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Clinical Medicine II > Renal: UTI, Cystitis, Pylo > Flashcards

Renal: UTI, Cystitis, Pylo Flashcards

1
Q

Pylo or GN?

WBC casts

A

pylo

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2
Q

Do negative LE/nitrite r/o UTI in symptomatic patients?

A

no

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3
Q

what are 2 reasons for false negative for nitrite on urine dipstick?

A

non-nitrate redox bacteria

frequent urination

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4
Q

what 2 things can cause false positive LE on urine dipstick>

A

vaginal contamination

trichomonas

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5
Q

Pylonephritis is a UTI of which tract?

A

upper tract

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6
Q

Cystitis, prostatitis, urethritis are UTIs of..

A

lower tract

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7
Q

Men or women?

More common (50x)
cystitis, pylo
A

women

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8
Q

Men are prone to which UTIs?

A

urethritis

prostatitis

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9
Q

Ascending bacterial infx is responsible for ___% of UTI

A

95%

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10
Q

most common pathogen responsible for UTI?

A

E. Coli (75-95%)

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11
Q

The following are causes of what UTI risk factor?

  • urine outflow obstruction
  • inadequate fluid intake
  • neurogenic bladder
A

reduced flow

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12
Q

The following are causes of what UTI risk factor?

  • sexual activity
  • spermicide use
  • fecal incontinence
A

promote colonization

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13
Q

The following are causes of what UTI risk factor?

catheterization
urinary incontinenze
fecal incontinence

A

facilitate ascent

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14
Q

What type of UTI?

  • confined to bladder
  • non-pregnant
  • no s/s of upper tract or systemic infx
A

acute simple cystitis

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15
Q

What type of UTI?

-Acute UTI + extension beyond badder

  • fever, chills
  • signs of systemic illness
  • flank pain
  • CVA tenderness
  • Pelvic/perineal pain in men
A

acute complicated UTI

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16
Q

What are 5 special populations at risk for complicated UTI?

A

pregnant women

men

immunocompromised

urologic abnormalities

comorbid contitions

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17
Q

A patient presents with:

dysuria
frequency
urgency

+/- hematuria, suprapubic discomfort

What are you concerned for, what needs to be ruled out?

A

concerned for acute simple cystitis

r/o pylo
flank pain, hesitancy, pruritus, perineal pain, NV, fever

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18
Q

Who can have an atypical presentation in acute simple cystitis?

A

elderly

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19
Q

PE for acute simple cystitis usually reveals…

A

grossly normal

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20
Q

You suspect acute simple cystitis so you order a UA. What findings on dipstick and microscopy might confirm your Dx?

A

dipstick: (+) LE and Nitrites
micro: pyuria, bacteriuria

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21
Q

the following presentations warrant ordering what test?

  • atypical presentation, uncertain dx
  • complicated UTI (flank pain, etc)
  • unresolving sxs
  • resistance
  • special populations
A

urine culture

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22
Q

What number of CFU on urine culture is diagnostic for acute simple cystitis?

A

10^3 +

10^2 in women with typical sxs

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23
Q

What OTC analgesic can be recommended for acute simple cystitis tx? How long of course?

A

Pyridium (AZO) 200 mg TID PRN x 2 days

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24
Q

You’ve diagnosed acute simple cystitis in a non-pregnant individual. What are the two options for abx?

A

macrobid 100mg PO BID x 5 days

Bactrim 160/800mg PO BID x 3 days

fosfomycin 3gm mixed in water PO single dose

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25
Q

in early pylonephritis you have to avoid macrobin and fosfo because of …

A

low renal conc.

26
Q

If issues of allergy, interaction, resistance, cost, compliance, what other abx can you prescribe in acute simple cystitis of non-pregnant pt?

A

Beta lactam: augmentin

fluoroquinolones: cipro, levaquin

27
Q

What can you prescribe for acute simple cystitis in pregnant women?

A

augmentin, cefpodoxime, fosfomycin

28
Q

What should you avoid in pregnant pts with acute simple cystitis?

A

fluoroquinolones

29
Q

Men with acute simple cystitis can be prescribed the normal abx, but describe the duration of tx…

A

7 days (longer duration)

30
Q

Which patient populations should receive the primary therapies for 1-2 weeks in acute simple cystitis?

A

comorbidities, immunocompromise, urologic abnormality

31
Q

5 points of patient edu in acute simple cystitis

A 
increase fluids
void when need
hygeine
complete ABx
ER precaution pylo
32
Q

For whom are f/u urine cultures needed for acute simple cystitis if sxs resolve on abx?

A

pregnant women

33
Q

An infection of the kidney is called…

A

acute pylonephritis

34
Q

Ascent of bacteria up the ureters can lead to…

A

acute pylo

35
Q

A sick appearing patient presents with the following hx:

  • frequency
  • urgency
  • dysuria
  • flank pain
  • systemic sxs
  • GI sxs
A

acute pylonephritis

36
Q

A sick appearing patient presents with the following PE:

  • fever
  • tachy
  • hypotension
  • CVA tenderness
A

acute pylonephritis

37
Q

What diagnostics should be ordered for acute pyelonephritis?

A
  • UA
  • Urine C and S

+/- GC/Chlamydia, CBC/BMP, Imaging

38
Q

You receive the following results from UA and culture. What does this indicate?

(+) LE
(+) Nitrites
Pyuria (10+)
Bacteriuria
WBC casts
A

Acute Pyelonephritis

39
Q

CBC and BMP are only necessary if a patient with acute pyelonephritis is hospitalized. What might they show?

A

left shift leukocytosis

BMP for renal fxn, hydration, lytes

40
Q

The following presentations of acute pyelonephritis indicate what diagnostic may be necessary?

  • severe illness
  • sxs after 48-72 hours of abx
  • suspicion for obstruction
  • recurrent sxs w/in weeks of tx
A

Imaging:

CT A/P
Renal US
MRI

41
Q

how long after starting tx should simple cystitis sxs be relieved?

A

48 hrs

42
Q

Describe the tx of acute pyelonephritis for mild-moderate outpatient illness…

A

fluoroquinolones:

  • cipro 500mg PO BID x 5-7
  • Levofloxacin 750mg PO QD x 5-7 days
43
Q

If FLQ prevalence in E. Coli > 10%, what can be an alternative tx of acute pyelonephritis?

A

Ceftriaxone 1g IV/IM + FLQ

44
Q

If you know the pathogen is susceptible to TMP-SMZ, what therapy can be used?

A

Bactrim 160/800mg PO BID x 7-10 days

45
Q

When must follow up occur in mild/moderate outpatient acute pyelonephritis?

A

48-72 hours

46
Q

The following are indications for what intervention in the tx of acute pyelonephritis:

  • hemodynamic instability
  • persistant fever > 101
  • persistent pain/debility
  • suspected obstruction
  • metabolic dysfunction
  • NPO
  • compliance issues
A

hospitalization

47
Q

This condition is defined by…

bladder pain, pressure and discomfort for more than six weeks in absence of infx or other causes

-can be relieved with voiding, worse with filling

A

interstitial cystitis

48
Q

What is the most important part of assessment for IC?

A

careful hx

duration, triggers, # of voids

49
Q

The components to the physical exam for IC…

A

abd, pelvic (females), rectal (males)

50
Q

What labs can help r/o other causes to lead you to IC? (5)

A

UA and Culture

Urine cytology if TOBB

STI testing

post-void residual volume

cystoscopy

51
Q

What may be identified on cystoscopy to support dx of IC?

A

altered urothelium

  • glomerulations
  • hunner lesions
52
Q

What is 1st line tx for IC?

A

supportive and behavioral modification

53
Q

What is the 2nd line for IC?

A

amitryiptyline, elmiron, hydroxyzine PO

intravesical lido

PT

54
Q

How long may it take for elmiron to start acting?

A

3-6 mo

55
Q

Urinary urgency +/- incontinence with nocturia and frequency.

Caused by overactive detrusor

A

overactive bladder

56
Q

The following are risk factors for what?

> 65 yo
obesity
parity
prolapse
DM
neuro dz
A

OAB

57
Q

The physical exam for OAB should target…

A

pelvic floor muscles, vaginal atrophy, pelvic masses

58
Q

What labs may be helpful in OAB?

A

UA, culture

59
Q

1st line tx for OAB is…

A

kegel, lifestyle mod, bladder training

60
Q

2nd line meds for OAB…

A

antimuscarinics

beta 3 agonist

61
Q

What is a caution for tx of OAB with antimuscarinics?

A

anticholinergic sfx

Clinical Medicine II (31 decks)

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