GU 1

Question 1

cystitis

Answer 1

lower UTI; bacterial infection of the bladder

Question 2

lower UTI; bacterial infection of the bladder

Answer 2

cystitis

Question 3

pyelonephritis

Answer 3

upper UTI; ascending bacterial infection of the kidney from the bladder

Question 4

upper UTI; ascending bacterial infection of the kidney from the bladder

Answer 4

pyelonephritis

Question 5

cystitis - pt common presents w/
4

Answer 5

1. dysuria
2. urinary urgency/frequency
3. suprapubic pain
4. +/- hematuria

Question 6

pyelonephritis - pt commonly presents w/
4

Answer 6

1. flank/back pain
2. fever/chills
3. +/- NV
4. +/- symptoms of cystitis

Question 7

vitals signs for upper/complicated UTI

Answer 7

+/- fever
tachycardia - think pain, sepsis

Question 8

suprapubic tenderness is common in ____

Answer 8

cystitis

Question 9

CVA tenderness is common in ____

Answer 9

pyelonephritis

Question 10

UTI/pyelonephritis img/testing
2

Answer 10

1. pregnancy test
2. POC urine

Question 11

UTI/pyelonephritis - urine cx recommended in who

Answer 11

suspected complicated or upper UTI

Question 12

cystitis DD
5

Answer 12

1. STI
2. vaginitis
3. genital HSV
4. prostatitis
5. urolithiasis

Question 13

pyelonephritis DD
9

Answer 13

1. MSK stain
2. urolithiasis
3. appendicitis
4. biliary disease
5. pancreatitis
6. AAA
7. SBO
8. ovarian conditions
9. ectopic pregnancy

Question 14

UTI symptom relief rx
4

Answer 14

1. NSAIDs
2. acetaminophen
3. phenozopyridine/Pyridium
   Adults 12+: 100-200 mg PO q8H x 2 days
   Peds 6-12 years 4 mg/kg/dose PO TID X 2 days after emails
   Can get AZO OTC but lower dose
4. antiemetics i.e. ondansetron 4 mg PO q8h prn

Question 15

cystitis rx
3

Answer 15

Per UTD
1. Macrobid 5 days
2. Bactrim 3 days
3. Fosfomycin 3 g once PO

1. cephalexin 500 mg PO BID 5-7 days (first line in pregnant pts)
2. nitrofurantoin 100 mg PO BID x 5 days (poor renal penetration, avoid in pts w/ renal insufficiency, pyelonephritis, 1st tri pregnancies)
3. TMP/SMX DS/ Bactrim - 1 tab PO BID for 3-5 days

Question 16

male patient UTIs should be treated as

Answer 16

complicated UTIs and require longer duration of tx - typically 7 days; may only need 5 days if needing a fluoroquinolone

Question 17

cystitis 1st line and duration

Answer 17

nitrofurantoin 100 mg PO x 5 days(F)/10 days(M)

Question 18

cystitis 2nd line and duration

Answer 18

TMP/SMX DS 160/800 mg BID x 3 days (F)/10 days(M)

Question 19

pyelonephritis rx

Answer 19

1. cefpodoxime 200 mg PO BID for 10-14 days
2. TMP/SMX DS 160/800 mg 1 tab BID 10-14 days
3. ciprofloxacin 500 mg PO BID x 7 days

Question 20

UTI/pyelonephritis - f/u

Answer 20

with PCP in 2-3 days if sx persist or sooner if worsening

Question 21

UTI/pyelonephritis - when to refer to ER
5

Answer 21

1. inability to tolerate PO
2. concern for infected kidney stone - sx of kidney stone + fever or evidence of UTI on POC urine
3. signs of sepsis
4. complicated UTI - significant comorbidities such as uncontrolled DM, renal failure, pregnancy, immunosuppressed, known uro abnormalities (single kidney)
5. failure of OP abx therapy (48-72 hrs)

Question 22

kidney stones

Answer 22

stones form in renal pelvis and typically become symptomatic w/ passage into the narrow ureter

Question 23

kidney stones - clinic pres can include
4

Answer 23

1. acute onset of colicky, waxing/waning unilateral flank pain
2. often w/ radiation to unilateral lower abd, groin, or genitalia
3. NV
4. hematuria

Question 24

kidney stones - general appearance
2

Answer 24

often unable to find a comfortable position
pacing/writhing in pain

Question 25

kidney stones - vitals and PE exam findings 3

Answer 25

VS typically normal - may have pain related tachycardia +/- CVA tenderness +/- abd/pelvic tenderness

Question 26

kidney stones - fever raises concern for

Answer 26

infected stones

Question 27

kidney stones - img/testing 2

Answer 27

POC urine (hematuria in 80-90%) pregnancy test

Question 28

kidney stones - DD 6

Answer 28

1. AAA 2. appendicitis 3. pyelonephritis 4. biliary disease 5 - Gyno concerns - pregnancy. ovarian conditions, cyst 6. MSK strain

Question 29

kidney stones - overall tx care includes 3

Answer 29

1. hydration 2. analgesics 3. antiemetics

Question 30

kidney stones - analgesia meds 3

Answer 30

1. ketorolac - Weight ≥50 kg and <65 years of age: 30 to 60 IM once in office; Weight <50 kg or ≥65 years of age: 30 mg IM once while in office then 2. PO NSAIDs i.e. ibuprofen 3. opiates for severe pain

Question 31

kidney stones - antiemetic option

Answer 31

ondansetron 4 mg PO q6h prn

Question 32

kidney stone pt education 3

Answer 32

1. keep hydrated 2. most stones pass on their own w/in 4 weeks of onset of symptoms (5-10 mm most pass on their own, 10 mm or bigger may req tx) 3. consider urine strainer to collect calculus

Question 33

kidney stone referral

Answer 33

urology

Question 34

kidney stones - when to refer to ER 4

Answer 34

1. signs of systemic infection - concern for infected kidney stone (fever, evidence of UTI on urine) 2. suspected urolithiasis in a pt with solitary or transplanted kidney, CKD 3. unable to tolerate PO, hypovolemia 4. consider referral to ER for imaging, especially in elderly pts or first episode