Session 10: Group Work Flashcards
Use the urinalysis strip sample to record the results for:
Blood
Nitrite
Protein
Leukocyte esterase
Glucose
Ketone
pH
Blood (-)
Nitrite +
Protein (-)
Leukocyte esterase +++
Glucose (-)
Ketone (-)
pH 7.0
What conditions should you consider in this case?
UTI
Bacterial cystitis
Urethritis
STI
Pregnancy
Diabetes
What further questions should you ask the GP?
Medication
Nausea/vomiting
Loin pain (pyelonephritis)
Any recent infections
Fever?
The GP suspects uncomplicated bacterial cystitis, are any other investigations recommended?
U & Es
FBC
BP
Swab test (vaginal)
Prenancy test
Mid stream (not needed in uncomplicated)
How sensitive and specific is dipstick testing of urine?
Very sensitive and also pretty specific so it is a good test
What specific course of treatment is recommended for this patient?
Trimethoprime 3 day course
Or nitrofurantoin
What is/are the most likely pathogen(s) causing this woman’s symptoms?
E. coli
Klebsiella
In this case the urine dip sitck was positive for nitrites.
If the woman presented as above but the urinary findings were negative for nitrites, positive for leucocyte esterase (LE).
Now what is/are the most likely pathogen(s) cuasing this woman’s symptoms?
Not E. coli as E. coli is a coliform and breaks down nitrates into nitrites.
Staphylococcus saprophyticus or enterococci
Use urinalysis strip sample 2 and record the results in the table.
Blood ++
Nitrite +
Protein (-)
Leukocyte esterase +++
Glucose (-)
Ketone (-)
pH 7.0
The patient had renal angle tenderness. What do you think this indicates?
Pyelonephritis
Renal stone
Renal abscess
Give a differential diagnosis
Pyelonephritis
Renal stone
Renal abscess
Cystitis
STI
AKI
CKD
Glomerulonephritis
Nephrotic/nephritic syndrome
Prostitis
BPH
Urinary calculi
Admission to hospital is strongly advised but the patient refuses. The patient is prescribed a three-day course of trimethoprim and an MSU sample is sent off for analysis.
What do you think of the management of this patient?
Wrong as it is complicated it should be a 5 day course of nitrofurantoin.
What is you diagnosis at this stage?
Pyelonephritis
The patient is admitted to hospital. Co-amoxiclav and ciprofloxacin are the recommended treatments for acute pyelonephritis. In patients who are unwell and admitted to hospital intravenous co-amoxiclav is used first-line and meropenem as second-line.
What information does the admitted doctor need to find out before prescribing antiobiotics?
Any allergy to penicillin or other medication
What do the results show?
Kidney failure?
AKI
The bacteria has formed an absecess so the meropenem can’t kill it all off quickly.
Nitrofurantoin
He has a CA allergy
Cefalexin can cause C. diff
Ciprofloxacin can cause C. diff
Use the urinalysis strip on the sample and record results.
Blood (-)
Nitrite (-)
Protein +++
Leukocyte esterase (-)
Glucose (-)
Ketone (-)
pH 7.0
Use the urinalysis.
Blood (-)
Nitrite (-)
Protein (-)
Leukocyte esterase (-)
Glucose (+)
Ketone (80 large)
pH 5.0
