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GU disorders Flashcards

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1
Q

Most common organism for UTI

A

E.coli

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2
Q

Most common UTI organism for women with STI’s

A

S. saprophyticus

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3
Q

Why is asymptomatic UTI in pregnancy dangerous

A

can precipitate pre-term labor

increased risk for PN

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4
Q

Criteria for uncomplicated UTI

A

lack of systemic symptoms and low-risk patient

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5
Q

UTIs are more common in boys or girls during infancy

A

boys

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6
Q

UTI labs

A
  • dipstick: leukocytes positive
  • nitrites: negative or positive (e.coli will be positive)
  • sometimes hematuria
  • C&S: (midstream) positive if >100,000 CFU/mL with pyuria
  • if with catheter: >1000 is positive
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7
Q

pyuria

A

urine with WBC

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8
Q

Treatment duration of uncomplicated UTI

A

3 days

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9
Q

Treatment duration for complicated UTI

A

5 days

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10
Q

Uncomplicated UTI treatment

A

-Bactrim x 3 days
-Macrobid x 5 days, or fosfomycin x 1 dose, or augmentin x 5-7 days if bacterial resistance >20% or sulfa allergy
Alt: Cipro or levaquin x 3 days
-Pyridium x 2 days PRN dysuria
-increase fluid intake
-avoid high oxalate foods
-

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11
Q

Patient population considered as complicated UTi

A
  • males
  • poorly controlled DM
  • pregnant women
  • children or elderly
  • immunocompromised
  • recurrent UTI or reinfections
  • anatomical abnormalities
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12
Q

Complicated UTI treatment

A
  • Cipro or Levaquin x 7-10 days

- Bactrim or Suprax 7-10 days

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13
Q

Treatment for postcoital UTI

A
  • Bactrim one tablet after sex

- increase fluids before and after sex

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14
Q

Antimicrobial prophylaxis for UTI

A

Bactrim one tablet HS

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15
Q

Are UTI’s ever normal in males

A

no, refer to urologist

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16
Q

Recurrent UTI requirement in women

A
  • 3 or more UTI’s in 1 year

- or 2 infections within 6 months

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17
Q

Long-term use of Macrobid is associated with

A
  • lung problems
  • chronic hepatitis
  • neuropathy
  • contraindicated with renal insufficiency
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18
Q

Antibiotic choice for pregnant

A

Keflex

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19
Q

UTI antibiotics to avoid with pregnancy

A
  • Macrobid
  • Cipro
  • Levaquin
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20
Q

Antispasmodic medications

A

-Ditropan (oxybutynin)

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21
Q

Complicated UTI symptoms

A
  • fever, chills
  • marked fatigue
  • indicates spread beyond bladder
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22
Q

Common organisms for acute PN

A
  • e.coli
  • K. pneumoniae
  • P. mirabilis
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23
Q

WBC casts in urine suggests

A

pyelonephritis

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24
Q

PN treatment

A
  • refer ED
  • outpatient if mild
  • Fluoroquinolones preferred (if resistance <10%)
  • Rocephin 1 g IM stat single dose if unable to take FQ
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25
When to refer PN
- pregnant - children - elderly - anatomical abnormalities - DM - etc.
26
Next step with dipstick is heme positive
send for microscopic UA order C&S if infection suspected if malignancy suspected send for urine cytology
27
Biggest concern with hematuria
bladder cancer
28
Benign causes of hematuria
- exercise induced | - resolves in 72 hours
29
RBC casts in urine suggest
glomerulonephritis if accompanied by edema, weight gain, dark cola-colored urine or HTN
30
Nephrolithiasis is...
kidney stones
31
Risk factors for nephrolithiasis
- family history of stones - low fluid intake - gout - bariatric surgery
32
Nephrolithiasis presentation
- acute onset of severe flank pain - pain comes in waves - episodes may last from 20-60 minutes - N/V with severe pain - gross or microscopic hematuria - most will pass stone in 48 hours
33
Nephrolithiasis treatment
- Toradol injection if not contraindicated - strain urine for several days and bring stone to office for analysis - renal US to determine location and size - urology referral if unable to pass or large stone - Refer to ED if with high fever, extreme pain, or acute renal failure - increase fluid intake - avoid high-oxalate foods
34
high oxalate foods
- rhubarb - spinach - beets - chocolate - tea - meats
35
Cr level with low muscle mass and normal renal function
decreased serum Cr
36
Cr level with high muscle mass and normal renal function
high serum Cr
37
What is creatinine
a byproduct of muscle metabolism excreted through kidneys
38
CrCl is often done by | what lab is instead used
nephrologists inconvenient for primary care use GFR instead
39
Abnormal GFR
<60
40
Which cast is always pathological
RBC casts --> refer
41
Which cast type is most common
hyaline
42
Hyaline casts may present due to
low urine flow dehydration vigorous exercise
43
Crystal casts
no clinical significance
44
Right kidney placement
sits lower than left due to liver displacement
45
Large number of squamous epithelial cells in urine may indicate
contamination
46
Use of ___ can increase UTI in females
spermicides | up to 1 year
47
Imaging with highest sensitivity/specificity for kidney stones
noncontrast CT
48
Initial imaging test for kidney stones
US
49
What is BUN
kidneys ability to excrete urea
50
What can cause elevated BUN
- acute renal failure - high-protein diet - hemolysis - CHF - drugs
51
Few amounts of epithelial cells in urine
normal
52
Normal WBC in urine
<10
53
If multiple bacteria are present in a urine sample, it is considered
contaminated
54
Urine dipstick detects only ___, not microalbumin
albumin
55
Organisms that breakdown nitrates to nitrites
- E.coli - Klebsiella - Proteus - Enterobacter - Citrobacter - Pseudomonas
56
Urge incontinence
- detrusor instability | - sudden urge to urinate
57
Stress incontinence
- sphincter incompetence | - unintentional loss of urine
58
Treatment for urinary incontience
- avoid all irritating liquids - weight loss - regular voiding (but not frequent) - Kegel exercises daily x 3 months - minimize fluids at dinner - take diuretics in afternoon
59
Overactive bladder medication treatment
- anticholinergics --> Mirabegron (Myrbetriq) fewer side effects - Estrogen for postmenopausal women - pelvic PT, pessaries - surgery
60
Urolithiasis vs. nephrolithiasis
- Uro: stones anywhere in urinary system | - Nephro: stones in kidneys
61
A positive Prehn sign indicates
epididimytis | -relief of pain with elevation of affected testicle
62
Catheter associated UTI organism
Proteus mirabilis
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