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PNP1 Exam 3 > GU- UTI > Flashcards

GU- UTI Flashcards

1
Q

Most frequent pathogen

A

E-coli

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2
Q

how many percent of children yearly?

A

2.4%

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3
Q

up to 6 months old which gender is more common?

A

males

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4
Q

incidence in males <6 months

A

2 per 100 births

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5
Q

what is the increased risk to uncirc males <6 months old ?

A

tenfold!

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6
Q

more common in famales after what age?

A

1 year

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7
Q

what percent of toilet trained females get UTI?

A

3%

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8
Q

what percent of children with UTI develop renal scarring?

A

15%

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9
Q

10-20% of kids with renal scarring will develop

A

hypertension

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10
Q

symptoms in infants

A

fever, irritability, poor feeding, vomiting, diarrhea

suspect when no other source of fever or illness present

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11
Q

symptoms in older children

A

dysuria, suprapubic/urethral pain, urinary frequency, incontinence

foul smelling urine and constipation- always get stool history

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12
Q

s/s if kidney is involved

A

fever, flank pain, nausea, vomiting

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13
Q

in infants with gross anatomic abnormalities such as obstruction

A

may detect a mass

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14
Q

physical findings

A

CVA tenderness

external irritation r/t incont, vaginal voiding, labial adhesions

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15
Q

diagnosis that are misdiagnosed as UTI

A

vaginitis

pinworms

both present frequently with dysuria

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16
Q

What to do if vaginal discharge is present

A

culture

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17
Q

What do we rule out in older males?

A

scrotal exam to r/o epididymis especially if sexually active

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18
Q

What are you looking for on ABD exam?

A

large stool burden, constipation is common

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19
Q

What patients need US?

A

First positive uti with fever and systemic illness

infants, febrile UTI’s, recurrent UTI’s, children not toilet trained,

Must document true infection via cath sample to decide what additional evaluation is needed (if doing xrays)

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20
Q

bagged specemin

A

helpful in r/o UTI

if positive: need cath sample

False positives in 90% especially if left on >20 min

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21
Q

clean-catch

A

better- small colony counts of multiple orgamisns suggests contamination

difficuly for children to perform even with parents help, urine hits perineum first, difficulty separating to wipe first

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22
Q

cath specimen

A

Most widely accepted technique

some offices not able to perform

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23
Q

urinalysis provides

A

lueks

nitrates (positive highly suggestive of infection)

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24
Q

culture assesses

A

colony count

what pathogens

suceptability to atb

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25
Q

suprapubic aspirate

A

most reliable

rarely used d/t anxiety of needle use to parent and child

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26
Q

Who provides guidelines for treatment of UTI’s?

A

UK National Institute for healthy and clinical experience (NICE) and

the AAP

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27
Q

when so we perform renal US?

A

if child is not responding to therapy- promptly

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28
Q

What do we consider if renal US is abnormal?

A

VCUG or DMSA

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29
Q

urinary tract obstructions are seen in what percent

A

5-10%

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30
Q

vesicoureteral reflux in what percent?

A

21-57 of patients with obstruction

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31
Q

when to refer?

A

positive testing for reflux/obstruction

febrile UTI

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32
Q

Lab tests

A

only done in significantly ill, febrile child

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33
Q

Elevated creatinine or BUN indicates

A

urinary tract problem

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34
Q

elevated WBC on CBC indicates

A

infection

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35
Q

Who should be hospitalized?

A

infants who appear systemically ill or are < 3months old

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36
Q

choice for parenteral atb

A

third gen cephalosporins

aminoglycosides

therapy lasts 7-14 days

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37
Q

Management of young children that are ill appearing at home

A

must have confidence in family

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38
Q

approved for complicated UTI/pyleonephritis but concern for safety in children - use situational and limited

A

Quinilones

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39
Q

when can parenteral treatment be stopped?

A

may change to PO after clinical picture is improving and sensitivity on culture returns

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40
Q

not good choice for systemically ill patient, doesnt reach high serum concentrations

A

Nitrofurantoin

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41
Q

Uncomplicated UTI described as

A

lower urinary tracy or bladder infections

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42
Q

legnth of atb for uncomplicated UTI

A

3-5 days oral atb

43
Q

oral treatment of choice prophylaxis

A

Nitrofurantion - high urinary concentration

44
Q

Nitrofuration prophylactic dose

A

1-2 mg/kg single daily dose

expensive and liquid is poorly tolerated

sprinkle capsules in yogurt, applesauce

45
Q

TMP-SMX prophylactic dosage

A

2mg/kg once per day or

5mg/kg twice per week <1 month

46
Q

age for keflex and amplcillin

A

newborns

47
Q

Treatment of choice for uncomplicated UTI, PO

A

TMP-SMX (bactrim)

AmmoxCluv (Augmentin)

second or third gen cephalosporin

48
Q

legnth of atb if febrile or 2-24 months

A

7-10 days

49
Q

Bactrim dose - first line treatment

A

8 to 12mg/kg trimethoprim

30-60mg/kg sulfamethoxazole

in two divided doses

50
Q

bactrim age

A

greater than 2 months old

51
Q

Cultures

A
52
Q

acute UNCOMPLICATED pylonephritis treatment options for young children

A

Oral cefixime

ceftibuten

ammox/clauv

53
Q

acute UNCOMPLICATED pylonephritis treatment options for adolescents option 1 and dose

A

ammox-clauv (augmentin) PO

875/125 mg BID

54
Q

acute UNCOMPLICATED pylonephritis treatment options for adolescents option 2 and dose

A

Cipro 500mg BID or ER 1000mg daily

55
Q

Admission criteria for “complicated” pyelonephritis- req IV atb

A

less than 1 months old

vomiting

not drinking

dehydration concerns

56
Q

tylenol

A

10-15 Q4-6

max 5 doses in 24 hours

57
Q

motrin

A

5-10 Q6 hrs

not to exceed 40mg/day

choose one

58
Q

phenazopyridine

ages and doses (2)

A

12mg/kg/day 6-12 years old

200mg TID >12 years old

59
Q

foods to aviod

A

caff, carb beverages, choc, citrus, aspartame, alcohol, spicy foods

60
Q

when to follow up

A

48-72 hours after starting treatment

61
Q

what if response to appropriate atb was ineffective?

A

repeat culture in 48-72 hours

if reocurrant treatment problems get culture 3-7 days after atb completed

62
Q

follow up for children <2 years old

A

febrile UTI, recurrent UTI, pyelonephritis

63
Q

Who needs a VCUG scan?

A

second febrily UTI

child with sibling with VUR

history of maternal UTI

neurogenic bladder

BBD

64
Q

neonates and VCUG

A

neonates with complex medical conditions may have scan after first episode of pylonephritis to assess renal scarring

65
Q

infection of bladder leading to lower uti - no renal injury or fever

A

cystitis

66
Q

bacteria in urine w/o other symptoms, benign, no renal injury

A

asymptomatic

67
Q

most severe uti, renal parychema or kidneys involved

may cause irreversible renal damage

A

pyelonephritis

68
Q

complicated UTI

A

with fever, toxicity or dehydration

child < 3-6 months old

VUR, abnormalities

69
Q

most important risk factor for developing pyelo

A

VUR

10-45% of children with symptomatic UTI

70
Q

most common time for UTI

A

infancy and toilet training

also at onset of sexual activity in females

71
Q

Most common cause of fever wihtout focus in less than 24 months

A

UTI

72
Q

how are UTIs identified

A

first occuance

reoccurent (within two weeks, same or different organism)

chronic- ongoing or unresolved

73
Q

diagnosis of UTI from clean catch sample

A

>100,000 colonies of single pathogen

74
Q

diagnosis of uti from cath or suprapubic sample

A

50,000 colonies

75
Q

diagnosis of uti in symptomatic child

A

>10,000 colonies of single pathogen

76
Q

UTI < 5 years chart

uncomplicated cystitis

A

out pt

PO ATB

repeat culture 48-72 hours

sterile=complete atb,

if not sterile repeat c/s and treat

repeat culture 3-4 days p atb dome

US and VCUG if indicated when sterile (up to 6 weeks)

77
Q

UTI <5 years chart

uncomplicated pyelo

(febrile, >3-6 months, well hydrated, no vomiting, no abd pain)

A

out pt

PO/IM ATB

repeat culture 48-72 hours

sterile=complete atb,

if not sterile repeat c/s and treat

repeat culture 3-4 days p atb dome

US and VCUG if indicated when sterile (up to 6 weeks)

78
Q

UTI < 5 years

complicated pyelo

(febrile, <3-6 months, toxic, dehydrated, and/flank pain, vomiting)

A

in pt

IV ATB

repeat culture 48-72 hours

sterile and stable= discharge home

if not sterile repeat c/s and treat

repeat culture 3-4 days p atb dome

US and VCUG if indicated when sterile before d/c, after atb completion or up to 6 weeks as long as child is on pruphylactic atb until test done

79
Q

Infants 2-24 months

A

for diagnosis should have suggestive ua (positive nitrates, lueks) followed by urine culture from sterile cath with >50,000 cfu/ml

80
Q

Bactrim dose adolescents

(uncomplicated cystitis)

A

160 mg of tmp componend Q12 (TMP cpmponent)

81
Q

augmentin dose <3 months

(uncomplicated cystitis)

A

30mg/kg/day two divided doses

82
Q

augmentin dose >3 months

(uncomplicated cystitis)

A

20-45mg/kg/day 2-3 divided doses

83
Q

augmentin dose adolescents

(uncomplicated cystitis)

A

250-500 Q8 or

875 Q12

84
Q

nitrofurantoin > 1 month

(uncomplicated cystitis)

A

> 1 month- 5-7mg/kg/day divided Q6

max 400mg in 24 hours

85
Q

DMSA

A

to detect renal scars or parenchymal inflammation changes in the kidney, done 6 months after infection when inflammatory changes in the kidney have resolved

86
Q

IVP

A

done if further definition of structure or function is needed - rare

87
Q

asymptomatic bacturea does not need treatment if

A

there are no leukocytes

88
Q

Nitrofurantoin adolescents

(uncomplicated cystitis)

A

adolescents 50-100mg/dose Q6 or

100mg BID (dual release)

89
Q

Ammoxicillin < 3 months

(uncomplicated cystitis)

A

20-30mg/kd/day two divided doses

90
Q

ammoxicillin > 3 months old

(uncomplicated cystitis)

A

25-50mg/kg/day two divided doses

91
Q

Ammoxicillin adolescents

(uncomplicated cystitis)

A

250-500mg Q8 hrs or

875mg BID

92
Q

Bactrim > 2 months old

A
93
Q

cephalexin

(uncomplicated cystitis)

A

50-100 mg/kg/day given Q6

max dose 4g/day

94
Q

cefixime >6 months old

(uncomplicated cystitis)

A

16mg/kg/day two divided doses

max 400mg/kg/day

95
Q

cefpodoxime proxetil 2 months - 12 years

(uncomplicated cystitis)

A

10mg/kd/day two divided doses

max 400mg/kg/day

96
Q

cefixime adolescents

(uncomplicated cystitis)

A

400mg Q12-24 hours

97
Q

cefpodoxime proxetil

adolescents

(uncomplicated cystitis)

A

200-800mg/day two divided doses

max 800mg/day

98
Q

ciprofloaxcin ER

(uncomplicated cystitis)

A

<18 years old

once daily X3 days

99
Q

acute pyelo treatment choices in young children

(uncomlicated)

A

cefixime

ceftibuten

augmentin

100
Q

acute pyelo in adolescent treatment choices

(uncomplicated)

A

augmentin 875/125 BID

Cipro 500mg BID

or cipro 1000mg ER daily

101
Q
A
102
Q

Cephalexin prophylactic dose

A

10mg/kg single daily dose

103
Q

Ammox prophylactic dose

A

10mg/kg single daily dose

can use in newborns/premies

cant use past 2 postnatal months

liquid good for 14 days

PNP1 Exam 3 (17 decks)

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