GU

Question 1

pathogen responsible 85-90% of time for UTI

Answer 1

E Coli

Question 2

UTI s/s

Answer 2

frequency, urgency, dysuria (suprapubic discomfort)

- physical exam unremarkable

Question 3

UTI aka

Answer 3

acute cystitis

Question 4

UTI labs

Answer 4

UA: pyuria gt 10 leukocytes/ml & bacteriuria 102 - 105 cfu/ml

degree of each doesn’t correlate with infection severity

Question 5

UTI treatment: 1st line, alt, 2nd line

Answer 5

Bactrim (trimethoprim-sulfamethoxazole)

• • 3 days uncomplicated
• • 7-10 days if complicated
• if resistant to Bactrim & F: Macrobid (nitrofurantoin)
• 2nd line: Keflex, Cipro

Question 6

acute pyelonephritis definition

Answer 6

renal parenchyma and pelvis

causative: E Coli or Klebsiella

can lead to sepsis

Question 7

acute pyelonephritis : s/s

Answer 7

TOXIC: fever, shaking, chills, tachycardia

flank or back pain, FUD, CVA tenderness

Question 8

acute pyelonephritis: tx stable vs unstable

Answer 8

stable: Bactrim x 14 days
unstable: ampicillin or Gentamicin

repeat culture

Question 9

renal calculi: s/s

Answer 9

acute colic (sudden onset flank pain, migrates to groin as stone moves, restless)

N, V (ddx: appendicitis)

hx: diet, hydration, environment, habits

Question 10

renal calculi labs:

Answer 10

serum Ca, PO4, lytes, uric acid

UA: microscopic hematuria (r/t calculi trauma)

urine pH:

• lt 5 = uric acid or cystine calc
• gt 7.5 = struvite or staghorn

Question 11

renal calculi: urine pH
lt 5
gt 7.5

Answer 11

5 = uric acid or cystine calc

gt 7.5 = struvite or staghorn

Question 12

renal calculi: tx

Answer 12

fever + pain = admit to prevent staghorn

Question 13

staghorn calculi: what is it and what’s the most common agent?

Answer 13

infectious renal calculi, usually proteus, assoc with urease-producing bacteria (E Coli usually doesn’t do this.)

Question 14

renal calculi: labs

Answer 14

CBC
PTT
serum lytes
creatinine

Question 15

renal calculi: tx

Answer 15

• push fluids
• observe + 6 wks pain meds
• intervention: ureteroscopic stone extraction, lithotripsy

Question 16

benign prostatic hyperplasia s/s

Answer 16

s/s of chronic obstruction! (difficulty urinating/emptying bladder)

• Obstructive symptoms
• Decrease force or caliber of stream, dribbling
• Intermittent stream or hesitancy
• Irritative symptoms
• Urgency
• Irritative: Frequency, nocturia, urgency

Question 17

benign prostatic hyperplasia: PE

Answer 17

• Rectal exam: enlarged prostate, smooth. rubbery
• Abd exam: assess for distended bladder, mass, neoplasm, cystic dz, tenderness=infection
• Neuro exam: Rectal tone, genital/perineal sensation motor & sensory & DTRs (r/o r/t nerve impingement on enervation of bladder)

Question 18

benign prostatic hyperplasia: dx/labs

Answer 18

uroflometry (assess degree obstruction)

BUN, Cr, UA (hematuria), PSA: assess for cancer