CMN 568 Unit 4 Test Questions and Answers Rated A
Infection of the bladder commonly due to coliform bacte-
Acute Cystitis - Definition
ria (e coli) and gram positive (enterococci)
irritative voiding
Acute cystitis symtoms suprapubic discomfort
hematuria
Acute cystitis signs UA - pyuria, bacteriuria, hematuria
Uncomplicated in women: cephalexin, nitrofurantoin,
trimethoprim-sulfamethaxazole
Acute cystitis treatment Restrictive use of fluoroquinolone
Refer if - radiographic abnormality evidence of urolithiasis
or recurrent cystitis due to bacterial persistence.
Infectious inflammatory disease of the kidney parenchyma
and renal pelvis.
Acute pyelonephritis - definition
Gram negative bacterial most causative agents - e coli,
proteus, klebsiella, enterobacter, pseudomonas
Acute pyelonephritis - symptoms fever, flank pain, shaking chills, irritative voiding symptoms
CBC- leukocytosis and a left shift
UA - pyuria, bacteriuria, hematuria
Acute pyelonephritis - signs White cell casts
Renal ultrasound may show hydronephrosis
ditterentials include acute cystitis or a lower urinary source
Outpatient setting empiric therapy - ampcilillin,
ciprofloxacin, levofloxacin, trimethoprim-sulfamethaxa-
zole
CT or Ultrasound
Acute pyelonephritis - treatment
Catheter or nephrostomy drain
refer - complications, urolithiasis, obstruction
Admit for parenteral antibiotics, complicating factors, sep-
sis
Urinary stone disease- patients
,Exceeded in frequency as a urinary tract disorder by infec-
tions and prostatic disease
White men more frequently attected
Five major types of urinary stones: calcium oxalate, calci-
um phosphate, struvite, uric acid, and cyctine
Most common types are composed of calcium
Urinary stone disease - types Geographic factors contribute to the development of
stones
Areas of high humidity and elevated temps are contribut-
ing factors
Sedentary lifestyles have higher incidence
Higher rates of hypertension, carotid calcification, and CV
disease
Urinary stone disease - risk factors High protein, salt intake, inadequate hydration appear
most important factors
Sodium intake should be restricted to keep urinary sodi-
um levels less than 150 meq/day
Pain may occur episodically and radiate anteriorly over the
abdomen
Nausea and vomiting
ID on non contrast CT or ultrasound
Urinary stone disease-signs and symptoms Obstructing urinary stone are usually present with acute
or severe colic
severe flank pain
Urinary pH is valuable clue to the cause
Dietary counseling
Urinary incontinence - Types urge, stress, transient, overflow, functional
Most common cause of persistent incontinence in the
Urge incontinence
elderly, involuntary leakage
, Present when involuntary leakage occur from ettort or
Stress incontinence
exertion or from sneezing or coughing
Incontinence less than 6 weeks spontaneously resolves
Transient incontinence
when the underlying condition is treated
Prevalence of prostate disorders, incontinence in older
Overflow incontinence men. Caused by obstruction of urinary outflow. Dribbling
is a symptom
Inability or willingness to toilet because of physical, cogni-
Functional Incontinence tive, psychological, or environmental factors. Common in
hospital and nursing home patients.
One of most frequent complaints in primary care
Abdominal pain
Most patients have minor non-surgical causes
Onset: sudden, gradual
Location: where, radiation?
Duration: chronic >2 weeks
Character: Sharp, well localized, dull, dittuse, burning,
knawing, crampy, colicky.
Aggravating factors: Makes pain worse, food, movement,
position
History of ABD pain is Important Relieving factors: makes pain better, position, antacids,
food, defecation or urination
Timing: Constant or intermittent, certain times of day, re-
lated to meals or school
Associated symptoms: Fever, vomiting, diarrhea, anorexia,
hematemesis or melena, constipation, amenorrhea, dy-
suria, jaundice
ALWAYS document LMP!
inflammatory bowel disease (Chron disease and ulcerative
IBD
colitis)
Infection of the bladder commonly due to coliform bacte-
Acute Cystitis - Definition
ria (e coli) and gram positive (enterococci)
irritative voiding
Acute cystitis symtoms suprapubic discomfort
hematuria
Acute cystitis signs UA - pyuria, bacteriuria, hematuria
Uncomplicated in women: cephalexin, nitrofurantoin,
trimethoprim-sulfamethaxazole
Acute cystitis treatment Restrictive use of fluoroquinolone
Refer if - radiographic abnormality evidence of urolithiasis
or recurrent cystitis due to bacterial persistence.
Infectious inflammatory disease of the kidney parenchyma
and renal pelvis.
Acute pyelonephritis - definition
Gram negative bacterial most causative agents - e coli,
proteus, klebsiella, enterobacter, pseudomonas
Acute pyelonephritis - symptoms fever, flank pain, shaking chills, irritative voiding symptoms
CBC- leukocytosis and a left shift
UA - pyuria, bacteriuria, hematuria
Acute pyelonephritis - signs White cell casts
Renal ultrasound may show hydronephrosis
ditterentials include acute cystitis or a lower urinary source
Outpatient setting empiric therapy - ampcilillin,
ciprofloxacin, levofloxacin, trimethoprim-sulfamethaxa-
zole
CT or Ultrasound
Acute pyelonephritis - treatment
Catheter or nephrostomy drain
refer - complications, urolithiasis, obstruction
Admit for parenteral antibiotics, complicating factors, sep-
sis
Urinary stone disease- patients
,Exceeded in frequency as a urinary tract disorder by infec-
tions and prostatic disease
White men more frequently attected
Five major types of urinary stones: calcium oxalate, calci-
um phosphate, struvite, uric acid, and cyctine
Most common types are composed of calcium
Urinary stone disease - types Geographic factors contribute to the development of
stones
Areas of high humidity and elevated temps are contribut-
ing factors
Sedentary lifestyles have higher incidence
Higher rates of hypertension, carotid calcification, and CV
disease
Urinary stone disease - risk factors High protein, salt intake, inadequate hydration appear
most important factors
Sodium intake should be restricted to keep urinary sodi-
um levels less than 150 meq/day
Pain may occur episodically and radiate anteriorly over the
abdomen
Nausea and vomiting
ID on non contrast CT or ultrasound
Urinary stone disease-signs and symptoms Obstructing urinary stone are usually present with acute
or severe colic
severe flank pain
Urinary pH is valuable clue to the cause
Dietary counseling
Urinary incontinence - Types urge, stress, transient, overflow, functional
Most common cause of persistent incontinence in the
Urge incontinence
elderly, involuntary leakage
, Present when involuntary leakage occur from ettort or
Stress incontinence
exertion or from sneezing or coughing
Incontinence less than 6 weeks spontaneously resolves
Transient incontinence
when the underlying condition is treated
Prevalence of prostate disorders, incontinence in older
Overflow incontinence men. Caused by obstruction of urinary outflow. Dribbling
is a symptom
Inability or willingness to toilet because of physical, cogni-
Functional Incontinence tive, psychological, or environmental factors. Common in
hospital and nursing home patients.
One of most frequent complaints in primary care
Abdominal pain
Most patients have minor non-surgical causes
Onset: sudden, gradual
Location: where, radiation?
Duration: chronic >2 weeks
Character: Sharp, well localized, dull, dittuse, burning,
knawing, crampy, colicky.
Aggravating factors: Makes pain worse, food, movement,
position
History of ABD pain is Important Relieving factors: makes pain better, position, antacids,
food, defecation or urination
Timing: Constant or intermittent, certain times of day, re-
lated to meals or school
Associated symptoms: Fever, vomiting, diarrhea, anorexia,
hematemesis or melena, constipation, amenorrhea, dy-
suria, jaundice
ALWAYS document LMP!
inflammatory bowel disease (Chron disease and ulcerative
IBD
colitis)
