Urinary Tract Infection / Infectious disease Flashcards
Older adults in the community may have similar symptoms to younger persons, such as:
Dysuria
Frequency
Urgency
Hematuria
Post-menopausal women may have symptoms such as:
Hematuria
Low back pain
Constipation
Older adults can have atypical symptoms such as:
Confusion and changes in cognition
True or False:
Older adults should not be treated based on symptoms alone.
True: Common symptoms can mimic other disease processes.
Name four medications that can be used for UTI?
Cipro
Bactrim
Macrobid
Keflex
An 86-year-old man with no ADL deficits who has stopped driving because of macular degeneration is evaluated for a urinary tract infection associated with urinary retention. The consulting urologist places a Foley catheter and sends a prostate-specific antigen (PSA) level that comes back at 12 ng/mL. Three months later, after the Foley has been removed, he has had a good response to tamsulosin; his PSA is still 10 ng/mL. What is the appropriate next step in managing this man’s prostate problem?
a. Transrectal ultrasound and biopsy
b. Empiric finasteride
c. Bone scan
d. Repeat PSA in 6 months
e. Observation
d. Repeat PSA in 6 months
In which of the following patients is chemical or surgical castration likely to prolong survival?
a. A 78-year-old man with advanced dementia and prostate cancer metastatic to the
bone.
b. A 78-year-old man who had a radical prostatectomy 10 years earlier and now has a PSA level of 5.7 ng/mL. A year ago, it was 0.1 ng/mL. A bone scan is negative, and an abdomen-pelvis computed tomography (CT) is negative.
c. A 78-year-old man who had a radical prostatectomy and external beam radiation therapy 10 years earlier now has a PSA level of 24.5 ng/mL. A CT scan of the pelvis shows an enlarged pelvic lymph node and a bone scan is positive in the pelvis.
d. A 78-year-old man with prostate cancer limited to the prostate with a Gleason score of 6.
c. A 78-year-old man who had a radical prostatectomy and external beam radiation therapy 10 years earlier now has a PSA level of 24.5 ng/mL. A CT scan of the pelvis shows an enlarged pelvic lymph node and a bone scan is positive in the pelvis.
A 78-year-old man has an emergency partial colectomy for lower gastrointestinal bleeding. A localized colonic adenocarcinoma is completely resected. The surgeon did not dissect lymph nodes for metastatic sampling. The patient wants to know if he should
have chemotherapy. Should he?
a. Yes because without knowing his complete staging it would be safer.
b. No because he can be followed
with serial carcinoembryonic antigens and CT scans.
c. Yes because the severe bleeding indicates advanced disease.
d. No because he is too old and will not likely have any problems during his lifetime.
e. No because the chemotherapy is too toxic
b. No because he can be followed
with serial carcinoembryonic antigens and CT scans.
An 85-year-old man with chronic obstructive pulmonary disease presents to your office with his daughter with the complaint of new onset chest pain, shortness of breath, and cough. He is clearly tachypneic and has tactile fremitus and egophany and crackles
heard at the right lung base. His daughter just wants you to give him an antibiotic pill so that she can take him home. You are concerned that he might need to be hospitalized and require IV antibiotics. What statement is true?
a. All older adults with pneumonia must be treated for methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas infection.
b. Treatment decisions for pneumonia are based on its severity, the presence of comorbid illnesses, and a prior history of MRSA or Pseudomonas respiratory infection.
c. All older adults with pneumonia must be treated in the hospital.
d. Pulse oximetry, respiratory rate, and chest radiography would not be helpful for thediagnosis and management of pneumonia in older adults.
b. Treatment decisions for pneumonia are based on its severity, the presence of comorbid illnesses, and a prior history of MRSA or Pseudomonas respiratory infection.
An 80-year-old woman that you follow in a nursing home has an acute decline in her mental status. She has a fever >100° F, but no other focal complaints or findings on
physical examination except for a chronic indwelling urinary catheter. What statement is
true?
a. Fever in an older adult with an indwelling urinary catheter is an appropriate indication to start empiric antibiotic therapy.
b. Older adults with an indwelling urinary catheter are less likely to have bloodstream infection than older adults without a catheter.
c. It is not necessary to obtain a urine culture; empiric antibiotic treatment is sufficient.
d. She only needs antibiotic treatment for 3 day
a. Fever in an older adult with an indwelling urinary catheter is an appropriate indication to start empiric antibiotic therapy.
An 82-year-old woman receives oral amoxicillin-clavulate for a skin abscess on her leg. She develops new onset of frequent watery stool that persists for several days after the antibiotic is stopped. You obtain a stool for Clostridium difficile antigen, toxin, and polymerase chain reaction (PCR). The antigen and PCR are both positive. She has never
had C. difficile infection before. What one statement is the best answer regarding her management?
a. Metronidazole is the treatment of choice for C. difficile infection.
b. Older adults with their first episode of C. difficile require a longer duration of treatment with vancomycin.
c. Fecal transplantation is the treatment of choice for C. difficile infection.
d. Either vancomycin or fidaxomicin is recommended for the first episode of C. difficile infection.
d. Either vancomycin or fidaxomicin is recommended for the first episode of C. difficile infection.
