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NRNP 6550 FINAL EXAM,,QUESTIONS AND
ANSWERS [RATED A]
Question : Urine culture with UTI
CORRECT ANSWER : 100.000 colonies in asymptomatic: bacteruria 10 - 10.000 colonies in symptomatic patients but also
pyuria pyuria: more than 10 leukocytes elevated erythrocytes
with pyelonephritis WBC in urine
Question : false positive with tumor, urethritis and poor
collection technique
CORRECT ANSWER : Repeat in pregnant women
Question : Lower urinary tract UTI and upper urinary tract UTI
CORRECT ANSWER : bladder and urethra: cystitis/ urethritis/
prostatitis kidney and ureters: pyelonephritis/ renal abcess
Question : Uncomplicated and complicated uti
CORRECT ANSWER : Uncomplicated: in normal working
urinary tract Complicated: defects in urinary tract or with other
health problems
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Question : Common pathogens for UTI
CORRECT ANSWER: E.coli (elderly women) Staphylococcus
proteus mirabilis (elderly men) Klebsiella enterecoccus
pseudomonas Providencia (institutionalized) Fungus: candida
Question : Risk factors for UTI
CORRECT ANSWER : Female critically ill elderly catheter
(caused by biofilm) DM calculi, tumor, stricture neurogenic
bladder Women: sexual intercourse or new sex partner
pregnancy previous UTI Men: prostate enlargement prostatitis
lack of circumcision gay HIV
Question : Findings UTI
CORRECT ANSWER : Lower: Dysuria/ urgency/ frequency/ incontinence suprapubic pain hematuria fever/ chills uncommon
No flank pain Upper: flank pain fever and chills hematuria n/v
ams (in elderly) malaise tachycardia/ tachypnea
Question : Testing and results for UTI
CORRECT ANSWER : Gold standard: urine culture and sensitivity: detection of bacteria. Start with POC: urine analysis.UA: pos for nitrite or leukocyte or blood CBC: leukocyte with
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left shift in pyelonephritis For recurrent UTI in women or UTI
in men rule out obstruction, calculi, or necrosis with: xr voiding
CT abdomen US pelvis MRI pelvis
Question : Management acute cystitis
CORRECT ANSWER : First line: - Single dose Fosfomycin (monurol) - 3 day: sulfa: trimethoprim/ sulfa (bactrim) (do not give near delivery of baby, give cephalexin instead) or sulfa - 5 days: nitrofurantoin, caution in elderly Second line: -
qiunolones: ciprofloxain or levofloxacin for 3 days (not for
pregnant women!) - B-lactams: amoxi-clav, cefdinir for 3 - 7
days
Question : Management uncomplicated upper UTI
CORRECT ANSWER : Outpt: quinolone: ciprofloxacin for 7
days or levofloxacin for 5 days Sulfa: trimethoprim/ sulfa
(bactrim) for 14 days Inpt: Ceftriaxone or cefotaxime Ampicillin
CAUTI: bacterial: treat with AB for 7 days Candiduria:
fluconazole for 14 days Discomfort: Pyridium
Question : Management acute complicated bacterial
pyelonephritis
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CORRECT ANSWER: - Admit - Aminoglycosides: gentamicin/ tobramycin (not for monotherapy), based on renal function (trough less than 2 and peak level 5-10mg/L) and do not give for CKD - Ampicillin - Cefazolin - Cefotaxime and Ceftriaxon based on obesity and pulm disease
Question : Urine analysis: glucose and ketones
CORRECT ANSWER : Serum glucose at least 180mg/dl for
glucose to appear in urine
Question : Glucose in ua caused by: CORRECT ANSWER : - Fancone Syndrome (bad wall: caused by ahminoglycosides for example) - DM - Cushing's - Vit C can give false negative
Question : Ketones in urine:
CORRECT ANSWER : - Alcohol - Diabetic - Starvation
Question : Acute Kidney Injury
CORRECT ANSWER : -Acute renal function loss with
inability to excrete metabolic waste products (urea nitrogen and