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60 Cards in this Set
- Front
- Back
what is... |
1. ENURESIS: when you cant hold your bladder
2. MICTURATION: peeing 3. NOCTURIA peeing excessively at night 4. : POLYURIA: : lots of volume 5. FREQUENCY: peeing often 6. DYSURIA: painful urination 7. DYSURIA: difficult urination 8. BACTURIA: bacteria in urine, cal also have asymptomatic bacturia 9. PYURIA: pus in urine, WBC means infection usually 10. UTI: infection anywhere in the UT |
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what is
acute cystitis? Acute Pyelonephritis? Chronic Pylonephritis? Acute bacterial prostatitis? Chronic bacterial prostatitis? |
acute cystititis- infected bladder epithelium
Acute Pyelonephritis- infection of renal parynchema Chronic Pylonephritis- inflammation/scarring of renal parynchema. seen in kids with chronic UTI/vesicurectal reflux Acute bacterial prostatitis- uropathogens cause infection, prostate is tender, sx of cystitis Chronic bacterial prostatitis- recurrent prostatic infection |
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what is a complicated UTI
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anyone who is not a healthy young non pregnant woman
**complications: may have fever, nausea, flank pain, DM Old Pregnant men vesicourethral reflux catheter obstruction |
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what is a relapse of UTI?
what is reinfection of UTI? |
recurrence of bug in original isolate within 2 weeks after tx ends
new bacteria |
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what are some natural ways we prevent UTI
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1. peeing at regular frequency
2. emptying bladder completely 3. mucopolysaccharide layer of bladder that is anti adherant/antibacterial 4. angled uretocystic junction- prevents reflux from bladder into ureter 5. Urethra- keeps the buggy outside away from the sterile bladder |
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what are some thigns that increase UTI in male and female
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MALE:
old, DM, anal, uncircumsized, catheter, neuro issues, anatomical/obstruction FEMALE: same but diaphragm, spermicide, pregnant |
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why the increase risk of UTI with diaphragm adn spermicide
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alter normal flora so that bugs can attach easier
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what are most uncomplicated UTI's caused by
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E coli
**it migrates from the rectum to urethro |
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Recurrent or complicated UTI's are associated with what?
what bug/ |
long term catheterization, recent AB use
*Proteus- urea splitter, urine pH >8 pseudomonas Klebsiella Serratia Providencia Enterobacter Enterococcus |
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what can cause pyelonephritis
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organsims ascend from outside to kidney
**infection of renal parynchema |
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why ask UTI pt about location and character of pain/discomfort
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flank pain indicates pyelonephritis
itching when pee- vaginitis burning when you pee- cystitis, urethritis pain that comes and goes (colicky) and radiates to groin- stone |
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why ask how long a pt has been in pain when you think its UTI
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sx >7 days pyelonephritis, non bacterial urethtitis, vagninis
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what 3 things might present a little like UTI but last way longer (7 days or more)
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1. Vaginitis
2. pyelonephritis 3. non bacterial urethritis |
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if a pt presents with UTI like things and has... does your ddx change
1. fever, vomit, 2. vaginal/penile dischagre |
1. pyelonephritis
2. vaginitis/STD |
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why do you ask a pt if they have taken AB
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it will make a test (-)
it increases likelihood of resistance **sometimes pts take their left over AB they have around the house |
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why ask a pt with UTI sx if they have had it before
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find out when and determine if you have relapse (same bug 2 weeks after tx) or reinfection (new infection)
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you always need to get the whole story, including PMH. whats the dignificance of tehse assoiated with UTI
1. DM 2. Sickle Cell/NSAIDS |
1. DM increases risk of asocaited kidney issues (abcess, papillary necrosis)
2. papillary necrosis, ureter onstruciton |
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on physical exam for a pt presenting with UTI what does it mean if they have
1. Fever 2. Tachycardia, hypotension, altered mental status |
1. pyelonephritis (also have CVA tenderness)
2. sepsis, volume depletion |
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what might you think if a pt has CVA tenderness with UTI sx
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pyelonephritis (also fever)
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what are the 2 things you are looking for on abdominal exam for person with UTI sx
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1. Kidney: enlargement may indicate polycystic kidney
2. Bladder, shouldnt be percussable or palpable. if its full of pee you can |
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why do a pelvic for pts with sx of UTI
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if they have vaginal discharge/odor, painful sex, itching or pain do a pelvic
1. can be VD: gonorrhea, chlamydia, PID, cystocele, urethrocele |
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what is the presentation for acute cystitis
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1. dysuria
2. frequency 3. urgency 4. suprapubic pain 5. hematuria **common in pregnant ppl |
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so if we have dysuria, frequency, ugency, we may think acute cyctitis, what if there is also: fever, flank pain, nausea, vomit, malaise
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acute pyelonephritis
if they dont have flank pain its prbly something else! dangerous for kids nad oldies |
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whats the big word for stones. whats hte presentation for stones?
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Nephrolithiasis, Ureterolithiasis
Colicky flank pain that radiates to groin dysuria, hematuria, |
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Acute Pyelonephritis:
Clinical Findings Dx Test Results |
Clinical: fever, flank pain, CVA tenderness
Dx: UA shows pyuria, bacteriuria, white cell clasts **infection of renal parynchema |
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when do you see white cell clasts
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in the urine of ppl with acute pyelonephritis, infection of renal parynchema
**not always seen though bc the speciman is handled rough and they break all apart |
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Cystitis:
Clinical Findings: Dx test results: |
Clinical: suprapubic pain, dysuria, uegency, frequency, some hematuria
Dx: Pyuria, bacteriurea |
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Urethritis-Chlamydia
Clinical Presentation Dx test |
Clinical: new sexual partner, discharge, dyruria
Dx: pyuria WITHOUT bacteruria. positive chlamydia test |
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Urethritis- Gonococcal
Clinical Findings Dx test |
Clinical: cervical or penile discharge, hx of gono in pt or partner
Dx: gram - intracellular diplococci (pyuria WOTHOUT bacteruria) |
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prostatitis
Clinical Findings Dx test results |
Clinical: super tender prostate, perineal or suprapubic pain, dysuria, fever, urinary retention. deep ache with LBP
Dx: pyuria, bacteruiria, leukocytosis, L shift |
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Epididymitis
Clinical Findings DX |
Clinical: enlarged epididymis, dysuria, painful, discharge if STD
Dx: leukocytosis, L shift, pyuria, bacteruiria. if STD will have + std test |
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Stones
Clinical Presentation Dx test |
Clinical: Flank pain that may radiate to groin (if stone in ureter), colicky, hematuria, dysuria,
Dx: hematuria WITHOUT bacteriura/ + IVP or CT for stones |
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Vaginitis
Clinical Presetation Dx test |
Clinical: vaginal discharge, itch, irritation
Dx test: culture- yeast, trichomonadas |
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ok so you can tx UTI on histroy alone and can even do telephone treatment. what needs to be the sx
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1. dysuria
2. frequency 3. NO VAGINAL DISCHARGE/Irritation ** good way to treat uncomplicated UTI |
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how shoudl you collect UA for cystitis and pyelonephritis
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clean catch,
wipe, collect midstream for "sterile" urine |
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what is normal urine pH, what if its higher?
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5-9
more basic indicates proteus, this is an ammonium splitter that makes the pee more basic |
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what does nitrites in the urine mean
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bacteria
**they spilt nitrates into nitrites, nitrites not normally found |
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what does leukocyte esterase on dipstick indicate
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WBC
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how can you tell if there is bacteruiria?
what about pyuria |
Bacteriura: nitrite (bugs convert nitrite to nitrate)
Pyuria; leukocyte esterase (indicates WBC) |
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what sthe best way to ID pyuria? what can be used as an alternative?
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microscopic
can use leukocyte esterase in dipstick analysis as alternate |
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what do you tthink if leukocyte esterase is negatine
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think non infectious cause
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so its good to lookfor WBC on microscopy, what about bacteria
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not really, they are too tiny!
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what values give us good reason to suspect an infection?
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pyuria nad bacteruira seen together!
when its just pyuria it may be STD |
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what does a comtaminated speciman look like
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Epithelial cells on microscopic exam
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is a urine culture necessary for UTI
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not for an uncomplicated one (non pregnant female)
But shoudl take a culture for: 1. men 2. recurrent/relapse 3. complicated UTI 4. pyelonephritis 5 |
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when take a CBC for pt presenting with dysuria
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looking for systemic infection
*fever, flank pain, nausea/vomit, Leukocytosis/left shift indicate systemic infectino |
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what additional tests might you order if you think a pt has sepsis
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1. CBC
2. Blood Culture 3. Renal fx test |
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why might you order imaging for dysuria
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1. recurrent pyelonephritis
2. relapsed cystitis 3. stone 4. fever >72 hrs after tx 5. male 6. in a child with UTI |
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when do you US a kid with UTI
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always!!
when they have thier first bladder infection it can indicate a problem in the urinary tracy, do US on the whole thing |
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how do we manage fever and pain for UTI
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1. Fever: should go away with tx, if its there for more than 72 hours maybe a resistant orgamism
2. Pain: phenazopyridine (pyridium), 2 days |
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what is the tx plan for out patient acute pyelophritis?
what about in patiend |
1. Ciprofloxacin or Fluoroquinolone for 7-14 days. no systemic effects (can have low fever and slight WBC elevation)
2. In Patient: if vomiting, IV meds until the fever is gone for 24 hrs, continue on oral AB |
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how is an uncomplicated acute cystitis treated
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3 days of oral AB:
TMP-SMX nitrofurantoin monohydrate flouroquinolones |
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how long do you treat?
uncomplicated UTI Complicated UTI |
3 days (TMX-SMX, flouroquinolens, nitrofurantoin)
7 days (broad spectrum AB) |
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Drugs to tx pyelonephritis?
Drugs to tx cystitis |
fluoroquinolone- ciprofloxacin
flouroquinnolones (cipro andothers), TMP-SMX (bactrum) |
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e coli causes what?
proteus causes what |
Uncomplicated UTI
Basic Urine |
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can you tx UTI prophylatically
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yep, if they have more than 3 UTI/year and dont have other things goind on
can take a pill after sex or every night (TMX-SMX, Nitrofurantoin, Cephalaxin) |
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what is self initiated UTI therapy
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woman can administer AB herself if she knows she has one
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how is estrogen cream used for UTI
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keeps the pH normal in post menopausal women
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should we screen for asymptomatic bacteruria in,,,
1. Preggos 2. men 3. non preg woman |
1. yes (canbe asymptomatic
2. no 3. no **screen with a culture **Tx asymptomatic bacteruria in preggos and ppl about to have urologic procedure |
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if a child presents with back pain, abd pain, and dysuria/frequency and you are thinking UTI what can abother sx be that adults dont ahve
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incontinence
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