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Clin Med II > Cystitis, Pyelonephritis, IC & OAB > Flashcards

Cystitis, Pyelonephritis, IC & OAB Flashcards

1
Q

When is a urine dispstick most accurate in predicting a UTI?

A

If sxs AND + for leukocyte esterase/ nitrate

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2
Q

Non-nitrate reducing organisms and frequent urination/ urine in bladder < 4 hrs can cause what?

A

False negative on urine dipstick

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3
Q

Vaginal contamination and trichomonas infection can cause what?

A

False positive on urine dipstick

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4
Q

Upper urinary tract infection is aka?

A

Pyelonephritis

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5
Q

Lower tract infection is aka?

A

Cystitis (also prostatitis, urethritis)

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6
Q

What is the majority cause of UTI’s?

A

Ascending bacterial infection (E. coli)

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7
Q

↓ urine flow is a RF for UTI. What 3 things can cause this?

A

Urine outflow obstruction, inadequate fluid intake, neurogenic bladder

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8
Q

Promotion of colonization is a RF for UTI. What 3 things can cause this?

A

Sexual activity, spermicide use, recent antimicrobial use

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9
Q

Facilitated ascent is a RF for UTI. What 2 things can cause this?

A

Catheterization, urinary/ fecal incontinence

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10
Q

Acute simple cystitis is confined to where? (although there may be an atypical presentation in elderly)

A

Bladder (lower urinary tract) (in non-pregnant individual)

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11
Q

What are the most common sxs of a UTI? (3)

A

Dysuria, urinary frequency, urgency

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12
Q

You note a normal PE and a UA with + leukocyte esterase & nitrates, microscopy w/ + pyuria, and bacteriuria. What should you be suspicious for?

A

UTI

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13
Q

The following are indications for what? Atypical presentation, suspect complicated UTI, recurring/ non-resolving sx, ABX resistance, special populations (pregnant, men, IMC, underlying urogenital abn)

A

Culture (routine cultures not usually needed for women w acute simple cystitis)

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14
Q

CFU of what for uropathogen is diagnostic for a UTI?

A

≥ 103 CFU

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15
Q

CFU of what for women with presence of UTI symptoms is considered positive?

A

>102 CFU

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16
Q

Typical tx for uncomplicated URI is what?

A

Urinary analgesic (Pyridium), limit to 2 day course

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17
Q

What abx should be used in the tx of a UTI?

A

Nitrofurantoin, Bactrim, Fosfomycin

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18
Q

What abx should be avoided in the tx of UTI if there is presence of early pyelonephritis?

A

Nitrofurantoin and Fosfomycin

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19
Q

What abx should be avoided in pregnancy for the treatment of a UTI?

A

Fluoroquinolones

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20
Q

Men with a UTI should be treated for longer duration of how long in order to r/o prostatitis?

A

7 days

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21
Q

Pts who are IMC should be treated for longer duration of how long for a UTI?

A

1-2 weeks

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22
Q

Pts with a UTI should experience relief in how long after initiation of abx treatment?

A

W/i 48 hrs

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23
Q

What ER precautions should be given to a pt with a UTI?

A

Signs of pyelonephritis (fever, chills, flank pain)

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24
Q

When should f/u urine cultures be taken in pts with a UTI?

A

Pregnant women

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25
Q

What type of UTI is an extension of infection beyond the bladder?

A

Acute complicated UTI

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26
Q

What is the term for infection of the kidney (upper urinary tract) usually from ascent of bacterial pathogen?

A

Pyelonephritis

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27
Q

What sxs will you see on a pt with pyelonephritis? (7)

A

Dysuria, fever, chills, fatigue, flank pain, CVAT, GI sx

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28
Q

What 3 tests will you order is you suspect a pt has pyelonephritis?

A

UA/culture, CBC, BMP

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29
Q

What will you see on UA/ culture of a pt with pyelonephritis?

A

WBC casts (also + leukocyte esterase, + nitrites, pyuria (≥ 10 leukocytes/mL), bacteriuria)

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30
Q

What is the imaging of choice for a pt with pyelonephritis?

A

CT A/P w/ & w/o contrast

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31
Q

What is the treatment for outpatient pyelonephritis?

A

Fluoroquinolone (Ciprofloxacin, Levofloxacin)

32
Q

What is the treatment for outpatient pyelonephritis if the pt has a FLQ resistance?

A

IV or IM dose of Ceftriaxone followed by Cipro or Levofloxacin

33
Q

What is the treatment for inpatient pyelonephritis

A

IV ABX, supportive care

34
Q

How soon must a pt w/ pyelonephritis f/u if they are symptomatic (mild-mod illness) or out pt management?

35
Q

The following complications are associated with what condition? Sepsis w/ shock Renal failure Scarring/chronic pyelonephritis (if coexistent kidney disease) Renal abscess formation

A

Pyelonephritis

36
Q

What is prostatitis? (men)

A

Pelvic or perineal pain

37
Q

Bladder pain syndrome (BPS) and painful bladder syndrome (PBS) are aka what?

A

Interstitial cystitis (IC)

38
Q

Chronic debilitating condition characterized by bladder pain > 6 wk is what condition?

A

Interstitial cystitis (IC)

39
Q

When is the bladder pain better/ worse with Interstitial cystitis (IC)?

A

Worse w/ bladder filling, relieved w/ voiding

40
Q

Men with Interstitial cystitis (IC) may present as having pelvic pain along with what other complaint?

A

Sexual dysfunction

41
Q

Interstitial cystitis (IC) is really a clinical dx of inclusion. This involves performing a UA and urine culture to exclude what?

A

Hematuria and infection

42
Q

Cystoscopy of a pt with Interstitial cystitis (IC) might show what, which is used to support the dx?

A

Altered urothelium (glomerulations and hunner lesions)

43
Q

Which condition has the potential to impacts psychosocial functioning and QOL?

A

Interstitial cystitis (IC)

44
Q

Is treatment of Interstitial cystitis (IC) curative?

A

No, goal is to provide symptomatic relief

45
Q

What is 1st line tx for Interstitial cystitis (IC)? (5)

A

Lifestyle changes, behavior modification, exercise, support groups, urinary analgesics

46
Q

What is 2nd line tx for Interstitial cystitis (IC)? (3)

A

Oral meds (Amitriptyline, Elminron, Hydroxyzine) Intravesical meds (Lidocaine) Pelvic PT

47
Q

Pt presents with a hx of urinary urgency +/- incontinence, often w/ nocturia and urinary frequency. They state their sxs are impacting their QOL. What should you be considered for?

A

Overactive Bladder (OAB)

48
Q

What is the etiology for Overactive Bladder (OAB)?

A

Detrusor muscle overactivity → involuntary bladder contraction → leakage

49
Q

What labs should you get if you are suspicious for Overactive Bladder (OAB)?

A

UA, + urine culture if UTI or hematuria

50
Q

What is 1st line tx for Overactive Bladder (OAB)? (3)

A

Pelvic floor muscle exercises, lifestyle/behavioral changes (weight loss, caffeine reduction), bladder training

51
Q

What is 1st line tx for Overactive Bladder (OAB)? (2)

A

Antimuscarinics (interfere w/ detrusor muscle) Mirabegron

52
Q

What cautions should you be aware of when treating Overactive Bladder (OAB)?

A

Cautions w/ anticholinergic side effects

53
Q

Pt presents w sharp, stabbing back pain of waxing and waning severity that radiates from flank to groin. What should you be concerned about?

A

Nephrolithiasis

54
Q

What are the most common associated sxs of nephrolithiasis? (3)

A

Pain (flank radiating to groin), hematuria, passage of stone/ gravel

55
Q

What is the pathogenesis of nephrolithiasis?

A

Supersaturation of urine = crystal formation

56
Q

What are the most common type of stones?

A

Calcium oxalate > calcium phosphate

57
Q

What type of stones are typically radiolucent?

58
Q

What are RF’s for nephrolithiasis? (5)

A

Hx of prior stone, FH, decreased fluid intake, malabsorption, hyperparathyroidism

59
Q

What is the gold standard for dx of nephrolithiasis? (check for both stone and obstruction)

A

Non-contrast low radiation CT (IV contrast decreases sensitivity for small stones) (can also use US)

60
Q

What happens to kidney stones ≤ 5mm?

A

Pass spontaneously

61
Q

Besides pain meds, hydration, and urine straining, what pharmacologic tx is used for nephrolithiasis in order to facilitate stone passage?

A

Tamsulosin 0.4mg qd (alpha blocker)

62
Q

Stones >10mm, failure to pass stone w conservative management, and significant obstruction are indications for what?

A

Urology referral

63
Q

Urologic infection, AKI, anuria, and unyielding pain, n/v with respect to nephrolithiasis management are indications for what?

A

Urgent urology referral

64
Q

What are the 3 possible surgical removal options for tx of nephrolithiasis?

A

Shock wave lithotripsy Ureteroscopy Percutaneous nephrolithotomy

65
Q

What pt edu should be provided for the management of nephrolithiasis? (3)

A

Eval for underlying causes Diet +/- Allopurinol (gout), HCTZ

66
Q

If on eval of a non-contrast CT of a pt w possible nephrolithiasis you note perinephritic stranding. What does this indicate?

A

Signs of inflammation or obstruction

67
Q

What lifestyle habit is associated with increased risk of renal cell carcinoma?

A

Cigarette smoking

68
Q

What is the classic triad for renal cell carcinoma?

A

Hematuria, flank pain, palpable abd mass

69
Q

What is the test of choice for definitive dx of renal cell carcinoma?

A

Tissue bx (often found incidentally on CT or US)

70
Q

What is the tx for localized renal cell carcinoma?

A

Nephrectomy

71
Q

What sxs are typically associated with PKD? (3)

A

HTN, abd/ flank pain, hepatic cysts

72
Q

What gene is associated with autosomal recessive PKD?

A

PKHD1 gene

73
Q

What is the treatment for autosomal dominant PKD?

A

Tolvaptan (also dialysis, kidney transplant)

74
Q

The following pathogenesis ultimately causes what complication in pts with PKD? BIL: cysts → enlarge → compress parenchyma → compromise renal function/ BF →

A

ESRD (> 50% by age 60)

75
Q

What systems are affected by recessive PKD?

A

Kidneys and hepatobiliary tract

Clin Med II (12 decks)

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