Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Unit 3 Clin Med II > L18: Cystitis + Pyelonephritis > Flashcards

L18: Cystitis + Pyelonephritis Flashcards

1
Q

Upper tract infections

A

Pyelonephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Lower tract infections (3)

A
  1. Cystitis
  2. Prostatitis
  3. Urethritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

in men aged 20-50, most UTIs are

A

Urethritis

Prostatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

In women aged 20-50, most UTIs are

A

cystitis

pyelonephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how do 95% of UTIs occur

A

ascending bacterial infection

remaining are hematogenous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Causes of most UTIs

A

E coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

UTI risk factors: reduced urine flow

A
  1. Urine outflow obstruction
  2. inadequate fluid intake
  3. neurogenic bladder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

UTI risk factors: promote colonization

A
  1. sex
  2. spermicide
  3. recent abx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

UTI risk factors: facilitate ascent

A
  1. Catheters
  2. Urinary incontinence
  3. Fecal incontinence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Acute complicated UTI

A

acute UTI + extension of infection beyond the bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what symptoms might suggest a UTI is complicated?

A 
Fever > 99.9
Chills, rigor, fatigue/malaise
Flank pain
CVA tenderness
Pelvic or perineal pain (men)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

who is more at risk for complicated UTI

A 
Pregnant women
Men
Comorbidities
Immunocompromised
Urologic abnormalities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Irritative voiding symptoms of acute cystitis

A 
***
Dysuria
Urinary frequency
Urinary urgency
***

+/- hematuria, suprapubic discomfort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Physical exam of acute simple cystitis

A

TYPICALLY NORMAL

Women +/- suprapubic tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Urine dipstick acute simple cystitis

A

+ Leukocyte esterase and nitrites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Urine microscopy acute simple cystitis

A

Pyuria: >10 leukoctyes/micrL

Bacteriuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When to do a urine culture for acute simple cystitis

A 
Atypical presentation
Diagnosis uncertain
Suspect complicated
Sx do not resolve/recur
Suspect abx resistance
Special populations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Diagnostic urine culture for UTI

A

> 1000 CFU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Diagnostic urine culture in women with typical UTI sx

A

> 100 CFU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Symptomatic relief for UTI

A

Phenazopyridine (pyridium)

2 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When to avoid TMP-SMX for acute simple cystitis

A

more than 20% of local e coli are resistant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When to avoid nitrofurantoin and fosfomycin

A

early pyelonephritis

due to low renal concentrations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

3 primary therapies for acute simple cystitis

A
  1. Nitrofurantoin 100 mg po BID 5 days
  2. TMP-SMX 160/800 mg po BID 3 days
  3. Fosfomycin 3 g PO single dose
  • men: 7 days
    • comorbidies, immunocompromised, urologic abnormalities: 1-2 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Alternative therapies for acute simple cystitis

A

Beta-lactams (augmentin, cefdinir)

Fluoroquinolones (ciprofloxacin, levaquin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

When can nitrofurantoin and TMP-SMX be used in pregnant women

A

“use/avoidance based on trimester”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Options for pregnant women

A

Augmentent
Cephalexin
Cefpodoxime
Fosfomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

DON’T give to pregnant women

A

Fluoroquinolones (ciprofloxacin, levaquin)
**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

who needs follow up cultures in acute simple cystitis or pyelonephritis

A

pregnant women

symptoms do not resolve on abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

pyelonephritis cause

A

ascent of bacteria up ureters from bladder to the kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Symptoms of pyelonephritis

A 
UTI symptoms 
Flank pain
Fever, chills, malaise
GI: N/V/A, abdominal pain
Fever
CVA tenderness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what differentiates pyelonephritis from UTI on UA?

A

same findings except pyelonephritis has white blood cells casts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Positive urine culture for pyelonephritis

A

> 10^5 CFU/ml (100,000)

33
Q

when is a CBC and BMP necessary for acute pyelonephritis

A

hospitalized patients

34
Q

CBC of pyelonephritis

A

leukocytosis with left shift

35
Q

BMP of pyelonephritis

A

assess renal function, hydration, lytes

36
Q

when to do imaging for acute pyelonephritis

A

Severely ill
symptoms 48-72 hours after abx
suspect obstruction
recurrence

37
Q

image of choice for pyelonephritis

A

CT A/P with and without contrast

other: US, MRI if contrast/radiation undesirable

38
Q

mild-moderate outpatient pyelonephritis tx

A

Fluoroquinolones:
Ciprofloxacin 500 mg PO BID x 5-7 days
Ciprofloxacin ER 1000 mg PO once daily x5-7 days
Levofloxacin 750 mg PO once daily x 5-7 days

39
Q

Acute pyelonephritis: Mild/Moderate, outpatient, fluoroquinolone-resistant E coli: tx

A

Initial IV/IM dose of Ceftriaxone 1gm + fluoroquinolone therapy

40
Q

Acute pyelonephritis: Mild/Moderate, outpatient: uropathogen known to be TMP-SMX susceptible

A

TMP-SMX 160/800 mg PO BID x 7-10 days

41
Q

what must an outpatient pyelonephritis case do

A

MUST FOLLOW UP IN 24-48 HOURS

***to check abx susceptibility studies and

42
Q

who to hospitalize for pyelonephritis

A

Critically ill/hemodynamic instability
Fever >103 F
Persistent pain/marked debility
Suspected or documented urinary tract obstruction
Metabolic derangements (renal dysfunction)
Unable to take liquids by mouth
Concerns with follow up compliance as outpatient

43
Q

Acute pyelonephritis: complicated/severe, inpatient tx

A 
IV abx:
Fluoroquinolone
Extended spectrum cephalosporin or penicillin
Carbapenem: Vabomere
Aminoglycoside: Zemdri
44
Q

Supportive care for Acute pyelonephritis: complicated/severe, inpatient

A

Analgesics/Antipyretics
Antiemetic
IV fluids

45
Q

all the names for bladder pain syndrome

A

bladder pain syndrome
interstitial nephritis
painful bladder syndrome

46
Q

who gets interstitial nephritis

A

Women >40 +/- fibromyalgia, IBS

47
Q

bolded thing about interstitial nephritis

A

Impacts psychosocial funtioning and quality of life

-sleep dysfunction, sexual dysfunction, depression

48
Q

Pathophysiology of interstitial nephritis

A

Altered urothelium: multifactorial: +/-

Disruption of glycosaminoglycan layer
Bladder urothelial injury
Secretion of proinflammatory substances, mast cell activation, fibrosis
Neural hypersensitivity
Neuropathic pain & voiding dysfunction

49
Q

Presentation of interstitial nephritis

A

HIGHLY VARIABLE:
Suprapubic/bladder pain, often worse with filling, relieved with voidinG
+/- urgency, frequency, nocturia
+/- pain: pelvic, perineum, urethra, lower abdomen/back
+/- dyspareunia, vaginal burning

50
Q

Presentation of interstitial nephritis in men

A

pelvic pain with concomitant sexual dysfunction

51
Q

interstitial nephritis history

A

Gradual onset of sx >6 weeks
Triggers: food/beverages, stress, activities, menstruation
# of void/day
Validated symptom scales: assess severity, monitor progress

Prior/recurrent UTIs, pelvic trauma/surgery/radiation

52
Q

Physical exam of interstitial nephritis should include

A

Abdominal exam
Women: bimanual
Men: rectal

53
Q

Physical exam of interstitial nephritis may show

A

variable tenderness +/- pelvic floor muscle spasm

54
Q

How is interstitial nephritis diagnosed?

A

diagnosis of exclusion:

UA, microscopy are unremarkable

55
Q

Get a urine cytology in interstitial nephritis patients with

A

smoking history (cancer)

56
Q

if an interstitial nephritis UA comes back with hematuria:

A

do urine cytology and cystoscopy

57
Q

Postvoid residual urine volume is used to rule out

A

bladder outlet obstruction

neuro disorders

58
Q

Cystoscopy if indicated

A

if in doubt of interstitial nephritis diagnosis

59
Q

done to detect glomerulations (submucosal hemorrhage)

A

bladder hydrodistention

60
Q

what would cystoscopy show for interstitial nephritis?

A

altered urothelium
glomerulations
hunner lesions

61
Q

Refer interstitial nephritis when

A

Hematuria
Complex symptoms (pain with incontinence)
Incomplete bladder emptying
Neurologic disorder that affects bladder function
Prior pelvic radiation or surgery
Has not responded to oral meds

62
Q

1st line interstitial nephritis tx

A

Self-care/behavioral modifications
Diet modifications: avoiding citrus, acidic/spicy foods, caffeine, EtOH, carbonation
Bladder retraining: increase voiding intervals
Low-impact exercise
Psychotherapy, support groups
Urinary analgesics for flares: Pyridium

63
Q

2nd line interstitial nephritis tx

A

Oral medication:
→ Tricyclic antidepressant (amitriptyline)
Pentosan polysulfate (elmiron) (takes months to respond)
Antihistamines: Hydroxyzine

Intravesical medication: lidocaine

Pelvic physical therapy

64
Q

3rd line interstitial nephritis tx

A

Cystoscopy + short duration low pressure bladder hydrodistention under anesthesia

Intravesical instillation of glycosaminoglycans

Intravesical dimethyl sulfoxide (DMSO)

65
Q

4th line interstitial nephritis tx

A

Intradetrusor botulinum toxin

Sacral neuromodulation

66
Q

5th line interstitial nephritis tx

A

Cyclosporine

67
Q

6th line interstitial nephritis tx

A

Urinary diversion surgery

68
Q

what line of tx for interstitial nephritis is pyridium?

A

1st line for flares

69
Q

what line of tx for interstitial nephritis is pelvic physical therapy?

A

2nd line

70
Q

Amitriptyline

A

Tricyclic antidepressant

71
Q

Pentosan

A

Tricyclic antidepressant

72
Q

Hydroxyzine

A

Antihistamine

73
Q

Lidocaine is given

A

intravesically (2nd line)

74
Q

what line of tx for interstitial nephritis are tricyclic antidepressants

A

2nd line

75
Q

what line of tx for interstitial nephritis is intravesical lidocaine

A

2nd line

76
Q

what line of tx for interstitial nephritis are antihistamines?

A

2nd line

77
Q

what line of tx for interstitial nephritis is Cystoscopy + short duration low pressure bladder hydrodistention under anesthesia

A

3rd line

78
Q

what line of tx for interstitial nephritis is intravesical instillation of glycosaminoglycans

A

3rd line

79
Q

what line of tx for interstitial nephritis is intravesical Dimethyl sulfoxide (DMSO)

A

3rd line

Unit 3 Clin Med II (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions