CMN 568 Unit 4-6 questions with 100% correct answer s with all complete tests
CMN 568 Unit 4
Acute Cystitis - Definition - correct answer Infection of the bladder
commonly due to coliform bacteria (e coli) and gram positive (enterococci)
Acute cystitis symtoms - correct answer irritative voiding
suprapubic discomfort
hematuria
Acute cystitis signs - correct answer UA - pyuria, bacteriuria, hematuria
Acute cystitis treatment - correct answer 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 - correct answer 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 - correct answer fever, flank pain, shaking
chills, irritative voiding symptoms
Acute pyelonephritis - signs - correct answer 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
,CMN 568 Unit 4-6 questions with 100% correct answer s with all complete tests
Acute pyelonephritis - treatment - correct answer 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 - correct answer Exceeded in frequency as a
urinary tract disorder by infections and prostatic disease
White men more frequently affected
Urinary stone disease - types - correct answer 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 - correct answer 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 - correct answer 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
,CMN 568 Unit 4-6 questions with 100% correct answer s with all complete tests
Urinary pH is valuable clue to the cause
Dietary counseling
Urinary incontinence - Types - correct answer urge, stress, transient,
overflow, functional
Urge incontinence - correct answer Most common cause of persistent
incontinence in the elderly, involuntary leakage
Stress incontinence - correct answer Present when involuntary leakage occur
from effort or exertion or from sneezing or coughing
Transient incontinence - correct answer Incontinence less than 6 weeks
spontaneously resolves when the underlying condition is treated
Overflow incontinence - correct answer Prevalence of prostate disorders,
incontinence in older men. Caused by obstruction of urinary outflow. Dribbling is
a symptom
Functional Incontinence - correct answer Inability or willingness to toilet
because of physical, cognitive, psychological, or environmental factors. Common
in hospital and nursing home patients.
Abdominal pain - correct answer One of most frequent complaints in
primary care
Most patients have minor non-surgical causes
History of ABD pain is Important - correct answer 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
, CMN 568 Unit 4-6 questions with 100% correct answer s with all complete tests
Associated symptoms: Fever, vomiting, diarrhea, anorexia, hematemesis or
melena, constipation, amenorrhea, dysuria, jaundice
ALWAYS document LMP!
IBD - correct answer inflammatory bowel disease (Chron disease and
ulcerative colitis)
IBS - correct answer irritable bowel syndrome
Past medical history related to ABD pain - correct answer 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
Social history related to ABD pain - correct answer Smoking - worsens
symptoms in GERD, PUD, Crohn's, may lessen symptoms in UC
Alcohol - very important to quantify, binge drinking associated with pancreatitis
Recent travel(esp out of country), camping (contaminated water, giardia), unusual
food exposures (anyone else sick)
ABD pain assessment - correct answer Look: distension, surgical scars,
visable peristalsis, pulsations, engorged veins, skin tugor, hernias
Listen: bowel sounds, renal aortic bruits
Feel: palpate painful areas last, distract patient, assess size of spleen/liver,
rigidity, masses, pulsations, rebound tenderness
Percuss: ascites, CVA tenderness, hepatospleenomegaly
ABD pain special exams - correct answer Rectal exam on most patients with
abd pain, check for stool in vault, guiac stool or occult blood
