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