GU Flashcards
Most common pathogen causing UTI
E. Coli
Gram neg bacilli from the gut = 80%
1st line treatment for UTI
Course of tx?
Nitrofurantoin
M= 7-10d
F= 3d
Pts with comorbid conditions = 7-10d
What is the indication for phenazopyradine?
Anti-spasmodic- can be prescribed for UTI to prevent bladder spasm
SI- orange urine
Indication for fluvoxate?
Anti-spasmodic- prevent bladder spasm in UTI - makes urine bright orange
Who do you prescribe cephalosporins to with UTIs?
Reserve for pregnant ppl and Children
indication to follow-up with UTI
If blood present in the urine- ensure eradication with treatment to r/o cancer
Preferred medicine for OAB
Mirabegron
Post-menopausal women with OAB tx
Estrogen topical
Peasized amount in general genital area
Once daily x 2-4 wks
The twice weekly
Nitrites in urine indicate what?
Gram negative bacteria ie. ecoli
Causes of elevated BUN x4?
Low BUN?
Elevated- Renal Injury / high protein diet / hemolysis / CHF
Low- liver damage
What type of Casts in UA indicate:
Normal?
Infx?
Glomeural dysfunction?
N- Hyaline
Infx- WBC
Glomerular dx- RBC
Pt has a + Urine dip for protein. What is this measuring?
What should you order?
Albumin in urine——- NOT microambumin
Order 24h Urine
Causes of hematuria x5
Renal Colic
Cystitis
Pyelo
Cancer
Menses contam.
Treatment of Asymptomatic Bacteriuria
None EXCEPT Pregnant persons!
UTI’s in what population are more likely to become Pyelo
Children <3y & Pregnant person
Multiple bacteria on Urine C&S suggests what?
Sample contamination
Uncomplicated UTIs treatment
Septra (TMP/SMX) x 3d ——20% resistance rates
If likely resistant or allergic to sulfa-
Nitrofurantoin x 5d
What/ who are considered Complicated UTIs?
Considerations for treatment?
** Must treat for a minimum of 7d
Men
Children
Pregnant persons
Ppl with comorbid conditions
Immunocompromised
Recurrent UTI’s
Anatomical abnormalities
Recurrent UTI definition
F- >/= 3 per year or 2 in 6 months
Never normal in Males
R/o structural abnormalities/ other etiology
If UTI symptoms persist beyond 48-72 with abx treatment- what’s next?
Order C&S and UA
Change abx and extend course to 7 days
UTI definition (organism count)
> 100 000 CFU/mL of one organism
Pyelonephritis treated with Quinolones (ie. Ciprofloxacin or Levofloxacin) can be treated for ____ days
7 days = shorter
Describe Kidney position
Retroperitoneal at CVA
R is lower than L due to displacement by Liver
+++ Squamous epithelial cells in urine mean ?
Contamination
Normal WBC count?
Normal Neuts ?
WBC- 10.5
Neuts- > 80%
Presence of band or stabs in CBC indicate what?
Serious bacterial infx
Spermicides do what to females?
Increase risk of UTI
Oliguria is ?
< 400 ml urine / day
Normal urine output
1500 cc / day
RPR & VDRL are used for what?
Screening tests for syphillis
Non-treponemal
If + order treponemal test
What test is confirmatory of syphallis ?
FTA-ABS - treponemal test
Tx Primary/ secondary/ early latent (<1yr)
Tx latent (>1yr)
Pen G 2.4 million U IM x1
Latent = x 3
T/F-
1. If a patient tests positive for gonorrhea, always treat for chlamydia.
2. If a patient tests positive for chlamydia and negative for gonorrhea- treat for both.
- TRUE
- False
Gonorrhea treatment
Ceftriaxone IM x1
+ chlamydia treatment
Chlamydia treatment
Azithryomycin x 1 or doxy x 7d
NAAT are highly sensitive for what STIs?
Chlamydia & Gonorrhea
Collected via urine (pref for males) / SWAB of vag/crevix/urethra/pharynx/rectum
If infected with G&C- when do you test for cure?
If pregnant?
3 months
3 weeks
PID / Proctitis treatment
Ceftriaxone IM x 1 + Doxy x 14d +/- Metronidazole x 14d
Treponema Pallidum causes what dx?
Syphilis
Test of cure for syphilis
RPR or VRDL at 6 and 12 months after treatment
Treating sexual partners- syphilis
Within 90 days even if screening test neg
T/F- acute retroviral syndrome / primary HIV = flu like symptoms - non contagious time
FALSE- highly contagious time- treat HIV ASAP
What locations are most common of HSV-1 vs HSV-2
HSV-1 = oral mucosa
HSV - 2 = genitals
STD symptoms + new swollen knee pain (or other joint)- think——?
Disseminated gonorrhoea infection
Acute febrile reaction within 24 hours after treatment of syphilis or lymes disease
Jarisch-Herxheimer Rxn
Fitz-Hugh- Curtis syndrome/ perihepatitis ?
Gonorrhea and/or chlamydia infx of the liver capsule
HIV tests
HIV 1 & 2antibodies
P24 antigen
—— if + the lab will differentiate antibodies
If inconclusive- order HIV RNA
Viral load measuring in HIV?
What is successful treatment?
Number of HIV RNA in 1ml of plasma
Tx success = < 50 copies/ ml
Increased CD4 count suggests what of HIV therapy?
Responding to ART = good!
Viral load decreases and CD4 count increases
ELISA is screening test for ?
HIV
Normal CD4 counts?
> 500 cells
Monitoring viral load with HIV treatment?
Initial = q1-2 months until undetectable
Then q 3-4 months
Thrush + Kaposis Sarcoma + pneumocystitis jirovecii are suggestive of what?
AIDS
AIDS is defined by an absolute CD4 count less than?
200
PCP prophylaxis in pts with HIV is when CD4 count is less than?
200
Prophylactic PCP treatment is?
Bactrim
Sulfa allergy - Dapsone
High risk oncogenes HPV types are ?
16 & 18
1st episode treatment of herpes
Flare tx?
Antiviral (valcyclovir or acyclovir or famcyclovir) x 7-10 days
Same X 5 days
What is imiquimod indicated for?
Immune modulator treatment for genital warts that can be used at home by pt
Podofilox/ podophylla/ imiquimod are contraindicated in ———-
Pregnancy
Tzanck smear is used to detect what infection
Varicella/ HSV
Genital herpes treatment duration:
Primary-
Recurrent-
1st- 7-10d
Recurrent - 5d
Bacterial vaginitis treatment
Metronidazole x 7d
Trichamoniasis treatment
Partner?
Metronidazole x 1
Yes- treat partner at same time
Western blot test
Confirms HIV dx
Clue cells on saline wet mount ?
BV
