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1 Rotations > CAD II > Flashcards

CAD II Flashcards

1
Q

pertinent ROS (19)

A
  • urinary frequency/ urgency/ hesitancy
  • nocturia
  • hematuria
  • incontinence
  • color/ odor of urine
  • suprapubic pain
  • fever
  • N/V
  • flank/ low back pain
  • genital discharge/ irritation/ itching
  • ulcerations/ blisters
  • rash
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2
Q

pertinent hx for M & F (7)

A
  • pyelo
  • nephrolithiasis
  • STI’s
  • GU procedures
  • GU CA
  • sexual activity/ protection
  • new meds
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3
Q

pertinent hx for M only

A

BPH

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4
Q

pertinent hx for F only (5)

A
  • contraception
  • LMP
  • menses schedule (flow, duration, intermenstrual bleeding)
  • pregnancy
  • last pap
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5
Q

other ROS (16)

A
  • chills
  • fatigue
  • malaise
  • sweats
  • sleep interruptions
  • unintentional weight changes
  • dysmenorrhea
  • eye redness/ pain/ blurring/ discharge
  • abd pain
  • change in bowel habits
  • jaundice
  • joint pain/ stiffness
  • swollen lymph nodes
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6
Q

inspect/ palpate penis for…

A

localized GU dermatitis, penile discharge, penile lesions

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7
Q

inspect/ palpate scrotum for…

A

epididymal/ testicular tenderness

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8
Q

palpate inguinal region (M) for…

A

LAD, masses, hernia

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9
Q

inspect pubic region (F) for…

A

localized GU dermatitis

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10
Q

palpate inguinal region (F) for…

A

LAD

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11
Q

inspect introitus for…

A

vulvar lesions, vaginal discharge, vaginal atrophy

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12
Q

speculum exam for…

A

cervical discharge, discoloration/ erythema

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13
Q

bimanual exam for…

A

cervical motion tenderness, uterine tenderness

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14
Q

rectal exam/ palpate prostate for…

A

swollen, tender

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15
Q

labs to order (4)

A

pregnancy test, UA, urine culture, STD screening

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16
Q

bladder/ renal US for…

A

bladder distention, hydronephrosis

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17
Q

CT abd/ pelvis WITHOUT contrast for…

A

nephrolithiasis

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18
Q

CT abd/ pelvis WITH and without contrast for…

A

hematuria, malignancy

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19
Q

cystoscopy for…

A

malignancy, interstitial cystitis

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20
Q

pain at start of void indicates

A

urethral source

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21
Q

pain at end of void indicates

A

bladder source

22
Q

what makes acute cystitis complicated (8)

A
  • sxs > 7 days
  • pregnancy
  • DM
  • male
  • elderly
  • IMC
  • indwelling catheter
  • anatomic abn

(risk of therapeutic failure)

23
Q

MC etiology

A

E. coli

24
Q

2nd MC etiology in sexually active women

A

Staph. saprophyticus

25
Q

findings on UA suggestive of acute cystitis (6)

A
  • pyuria (> 10 WBCs/ hpf)
  • hematuria
  • leukocyte esterase
  • nitrites
  • cloudy urine
  • increased pH (if proteus)
26
Q

when is urine culture indicated for acute cystitis

A

if complicated

27
Q

1st line management for acute cystitis

A

Nitrofurantoin (Macrobid) ER 100 mg PO BID x 5 days

OR

Trimethoprim-sulfamethoxazole (Bactrim) 160 mg TMP/ 800 mg SMX PO BID x 3 days

28
Q

1st line management for acute cystitis in MEN

A

Nitrofurantoin (Macrobid) ER 100 mg PO BID x 7 days

OR

Trimethoprim-sulfamethoxazole (Bactrim) 160 mg TMP/ 800 mg SMX PO BID x 7 days

29
Q

1st line management for acute cystitis if comorbid conditions

A

Ciprofloxacin ER 1000 mg QD x 7-14 days

30
Q

2nd line management for acute cystitis

A

Amoxicillin-clavulanate (Augmentin) 500 mg/ 125 mg BID x 7 days

OR

Ciprofloxacin 250 mg BID x 3 days

31
Q

1st line management for acute severe cystitis in MEN

A

Ciprofloxacin 500 mg BID x 5 days

32
Q

1st line management for acute cystitis if PREGNANT

A

Amoxicillin-clavulanate (Augmentin) 500 mg/ 125 mg BID x 7 days

33
Q

adjunct treatment for symptom control of acute cystitis

A

Phenazopyridine (Pyridium) 200 mg TID PRN x 2 days

34
Q

pt edu if giving Pyridium

A

do not use > 48 hours due to SE’s, turns urine orange

35
Q

when will pts experience sx relief with abx tx of acute cystitis

A

within 48 hrs

36
Q

pt edu for acute cystitis

A
  • increase fluid intake
  • void when feel urgency
  • void after intercourse
  • proper hygiene
37
Q

when do you need a f/u urine culture for acute cystitis

A

pregnancy

38
Q

f/u for acute cystitis

A

48-72 hrs if no sx relief

39
Q

signs of pyelo in addition to lower tract sxs (6)

A
  • fever > 99.9
  • chills
  • back/ flank pain
  • CVA tenderness
  • N/V
  • tachycardia
40
Q

signs of pyelo in MEN in addition to lower tract sxs

A

pelvic/ perineal pain

can suggest accompanying prostatitis

41
Q

findings on UA unique to pyelo

A

WBC casts

42
Q

findings on CBC suggestive of pyelo

A

leukocytosis with L shift

43
Q

outpatient tx for pyelo

A

Ciprofloxacin 500 mg BID x 7 days

44
Q

outpatient tx for pyelo if concerns of resistance

A

Ceftriaxone 1 g IV/ IM

PLUS

Ciprofloxacin 500 mg BID x 7 days

45
Q

outpatient tx for pyelo if concerns of resistance and FLQ allergy

A

Ceftriaxone 1 g IV/ IM

PLUS

Bactrim 160/800 mg PO BID x 7-10 days

46
Q

f/u for pyelo if treated outpatient

A

48-72 hrs

47
Q

when is inpatient management indicated for pyelo (10)

A
  • septic/ critically ill
  • persistently high fever > 101
  • pain/ marked debility
  • older age
  • pregnant
  • signs of obstruction
  • comorbid conditions
  • inability to tolerate PO
  • renal dysfunction
  • compliance concerns
48
Q

management of pyelo if pregnant

A

admit for IV abx (amp/ gent or ceftriaxone) until afebrile for 24-48 hrs and sxs improved

49
Q

diagnostic test of choice for chlamydia

A

NAAT via vaginal swab in women or first-catch urine in men

50
Q

tx for chlamydia/ gonorrhea

A

Doxycycline delayed release 200 mg QD x 7 days

OR

Azithromycin 1 g single dose

OR

Ceftriaxone 500 mg IM x 1 dose

51
Q

complications of pyelo

A
  • sepsis with shock
  • renal failure
  • scarring/ chronic pyelo
  • renal abscess if inadequate therapy

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