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Review > GU disorders > Flashcards

GU disorders Flashcards

1
Q

Most common organism for UTI

A

E.coli

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2
Q

Most common UTI organism for women with STI’s

A

S. saprophyticus

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3
Q

Why is asymptomatic UTI in pregnancy dangerous

A

can precipitate pre-term labor

increased risk for PN

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4
Q

Criteria for uncomplicated UTI

A

lack of systemic symptoms and low-risk patient

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5
Q

UTIs are more common in boys or girls during infancy

A

boys

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6
Q

UTI labs

A
  • dipstick: leukocytes positive
  • nitrites: negative or positive (e.coli will be positive)
  • sometimes hematuria
  • C&S: (midstream) positive if >100,000 CFU/mL with pyuria
  • if with catheter: >1000 is positive
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7
Q

pyuria

A

urine with WBC

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8
Q

Treatment duration of uncomplicated UTI

A

3 days

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9
Q

Treatment duration for complicated UTI

A

5 days

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10
Q

Uncomplicated UTI treatment

A

-Bactrim x 3 days
-Macrobid x 5 days, or fosfomycin x 1 dose, or augmentin x 5-7 days if bacterial resistance >20% or sulfa allergy
Alt: Cipro or levaquin x 3 days
-Pyridium x 2 days PRN dysuria
-increase fluid intake
-avoid high oxalate foods
-

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11
Q

Patient population considered as complicated UTi

A
  • males
  • poorly controlled DM
  • pregnant women
  • children or elderly
  • immunocompromised
  • recurrent UTI or reinfections
  • anatomical abnormalities
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12
Q

Complicated UTI treatment

A
  • Cipro or Levaquin x 7-10 days

- Bactrim or Suprax 7-10 days

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13
Q

Treatment for postcoital UTI

A
  • Bactrim one tablet after sex

- increase fluids before and after sex

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14
Q

Antimicrobial prophylaxis for UTI

A

Bactrim one tablet HS

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15
Q

Are UTI’s ever normal in males

A

no, refer to urologist

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16
Q

Recurrent UTI requirement in women

A
  • 3 or more UTI’s in 1 year

- or 2 infections within 6 months

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17
Q

Long-term use of Macrobid is associated with

A
  • lung problems
  • chronic hepatitis
  • neuropathy
  • contraindicated with renal insufficiency
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18
Q

Antibiotic choice for pregnant

A

Keflex

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19
Q

UTI antibiotics to avoid with pregnancy

A
  • Macrobid
  • Cipro
  • Levaquin
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20
Q

Antispasmodic medications

A

-Ditropan (oxybutynin)

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21
Q

Complicated UTI symptoms

A
  • fever, chills
  • marked fatigue
  • indicates spread beyond bladder
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22
Q

Common organisms for acute PN

A
  • e.coli
  • K. pneumoniae
  • P. mirabilis
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23
Q

WBC casts in urine suggests

A

pyelonephritis

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24
Q

PN treatment

A
  • refer ED
  • outpatient if mild
  • Fluoroquinolones preferred (if resistance <10%)
  • Rocephin 1 g IM stat single dose if unable to take FQ
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25
Q

When to refer PN

A
  • pregnant
  • children
  • elderly
  • anatomical abnormalities
  • DM
  • etc.
26
Q

Next step with dipstick is heme positive

A

send for microscopic UA
order C&S if infection suspected
if malignancy suspected send for urine cytology

27
Q

Biggest concern with hematuria

A

bladder cancer

28
Q

Benign causes of hematuria

A
  • exercise induced

- resolves in 72 hours

29
Q

RBC casts in urine suggest

A

glomerulonephritis if accompanied by edema, weight gain, dark cola-colored urine or HTN

30
Q

Nephrolithiasis is…

A

kidney stones

31
Q

Risk factors for nephrolithiasis

A
  • family history of stones
  • low fluid intake
  • gout
  • bariatric surgery
32
Q

Nephrolithiasis presentation

A
  • acute onset of severe flank pain
  • pain comes in waves
  • episodes may last from 20-60 minutes
  • N/V with severe pain
  • gross or microscopic hematuria
  • most will pass stone in 48 hours
33
Q

Nephrolithiasis treatment

A
  • Toradol injection if not contraindicated
  • strain urine for several days and bring stone to office for analysis
  • renal US to determine location and size
  • urology referral if unable to pass or large stone
  • Refer to ED if with high fever, extreme pain, or acute renal failure
  • increase fluid intake
  • avoid high-oxalate foods
34
Q

high oxalate foods

A
  • rhubarb
  • spinach
  • beets
  • chocolate
  • tea
  • meats
35
Q

Cr level with low muscle mass and normal renal function

A

decreased serum Cr

36
Q

Cr level with high muscle mass and normal renal function

A

high serum Cr

37
Q

What is creatinine

A

a byproduct of muscle metabolism excreted through kidneys

38
Q

CrCl is often done by

what lab is instead used

A

nephrologists
inconvenient for primary care
use GFR instead

39
Q

Abnormal GFR

A

<60

40
Q

Which cast is always pathological

A

RBC casts –> refer

41
Q

Which cast type is most common

A

hyaline

42
Q

Hyaline casts may present due to

A

low urine flow
dehydration
vigorous exercise

43
Q

Crystal casts

A

no clinical significance

44
Q

Right kidney placement

A

sits lower than left due to liver displacement

45
Q

Large number of squamous epithelial cells in urine may indicate

A

contamination

46
Q

Use of ___ can increase UTI in females

A

spermicides

up to 1 year

47
Q

Imaging with highest sensitivity/specificity for kidney stones

A

noncontrast CT

48
Q

Initial imaging test for kidney stones

A

US

49
Q

What is BUN

A

kidneys ability to excrete urea

50
Q

What can cause elevated BUN

A
  • acute renal failure
  • high-protein diet
  • hemolysis
  • CHF
  • drugs
51
Q

Few amounts of epithelial cells in urine

A

normal

52
Q

Normal WBC in urine

A

<10

53
Q

If multiple bacteria are present in a urine sample, it is considered

A

contaminated

54
Q

Urine dipstick detects only ___, not microalbumin

A

albumin

55
Q

Organisms that breakdown nitrates to nitrites

A
  • E.coli
  • Klebsiella
  • Proteus
  • Enterobacter
  • Citrobacter
  • Pseudomonas
56
Q

Urge incontinence

A
  • detrusor instability

- sudden urge to urinate

57
Q

Stress incontinence

A
  • sphincter incompetence

- unintentional loss of urine

58
Q

Treatment for urinary incontience

A
  • avoid all irritating liquids
  • weight loss
  • regular voiding (but not frequent)
  • Kegel exercises daily x 3 months
  • minimize fluids at dinner
  • take diuretics in afternoon
59
Q

Overactive bladder medication treatment

A
  • anticholinergics –> Mirabegron (Myrbetriq) fewer side effects
  • Estrogen for postmenopausal women
  • pelvic PT, pessaries
  • surgery
60
Q

Urolithiasis vs. nephrolithiasis

A
  • Uro: stones anywhere in urinary system

- Nephro: stones in kidneys

61
Q

A positive Prehn sign indicates

A

epididimytis

-relief of pain with elevation of affected testicle

62
Q

Catheter associated UTI organism

A

Proteus mirabilis

Review (24 decks)

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