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Q3 Clin Med II Test 3 (GU) > UTI/Cystitis > Flashcards

UTI/Cystitis Flashcards

1
Q

Lower tract UTI is?

A

Cystitis

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2
Q

Upper tract UTI is?

A

Pyelonephritis

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3
Q

In Men 20-50 yo, UTI’s U from what?

A

urethritis

prostatitis

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4
Q

UTI risk factors: reduced urine flow

A 
outflow obstruction
↓ fluid intake
neurogenic bladder (no control)
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5
Q

UTI risk factors: promote colonization

A

sex activity, spermicide use
estrogen depletion
recent abx

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6
Q

UTI risk factors: facilitate ascent

A

catheterization

incontinence

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7
Q

Uncomplicated UTIs are?

A

Otherwise healthy/whole
Not pregnant
Premenopause

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8
Q

Complicated UTIs are?

A 
Men UTIs (U) complicated
Hx of UTIs
Immuno ↓
Preadolescent/Postmenopausal
Metabolic disorder (i.e. DM)
Uro abnormalities (i.e. stones, stents, neuro)
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9
Q

Acute Cystitis presentation?

A

pain
frequency
urgency
(P) blood, suprapub pain

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10
Q

Probability of cystitis if +dysuria/frequency and no vaginal d/c?

A

90%

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11
Q

Acute Cystitis physical exam should include?

A 
General (look ill?)
Dehydration
CVA tenderness
Abd exam
(P) pelvic
Genital (men), (P) digital rectal
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12
Q

Acute Cystitis diagnostics?

A

UA = pyuria (WBCs >10^3)
Dip = +LE/+nitrites
Cx if complicated, pyeloneph, unresolving, atypical
Pregnancy test

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13
Q

False + for nitrites when?

A

if taking pyridium or if strip left exposed to air

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14
Q

Acute Cystitis tx: 1st line for uncomplicated?

A

Trimeth-sulfa* or
Macrobid or
Monurol

*use this if suspect pyeloneph

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15
Q

Acute Cystitis tx: 2nd line for uncomplicated?

A

(if allergies, cost, etc)

Cipro (fluoroquins)

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16
Q

Acute Cystitis and use of Pyridium?

A

only give for 2 days ->

if abx not working, pain is masked and pt may not return for change in tx

17
Q

Acute Cystitis tx: 1st line for complicated

Non-preggos?

Preggos?

A

NON-preggos:
Cipro (fluoroquins) oral or parenteral

PREGGOS:
Augmentin or
Macrobid (but not near term)
NO fluoroquins!

18
Q

Acute Pyelonephritis presentation?

A

UTI sxs
Flank pain
Fever, chills, malaise
N/V/D

19
Q

Acute Pyelonephritis labs? (4)

A

UA =
pyruia >10
+/- hemat
WBC CASTS

Cx = + >10^5 colony count

CBC = WBC L shift

BMP: assess renal fxn

20
Q

Acute Pyelonephritis imaging?

A

Only if complicated or severely ill:

CT w/ contrast
Renal US

21
Q

Acute Pyelonephritis tx: 1st line mild/mod?

A

Cipro (Fluoroquin)

if e. coli resistant add Rocephin (ceftriaxone)

22
Q

Acute Pyelonephritis outpt f/u?

A

48 hrs!!

23
Q

Acute Pyelonephritis reasons to hospitalize? (9)

A 
Comorbids
Hemo instability (sepsis/shock)
Male
Metabolic dysf (acidosis)
Pregnancy
Severe pain
Toxic appearance
Can't take PO fluids
Fever > 103
24
Q

Interstitial Cystitis/Bladder Pain Synd (PBS) is?

A

infectionless discomfort in bladder

a/w cystitis sxs > 6wks

25
Q

PBS epidemiology?

A

W > M
4th decade
a/w chronic pain conditions

26
Q

PBS impact on quality of life?

A

sex dysfxn

depression

27
Q

PBS pathophys?

A

multifactorial

K+ leak thru tissue depols nn -> damages tissue

Most important finding: ALTERED UROTHELIUM (U Glycosaminoglycan layer)

28
Q

Glycosaminoglycan damage results in?

A 
↓ urothelial growth
chronic inflam
mast cell activity
sensory nn upreg
void dysfxn
29
Q

PBS presentation?

A

Suprapubic/bladder pain: worse when full, better when empty

P) frequency/urgency
(P) dyspareunia (sex pain

30
Q

PBS hx?

A 
sxs > 6 wks
location/severity/character of pain
recurrent UTIs
pelvic trauma/surgery/radiation
void several times/day
31
Q

PBS physical exam should include?

A

Abd
Biman pubic (W)
Rectal (M)

32
Q

PBS diagnostics?

A

EXCLUSIONARY

UA/Cx: r/o infection (chalmydia)/hemato

Urine cytology if smoker

Post-void residual urine vol: r/o obstruction, neuro disorder

33
Q

PBS management?

A

Establish baseline sxs (pt log)

1st LINE:
Lifestyle Δ (diet, ↓ void frequency, low-impact exercise, psychotherapy)

2nd LINE:
TCAs (high s/e but fast relief)
Elmiron (low s/e but slow relief)

Q3 Clin Med II Test 3 (GU) (6 decks)

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