Common UTI Flashcards
Etiology in obstructive symptoms vs irritative:
- Obstructive is stones, stents, BPH > dripping, hesitancy, incomplete stream
- Irritative is inflammatory > Urgency, frequency, Incontinence, nocturia.
Pain at the end\start of urination
- End: cystitis
- Start: Urethritis
How to rule out pyelonephritis in UTI?
Flank pain & fever.
What are the risk factors for complicated UTI?
1- Pregnancy 2- Male 3- Postmenopausal 4- DM 5- Immunocompromised 6: hospital acquired UTI
When to order the following tests:
- Urinalysis
- Urine culture
- Renal function
- Nucleic acid amplification
- Imaging
- All dysuria
- RF for complicated UTI + no response to tx
- Pyelonephritis (creatinine + electrolyte if vomiting)
- Pyuria + sexually active + urethritis sign
- anatomic anomaly + complicated UTI
In which group of cystitis patients do we treat immediately w\out investigations.
(Dysuria + Frequency\urgency)
In patient with Dysuria + Vaginal discharge or irritation
what could be the possible causes?
1- Vaginitis if there’s positive saline or potassium hydroxide.
2- STD if NAAT
3- Dermatitis if there’s skin lesion
When would you treat the following patients:
Dysuria alone - suspected Pyelonephritis - complicated UTI
- Order analysis and if only 1 is present of the following is present (blood - leukocyte - nitrate) > treat.
- None is present BUT (instrumentation - toxic appearance - altered mental state) > treat.
What is the most common cause of simple cystitis?
E-coli
What are the first line treatment for acute simple cystitis
1- Nitrofurantoin [100 mg BID for 5d]
2- Trimethoprim-sulfamethoxazole [160-800mg BID for 3d]
3- Fosfomycin [single dose]
Male patient w\dysuria and genital lesions or discharge:
Test for STD by NAAT and check for dermatitis.
What would you do if the following patients were
Man with dysuria and
- positive blood in dipstick test:
- positive leukocyte or nitrate:
- Recently instrumented:
1- Urology referral
2- treat UTI, obtain culture & referral
3- Treat UTI, obtain culture & referral.
A male patient with dysuria presents to you, and examine them and found that they have tender prostate, your next step is to:
Obtain urine culture after gentle prostate massage
E-coli urinary diseases in female and male:
1- Female> simple cystitis
2- Male> acute prostatitis
To differentiate pyelonephritis from acute bacterial prostatitis, one needs to:
[both have: Fever, Nausea, vomiting, dysuria & urinary symptoms]
[different in Pain location: flank pain (costovertebral) is pyelo - pelvic pain is prostatitis]
How does prostate examination usually show in acute bacterial prostatitis?
Tender - enlarged- boggy.
How do we treat patient with acute bacterial prostatitis
- clinical diagnosis is sufficient
- we ask (STD?) then think to treat.
- we adjust the Ab after culture results.
If patient with Acute bacterial prostatitis is
- high risk for STD
- low risk for STD
How would you treat them?
- Cef-triaxone (1 dose IM) + Doxacycline (BID for 10d)
- Ciproflaxacin (BID for 10-12d)
When to treat\not treat patients with BPH?
Treat: large & cause obstructive symptoms
Not treat: asymptomatic
You examine a patient with obstructive or irritative symptoms and found enlarged non-tender prostate, what will you do next?
1- Order urinalysis only.
Add culture if there’s dysuria.
2- Post void test
3- PSA before treatment
What is the indication for surgery for BPH?
- refractory to medics
- Mod\severe voiding symptoms
What are the medications that can be given as a monotherapy in BPH?
- alpha blocker (trazosin)
- 5-alpha reductase inhibitor (finastride)
- anticholinergic
- phosphodiasterase inhibitor
When to refer BPH to urologist
- concern for cancer (abnormal exam “nodule” - hematuria - age<45)
- severity (acute retention - neurological)
- injury (invasive treatment)
Most common symptoms for renal stones?
Pain
Hematuria
Lower ureteral obstruction by stone can lead to radiation to:
- men:
- women:
- testicle
- labium
What is the most common type of stone:
Calcium
Risk factors for renal stones:
- dehydration (hot climate\low fluid intake)
- comorbidity (gout\HTN\liver diseases)
- diet (high in protein\salt\carb)
Investigations to order in renal stone
- urinalysis
- culture
- imaging (confirm and locate + R\o hydronephrosis)
When to refer patient with renal stone?
- sepsis\fever
- obstruction with (anuria - infection)
- pregnancy\delayed micturition (ectopic)
- > 60 or comorbidites.
Gold standard imaging for renal stones?
non-contrast CT
What is the size of renal stone that will demand urological evaluation
10mm
When to provide patient with renal stone with alpha blocker to facilitate stone passage?
Between 5-10mm
First line treatment of all renal stones?
NSAID
How to correct the following underlying metabolic defects that may predispose to renal stone?
- hypercalciuria:
- hyperuricosuria:
- Hypociratureia:
- thiazide
- allopurinol - potassium citrate
- potassium citrate
What would you recommend patients with renal stone to do?
- high fiber\vegetable diet
- normal (no change) calcium
- fluid intake up to 3L
- physical activity
Define microscopic hematuria:
3 or more RBC in urine
What is the risk of malignancy in patient with microscopic hematuria:
(High - low)?
When does it increase
- Low 5%
- smoker - old >35 - male
Most common cause of microhematuria:
- BPH
- calculi
- UTI
What to do if patient has <3 RBC in urinalysis?
Repeat 3x in 6w interval
What to do if patient has >3 RBC in urinalysis?
Assess for the cause (UTI etc..), treat & repeat.
- positive: assess renal diseases
When to preform CT in microhematuria?
- high risk malignancy
- good renal function
USPSTF recommends against screening for prostate cancer in which population?
Men >70yrs
Is PSA recommended BPH?
Only before starting tx.
