Genitourinary

Question 1

What percentage of urinary tract infections (UTIs) are caused by E. Coli?

Answer 1

Up to 90% of UTIs are caused by E. Coli.

Other organisms include Klebsiella, Proteus, and Enterococcus.

Question 2

List the risk factors for urinary tract infections (UTIs).

Answer 2

• Poor hygiene
• Diabetes
• Immunocompromised
• Frequent sexual intercourse
• Pregnancy
• Spermicide use

Question 3

What are the symptoms of an uncomplicated urinary tract infection (UTI)?

Answer 3

• Polyuria
• Dysuria
• Urgency
• Suprapubic pain
• Occasionally gross hematuria
• Absence of vaginal pruritus and/or discharge

These symptoms occur in the absence of vaginal pruritus and/or discharge.

Question 4

What characteristics indicate a complicated urinary tract infection?

Answer 4

• Systemic symptoms such as fever, chills, or costovertebral (CVA) tenderness
• Male gender
• Poorly controlled diabetes
• Pregnancy
• Children
• Elderly
• Immunocompromised
• Recurrent UTIs
• Presence of kidney stones or an obstruction
• Indwelling catheter in place

Question 5

What are the positive markers for diagnosing a urinary tract infection (UTI)?

Answer 5

• Nitrites
• White blood cells (WBCs)
• Leukocyte esterase

Question 6

Fill in the blank:

For uncomplicated UTIs, Cephalexin is administered at a dose of 500mg orally, 2 times a day, for ______ days.

Answer 6

5 to 7

Question 7

Which antibiotic should be avoided in the first trimester of pregnancy unless no other alternatives are available?

Answer 7

Nitrofurantoin

Question 8

What is the recommended treatment duration for TMP/SMX in uncomplicated UTIs?

Answer 8

3 to 5 days

Question 9

Which antibiotic is given as a single dose for uncomplicated UTIs?

Answer 9

Fosfomycin: 3g orally, once

Question 10

True or False:

Fluoroquinolones should be avoided in uncomplicated UTIs, unless no other alternatives are available.

Answer 10

True

Question 11

True or False:

Asymptomatic bacteriuria should be treated in all patients.

Answer 11

False

Asymptomatic bacteriuria should only be treated if the patient is pregnant.

Question 12

What are stones most commonly made up of in nephrolithiasis?

Answer 12

Calcium

Question 13

What is the preferred imaging modality for diagnosing nephrolithiasis?

Answer 13

Low-radiation-dose CT of the abdomen and pelvis without contrast

Ultrasound of the kidneys and bladder with abdominopelvic radiography is an alternative.

Question 14

What is the first-line treatment for pain relief in nephrolithiasis?

Answer 14

Ketorolac (inpatient), followed by NSAIDs (outpatient)

Question 15

What is the recommended treatment for patients with kidney stones >5 and ≤10 mm?

Answer 15

Tamsulosin: 0.4 mg once daily until the stone passes, or for up to 4 weeks

Question 16

Patients with stones ≤5 mm typically require what treatment?

Answer 16

Most stones this size will pass spontaneously.

Question 17

How should patients with stones >10 mm be managed?

Answer 17

Refer to urology for management.

Question 18

List the indications for hospitalization and urgent urology consult in nephrolithiasis.

Answer 18

• Unable to tolerate fluids
• Uncontrollable pain
• Fever
• Concurrent urinary tract infection
• Acute kidney injury
• Nausea or vomiting

Question 19

What are the two types of hematuria?

Answer 19

• Gross hematuria
• Microscopic hematuria

Question 20

What imaging is recommended for symptomatic patients with acute unilateral flank pain and hematuria?

Answer 20

Low radiation dose CT of the abdomen and pelvis

Question 21

What should be done for dysuria with hematuria?

Answer 21

Send urine out for culture to check for a bacterial infection.

Question 22

What are the indicators that hematuria may be related to kidney disease?

Answer 22

• New or worsening hypertension
• New or worsening edema
• Extremely dark, ‘coca cola’ urine
• Proteinuria
• Presence of dysmorphic RBCs

Question 23

What is the recommended follow-up for asymptomatic patients with transient hematuria?

Answer 23

Repeat urinalysis 4 to 6 weeks later to confirm hematuria was transient.

Question 24

What is the next step for patients with intermediate risk for urothelial cancer and hematuria?

Answer 24

Order a kidney and bladder ultrasound and refer to urology for cystoscopy.

Question 25

What **imaging** is required for high-risk patients with hematuria?

Answer 25

CT urography

Question 26

What is the **most common cause** of urinary tract infections (UTIs)?

Answer 26

E. Coli ## Footnote E. Coli belongs to the family of enterobacteriaceae.

Question 27

Which **symptoms** suggest a complicated urinary tract infection (UTI)?

Answer 27

* Fever * Chills * Costovertebral angle (CVA) tenderness ## Footnote Complicated UTIs can also occur in males, those with poorly controlled diabetes, pregnancy, children, elderly, immunocompromised, recurrent UTIs, presence of kidney stones or an obstruction, or if there is an indwelling catheter in place.

Question 28

# Fill in the blank: For an uncomplicated UTI, \_\_\_\_\_\_ is a treatment option that should be avoided if pyelonephritis is suspected or CrCl <30mL/min.

Answer 28

Nitrofurantoin

Question 29

Why is nitrofurantoin contraindicated in >36 weeks gestation?

Answer 29

Increased risk of neonatal hemolytic anemia.

Question 30

What is the **gold standard** for diagnosing and staging bladder cancer?

Answer 30

Cystoscopy

Question 31

What are non-pharmacological interventions for urinary incontinence?

Answer 31

* Avoid alcohol and caffeine * Pelvic floor exercises (e.g., Kegels) * Continence pessaries * Bladder training

Question 32

What is the first line pharmacological treatment for urinary incontinence?

Answer 32

Topical vaginal estrogen

Question 33

What is the definition of **acute kidney injury** (AKI)?

Answer 33

A sudden decline in the glomerular filtration rate | (GFR)

Question 34

What is the **KDIGO Stage 1 criteria** for acute kidney injury (AKI)?

Answer 34

* Increase in serum creatinine to 1.5 to 1.9 times baseline * Increase in serum creatinine by ≥0.3 mg/dL * Urine output <0.5 mL/kg/hour for 6 to 12 hours

Question 35

What are the **potential causes** of rhabdomyolysis?

Answer 35

* Traumatic or muscle compression injury * Non-traumatic, exertional injury * Non-traumatic, non-exertional injuries (e.g., drugs, infections, or electrolyte disorders)

Question 36

What are the **characteristic symptoms** of rhabdomyolysis?

Answer 36

* Markedly elevated creatine kinase (CK) levels * Muscle pain * Weakness * Dark urine (myoglobinuria) ## Footnote Serum CK levels at presentation are usually at least five times the upper limit of normal

Question 37

What does a **high blood urea nitrogen** (BUN) level indicate?

Answer 37

* Kidney dysfunction * Dehydration * High protein intake

Question 38

What is the **normal creatinine range**?

Answer 38

0.6–1.3 mg/dL ## Footnote Values can vary based on lab.

Question 39

What does a **low estimated glomerular filtration rate** (eGFR) indicate?

Answer 39

Kidney disease or impairment

Question 40

What is the **normal sodium (Na+) range**?

Answer 40

135–145 mmol/L ## Footnote Values can vary based on lab.

Question 41

# True or False: High potassium levels can be caused by kidney failure.

Answer 41

True

Question 42

What is the **normal bicarbonate (HCO3−) range**?

Answer 42

22–28 mmol/L ## Footnote Values can vary based on lab.

Question 43

What is the **normal range** for total protein?

Answer 43

6.0–8.3 g/dL ## Footnote Values can vary based on lab.