MSN-FNP Genitourinary

MSN-FNP Genitourinary Which of the following is not considered a risk factor for urinary tract infection (UTI) A. Intrauterine device B. Pregnancy C. Diabetes mellitus D. New sexual partner - ANSWER A. Intrauterine device Explanation: IUD is not a risk factor for UTI. Risk factors for UTI include: pregnancy, diabetes, diaphragm use, and a new sexual partner. A 52 yo female presents with c/o urinary incontinence that has progressively gotten worse over the last two months. She was abstinent up until six months ago when she got married. She has a history of irregular menses for the last 12 months. The incontinence has now progressed to the point where she leaks urine before she can make it to the bathroom. What is the most likely diagnosis? A. Urodynamic stress incontinence B. Neurologic detrusor hyperreflexia C. UTI D. Vaginal atrophy - ANSWER D. Vaginal atrophy Explanation: The patient presents with irregular cycles over the last year, which are mostly likely secondary to symptoms of perimenopausal with thinning of the vaginal mucosa. What accounts for 80-90% of UTIs in pregnant women? - ANSWER Escherichia coli A 63 yo female c/o of urinary leakage. She states for the past several months she feels she is constantly leaking small amounts of urine. She goes to the bathroom frequently but doesn't feel she is emptying her bladder. She feels her urine stream is weak and she is having nocturia. She denies any change with sneezing. She is not having significant urgency. What type of incontinence is this woman experiencing? - ANSWER Overflow incontinence Urine leakage which is involuntary and increases with intraabdominal pressure such as coughing, sneezing, or physical exertion is - ANSWER Stress incontinence Frequent or near-continuous feeling of needing to void immediately, with urine leakage either before or after urination is - ANSWER Urge incontinence A patient who has symptoms of stress and urge incontinence is - ANSWER Mixed incontinence Which of the following groups should asymptomatic bacteria be treated? A. Patients with diabetes mellitus B. Patients with spinal cord injuries C. Patients with indwelling catheters D. Pregnant women - ANSWER D. Pregnant women Explanation: Pregnant women are at an increased risk of asymptomatic bacteriuria becoming acute cystitis and/or acute pyelonephritis, and the maternal and obstetric risk associated with pyelonephritis are great. However, the Infectious Disease Society of America does not recommend that the remaining groups in the list undergo treatment of asymptomatic bacteriuria. A 40 yo female with stage 3 chronic kidney disease secondary to hypertension presents complaining of dysuria and frequency X 3 days. She denies fever or hematuria. On exam, her temp is 98.9, HR is 88, BP is 140/80. Exam is unremarkable except for suprapubic tenderness. UA reveals cloudy urine with positive leukocyte esterase, nitrites, and protein. Cultures are pending. What is the correct medication therapy for this patient? A. Oral trimethoprim-sulfamethizole B. IM ceftriaxone C. IV gentamycin D. IV vancomycin - ANSWER A. Oral trimethoprim-sulfamethoxazole (Bactrim) A 34 yo male arrives at clinic for c/o acute onset 30 minutes ago of server colicky flank pain on the left that is coming in waves. He c/o nausea and emesis X 3. On exam, he appears anxious and ill. Temp is 99, HR 100. Abdomen is soft, nontender, with normal bowel sounds. He provides a urinalysis and it is pink in color with a large number of red blood cells. Which of the following is true? A. An MRI should be ordered B. CPK should be ordered C. Renal ultrasound is indicated D. The patient should receive ceftriaxone 250 mg IM and 2 weeks of doxycycline - ANSWER C. Renal ultrasound is indicated Explanation: Patient presentation is consistent with nephrolithiasis and renal colic. Most kidney stones are made of calcium oxalate. The pain results from a stone will vary depending upon the location and size of the stone. Stones located in the renal pelvis or upper portion of the urethra will cause flank pain and tenderness. Stones located in the lower portion of the urethra will cause pain that radiates to the testicle or labia of the vagina. All kidney stones may case abdominal pain. Waves and colicky flank pain is consistent with movement of the stone. Pain can be severe and may be associated with nausea and vomiting. The stone may take hours to weeks to pass. Hematuria and or pink urine is commonly seen. Patients should strain their urine for several days and brink any tones to the office for analysis. Patients with fever or intractable pain should be referred to the ED. Patients with larger stones and acute renal failure should be referred to a urologist. A 38 yo African American female is referred by her gynecologist for a consultation concerning stage 3 CKD. She is not pregnant and uses a long acting reversible contraceptive (LARC). At her annual exam, BP 150/85, GFR was 59mL/min/1.73m2. She is not on anti-hypertensive therapy. You plan to prescribe an antihypertensive prior to the evaluation of her CKD and HTN. Which class of medication is the most appropriate initial therapy for this patient? A. Vasodilators B. Alpha-1 blocker C. Beta-blockers D. Angiotensin-converting enzyme inhibitors - ANSWER D. Angiotensin-converting enzyme inhibitors. Explanation: Angiotensin-converting enzyme inhibitors are known to slow progression of CKD. They should not be used in pregnancy because they are associated with fetal malformation. Although blacks are generally more responsive to calcium channel blockers than to monotherapy with ACE inhibitors, there are clear benefits to ACE inhibitors, usually in combination with other antihypertensive agents, in blacks with CKD, especially due to benign hypertensive nephrosclerosis.