The daughter of an elderly, confused female patient reports that her mother is having urinary incontinence several times each day. What will the provider
... [Show More] do initially?
Perform a bladder scan to determine distention and retention
Tell the daughter that this is expected given her mother's age and confusion
Obtain a urine sample for urinalysis and possible culture
Order serum creatinine and blood urea nitrogen tests {{Ans- Obtain a urine sample for urinalysis and possible culture
An adolescent male reports severe pain in one testicle. The examiner notes
edema and erythema of the scrotum on that side with a swollen, tender
spermatic cord and absence of the cremasteric reflex. What is the most
important intervention?
Immediate referral to the emergency department
Doppler ultrasound to assess testicular blood flow
Prescribing anti-infective agents to treat the infection
Transillumination to assess for a "blue dot" sign {{Ans- Immediate referral to the emergency department
A 20-year-old male has epididymitis. His most common complaint will be:
Scrotal pain
Burning with urination
Penile discharge
Testicular pain {{Ans- Scrotal pain
The most common complaint for epididymitis is scrotal pain. Usually
develops over a period of days. Burning with urination is possible if
the underlying cause is a urinary tract infection. However, this is more
common in older males. Testicular pain is not a common complaint
with epididymitis. Penile discharge may occur with gonorrhea or
Chlamydia infections.
A 16-year-old female patient is being treated for her first UTI. She had an
allergic reaction with hives after taking sulfa as a child. Which of the following antibiotics would be contraindicated?
Trimethoprim-sulfamethoxazole
Cephalexin
Nitrofurantoin
Ampicillin {{Ans- Trimethoprim-sulfamethoxazole
A young adult male reports a gradual onset 3/10 dull pain in the right scrotum
and the provider notes a bluish color showing through the skin on the affected side. Palpation reveals a bag of worms on the proximal spermatic
cord. What is an important next step in managing this patient?
Consideration of underlying causes of this finding
Referral to an emergency department for surgical consultation
Reassurance that this is benign and may resolve spontaneously
Anti-infective therapy with ceftriaxone or doxycycline {{Ans- Consideration of underlying causes of this finding
A 30-year-old male patient has a positive leukocyte esterase and nitrites on a
random urine dipstick during a well patient exam. What type of urinary tract
infection does this represent?
Unresolved
Uncomplicated
Isolation
Complicated {{Ans- Complicated
An older male patient reports gross hematuria but denies flank pain and
fever. What will the provider do to manage this patient?
Obtain a urine culture
Monitor blood pressure closely
Refer for cystoscopy and imaging
Perform a 24-hour urine collection {{Ans- Refer for cystoscopy and imaging
A male patient complaints of dysuria. His urinalysis is positive for nitrates, leukocytes, and bacteria. What medication should be given and for how
many days?
Ciprofloxacin for 3 days
Nitrofurantoin for 14 days
Doxycycline for 7 days
Trimethoprim-sulfamethoxazole for 7-10 days {{Ans- Trimethoprim-sulfamethoxazole for 7-10 days
A patient's recent blood work indicates acute kidney injury. You know that acute kidney injury can be caused from:
Heart failure exacerbation
GERD
Increase in metoprolol dose
atrial fibrillation {{Ans- Heart failure exacerbation
Heart failure exacerbation and cause decreased perfusion to the
kidneys, leading to acute kidney injury. Changes in medications or
nephrotoxic can cause acute kidney injury, metoprolol is not one of
them. While patients with atrial fibrillation can have decreased
cardiac output, it is often compensated to preserve renal perfusion
The provider is evaluating a patient for potential causes of urinary
incontinence and performs a postvoid residual (PVR) test which yields 30 mL of urine. What is the interpretation of this result?
The patient may have overflow incontinence.
The patient probably has a UTI.
This represents incomplete emptying.
This a normal result. {{Ans- This a normal result.
A female patient reports hematuria and a urine dipstick and culture indicate a urinary tract infection. After treatment for the UTI, what testing is indicated for this patient?
Voiding cystourethrogram
24-hour urine collection to evaluate for glomerulonephritis
No testing if hematuria is resolved
Bladder scan {{Ans- No testing if hematuria is resolved
A physically independent 75 year old was diagnosed with mild cognitive impairment 6 months ago. She resides in an assisted living facility. she is in clinic today for scheduled visit. Her adult daughter reports that about 2 weeks ago her mother had an episode of urinary incontinence, but no episode since then. She is found to have asymptomatic bacteriuria. How should this be managed?
Repeat the urinalysis in 7 days
Repeat the urinalysis in 4 weeks
Treat her today with one dose of an antibiotic
Monitor her for symptoms of urinary tract infection {{Ans- Monitor her for symptoms of urinary tract infection
Approximately 30-50% of older females living in institutions have
asymptomatic bacteriuria. No data support treatment of patients to prevent future problems or complications. In fact, asymptomatic bacteriuria is not usually treated unless the patient is pregnant, immunocompromised, or is undergoing a urinary procedure.
A pregnant patient has asymptomatic bacteriuria. What is the likely pathogen?
Escherichia coli
Staph aureus
Klebsiella
No pathogen {{Ans- Escherichia coli
Of pregnant patient with asymptomatic bacteriuria should be treated with antibiotics because she is at high risk of developing pyelonephritis and/or preterm labor. The most common pathogen is Escherichia coli.
The provider is counseling a patient who has stress incontinence about ways to minimize accidents. What will the provider suggest initially?
Voiding every 2 hours during the day
Referral to a physical therapist
Increasing fluid intake to dilute the urine
Taking pseudoephedrine daily {{Ans- Voiding every 2 hours during the day
A patient with urolithiasis is more likely to:
Demonstrate RBC casts
Have chills and fevers
Be of male gender
Have frequent UTIs {{Ans- Be of male gender
Males are more likely than females to have urolithiasis. There is no
increased incidence of stone formation among patients with frequent UTIs. Patients with your urolithiasis may exhibit fever and chills of infection if associated with a very large stone, but this is not the usual case. RBC casts are formed in the renal tubules, this generally indicates glomerular injury, not urolithiasis.
A pregnant patient is found to have a urinary tract infection. What is the appropriate course of action?
Prescribe nitrofurantoin
Prescribe ciprofloxacin
Prescribe TMP/SMX
Prescribe no antibiotics {{Ans- Prescribe nitrofurantoin
Nitrofurantoin is considered probably safer to use during pregnancy. It provides coverage for most common UTI pathogens. TMP/SMX is a full of acid antagonist and may be associated with increased risk of congenital malformation. Ciprofloxacin is not to be used first line for any simple UTI, and may not be safe during pregnancy. In some occasions it could still be given if benefits outweigh risks.
An adolescent male reports severe pain in one testicle. The examiner notes edema and erythema of the scrotum on that side with a swollen, tender spermatic cord and absence of the cremasteric reflex. What is the most important intervention?
Prescribing anti-infective agents to treat the infection
Immediate referral to the emergency department
Transillumination to assess for a "blue dot" sign
Doppler ultrasound to assess testicular blood flow {{Ans- Immediate referral to the emergency department [Show Less]