NGR6605 EXAM 2 GU UPDATED ACTUAL QUESTIONS
AND CORRECT ANSWERS
Question:
Asymptomatic Bacteriuria
Answer:
Defined as the presence of 1 or more bacteria growing in the urine at specified
quantitative counts of at least 100,000/ml (>/= 10^5 CFU) and NO signs or symptoms that
can be attributed to a UTI. Usually caused by E.coli Most common after menopause,
pregnancy, BPH, catheters. Treatment is not necessary unless pregnant or
immunocompromised (HIV/AIDA, transplan recipient, taking immunsuppressants,
cancer, neutropenia). Recommend increasing po fluids and avoiding bladder stasis with
frequent voiding.
Question:
A UTI is the most common infection of all ages as well as most common nosocomial
infection, T/F?
Answer:
True Always use Cat B antibiotics for pregnant/lactating women unless risk severly
outweight the benefits. Think pregnant women may like to "CAMP" *Cephalosporins
*Amoxicillin *Macrolides *PNC's Patients who are hemodynamically unstable, severely
dehydrated, or unable to take po meds should be admitted Refer:
- UTIs in men
- Hemodynamically unstable pts.
- Recurrent
- Structural abnormalities?
Question:
Refer unusual presentations and those with recurrent problems or who do not respond
to standard treatment, T/F?
Answer:
True
Question:
Cystitis:
Answer:
Usually an uncomplicated lower urinary tract infection involving the urethra and
bladder Most commonly caused by the gram negative bacteria E. Coli (80-90% of cases)
Risk factors:
*Female *DM *Pregnancy *Aging *Constipation *Family history *Catheters *Oral
contraceptives? *Neurogenic bladder *Spermicides & barrier methods *Frequent
sexual activity (esp. anal sex) *Tumors *Stones *Strictures (Reflux of urine)
,Question:
Bacteriuria in older adults (over 65 yrs) may present with:
Answer:
- Mental status changes
- May present may be afebrile
* Older adults often do NOT have fevers with UTIs
Question:
Diagnosis of Cystitis:
Answer:
UA Dipstick (always do clean catch) o (+) leukocytes o (+) Nitrites (gram negative
bacteria) o Possible (+) blood o Possible WBC or WBC esterase o Bacteria o Cloudy or
Turbid foul smelling Obtain a Urine sample for C & S- If atypical symptoms, recurrent
UTI
(esp. within 2-4 weeks after antibiotic tx), older patients, diabetics, or is you suspect
more severe UTI or pyelonephritis. Not all UTI have nitrates on UA. Consider imaging If:
*Atypical symptoms, *Recurrent UTI (>3/year or 2 in 6 months) *Older patients
*Diabetics *Severe UTI *Pyelonephritis
Question:
Treatment of Uncomplicated Cystitis:
Answer:
- TMP-SMX (Bactrim DS) 1 tablet po BID X 3 days (IDSA recommends 3 days for
complicated and 14 days for uncomplicated)
- Nitrofurantoin (Macrobid) 100 mg po BID X 5-7 days
- Ciprofloxacin (Cipro) 250-500 mg po Q 12hrs X 3 days
- Cephalexin (Keflex) 250-500 mg po Q 6hrs X 3-7 days ***Do not give Macrobid in the
3rd trimester*** Consider treatment with:
Low dose daily antibiotics, post-coital antibiotics (single dose after sex), or "self-start"
antibiotics (meaning they have refills of antibiotics on hand to use when the symptoms
start)
Question:
Treatment Of Cystitis:
• Complicated (ie. severe infection, recurrent infection, infections in males, or in
immunocompromised pts)
Answer:
- Levofloxacin (Levaquin) 500-750mg po daily 7-10 days
- TMP-SMX (Bactrim DS) 1 tablet po BID x14 days
- Ciprofloxacin (Cipro) 250-500 mg po Q 12hrs x14 days
- Cephalexin (Keflex) 250-500 mg po Q 6hrs x14 days
- Nitrofurantoin (Macrobid) 100 mg po BID x14 days (Poor choice for
pyelonephritis/complictaed UTI) ***Do not give Macrobid in the 3rd trimester*** Pain
relief:
- Pyridium (phenazopyridine) 100-200 mg po TID, for max 2-3 days. Do not give with
G6PD anemia. liver or renal disease.
,Question:
Prevention of Cystitis:
Answer:
Teach:
o Post-coidal voiding o Avoid barrier methods and spermacides o Increase po fluid
intake o Drink cranberry juice daily - changes pH of urine making harder for bacteria
to stick "controversial" o Consider intra-vaginal estrogen replacement for post
menopausal women o Good hygiene, wipe front-back o No douches o Showers instead
of baths o Finish entire course of antibiotics
Question:
Treatment of Cystitis inpregnancy:
Answer:
o Avoid Quinolones and Sulfa o Obtain follow up urine C & S after therapy to ensure
critters eradicated o Admit if has fever, leukocytosis, emesis/ dehydration Think
pregnant women may like to "CAMP" *Cephalosporins *Amoxicillin *Macrolides *PNC's
***Do not give Macrobid in 3rd trimester***
, Question:
Interstitial Cystitis:
Answer:
Painful bladder syndrome o Pain with filling; relieved by emptying*** o Characterized
by frequency & urgency*** o No flank pain***
• More common in women
• Look for underlying cause. Unknown cause but there are certain toxins that tend to
irritate bladder
tissue. Avoid trigger foods - coffee, tea, chocolate, carbonated beverages, ETOH, acidic
juice, spices, nitrates, sweeteners, vitamin C Treatment of Interstitial Cystitis
• Refer to urology
• Need cystoscopy First line treatment: patient education, diet modification, stress
management Second line treatment: physical therapy, and prescription dugs - Oral
pentosane polysulfate
- DMSO- Hydroxyzine -Elavil 10-75 mg?-CCB's?
• TENS
• Acupuncture
AND CORRECT ANSWERS
Question:
Asymptomatic Bacteriuria
Answer:
Defined as the presence of 1 or more bacteria growing in the urine at specified
quantitative counts of at least 100,000/ml (>/= 10^5 CFU) and NO signs or symptoms that
can be attributed to a UTI. Usually caused by E.coli Most common after menopause,
pregnancy, BPH, catheters. Treatment is not necessary unless pregnant or
immunocompromised (HIV/AIDA, transplan recipient, taking immunsuppressants,
cancer, neutropenia). Recommend increasing po fluids and avoiding bladder stasis with
frequent voiding.
Question:
A UTI is the most common infection of all ages as well as most common nosocomial
infection, T/F?
Answer:
True Always use Cat B antibiotics for pregnant/lactating women unless risk severly
outweight the benefits. Think pregnant women may like to "CAMP" *Cephalosporins
*Amoxicillin *Macrolides *PNC's Patients who are hemodynamically unstable, severely
dehydrated, or unable to take po meds should be admitted Refer:
- UTIs in men
- Hemodynamically unstable pts.
- Recurrent
- Structural abnormalities?
Question:
Refer unusual presentations and those with recurrent problems or who do not respond
to standard treatment, T/F?
Answer:
True
Question:
Cystitis:
Answer:
Usually an uncomplicated lower urinary tract infection involving the urethra and
bladder Most commonly caused by the gram negative bacteria E. Coli (80-90% of cases)
Risk factors:
*Female *DM *Pregnancy *Aging *Constipation *Family history *Catheters *Oral
contraceptives? *Neurogenic bladder *Spermicides & barrier methods *Frequent
sexual activity (esp. anal sex) *Tumors *Stones *Strictures (Reflux of urine)
,Question:
Bacteriuria in older adults (over 65 yrs) may present with:
Answer:
- Mental status changes
- May present may be afebrile
* Older adults often do NOT have fevers with UTIs
Question:
Diagnosis of Cystitis:
Answer:
UA Dipstick (always do clean catch) o (+) leukocytes o (+) Nitrites (gram negative
bacteria) o Possible (+) blood o Possible WBC or WBC esterase o Bacteria o Cloudy or
Turbid foul smelling Obtain a Urine sample for C & S- If atypical symptoms, recurrent
UTI
(esp. within 2-4 weeks after antibiotic tx), older patients, diabetics, or is you suspect
more severe UTI or pyelonephritis. Not all UTI have nitrates on UA. Consider imaging If:
*Atypical symptoms, *Recurrent UTI (>3/year or 2 in 6 months) *Older patients
*Diabetics *Severe UTI *Pyelonephritis
Question:
Treatment of Uncomplicated Cystitis:
Answer:
- TMP-SMX (Bactrim DS) 1 tablet po BID X 3 days (IDSA recommends 3 days for
complicated and 14 days for uncomplicated)
- Nitrofurantoin (Macrobid) 100 mg po BID X 5-7 days
- Ciprofloxacin (Cipro) 250-500 mg po Q 12hrs X 3 days
- Cephalexin (Keflex) 250-500 mg po Q 6hrs X 3-7 days ***Do not give Macrobid in the
3rd trimester*** Consider treatment with:
Low dose daily antibiotics, post-coital antibiotics (single dose after sex), or "self-start"
antibiotics (meaning they have refills of antibiotics on hand to use when the symptoms
start)
Question:
Treatment Of Cystitis:
• Complicated (ie. severe infection, recurrent infection, infections in males, or in
immunocompromised pts)
Answer:
- Levofloxacin (Levaquin) 500-750mg po daily 7-10 days
- TMP-SMX (Bactrim DS) 1 tablet po BID x14 days
- Ciprofloxacin (Cipro) 250-500 mg po Q 12hrs x14 days
- Cephalexin (Keflex) 250-500 mg po Q 6hrs x14 days
- Nitrofurantoin (Macrobid) 100 mg po BID x14 days (Poor choice for
pyelonephritis/complictaed UTI) ***Do not give Macrobid in the 3rd trimester*** Pain
relief:
- Pyridium (phenazopyridine) 100-200 mg po TID, for max 2-3 days. Do not give with
G6PD anemia. liver or renal disease.
,Question:
Prevention of Cystitis:
Answer:
Teach:
o Post-coidal voiding o Avoid barrier methods and spermacides o Increase po fluid
intake o Drink cranberry juice daily - changes pH of urine making harder for bacteria
to stick "controversial" o Consider intra-vaginal estrogen replacement for post
menopausal women o Good hygiene, wipe front-back o No douches o Showers instead
of baths o Finish entire course of antibiotics
Question:
Treatment of Cystitis inpregnancy:
Answer:
o Avoid Quinolones and Sulfa o Obtain follow up urine C & S after therapy to ensure
critters eradicated o Admit if has fever, leukocytosis, emesis/ dehydration Think
pregnant women may like to "CAMP" *Cephalosporins *Amoxicillin *Macrolides *PNC's
***Do not give Macrobid in 3rd trimester***
, Question:
Interstitial Cystitis:
Answer:
Painful bladder syndrome o Pain with filling; relieved by emptying*** o Characterized
by frequency & urgency*** o No flank pain***
• More common in women
• Look for underlying cause. Unknown cause but there are certain toxins that tend to
irritate bladder
tissue. Avoid trigger foods - coffee, tea, chocolate, carbonated beverages, ETOH, acidic
juice, spices, nitrates, sweeteners, vitamin C Treatment of Interstitial Cystitis
• Refer to urology
• Need cystoscopy First line treatment: patient education, diet modification, stress
management Second line treatment: physical therapy, and prescription dugs - Oral
pentosane polysulfate
- DMSO- Hydroxyzine -Elavil 10-75 mg?-CCB's?
• TENS
• Acupuncture
