urine culture

high risk men should be evaluated for G&C

23
Q

when should you get imaging in a patient with ABP?

A

patients who remain febrile after 36 hours or whose symptoms do not improve with antibiotics

24
Q

what imaging is obtained in ABP

A

CT
transrectal US
NOT a renal US

25
Q

outpatient treatment of ABP

A

fluoroquinolone or TMP-SMX for 4 weeks
OR
if high risk sexual activity:
ceftriaxone 250 mg IM + doxy for 10 days

26
Q

inpatient treatment of ABP

A 
IV fluoro
vs
IV B-lactam (ceftriaxone)
vs
IV extended spectrum B-lactamases
**treat for 24-48 hours with parenteral and transition to oral for 6 weeks
27
Q

appearance of prostatic abscess on imaging

A

darker area within an enlarged prostate

28
Q

characterize prostatic abscess

A

occur in 2.7% of patients with ABP

risk factors: urinary catheterization, urethral manipulation, immunocompromised state

29
Q

how to evaluate recurrent male UTI

A

UA
post void residual
URINE CULTURE
start empiric antibiotics

30
Q

ddx of recurrent UTIs in men

A

BPH
infected kidney stones
chronic bacterial prostatitis
urinary tract neoplasm

31
Q

how to distinguish chronic bacterial prostatitis from urethral infection

A

four glass test

32
Q

four glass test

A

midstream urine culture is negative

after prostatic massage, prostatic secretions and urine are both positive

33
Q

characterize chronic bacterial prostatitis

A

usually presents as recurrent UTIs with the same strain

difficult to eradicate given limited diffusion of abx into the prostate gland

34
Q

treatment of CBP

A

fluoroquinolone or TMP-SMX for 30 days

35
Q

long term management of CBP

A

patients with urinary obstruction should be counseled on transurethral resection of the prostate to improve flow and potentially remove infected prostate tissue
suppressive antibiotics
self start antibiotics

RDS Test 3 (15 decks)

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