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D&T3 Exam 1 > Dysuria-Petrany > Flashcards

Dysuria-Petrany Flashcards

1
Q

Urine Culture

Indications

A

Suspicion of complicated UTI

Atypical symptoms

Tx failure

Recurrent symptoms (<1 month after rx of previous UTI)

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2
Q

Cystitis

Prevention

A

Cranberry juice (contains tannins which can dec binding ability of E. Coli)
Void soon after sex
Avoid prolonged bath soaking
Wipe front to back
Void when urge-don’t hold it
Drink lots of water
Cotton underwear, loose fitting clothes, dec warmth and lessen colonization of perineum

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3
Q

Urethritis

Gonorrhea

Common pt

A

Indigent inner-city woman

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4
Q

UTI

Lower tract

Cystitis

Urinalysis

A

Pyuria (culture not need if uncomplicated)

Hemorrhagic cystitis if hematuria present

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5
Q

Vaginitis

Common causes

A

Candida vaginitis

Trichomonas vaginitis

Bacterial vaginosis

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6
Q

Urinalysis

UTI diagnosis sensitivities and specificities

A

Sensitivity. Specificity
Microscopic pyuria. >90. >50-75
Leukocyte esterase. 75-95. 94-98
Nitrite*. 35-85. 90-100

*only pos for enterobacteriaceae. Not staph, enterococcus, pseudomonas

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7
Q

You get a phone call…

A

Check for fever, N/V, comorbid conditions like pregnancy, DM, immunosuppression, possibility of STD (discharge)

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8
Q

Bacterial Vaginosis

A

Metronidazole

Clindamycin

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9
Q

Complicated UTI

Factors

A 
Pregnancy
Diabetes
Hx of acute pyelonephritis in last year
Relapsing UTI in past year
Hx of UTI in childhood
3 or mor UTIs in past year
Uropathogen with multiple resistance pattern
Hospital acquired UTI 
In-dwelling urinary catheter
An atomic of fxnal abnormality of urinary tract
Antibiotic tx within the last month
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10
Q

Urine Culture

Pos value if these symptoms

A

> 1000 CFU/mL

Diluted, washed out urine

Early infxn

On antibiotics

Men (contamination less likely)

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11
Q

UTI

Lower tract

Cystitis

What constitutes adequate diagnosis

A

UTI symptoms in presence of leukocytes

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12
Q

Urine sampling

Clean catch urine specimen

A

Woman must spread labia and whip with antiseptic wipe front to back and place cup in the midstream

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13
Q

Urethritis

Gonorrhea

Rx

A

Ceftriaxone (parenteral), ofloxacin

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14
Q

UTI Children

Rx

A

7-14 days of antibiotics

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15
Q

UTI

Lower tract

Cystitis

Involvement

A

Both bladder and urethra involved

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16
Q

Urethritis

Chlamydia

Risks

A

Sexually active, multiple partners, no barrier contraception

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17
Q

UTI

Lower tract

Cystitis

A

MC cause of dysuria in adult women

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18
Q

Indwelling bladder catheters

A

Avoid long term use if possible

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19
Q

UTI

Lower tract

Cystitis

Symptoms

A

Dysuria
Frequency
Urgency
Suprapubic pain

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20
Q

Dysuria

Symptomatic treatment

A

Phenazopyridine

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21
Q

Vaginitis

Urinalysis

A

Little to no pyuria

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22
Q

Vaginitis

Bacterial vaginosis

A

Thin off white fishy odor dishcharge

Ph>4.5

Clue cells

Pos whiff test

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23
Q

UTI

Lower tract

Cystitis

Exam

A

OK except Suprapubic tenderness

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24
Q

Urethritis

Gonorrhea

Gram stain

A

Gram negative diplococci

25
Q

UTI inpatient Therapy

Pyelonephritis: when to admit

A

More severe illness, toxic appearing

Complicated UTI (elderly, instrumented, diabetic, urologic abnormality)

May be unable to take oral meds (N/V)

Pregnancy

Concerned about compliance

26
Q

Urine sampling

Urine handling

A

Bacteria still grow in warm urine so cool specimen if delay (OK overnight but WBCs may be affected

27
Q

UTI

Upper tract symptoms

A

Flank pain
Fever
Abdominal pain
Nausea/vomiting

28
Q

UTI Antibiotic Therapy (Adults)

Uncomplicated cystitis

A

Short (1-3 days)

TMP-SMX (or fluoroquinolone)

29
Q

Urethritis

Gonorrhea

Gold standard

A

Urethral culture (calcium Latinate tip swab onto pre-warmed Thayer-Martin agar

DNA probe OK but less sensitive

30
Q

Vaginitis

Symptoms

A

Dysuria with vaginal discharge or odor, itching, dyspareunia

31
Q

Dysuria: Children

Infectious causes

A

Lower UTI

Pyelonephritis

Urethritis

Vaginitis

32
Q

UTI Antibiotic Therapy (Adults)

Complicated UTI

A

Longer course (7-14 days)

Broader spectrum floroquinolones

Don’t use amox, nitrofurantoin, sulfa

May need parenteral therapy

Culture guided rx

33
Q

Vaginitis

Trichomoniasis

A

Copious yellow green malodorous discharge

PH >4.5

Motile trichomonads, WBCs

34
Q

Atrophied vaginitis

A

Post-menopausal, estrogen deficient women

May have dysuria

Urinalysis normal and no growth on culture

Topical estrogen often effective

35
Q

Urethritis in men

A

Dysuria alone is chlamydia

Dysuria and discharge is gonorrhea

36
Q

Vaginitis

Candida

A

Thick, white cottage cheese discharge

Normal pH (<4.5)

Hyphae and budding yeast

37
Q

Phenazopyridine

Length of use

A

2 days only

38
Q

Phenazopyridine

Side effects

A

Turns urine red and leads to false pos dipstick (orange sweat)

G6PD deficient pts can get hemolytic anemia

39
Q

Candida vaginitis

Rx

A

Fluconazole or itraconazole oral

40
Q

Urine Culture

Pos for proper clean catch urine

A

> 100,000 CFU/mL

41
Q

Trichomonas vaginitis

Rx

A

Metronidazole

TREAT SEX PARTNERS

42
Q

UTI

Women

Risk factors

A

Sex

Hx of UTI

Diaphragm, spermicidal use

Pregnancy

Catheter

Postmenopause

43
Q

Urine sampling

Suprapubic aspiration of bladder

A

Needle into bladder (rarely used, best)

44
Q

UTI

Men

Risk factors

A

Prostatic hypertrophy

Urethral catheterization

45
Q

Urine sampling

In children in diapers

A

Need minicath or Suprapubic tap

46
Q

Dysuria: Children

Noninfectious causes

A

Irritants

Minor trauma

Labial adhesions with small tears

Psychogenic

47
Q

Complicated UTI

Procedure

A

Urine culture should be obtained with sensitivities

Therapy may need to be adjusted (longer, different antibiotic)

May require further evaluation

48
Q

Phenazopyridine

A

Urinary analgesics can be used one diagnosis is made

49
Q

Urethritis

Chlamydia

Testing and Rx

A

Test for DNA (NAAT)

Rx: azythromycin, doxycycline

50
Q

Uncomplicated UTI

A

Acute cystitis in an otherwise healthy non pregnant woman

51
Q

UTI

Common pathogens

A 
E. Coli (90%)
Enterococcus
Pseudomonas (nursing homes, hospitalized)
Proteus
Klebsiella
Staph saprophiticus
52
Q

Irritant Dysuria

A

Rxn to local contact with irritant (contraceptive gel, tampon, condom, bubble baths, etc.)

53
Q

Urethritis

Chlamydia

Urinalysis and culture

A

Pyuria without bacteriuria

Urine culture neg

54
Q

Acute dysuria

In men…

A

Acute cystitis rare (anatomic problems)

Urethritis more common in young sexually active men

UTI more common in older men with prostatic hypertrophy

55
Q

MC cause of dysuria in adult women

A

Cystitis (lower tract bacterial UTI)

56
Q

Urine sampling

Minicath urine sampling

A

Small sterile catheter inserted into bladder

57
Q

UTI

Lower tract symptoms

A

Dysuria
Frequency
Urgency
Suprapubic pain

58
Q

Acute dysuria

Common Causes

A

Cystitis

Urethritis

Vaginitis

59
Q

Uncomplicated UTI

Cause

A

Almost always E. Coli or S. Saprophyticus

D&T3 Exam 1 (19 decks)

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