NRNP 6550 FINAL EXAM WITH COMPLETE SOLUTION.ALREADY PASSED
Urine culture with UTI Correct Answer-100.000 colonies in asymptomatic: bacteruria
10 - 10.000 colonies in symptomatic patients but also pyuria
pyuria: more than 10 leukocytes
elevated erythrocytes with pyelonephritis
WBC in urine
false positive with tumor, urethritis and poor collection technique
Repeat in pregnant women
Lower urinary tract UTI and upper urinary tract UTI Correct Answer-bladder and urethra: cystitis/
urethritis/ prostatitis
kidney and ureters: pyelonephritis/ renal abcess
Uncomplicated and complicated uti Correct Answer-Uncomplicated: in normal working urinary tract
Complicated: defects in urinary tract or with other health problems
1
,Common pathogens for UTI Correct Answer-E.coli (elderly women)
Staphylococcus
proteus mirabilis (elderly men)
Klebsiella
enterecoccus
pseudomonas
Providencia (institutionalized)
Fungus: candida
Risk factors for UTI Correct Answer-Female
critically ill
elderly
catheter (caused by biofilm)
DM
calculi, tumor, stricture
neurogenic bladder
Women:
sexual intercourse or new sex partner
pregnancy
2
,previous UTI
Men:
prostate enlargement
prostatitis
lack of circumcision
gay
HIV
Findings UTI Correct Answer-Lower:
Dysuria/ urgency/ frequency/ incontinence
suprapubic pain
hematuria
fever/ chills uncommon
No flank pain
Upper:
flank pain
fever and chills
hematuria
3
, n/v
ams (in elderly)
malaise
tachycardia/ tachypnea
Testing and results for UTI Correct Answer-Gold standard: urine culture and sensitivity: detection of
bacteria. Start with POC: urine analysis.
UA: pos for nitrite or leukocyte or blood
CBC: leukocyte with left shift in pyelonephritis
For recurrent UTI in women or UTI in men rule out obstruction, calculi, or necrosis with:
xr voiding
CT abdomen
US pelvis
MRI pelvis
Management acute cystitis Correct Answer-First line:
- Single dose Fosfomycin (monurol)
- 3 day: sulfa: trimethoprim/ sulfa (bactrim) (do not give near delivery of baby, give cephalexin instead)
or sulfa
- 5 days: nitrofurantoin, caution in elderly
4
Urine culture with UTI Correct Answer-100.000 colonies in asymptomatic: bacteruria
10 - 10.000 colonies in symptomatic patients but also pyuria
pyuria: more than 10 leukocytes
elevated erythrocytes with pyelonephritis
WBC in urine
false positive with tumor, urethritis and poor collection technique
Repeat in pregnant women
Lower urinary tract UTI and upper urinary tract UTI Correct Answer-bladder and urethra: cystitis/
urethritis/ prostatitis
kidney and ureters: pyelonephritis/ renal abcess
Uncomplicated and complicated uti Correct Answer-Uncomplicated: in normal working urinary tract
Complicated: defects in urinary tract or with other health problems
1
,Common pathogens for UTI Correct Answer-E.coli (elderly women)
Staphylococcus
proteus mirabilis (elderly men)
Klebsiella
enterecoccus
pseudomonas
Providencia (institutionalized)
Fungus: candida
Risk factors for UTI Correct Answer-Female
critically ill
elderly
catheter (caused by biofilm)
DM
calculi, tumor, stricture
neurogenic bladder
Women:
sexual intercourse or new sex partner
pregnancy
2
,previous UTI
Men:
prostate enlargement
prostatitis
lack of circumcision
gay
HIV
Findings UTI Correct Answer-Lower:
Dysuria/ urgency/ frequency/ incontinence
suprapubic pain
hematuria
fever/ chills uncommon
No flank pain
Upper:
flank pain
fever and chills
hematuria
3
, n/v
ams (in elderly)
malaise
tachycardia/ tachypnea
Testing and results for UTI Correct Answer-Gold standard: urine culture and sensitivity: detection of
bacteria. Start with POC: urine analysis.
UA: pos for nitrite or leukocyte or blood
CBC: leukocyte with left shift in pyelonephritis
For recurrent UTI in women or UTI in men rule out obstruction, calculi, or necrosis with:
xr voiding
CT abdomen
US pelvis
MRI pelvis
Management acute cystitis Correct Answer-First line:
- Single dose Fosfomycin (monurol)
- 3 day: sulfa: trimethoprim/ sulfa (bactrim) (do not give near delivery of baby, give cephalexin instead)
or sulfa
- 5 days: nitrofurantoin, caution in elderly
4
