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Clinical Medicine 2 > Exam 3: UTI, Cysitis, Pyelo > Flashcards

Exam 3: UTI, Cysitis, Pyelo Flashcards

1
Q

** is the most accurate in predicting UTI when positive for ** in symptomatic patients.

A

Urine dipstick

Leukocyte esterase

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2
Q

What can cause false negative nitrate in urine dipstick results?

A
  • Non-nitrate reducing organisms

- Frequent urination/urine in bladder <4 hrs

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3
Q

What can cause false positive leukocyte esterase in urine dipstick?

A
  • Vaginal contamination

- trichomonas infection

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4
Q

What kind of UTI is pyelonephtritis?

A

Upper urinary tract infection?

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5
Q

What are the 3 kinds of lower urinary tract infections?

A

Cystitis, prostatitis, and urethritis

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6
Q

95% of UTIs occur from what?

A

An ascending bacterial infection

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7
Q

What bacteria accounts for the majority of of UTIs?

A

E. Coli

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8
Q

What are the risk factors for UTI?

A
  • Reduced urine flow (obstruction, inadequate fluid, neurogenic bladder)
  • Promote colonization (Sexual activity, recent Abx)
  • Facilitating ascent (catheterization, urinary incontinence, and fecal incontinence)
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9
Q

What kind of UTI is most common in men?

A

Prostatitis and urethritis

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10
Q

What is it called when there is an acute UTI presumed to be confined to the bladder in a non-pregnant individual?

A

Acute simple cystitis

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11
Q

What is it called when you have an acute UTI accompanied by s/s that suggest extension of infection beyond the bladder, such as fever, chills, CVA tenderness, and pelvic pain?

A

Acute complicated UTI

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12
Q

What populations are are risk for a complicated UTI?

A

-Pregnant women, men, and patients with comorbidities, immunocompromised conditions, or underlying urologic abnormalities

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13
Q

A patient presents with irritation voiding symptoms such as dyslexia, urinary frequency, and increased urgency. Patient has hematuria and suprapubic discomfort. What are you concerned about?

A

Acute simple cystitis

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14
Q

What is found on PE in acute simple cystitis?

A
  • The exam is typically normal

- 10-20% of women have suprapubic tenderness 4

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15
Q

What tests should be ordered for acute simple cystitis and what will they show?

A
  • Urine dipstick with positive leukocyte esterase and nitrites
  • Urine microscopy with pyuria (Abnormal >10), bacteriurua, and possibly hematuria
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16
Q

When is a urine culture indicated fro acute simple cystitis?

A
  • atypical presentation
  • suspect complicated UTI
  • Symptoms do not resolve
  • Suspect antimicrobial resistance
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17
Q

What is diagnostic of acute simple cystitis on a urine culture?

A

> 10^3 CFU/mL

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18
Q

What is the symptomatic treatment of acute simple cystitis?

A

-Urinary analgesic (pyridium) 200mg TID for most of 2 days

19
Q

What is the treatment for acute simple cystitis in a non-pregnant individual?

A
  • Nitrofurantoin (macrobid)
  • Bactrim
  • Fosfomycin
20
Q

What medications should you avoid if early pyelonephritis due to low renal penetration?

A

Macrobid and fosfomycin

21
Q

What is the treatment for acute simple cystitis in pregnant women?

A
  • Augmentin, cefpodoxime, or fosfomycin

- Avoid fluoroquinolones

22
Q

What is acute pyelonephritis?

A

-Infectious inflammatory process involving the kidney parenchyma and renal pelvis

23
Q

What will be seen on UA and urine culture in pyelonephritis?

A
  • Leukocyte esterase
  • nitrites
  • pyuria
  • bacteriuria
  • WBC casts
24
Q

What do WBC casts suggest?

A

Renal origin for pyruia

25
Q

Although imaging is not typically indicated with pyelonephritis, what is the test of choice when it is indicated?

A

CT A/P with and without contrast

26
Q

What is the outpatient management of acute mild-moderate pyelonephritis?

A
  • Cipro 500mg PO BID x 5-7 days
  • Cipro ER 1000mg PO once daily x 5-7 days
  • Levofloxacin 750mg PO once daily x 5-7 days
27
Q

If a patient with mild-moderate acute pyelonephritis has local FLQ resistance to E. Coli, how should you treat?

A

Initial IV or IM dose of Ceftriaxone followed by one of the FLQs

28
Q

When must a patient with Pyelonephritis follow up?

A

48-72 hours

29
Q

What are some of the indications for hospitalization in acute Pyelonephritis?

A
  • Critically ill and hemodynamically unstable
  • Persistent fever
  • suspected obstruction
  • metabolic derangement
  • cant take PO
  • Compliance concerns
30
Q

What are the acceptable IV Abx for inpatient management of complicated/severe Pyelonephritis?

A
  • Fluoroquinolone
  • Extending spectrum cephalosporin
  • Extended spectrum penicillin
  • Carbapenem
  • Aminoglycoside
31
Q

What are the possible complications with acute Pyelonephritis?

A
  • Sepsis/shock
  • renal failure
  • scarring or chronic Pyelonephritis
  • renal abscess
32
Q

Interstitial cystitis (IC) is synonymous with what other terms?

A

Bladder pain syndrome (BPS) and painful bladder syndrome (PBS)

33
Q

What is a chronic and debilitating conditions characterized by bladder pain?

A

IC

34
Q

How is IC diagnosed?

A
  • Usually a diagnosis of exclusion
  • UA with microscopy and urine culture (generally unremarkable)
  • Urine cytology
  • STI testing
  • PVR
  • Cystocopy
35
Q

What may be seen on cystoscopy with IC?

A

-May identify urothelium (glomerulations and hunner lesions)

36
Q

What is the first line treatment for IC?

A
  • Self care and behavioral modifications
  • Diet modifications
  • bladder retraining
  • low impact exercise
  • psychotherapy
  • urinary analgesics
37
Q

What are the second line treatments for IC?

A
  • Tricyclic Antidepressants (Amitriptyline)
  • Pentosan Polysulfate (Elmiron)
  • Antihistamines (Hydroxyzine)
  • Intravesical medications (lidocaine)
38
Q

What is the third line therapy for IC?

A
  • Cystoscopy with short duration, low pressure hydrodistention
  • Intravesical instillation of GAGs
  • Intravesical Dimetheyl Sulfoxide (DMSO)
39
Q

What is fourth line treatment for IC?

A
  • Intradestrusor botulinum toxin

- Sacral neuromodulation

40
Q

What is a syndrome characterized by urinary urgency, with or without incontinence, often accompanies by nocturnal and urinary frequency?

A

Overactive bladder

41
Q

What is the etiology of OAB?

A

Detrusor muscle overactivity, leading to involuntary bladder contractions that cause leakage

42
Q

What is the first line treatment for OAB?

A
  • Kegel exercises
  • Lifestyle and behavioral modifications
  • Bladder training
43
Q

What is the second line treatment for OAB?

A
  • Antimuscarinics such as oxybutynin, tolterodine, solifenacin, and darifenacin
  • *caution with anticholinergics side effect
  • Beta 3 agonists such as mirabegron

Clinical Medicine 2 (22 decks)

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