UTI disorders

Question 1

who most commonly gets UTIs

Answer 1

infants <1yo (males)
females 1-65
>65yo (equal)

Question 2

what causes UTIs

Answer 2

E coli and positive nitrites will be seen on UA

Question 3

risk factors for UTI?

Answer 3

sexual activity, hygiene, hormones, BMI, low fluid intake, delayed voiding, GU anomalies, catherization

Question 4

symptoms/signs of lower tract UTIs

Answer 4

urgency, incontinence, frequency, suprapubic/flank/low back pain,
dysuria, microscopic hematuria

Question 5

signs/symptoms of upper tract UTIs

Answer 5

fever, chills, N/V, flank pain or CVA tenderness, lethargy, myalgia,
odorous urine, macroscopic hematuria

Question 6

diagnosis of UTI: what must you rule out

Answer 6

STI, IC, stones, epididymitis, prostatitis, vagnitis

Question 7

diagnosis of UTI: labs

Answer 7

UA dipstick and microscopic tests, Urine culture

Question 8

diagnosis of UTI: imaging

Answer 8

US, KUB, MRI, IVP/IVU, cystoscopy, renogram

Question 9

treatment considerations for UTI includes…

Answer 9

age, gender, complicated vs uncomplicated, risk factors, pregnancy (must treat pregnant women with/without symptoms)

Question 10

what is usual treatment for UTIs?

Answer 10

antibiotics varying in duration depending on complexity

Question 11

prevention of UTIs: for men

Answer 11

urinate frequently, saw palmetto, cranberry, hydration, lactobacillus

Question 12

prevention of UTIs in women

Answer 12

D-mannose, cranberry, hydration, lactobacillus

Question 13

what is pyelonephritis

Answer 13

infection/inflammation of kidney/renal pelvis

Question 14

causes of pyelonephritis?

Answer 14

infection secondary to ascending lower UTI

Question 15

signs/symptoms of pyelonephritis

Answer 15

: fever (>102 F), CVA tenderness/flank pain, chills, tachycardia, N/V,
leukocytosis, bacteriuria, hematuria, WBC casts

Question 16

DDx for pyelonephritis

Answer 16

: cystitis, appendicitis, cholecystitis, pancreatitis, diverticulitis, epididymitis, prostatitis,
ectopic pregnancy, PID

Question 17

treatment for pyelonephritis

Answer 17

oral or IV antibiotics

Question 18

complications of pyelonephritis

Answer 18

recurrence of pyelonephritis, perinephric abscess (infection around
kidney), sepsis, acute renal failure

Question 19

urinary stones: what are nephrolithiasis vs ureterolithiasis

Answer 19

nephrolithiasis: calculi in kidney while ureterolithiasis is calculi in ureter (usually originate in kidney)

Question 20

urinary stones: who gets them

Answer 20

male/caucasian 35 (30-55 females)

Question 21

cause of urinary stones

Answer 21

supersaturation=salts become concentrated if volume of urine is significantly reduces or if high amounts of crystal-forming salts are present

Question 22

urinary stones risk factors:

Answer 22

pregnancy, urinary tract abnormalities, Southern U.S., specific foods,
obesity, stress, bedridden, medical conditions (HTN x3, IBD, etc), meds (thyroid
hormones, diuretics, antacids, etc)

Question 23

urinary stones: signs and symptoms

Answer 23

sudden onset of acute/colicky/flank or back pain radiating to groin, CVA
tenderness, location of pain travels w/ stone, rebound tenderness, dysuria, urgency,
increased frequency, hematuria, systemic symptoms (diarrhea, N/V, diaphoresis)

Question 24

are bigger stones more painful?

Answer 24

signs of stone does not predict severity of pain

Question 25

labs for urinary stones?

Answer 25

UA → ~85% exhibit hematuria, CBC, Blood chem (serum electrolytes, creatinine, Ca, uric acid, phosphorus) • If recurrent → 24 hour collection

Question 26

imaging for urinary stones

Answer 26

plain film of abdomen will often show stone and watchful waiting is OK for asymptomatic stones, non-contrast spiral CT, IVP

Question 27

DDx for urinary stones in males

Answer 27

testicular torsion, pyelonephritis, acute prostatitis, appendicitis, pancreatitis

Question 28

DDx for urinary stones in females

Answer 28

ovarian cyst or torsion, ectopic pregnancy, pyelonephritis, appendicitis, pancreatitis

Question 29

treatment for urinary stones

Answer 29

NSAIDs with medical expulsive therapy (MET) and wait for stone to pass (<5 mm diameter should pass within 3 weeks). Do not use opioids for pain. • If obstruction and infection present → ER surgery.

Question 30

prevention of urinary stones

Answer 30

``` increase fluids (~2L/day), diet low in sodium/protein/purine/oxalate, increase EFAs ```

Question 31

for prevention of urinary stones: if hypercalcuria what do you not want to limit and what should you take

Answer 31

do not limit Ca intake, and take dandelion lead

Question 32

for prevention of urinary stones: if hyperoxaluria what do you want to limit and what should you take

Answer 32

limit oxalates and take magnesium and B6

Question 33

who most often gets incontinence?

Answer 33

women twice as likely to get them . MC in homebound/instinutionalized elderly (>50%)

Question 34

causes of incontinence

Answer 34

carious neuro disorders from CNS, spinal cord, or peripheral n causing uncoordinated detrusor contraction with external sphincter relaxation

Question 35

what are 4 types of incontinence? (which is MC?)

Answer 35

stress (MC), urge, mixed, and overflow

Question 36

what causes stress incontinence?

Answer 36

poor sphincter function and or urethral mobility

Question 37

what causes urge incontinence?

Answer 37

detrusor overactivity/instability or related to BPH

Question 38

what is mixed incontinence? and who gets it MC

Answer 38

mix of both stress and urge incontinence seen in women over 65

Question 39

what causes overflow incontinence?

Answer 39

detrusor paralysis or bladder outflow obstruction

Question 40

what are risk factors for incontinence?

Answer 40

: any damage to pelvic floor mm or nn, vaginal deliveries, chronic increase in intra-abdominal pressure, pelvic organ prolapse, smoking, pelvic/prostate surgery, estrogen deficiency, BPH, UTI, bladder outlet obstruction, foreign bodies, neuro disorders, DM, meds

Question 41

what are management options for incontinence

Answer 41

pelvic floor exercises, electrical stim/biofeedback, barriers, behavioral modification, absorbent products, surgery, meds • Anticholinergic, antispasmodic, antidepressant, Ca channel blocker, betaagonist, estrogen

Question 42

what is interstitial cystitis?

Answer 42

a painful bladder condition that results in recurring discomfort or pain in the bladder and the surrounding pelvic region

Question 43

who gets interstitial cystitis MC

Answer 43

women (90%), Caucasian, 40yo

Question 44

conditions that can lead to interstitial cystitis in women?

Answer 44

chronic pelvic pain, dyspareunia, vulvodynia, improves w/ pregnancy

Question 45

conditions that can lead to interstitial cystitis in men?

Answer 45

chronic NB prostatitis, BPH, prostadynia

Question 46

signs/symptoms of interstitial cystitis?

Answer 46

mild discomfort, pressure, tenderness or intense pain in the bladder and pelvic area which may vary with bladder filling or emptying. Also urgency, nocturia, frequency (>60x/day!!), (pre)menstrual exacerbation, dyspareunia

Question 47

causes of interstitial cystitis

Answer 47

Unclear. Possibly: infectious, autoimmune, mechanical injury, mast cell activation, alteration in bladder lining (GAGs)

Question 48

how to dx interstitial cystitis

Answer 48

r/o other causes and confirm via cystoscopy w/ hydrodistention and bladder biopsy

Question 49

treatment for interstitial cystitis

Answer 49

relieve symptoms since causes unknown. Bladder distension is diagnostic and early treatment. possibly anti-inflamm diet, quit smoking, exercise, bladder training, support GAGs, decrease NO, increase bioflavonoids. meds