UTI and Pyelo

Question 1

False positive nitrate test can occur w/:

Answer 1

• substances that turn the urine red, such as beets or bladder anesthetic, phenazopyridine (pyridium)

Question 2

Infx of the upper urinary tract can also progress into 3 patterns of renal infx:

Answer 2

1- renal abscess
2- Acute bacterial nephritis
3- emphysematous pyelonephritis

Question 3

Missed pyelonephritis dx can lead to:

Answer 3

Urosepsis

Question 4

Uncomplicated UTI (Cystitis) tx:

Answer 4

Nitrofurantoin (macrobid) or TMP-SMX (Bactrim)- 5 day PO course outpt.

Question 5

Complicated UTI and Pyelonephritis tx:

Answer 5

• Rq. Culture and stain
• Cystitis- 7 day PO course
• Pyelonephritis or Recurrent Cystitis- 14 day PO course
• Levofloxacin (Levaquin) or Ciprofloxacin (Cipro)
• If severe infx, Rq IV Ceftriaxone (Rocephin) and admit to hospital
• If bacteria susceptible, TMP-BMX (Bactrim) or Amoxicillin-Clavulanic Acid (Augmentin)

Question 6

Urethritis tx:

Answer 6

• Culture for gonorrhea and chlamydia
• Ceftriaxone (Rocephin) IM- gonorrhea coverage AND one of:
  1- azithromycin (Zithromax)- for chlamydial coverage
  2- Doxycycline (Vibramycin)- for chlamydial coverage

Question 7

Who do we admit for a UTI? - 5

Answer 7

ADMIT
Accompanying kidney stone
Drinking (cant take)
Meds (cant take)
Infx- Urosepsis SXS
Tx outpt failed

Question 8

Indications to order a urine culture: - 5

Answer 8

CSAPP
Complicated UTI
Sepsis
Adult males
Pts w/ reinfx
Pregnant pts.

Question 9

dangerous UTI complications: 4

Answer 9

1- acute papillary necrosis
2- ephysematous pyelonephritis
3- septic shock
4- perinephric abscesses

Question 10

Acute pyelonephritis in pregnancy can precipitate: (3)

Answer 10

• preterm labor
• bacteremia
• septic shock

Question 11

MC cause of hematuria:

- 2nd MC cause

Answer 11

1- UTI

2- kidney stone

Question 12

Uroepithelial cancer RFs: (5)

Answer 12

1- fam hx of bladder ca
2- smoker
3- male
4- >50 y.o.
5- factory toxins (benzene, AA, dye exposure)

Question 13

Painless hematuria after 50 y.o. associated with increased risk for:

Answer 13

renal, bladder, prostate ca

Question 14

MC cause of hematuria ass. w/ urgency and dysuria:

Answer 14

cystitis

Question 15

Evaluating hydropnephrosis dx:

Answer 15

Renal U/S

Question 16

Chlamydial infx considered in: (4)

Answer 16

• vaginal discharge or irritation
• hx partner w/ urethritis
• exam findings of cervicitis
• low grade pyuria w/ no bacteria seen on UA