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Family Medicine > Common UTI > Flashcards

Common UTI Flashcards

1
Q

Etiology in obstructive symptoms vs irritative:

A
  • Obstructive is stones, stents, BPH > dripping, hesitancy, incomplete stream
  • Irritative is inflammatory > Urgency, frequency, Incontinence, nocturia.
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2
Q

Pain at the end\start of urination

A
  • End: cystitis

- Start: Urethritis

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3
Q

How to rule out pyelonephritis in UTI?

A

Flank pain & fever.

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4
Q

What are the risk factors for complicated UTI?

A 
1- Pregnancy 
2- Male
3- Postmenopausal
4- DM
5- Immunocompromised 
6: hospital acquired UTI
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5
Q

When to order the following tests:

  • Urinalysis
  • Urine culture
  • Renal function
  • Nucleic acid amplification
  • Imaging
A
  • All dysuria
  • RF for complicated UTI + no response to tx
  • Pyelonephritis (creatinine + electrolyte if vomiting)
  • Pyuria + sexually active + urethritis sign
  • anatomic anomaly + complicated UTI
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6
Q

In which group of cystitis patients do we treat immediately w\out investigations.

A

(Dysuria + Frequency\urgency)

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7
Q

In patient with Dysuria + Vaginal discharge or irritation

what could be the possible causes?

A

1- Vaginitis if there’s positive saline or potassium hydroxide.
2- STD if NAAT
3- Dermatitis if there’s skin lesion

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8
Q

When would you treat the following patients:

Dysuria alone - suspected Pyelonephritis - complicated UTI

A
  • 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.
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9
Q

What is the most common cause of simple cystitis?

A

E-coli

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10
Q

What are the first line treatment for acute simple cystitis

A

1- Nitrofurantoin [100 mg BID for 5d]
2- Trimethoprim-sulfamethoxazole [160-800mg BID for 3d]
3- Fosfomycin [single dose]

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11
Q

Male patient w\dysuria and genital lesions or discharge:

A

Test for STD by NAAT and check for dermatitis.

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12
Q

What would you do if the following patients were

Man with dysuria and

  • positive blood in dipstick test:
  • positive leukocyte or nitrate:
  • Recently instrumented:
A

1- Urology referral
2- treat UTI, obtain culture & referral
3- Treat UTI, obtain culture & referral.

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13
Q

A male patient with dysuria presents to you, and examine them and found that they have tender prostate, your next step is to:

A

Obtain urine culture after gentle prostate massage

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14
Q

E-coli urinary diseases in female and male:

A

1- Female> simple cystitis

2- Male> acute prostatitis

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15
Q

To differentiate pyelonephritis from acute bacterial prostatitis, one needs to:

A

[both have: Fever, Nausea, vomiting, dysuria & urinary symptoms]

[different in Pain location: flank pain (costovertebral) is pyelo - pelvic pain is prostatitis]

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16
Q

How does prostate examination usually show in acute bacterial prostatitis?

A

Tender - enlarged- boggy.

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17
Q

How do we treat patient with acute bacterial prostatitis

A
  • clinical diagnosis is sufficient
  • we ask (STD?) then think to treat.
  • we adjust the Ab after culture results.
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18
Q

If patient with Acute bacterial prostatitis is

  • high risk for STD
  • low risk for STD

How would you treat them?

A
  • Cef-triaxone (1 dose IM) + Doxacycline (BID for 10d)

- Ciproflaxacin (BID for 10-12d)

19
Q

When to treat\not treat patients with BPH?

A

Treat: large & cause obstructive symptoms

Not treat: asymptomatic

20
Q

You examine a patient with obstructive or irritative symptoms and found enlarged non-tender prostate, what will you do next?

A

1- Order urinalysis only.
Add culture if there’s dysuria.

2- Post void test

3- PSA before treatment

21
Q

What is the indication for surgery for BPH?

A
  • refractory to medics

- Mod\severe voiding symptoms

22
Q

What are the medications that can be given as a monotherapy in BPH?

A
  • alpha blocker (trazosin)
  • 5-alpha reductase inhibitor (finastride)
  • anticholinergic
  • phosphodiasterase inhibitor
23
Q

When to refer BPH to urologist

A
  • concern for cancer (abnormal exam “nodule” - hematuria - age<45)
  • severity (acute retention - neurological)
  • injury (invasive treatment)
24
Q

Most common symptoms for renal stones?

A

Pain

Hematuria

25
Q

Lower ureteral obstruction by stone can lead to radiation to:

  • men:
  • women:
A
  • testicle

- labium

26
Q

What is the most common type of stone:

A

Calcium

27
Q

Risk factors for renal stones:

A
  • dehydration (hot climate\low fluid intake)
  • comorbidity (gout\HTN\liver diseases)
  • diet (high in protein\salt\carb)
28
Q

Investigations to order in renal stone

A
  • urinalysis
  • culture
  • imaging (confirm and locate + R\o hydronephrosis)
29
Q

When to refer patient with renal stone?

A
  • sepsis\fever
  • obstruction with (anuria - infection)
  • pregnancy\delayed micturition (ectopic)
  • > 60 or comorbidites.
30
Q

Gold standard imaging for renal stones?

A

non-contrast CT

31
Q

What is the size of renal stone that will demand urological evaluation

A

10mm

32
Q

When to provide patient with renal stone with alpha blocker to facilitate stone passage?

A

Between 5-10mm

33
Q

First line treatment of all renal stones?

A

NSAID

34
Q

How to correct the following underlying metabolic defects that may predispose to renal stone?

  • hypercalciuria:
  • hyperuricosuria:
  • Hypociratureia:
A
  • thiazide
  • allopurinol - potassium citrate
  • potassium citrate
35
Q

What would you recommend patients with renal stone to do?

A
  • high fiber\vegetable diet
  • normal (no change) calcium
  • fluid intake up to 3L
  • physical activity
36
Q

Define microscopic hematuria:

A

3 or more RBC in urine

37
Q

What is the risk of malignancy in patient with microscopic hematuria:
(High - low)?

When does it increase

A
  • Low 5%

- smoker - old >35 - male

38
Q

Most common cause of microhematuria:

A
  • BPH
  • calculi
  • UTI
39
Q

What to do if patient has <3 RBC in urinalysis?

A

Repeat 3x in 6w interval

40
Q

What to do if patient has >3 RBC in urinalysis?

A

Assess for the cause (UTI etc..), treat & repeat.

  • positive: assess renal diseases
41
Q

When to preform CT in microhematuria?

A
  • high risk malignancy

- good renal function

42
Q

USPSTF recommends against screening for prostate cancer in which population?

A

Men >70yrs

43
Q

Is PSA recommended BPH?

A

Only before starting tx.

Family Medicine (15 decks)

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