Renal Clinical Medicine Part 4: Approach to Hematuria, Dysuria, and Nocturia (Selby)

Question 1

Acute cystitis or pyelonephritis in a non-pregnant outpatient woman without any anatomic abnormalities or urinary instrumentation is characterized as?

All other urinary infections are considered?

Answer 1

1) Uncomplicated UTI

2) Complicated UTI

Question 2

Recurrent UTI is characterized as?

Asymptomatic bacteriuria?

Catheter-associated UTI?

Answer 2

1) 2 or more infections in 6 months or 3 or more in a year
2) Bacteriuria present on urine culture but no clinical UTI symptoms
3) UTI associated with placement of urinary catheter or within 48 hours of removal

Question 3

What is the general pathogenesis of UTIs?

Answer 3

Bacteria that colonize the GI tract, perineum, or vagina inoculate the urethra and ascend into the bladder

Question 4

What is the most common UTI pathogen?

Answer 4

E. coli

Question 5

What is the classic presentation of cystitis?

Answer 5

Irritative voiding symptoms:

1) Dysuria (Burns when pee)
2) Urinary frequency
3) Urinary urgency

Question 6

Irritative voiding symptoms are present with pyelonephritis but patients also typically have what other symptoms?

Answer 6

1) Fever/chills/rigors
2) Flank pain
3) CVA tenderness on exam
4) Fatigue
5) Nausea/vomiting

Question 7

What is a common presentation of UTI in older adults?

Answer 7

Altered mental status

Question 8

What life threatening complication of UTI can be seen if left untreated?

What complications can be seen with pyelonephritis?

What complication is due to a gas-producing, necrotizing infection involving the renal parenchyma?

Answer 8

1) Sepsis/shock
2) AKI and Perinephric abscess
3) Emphysematous pyelonephritis

Question 9

Presence of what on a urine dipstick has a sensitivity of 75% and specificity of 82% for UTI?

Answer 9

Either leukocyte esterase or Nitrites

Question 10

In the diagnosis of UTIs, what are you looking for when performing urinalysis with microscopy?

Answer 10

1) Hematuria
2) Pyuria
3) WBC cast
4) Bacteria present

Question 11

When performing a urine culture report, what defines a true UTI?

Answer 11

Greater than 10^3 CFU (colony-forming units/ml)

Question 12

What imaging is typically reserved for patients with acute complicated UTIs and/or possible pyelonephritis?

Answer 12

CT Abdomen/pelvis with and without IV contrast

Question 13

In the treatment of UTI, what is given for an uncomplicated cystitis?

Answer 13

1) Nitrofurantoin
2) Trimethoprim-Sulfamethoxazole DS
3) Fosfomycin

Question 14

How is acute bacterial prostatitis and chronic bacterial prostatitis differentiated?

Answer 14

1) Chronic is greater than 3 months

2) Acute patients typically appear ill on presentation

Question 15

What is the general pathogenesis of prostatitis?

Answer 15

Bacteria in the urethra will migrate via the prostatic ducts into the prostate gland

Question 16

What is the most common pathogen of prostatitis?

Answer 16

E. coli

Question 17

What is performed in order to diagnosis acute prostatitis?

Answer 17

1) Digital rectal exam
2) Urinalysis and urine culture
3) Testing for gonorrhea and chlamydia

Question 18

What is the diagnostic standard for chronic prostatitis?

Answer 18

Prostatic massage (4-glass test or 2-glass test)

Question 19

What are treatment options for prostatitis?

What is the duration of Tx?

Answer 19

1) Fluoroquinolones (Ciprofloxacin) or Trimethoprim-Sulfamethoxazole
2) 4-6 weeks

Question 20

Benign Prostatic Hyperplasia (BPH) results from?

Answer 20

Increase in stromal and glandular epithelial cells within the prostate

Question 21

Lower Urinary Tract Symptoms (LUTS) results from both?

Answer 21

1) Bladder outlet obstruction (BOO) from BPH

2) Detrusor muscle overactivity secondary to BOO

Question 22

While BPH can be asymptomatic, when symptoms are present the patient presents with?

Answer 22

Lower urinary tract symptoms such as storage and voiding symptoms

Question 23

In the diagnosis of BPH what does a digital rectal exam typically reveal?

Answer 23

Enlarged but non-tender prostate

Question 24

What are most commonly used to treat BPH by blocking sympathetic adrenergic-receptor–mediated contraction of the prostatic smooth-muscle cells and bladder neck?

Answer 24

α1-blockers

Question 25

What is used to treat BPH by decreasing the conversion of testosterone to its active metabolite, dihydrotestosterone, which shrinks the prostate and decreases further prostatic growth?

Answer 25

5α-Reductase Inhibitors

Question 26

What is used to treat BPH predominately in patients with overactive bladder symptoms without elevated PVR by inhibiting muscarinic receptors in the detrusor muscle which decreases bladder contraction?

Answer 26

Anticholinergic agents

Question 27

What is used to treat BPH predominately in patients with erectile dysfunction and LUTs by increasing cAMP and cGMP leading to smooth muscle relaxation?

Answer 27

Phosphodiesterase-5 inhibitors

Question 28

What is a common surgical treatment of BPH?

Answer 28

Transurethral resection of prostate (TURP)

Question 29

Almost 80% of kidney stones are?

Which specific one is the most common?

Answer 29

1) Calcium

2) Calcium oxalate

Question 30

How does nephrolithiasis present?

Answer 30

1) Severe flank pain that radiates to groin

2) Hematuria

Question 31

What are potential complications of nephrolithiasis?

Answer 31

1) Hydronephrosis
2) AKI or CKD
3) Recurrent UTI

Question 32

What is the diagnostic standard of nephrolithiasis?

Answer 32

Non-contrast CT Abdomen and Pelvis

Question 33

What stones show hexagonal crystals on microscopy?

Which show coffin lid crystals?

Which show rhombic plates or rosette-shaped crystals?

Which show dumbbell-shaped crystals?

Which show envelope-shaped crystals?

Answer 33

1) Cystine
2) Struvite
3) Uric acid
4) Calcium oxalate monohydrate
5) Calcium oxalate dihydrate