GU

Question 1

What 3 organisms most commonly cause UTI’s?

Answer 1

E coli, proteus, klebsiella

Question 2

What 3 organisms often cause UTI’s in nursing homes?

Answer 2

enterococci, staph, and fungus

Question 3

If an elderly person has asymptomatic bacteruria, how do we treat?

Answer 3

YOU DON’T!

Question 4

What is 1st line treatment for and uncomplicated UTI?

Answer 4

TMP-SMZ, cephalexin, ampicillin

Question 5

What if a pt has a UTI and a sulfa allergy, what do you prescribe?

Answer 5

Amoxicillin-Clavulanate

Question 6

If a pt has a UTI + a sulfa allergy and there is known resistance in the area?

Answer 6

Floroquinolone

Question 7

What are 3 main variables of SIRS?

Answer 7

Temp >100.9; HR >90; Tachypnea >20/min

Question 8

What are the Inflammatory variables of SIRS?

Answer 8

WBC >12 (leukocytosis) or WBC <4 (leukopenia)

> 10% immature forms on normal WBC count

Question 9

What is Sepsis?

Answer 9

2 or more SIRS + infection (UTI, cellulitis, pneumonia, influ, shingles, meningitis, fungal)

Question 10

What is severe sepsis?

Answer 10

2 or more SIRS + Infection + End Organ Damage

Question 11

What are some examples of end organ damage?

Answer 11

Hypotension <65 or <90 at any on check

Renal failure (Cr >2)

Shock Liver (Bili >2)

Elevated Lactic Acid (>2)

Respiratory Failure

Question 12

How do we treat Sepsis?

Answer 12

give O2, goal directed (fluids), tx infection

Question 13

Urine storage is under what type of control?

Answer 13

Sympathetic

Question 14

Voiding is under what type of control?

Answer 14

Parasympathetic

Question 15

Urge incontinence is caused by what?

Answer 15

Detrusor over activity

Question 16

Stress incontinence is caused by what?

Answer 16

Weak pelvic floor & sphincter failure

Question 17

What are some red flag sxs with incontinence?

Answer 17

abrupt onset, pelvic pain, and hematuria

Question 18

What are some lifestyle Tx for incontinence?

Answer 18

weight loss, correct meds, avoid caffeine/alcohol, stop smoking!

Kegle’s + Bladder training
Prompted/scheduled voiding

Question 19

What pharm options are available for incontinence?

Answer 19

Oxybutynin

Question 20

What are some S/E’s of oxybutynin?

Answer 20

tooth decay & anticholinergic effects!!

Question 21

Increased frequency of urination, nocturia, hesitancy, and weak stream are all sxs of what?

Answer 21

BPH

Question 22

What kind of work-up should you do for BPH?

Answer 22

PE of urinary tract, abdomen, DRE, UA & culture

Question 23

What are some age related renal changes?

Answer 23

• Decreased bladder contractility
• Increased inhibited bladder contractions
• Urine output shifted to later in the day
• Sphincter striated muscle attenuated
• Decreased bladder capacity
• (Modest) increased PVR
• Decreased urethral closure pressure and vaginal mucosal atrophy
• BPH and prostate hypertrophy

Question 24

There are 6 major causes of sexual dysfunction, what are they?

Answer 24

• Vascular
• Neuropathic
• Drug Induced
• Psychogenic
• Hypogonadism
• Thyroid or Renal

Question 25

What should you always ask if a pt has when they are concerned about sexual dysfunction?

Answer 25

Are you able to masturbate & morning or sleep associated erections - If able, most likely psychogenic causes

Question 26

If a pt has femoral bruits & poor pedal pulses and they lack morning erections, diagnosis?

Answer 26

Vascular

Question 27

If a pt has a hx of pelvic surgery, irradiation, spinal injury or parkinson’s dz and they lack morning erections, diagnosis?

Answer 27

Neuropathic

Question 28

What PE finding would you see with neuropathic sexual dysfunction?

Answer 28

Loss of bulbocavernosus reflex

Question 29

What medications can induce sexual dysfunction?

Answer 29

SSRI’s MAOI’s antipsychotics antihypertensives (spironolactone, clonidine) statins (lovastatin, simvastatin, atorvastatin) alcohol opioids acid-suppression drugs (ranitidine)