23-year-old female presents to your office - abrahem

[ArchivalUser]

23-year-old female presents to your office complaining of a urinary tract infection. For the last 3 days, she has experienced burning with urination, increased frequency of urination, and urgency to urinate. She denies vaginal discharge, fevers, chills, nausea, and flank pain. She reports, œI tried to beat it with cranberry juice, but I guess I need antibiotics. Her exam, including vital signs, is normal. Urinalysis shows 2+ leukocyte esterase, 2+ blood, 50 WBCs/hpf, 10 RBCs/hpf, and many bacteria (squamous cells are rare).




1
Your next action is to:
A) Culture her urine.
B) Start an antibiotic.
C) Prescribe a bladder anesthetic.
D) Obtain a CBC.
E) Recommend drinking twice as much cranberry juice.


2
All of the following are acceptable first-line agents in a woman with an uncomplicated urinary tract infection EXCEPT:
A) Nitrofurantoin.
B) Ciprofloxacin.
C) An oral cephalosporin (e.g., cephalexin (Keflex))
D) Trimethoprim/sulfamethoxazole.
E) Azithromycin.


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When a patient develops a urinary tract infection, it is frequently cystitis or an uncomplicated UTI.




3
All of the following are risk factors for complicated UTI or renal infection EXCEPT:
A) Advancing age.
B) Frequent sexual intercourse.
C) Diabetes.
D) Recent antibiotic use.
E) Tampon use.


4
If you suspected that your patient had acute pyelonephritis, which of the following antibiotic regimens would you choose?
A) Trimethoprim/sulfamethoxazole DS PO BID for 3 days.
B) Trimethoprim/sulfamethoxazole DS PO BID for 10 days.
C) Levofloxacin 500 mg PO QD for 7 days.
D) Ceftriaxone 1 g IV QD for 7 days.

[ArchivalUser]

B
C
A or E??E
C

[ArchivalUser]

1. A
2. E
3. A
4. B

[ArchivalUser]

B
E
A
B

[ArchivalUser]

A 23-year-old female presents to your office complaining of a urinary tract infection. For the last 3 days, she has experienced burning with urination, increased frequency of urination, and urgency to urinate. She denies vaginal discharge, fevers, chills, nausea, and flank pain. She reports, œI tried to beat it with cranberry juice, but I guess I need antibiotics. Her exam, including vital signs, is normal. Urinalysis shows 2+ leukocyte esterase, 2+ blood, 50 WBCs/hpf, 10 RBCs/hpf, and many bacteria (squamous cells are rare).

Your next action is to:

A) Culture her urine.


B) Start an antibiotic.


C) Prescribe a bladder anesthetic.


D) Obtain a CBC.


E) Recommend drinking twice as much cranberry juice.



The correct answer is B. You have enough information to diagnose an uncomplicated acute cystitis (uncomplicated urinary tract infection, or UTI, is also an acceptable term). On a midstream, clean-catch urine specimen, the presence of > 10 WBCs/hpf is good evidence of infection, so long as the specimen has no evidence of contamination”in other words, has few squamous epithelial cells. The blood and bacteria on microscopic exam of the urine lend further support for the diagnosis of UTI. Since the clinical history and urinalysis findings are consistent with UTI and the patient is otherwise healthy, no further tests are necessary. You should proceed with antibiotic therapy. A bladder anesthetic, such as phenazopyridine hydrochloride (Pyridium), may be used in conjunction with an antibiotic, but should never be used alone in a known UTI. CBC is helpful when you are concerned about complicated UTI, as in pyelonephritis.

Helpful Tip: Although the diagnosis of UTI should be confirmed by urinalysis, there is evidence that history alone can be very accurate. If a woman complains of dysuria and increased frequency without vaginal discharge, the likelihood ratio of UTI is about 25, and UTI can be predicted with greater than 90% probability.

Helpful Tip: Urine should be cultured in the following situations: recurrent UTI, atypical presentation, inconclusive urinalysis, complicated urinary tract infection (e.g., pyelonephritis), or if the patient is pregnant, is diabetic, is a child, or is immunocompromised.





2 All of the following are acceptable first-line agents in a woman with an uncomplicated urinary tract infection EXCEPT:

A) Nitrofurantoin.


B) Ciprofloxacin.


C) An oral cephalosporin (e.g., cephalexin (Keflex))


D) Trimethoprim/sulfamethoxazole.


E) Azithromycin.



The correct answer is E. Answers A, B, and C are well-accepted initial treatments for uncomplicated urinary tract infections (UTIs) in women. Macrolides, such as azithromycin, have very poor gram-negative coverage and are not useful in treating UTI. If E. coli resistance to trimethoprim/sulfamethoxazole in your community is low, a 3-day course of trimethoprim/sulfamethoxazole should be the first choice for uncomplicated UTI in a healthy younger woman. A fluoroquinolone or nitrofurantoin can be substituted. If a patient has allergies to these drugs or is otherwise unable to tolerate any of these three options, consider an oral cephalosporin, amoxicillin/clavulanate, or doxycycline.



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When a patient develops a urinary tract infection, it is frequently cystitis or an uncomplicated UTI.

3 All of the following are risk factors for complicated UTI or renal infection EXCEPT:

A) Advancing age.


B) Frequent sexual intercourse.


C) Diabetes.


D) Recent antibiotic use.


E) Tampon use.



The correct answer is E. Tampons do not increase the risk of UTIs (although contraceptive diaphragms do). A complicated UTI is one that involves symptoms of upper tract infection, such as fever, nausea, and flank pain, in addition to typical symptoms of UTI (e.g., dysuria, frequency). Sexual intercourse in women increases the risk of UTIs as well. Additional risk factors for complicated UTI include urinary tract instrumentation, indwelling bladder catheter, neurogenic bladder, immunosuppression, anatomic abnormalities of the urinary tract, and UTI in childhood.

Helpful Tip: It is uncommon for men to develop a simple cystitis. Generally, men will have a complicated infection including pyelonephritis and prostatitis.





4 If you suspected that your patient had acute pyelonephritis, which of the following antibiotic regimens would you choose?

A) Trimethoprim/sulfamethoxazole DS PO BID for 3 days.


B) Trimethoprim/sulfamethoxazole DS PO BID for 10 days.


C) Levofloxacin 500 mg PO QD for 7 days.


D) Ceftriaxone 1 g IV QD for 7 days.



The correct answer is C. In cases of mild pyelonephritis in otherwise healthy females, outpatient treatment is preferred. Most authorities, including the Infectious Disease Society of America, recommend a fluoroquinolone. Studies have demonstrated that 7 days of levofloxacin are sufficient for the treatment of pyelonephritis. Although the chances of trimethoprim/sulfamethoxazole failure may be equal in uncomplicated UTI and pyelonephritis, the risks of treating pyelonephritis inadequately are higher than those for uncomplicated UTI. Therefore, trimethoprim/sulfamethoxazole is not the agent of choice for pyelonephritis. Parenteral therapy with agents such as ceftriaxone is not necessary if the patient can take antibiotics by mouth. Cephalosporins and amoxicillin/clavulanate are acceptable alternatives to fluoroquinolones for the outpatient treatment of uncomplicated pyelonephritis.

Helpful Tip: With typical UTI symptoms (e.g., dysuria, frequency) and a negative urinalysis, consider other causes: interstitial cystitis, chlamydia urethritis, prostatitis (in men), pelvic inflammatory disease (in women), pelvic mass, and drugs (e.g., diuretics, caffeine, and theophylline). Helpful Tip: When uncomplicated acute cystitis is recurrent, consider using prophylactic antibiotics daily or just after sexual intercourse. Encourage good fluid intake, proper hygiene, and voiding after intercourse

[ArchivalUser]

thx alot abraham for taking out the time to post q's and answers for all of us...good q's for review...may i know wat is ur source?

[ArchivalUser]

Reference: Harrison™s 16 edition Chapter 267