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Genitourinary > UTI/Epididymitis/Prostatitis/Pylenophritis > Flashcards

UTI/Epididymitis/Prostatitis/Pylenophritis Flashcards

1
Q

What is one of the most common entities encountered in medical practice?

A

UTI

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2
Q

What kind of bacteria is responsible for most UTI?

A

Coliform
E. coli being the most common

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3
Q

What is the most common route of infection for a UTI?

A

Ascending infection from urethra

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4
Q

What is acute cystitis?

A

Infection of the bladder

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5
Q

What coliform bacteria cause acute cystitis?

A

E coli
Gram positive bacteria (enterocci)

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6
Q

What is the most common route of infection for acute cystitis?

A

Ascending from urethra

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7
Q

What is the concern for cystitis in men?

A

It is rare and suggests a pathologic process such as infected stones, prostatitis, chronic urinary retention requiring further investigation

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8
Q

Female with irritative voiding sx, suprapubic discomfort and afebrile with hematuria after intercourse may have what condition?

A

Acute cystitis

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9
Q

What UA lab results may be indicative of acute cystitis?

A

Pyuria, bacteriuria and various degrees of hematuria

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10
Q

What imaging should be done if you suspect acute cystitis?

A

Abdominal ultrasonography or cystoscopy
CT

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11
Q

Antibiotic treatment for acute cystitis

A

Women:
Ciprofloxacin 250mg q12hrs po x 3days
Nitrofurantoin (Macrobid) 100mg q12hrs PO x 5-7days
Bactrim 150mg PO q12hrs x 3days

Men:
Depends on etiology

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12
Q

Urinary analgesics for acute cystitis

A

Phenazopyridine (pyrdium) 100-200mg q6h prn PO for MAX 3 days

Sitz baths may provide symptomatic relief

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13
Q

Women can be considered for prophylactic antibiotic therapy if they have how many episodes of acute cystitis per year?

A

3 per year

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14
Q

What are the prophylactic medications for acute cystitis?

A

Bactrim, Macrobid, Cephalexin

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15
Q

When should prophylactic medications for acute cystitis be taken?

A

Single dose at bedtime or at time or intercourse

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16
Q

What is pyelonephritis?

A

Infectious inflammatory disease involving the kidney parenchyma and renal pelvis

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17
Q

What are the most common causative agents of pyelonephritis?

A

Gram-negative bacteria:
E coli, proteus, klebsiella, Enterobacter, pseudomonas

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18
Q

What are less common causative agents of pyelonephritis?

A

Gram-positive bacteria:
Enterococcus faecalis, Staphylococcus aureus

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19
Q

Pyelonephritis infection usually scends from which portion of the urinary tract? What is the exception?

A

Usually ascends from lower urinary tract

Exception of S aureus which is spread hematogenous route

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20
Q

Patient presents with fever, flank pain, irritative voiding sx, shaking chills, n/v/d, tachycardia and CVA tenderness is likely to have what condition?

A

Pyelonephritis

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21
Q

What labs should be done on a patient with pyelonephritis and what would be the results?

A

CBC: leukocytosis w/ left shift
UA: pyuria, bacteriuria, hematuria
Urine Culture: heavy growth of offending organism
Blood culture: positive

22
Q

What imaging should be done for pyelonephritis?

A

Renal ultrasound

23
Q

What inpatient treatment should be done for pyelonephritis?

A

Ampicillin 1g q6h and gentamicin 1mg/kg q8h IV x 14 days
IV antibiotics are continued 24hrs after fever resolves and oral antibiotics are given for 14 days

24
Q

What outpatient medications should be given for pyelonephritis?

A

Cipro 750mg q12h PO 7-14 days
Levofloxacin 750 mg daily PO 7-14 days

25
Q

What complications could arise from pyelonephritis?

A

Sepsis, shock
Abscess formation
Catheter drainage may be necessary if urinary retention

26
Q

What is acute prostatitis?

A

Inflammation and infection of the prostate gland

27
Q

What is the usual cause of acute prostatitis?

A

Gram negative rods
E coli and pseudomonas

28
Q

What is less common cause of acute prostatitis?

A

Gram-positive organisms
Enterococci

29
Q

Patient presents with perineal/sacral/suprapubic pain with fever, irritative void sx, urinary retention and warm and tender prostate on exam, what condition might they have?

A

Acute prostatitis

30
Q

Should prostatic massage be done on acute prostatitis?

A

No, its contraindicated

31
Q

What labs should be done for acute prostatitis and what would their results be?

A

CBC: leukocytosis with left shift

UA: pyuria, bacteriuria, hematuria
Urine culture: positive

32
Q

What inpatient treatment should be done for acute prostatitis?

A

Ampicillin 1g q6h and gentamicin 1mg/kg q8h IV x 14 days
IV antibiotics are continued 24hrs after fever resolves and oral antibiotics are given for 4-6weeks

33
Q

What outpatient treatment should be done for acute prostatitis?

A

Cipro 750mg q12h PO 4-6 weeks
Levofloxacin 750 mg daily PO 4-6 weeks

34
Q

If a patient with acute prostatitis has urinary retention, what should be done?

A

Percutaneous suprapubic tube is required
Urethral catheterization is CONTRAINDICATED

35
Q

Can an IDC manage chronic bacterial prostatitis alone?

A

NOPE

36
Q

Patient presents with irritative voiding sx, low back and perineal pain, suprapubic discomfort and hx of UTIs with an unremarkable physical exam, what condition might they have?

A

Chronic bacterial prostatitis

37
Q

What labs should be done for chronic bacterial prostatitis and what would their findings be?

A

UA: normal or increased leukocytes

38
Q

What antibiotics should be given for chronic bacterial prostatitis?

A

Bactrim
Cipro
Levaquin

39
Q

What symptomatic relief can be given to a patient with chronic bacterial prostatitis?

A

NSAIDS
Sitz baths

40
Q

What is epididymitis?

A

Inflammation and/or infection of the epididymis

41
Q

What are the 2 categories of epididymitis?

A

Sexually transmitted and non sexually transmitted

42
Q

What age and what causes sexually transmitted epididymitis?

A

Typically in men under 35
Results from chlamydia trachomatis or Neisseria gonorrhoeae

43
Q

What age and what causes non sexually transmitted epididymitis?

A

Older man
Associated with UTIs and prostatitis
Caused by gram-neg rods )e-coli, klebsiella)

44
Q

What is the route of infection of epididymitis?

A

Through urethra to the ejaculatory duct

45
Q

Patient presents with pain following physical strain in the scrotum and radiates along spermatic cord and to the flank with a fever. Upon PE, you note scrotal swelling, what might this patient have?

A

Epididymitis

46
Q

What is the difference in presentation of early and late epididymitis?

A

Early: epididymis may be distinguishable from testis

Late: 2 may appear as one enlarged tender mass

47
Q

What is the prehn sign?

A

Elevation of scrotum above the pubic symphysis improves pain

48
Q

What laboratory studies and findings would be found with epididymitis?

A

CBC: Leukocytosis and left shift
GC
UA

49
Q

What imaging should be done for epididymitis?

A

Scrotal ultrasound

50
Q

How is sexually transmitted epididymitis treated?

A

Ceftriaxone (Rocephin)
PLUS
Doxycycline

Genitourinary (17 decks)

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