GU

Question 1

Uncomplicated UTI

Answer 1

Female ages 18-65 years. Symptomatic.

Treatment:

Bactrim BID x 3 days
Or sulfa allergy or bacterial resistance >20%
Nitrofurantoin BId x 5 days or
Fosfomycin 3 g x one dose or augmentin BID x 5-7 days

Alternative
Cipro or levofloxacin

Symptomatic treatment
Phenazopyridine (pyridium)

Question 2

Complicated UTI

Answer 2

Males, poorly controlled diabetes, pregnancy, children or elderly, immunocompromise, we are current UTIs or reinfections.

Must treat for 7 days or longer

Treatment:
Cipro or Levo x7-10 days
Bactrim or cefixime BID x 7-10 days
If Sulfa allergy: Cephalexin (keflex)

UA, C&S before and after treatment

UTIs are not normal in men, r/o ureteral structure, infected kidney stones, anatomical abnormality, acute prostatitis, STI.

Question 3

Acute pyelonephritis

Answer 3

Acute onset of high fever, chills, nausea/vomiting, and one sided flank pain.

Temperature greater than 100, costovertebral angle tenderness, you a large amount of leukocytes, hematuria, WBC cast and mild protein urea

CBC will show shift to the left a.k.a. leukocytosis and neutrophilia with bands (indicates serious bacteria infection)

Treatment:

Ceftriaxone injection in office may be given

1st line: Cipro or levofloxacin x 7 days
2nd line: augmentin BID x 14 days or bactrim x 14 days

Question 4

Best measure of kidney function

Answer 4

eGFR > serum creatinine > Bun/creatinine

Question 5

Imaging test most sensitive/ specific for kidney stones

Answer 5

Noncontrast scan but renal US usually initially testing in Primary Care)