GU Packet 3

Question 1

What most commonly cause bacterial cystitis

Answer 1

E. Coli

Question 2

What is the best diagnosis of bacterial cystitis

Answer 2

UA, clean-catch, mid-stream

Question 3

What are the first line antibiotics for bacterial cystitis

Answer 3

1. nitrofurantoin (Macrobid)
2. trimethoprim-sulfamethoxazole (Bactrim)

Question 4

What can be used for up to two days to help with irritative voiding symptoms caused by bacterial cystitis

Answer 4

phenazopyridine (Pyridium); should be limited to two days so that it does not mask a persistent infection

Question 5

What is urethritis often associated with

Answer 5

Chlamydia trachomatis, Neisseria gonorrhoeae

Question 6

What are the two classifications of urethritis

Answer 6

gonococcal and non-gonococcal

Question 7

What is the typical male presentation of urethritis

Answer 7

profuse and purulent urethral discharge
urethral itching/tenderness
dysuria

Question 8

What is the typical female presentation of urethritis

Answer 8

tenderness, swelling, and inflammation of the urethral meatus; dyspareunia; mucopurulent cervicitis

Question 9

What will be found on urine culture for urethritis

Answer 9

low/no bacteria count

Question 10

What is the treatment for gonococcal urethritis

Answer 10

Gonorrhea: single IM 500 mg dose of ceftriaxone (Rocephin)
Chlamydia: add 2g single dose of azithromycin

Question 11

What is the treatment for non-gonococcal urethritis

Answer 11

doxycycline 100 mg orally twice daily x 7 days

Question 12

What are the complications of urethritis

Answer 12

Males: urethral stricture
Females: PID

Question 13

What is acute pyelonephritis

Answer 13

serious, potentially life threatening infectious inflammation process involving the renal pelvis and parenchyma when bacteria spreads from the urinary bladder to the kidneys

Question 14

What causes acute pyelonephritis

Answer 14

Gram negative bacteria, usually E.coli

Question 15

What will be found diagnostically in pyelonephritis

Answer 15

leukocytosis on CBC
pyruia, bacteriuria, hematuria on UA
heavy growth of causative organism on urine C&S

Question 16

How should a clinically stable pt with acute pyelonephritis be treated

Answer 16

fluoroquinolones (Cipro) or trimethoprim-sulfamethoxazole (Bactrim) x 10-14 days

Question 17

What should a hospitalized pt with acute pyelonephritis be treated with

Answer 17

ampicillin/gentamicin or third gen cephalosporin

IV fluoroquinolones or ampicillin and gentamycin for 24-48 hours after pt becomes afebrile, then oral antibiotics to finish 2 wk therapy

Question 18

What is vesicoureteral reflux

Answer 18

Backward flow of urine from the bladder into the ureters often due to congenital abnormalities

Question 19

What is hydronephrosis

Answer 19

renal parenchyma can be slowly destroyed by the accumulation of urine in the renal pelvis

Question 20

What is the best diagnostic tool for VUR

Answer 20

Renal US and contrast voiding cystourethrogram (VCUG)

Question 21

What are some non-surgical treatment options for VUR

Answer 21

prophylactic antibodies
periodic radiographic evaluation
Antibiotics: Amoxicillin until 8 weeks old then trimethoprim sulfamethoxazole (Bactrim) or nitrofurantoin (Macrobid)

Question 22

What are surgical treatment options for VUR

Answer 22

cystoscopy and endoscopic injection of dextranomer/hyaluronic acid or open surgical tx

Question 23

What is the complication risk of VUR

Answer 23

acute pyelonephritis leading to renal scarring and CKD