AHN 568 EXAM SCRIPT VERIFIED
QUESTIONS WITH FULL SOLUTION
●● Symptoms of pyelonephritis
Answer: flank pain, fever, hematuria, nausea, vomiting, malaise,
pronounced costovertebral angle tenderness, tachypnea, tachycardia,
shaking chills, changes in mental status esp elderly, if symptoms more
than 3 days consider abscess formation
●● Common UTI bacteria
Answer: E.coli is most common, Staphylococcus Saprophyticus,
Klebsiella, Proteus, Enterococcus, Citrobacter
●● Common pyelonephritis
Answer: E.coli, Proteus, Klebsiella, Enterobacter, and Pseudomonas
●● Lower UTIs include?
Answer: cystitis, urethritis, prostatitis
●● Upper UTIs Include?
Answer: pyelonephritis or renal abscess
●● treatment options • Uncomplicated Lower UTIs
,Answer: A 3-day course is preferred over a single dose regimen due to
high relapse rates o options: Cephalexin, nitrofurantin (5 days),
trimethoprim-sulfamethoxazole
●● treatment options Uncomplicated Upper UTIs
Answer: Patients with mild to moderate illness who are able to take oral
medications can be safely treated as outpatients with Bactrim or Cipro
for 7 days
Patients with more severe illness, those who are nauseated or vomiting,
and pregnant patients should be treated initially with parenteral therapy.
May use third-generation cephalosporins, fluoroquinolones, or
aminoglycosides. o Patients of advanced age or with toxemia should be
hospitalized and initiated on aminoglycoside therapy
●● treatment for pyelonephritis
Answer: Inpatient- ampicillin and an aminoglycoside though you will
also see a third generation cephalasporin used IV
Outpatient: Cipro, levofloxacin, trimethoprim-sulfamethaxazole
●● Do NOT use this antibiotic for pyelonephritis
Answer: Nitrofurantoin
,●● When do Men need further urologic work up from uti
Answer: when treatment fails, in the event of recurrence, or when
pyelonephritis occurs
●● Patients who fail initial empiric treatment in 48 hours
Answer: antimicrobial therapy should be changed to treat the pathogen
detected by the initial urine culture and the presence of an anatomic
abnormality should be considered
●● Treatment for urinary retentino
Answer: Phenazopyridine hydrocholride (Pyridium) 200mg PO TID for
48 hours
●● Avoid these antibiotics during pregnancy and near delivery
Answer: Quinolones and Sulfonamides
●● Antibiotic of choice for pregnancy
Answer: Cephalexin
●● prophylactic treatment for uti may be used for who?
Answer: those with frequent reinfections (3 or more per year)
●● prophylactic UTI treatment includes
, Answer: TMP/SMX, 80mg/400mg or cephalexin 250mg after coitus.
TMP/SMX, 40mg/200mg QD or QOD for recurrences unrelated to
coitus.
●● additional work up for pyelonephritis includes
Answer: failure to respond within 48 hours warrants imaging (CT or
ultrasound) to exclude complicating factors that may require
intervention.
●● Indications for IVP
Answer: The intravenous pyelogram (IVP) had been the standard
imaging procedure for evaluating the urinary tract because it provides an
assessment of the kidneys, ureters, and bladder.
Useful in diagnosing certain disorders such as medullary sponge kidney
and papillary necrosis
●● Contraindications for IVP
Answer: An IVP necessitates the injection of contrast, however, and is
relatively contraindicated in patients at increased risk for AKI (eg,
diabetes mellitus with serum creatinine greater than 2 mg/dL, severe
volume depletion, or prerenal azotemia), CKD, and plasma cell
myeloma.
QUESTIONS WITH FULL SOLUTION
●● Symptoms of pyelonephritis
Answer: flank pain, fever, hematuria, nausea, vomiting, malaise,
pronounced costovertebral angle tenderness, tachypnea, tachycardia,
shaking chills, changes in mental status esp elderly, if symptoms more
than 3 days consider abscess formation
●● Common UTI bacteria
Answer: E.coli is most common, Staphylococcus Saprophyticus,
Klebsiella, Proteus, Enterococcus, Citrobacter
●● Common pyelonephritis
Answer: E.coli, Proteus, Klebsiella, Enterobacter, and Pseudomonas
●● Lower UTIs include?
Answer: cystitis, urethritis, prostatitis
●● Upper UTIs Include?
Answer: pyelonephritis or renal abscess
●● treatment options • Uncomplicated Lower UTIs
,Answer: A 3-day course is preferred over a single dose regimen due to
high relapse rates o options: Cephalexin, nitrofurantin (5 days),
trimethoprim-sulfamethoxazole
●● treatment options Uncomplicated Upper UTIs
Answer: Patients with mild to moderate illness who are able to take oral
medications can be safely treated as outpatients with Bactrim or Cipro
for 7 days
Patients with more severe illness, those who are nauseated or vomiting,
and pregnant patients should be treated initially with parenteral therapy.
May use third-generation cephalosporins, fluoroquinolones, or
aminoglycosides. o Patients of advanced age or with toxemia should be
hospitalized and initiated on aminoglycoside therapy
●● treatment for pyelonephritis
Answer: Inpatient- ampicillin and an aminoglycoside though you will
also see a third generation cephalasporin used IV
Outpatient: Cipro, levofloxacin, trimethoprim-sulfamethaxazole
●● Do NOT use this antibiotic for pyelonephritis
Answer: Nitrofurantoin
,●● When do Men need further urologic work up from uti
Answer: when treatment fails, in the event of recurrence, or when
pyelonephritis occurs
●● Patients who fail initial empiric treatment in 48 hours
Answer: antimicrobial therapy should be changed to treat the pathogen
detected by the initial urine culture and the presence of an anatomic
abnormality should be considered
●● Treatment for urinary retentino
Answer: Phenazopyridine hydrocholride (Pyridium) 200mg PO TID for
48 hours
●● Avoid these antibiotics during pregnancy and near delivery
Answer: Quinolones and Sulfonamides
●● Antibiotic of choice for pregnancy
Answer: Cephalexin
●● prophylactic treatment for uti may be used for who?
Answer: those with frequent reinfections (3 or more per year)
●● prophylactic UTI treatment includes
, Answer: TMP/SMX, 80mg/400mg or cephalexin 250mg after coitus.
TMP/SMX, 40mg/200mg QD or QOD for recurrences unrelated to
coitus.
●● additional work up for pyelonephritis includes
Answer: failure to respond within 48 hours warrants imaging (CT or
ultrasound) to exclude complicating factors that may require
intervention.
●● Indications for IVP
Answer: The intravenous pyelogram (IVP) had been the standard
imaging procedure for evaluating the urinary tract because it provides an
assessment of the kidneys, ureters, and bladder.
Useful in diagnosing certain disorders such as medullary sponge kidney
and papillary necrosis
●● Contraindications for IVP
Answer: An IVP necessitates the injection of contrast, however, and is
relatively contraindicated in patients at increased risk for AKI (eg,
diabetes mellitus with serum creatinine greater than 2 mg/dL, severe
volume depletion, or prerenal azotemia), CKD, and plasma cell
myeloma.
