FNP GU

Lack of circumcision and STD increase the risk of HIV transmission, especially ____________ by 5 times. But the greatest impact on transmission is ________

Chlamydia VIRAL LOAD (A normal viral load means less than 20 to 75). The highest viral loads are during the early stages of HIV and when antibodies are undetectable

Uncomplicated mild pyelonephritis can be treated with_________

Treat with ciprofloxacin (Cipro) 500 mg PO BID × 7 days or levofloxacin (Levaquin) 750 mg PO daily × 5 to 7 days. Close follow-up is needed for 12 to 24 hours. Complicated or severe cases are treated with IV antibiotics for 14 days (gram-negative bacteremia) in the hospital.

Use of the spermicide nonoxynol-9 can increase the risk of ______

UTIs in females. Also HIV and StD

The loop of Henle is responsible for reabsorption of ____

sodium

Pyridium will turn urine an orange/yellow color; avoid if liver or renal disease, glucose-6-phosphate dehydrogenase (G6PD) anemia. What else will Pyridium stain?

will stain contact lenses. DO NOT RX MORE THAN 3 days

How many colony-forming units (CFU)/mL of one dominant bacteria (usually Escherichia coli)?

≥105 colony-forming units IF MANY BACTERIA FOUND THE U/A IS CONTAMINATED

Secondary syphilis symptoms

-rash, on genitalia and prominent on palms and soles - can last up 6weeks and will resolve without treatment however pt will still be infected

Infants with hydrocele usually disappear around ___

1 yr - watchful waiting

What is consider recurrent UTI in females?

Three or more UTIs (culture positive) in 1 year or two UTIs within 6 months

Male pts that comes in for dysuria, what should be evaluated?

U/A, stds, epididymitis, prostatitis, urethritis, inspect and palpate the testicles and penis. Abdominal exam IS NOT necessary If we are treating for lower UTI - Bactrim for 7-10days

elderly pt living in an institution presents with asymptomatic bacteriuria. How should she be treated?

monitor her for sxs of uti

Medications like acyclovir, sulfadiazine, and indinavir can all increase risk for ________.

nephrolithiasis

The basic functional units of the kidney are-

nephrons: containing glomeruli and renal tubules

What should you do If clinical symptoms persist 48 to 72 hours after initiating antibiotics?

order urine C&S and UA. Rule out pyelonephritis. Switch to another antibiotic drug class treat for 7 to 10 days.

symptoms of acute renal failure are:

patient presents with bilateral edema in the legs and feet, weight gain of 15 lb, and decreased urine output. The patient may also complain of lack of appetite, nausea, and lethargy. His serum creatinine level will be elevate

Why should long-term use of nitrofurantoin, not be a good practice?

possible (lung problems, chronic hepatitis, and neuropathy).

WBC casts with proteinuria and hematuria are associated with ______.

pyelonephritis

An IVP is a radiographic test that is used to evaluate _______

the urinary system and would be used to determine the cause of renal failure, such as tumor or scarring.

An elderly patient with complicated cystitis can be treated for _____

to 7 days with levofloxacin (Levaquin) 750 mg once daily or ciprofloxacin (Cipro) 500 mg BID, if there is low risk of multidrug-resistant organisms.

what is the preferred ( highest sensitivity/specificity) imaging method for ruling in kidney stones?

CT of the abdomen and pelvis without contrast. USE ULTRASOUND IN PREGNANCY

A 27-year-old male patient comes into the office for a follow up on an STI screening after recent intercourse with a new partner. All tests are negative except the Nucleic acid amplification test (NAAT) which is positive for chlamydia. What would be the best treatment option for this patient?

Chlamydia is typically treated with 1g oral azithromycin single dose, without co-treatment for gonorrhea. Another treatment option for chlamydia is 100mg doxycycline twice a day for 7 days. "

treatment for Complicated UTIs:

Ciprofloxacin (Cipro) 500 mg BID or 1,000 mg extended release once daily or levofloxacin 750 mg once a day × 5 to 7 days. UA and urine C&S before and after treatment (to document resolution) if high risk of multidrug-resistant organisms: Nitrofurantoin (Macrobid) 100 mg PO BID

An adult patient has 2+ leukocytes, 2+ nitrites, and 2+ blood on a urinalysis. Due to this and their presenting symptoms of urinary frequency, pain with urination, and blood in their urine, the nurse practitioner decides that they likely have a urinary tract infection (UTI). Considering the patient is allergic to sulfas, which of the following treatments would be the most appropriate? "

Ciprofloxacin (Cipro) BID x 3 days Fosfomycin 3g x 1dose Macrobid 100mg BID x 5-7 days Amoxicillin 500mg bid daily x 10days

A sensation of scrotal heaviness is relieved when recumbent. This dx is exacerbated when straining, lifting heavy, prolonged standing or having a bowel movement. Common in males.

Inguinal hernia- if pain is not relieved when recumbent, or pain is severe, it may be strangulated. An immediate referral is needed

Statistics show what's the majority of percentage of patients with pyelonephritis will respond to antibiotic treatment within 48 hours?

Majority of patients (95%)

The nurse practitioner is doing a chart review of a new patient presenting to the clinic for erectile dysfunction. Which item in the patient's history would contraindicate the use of sildenafil (Revatio)?

Myocardial infarction in the last year Pigmentary retinopathy Multiple myeloma Multiple myeloma (the plasma cells are a type of white blood cell in the bone marrow. With this condition, a group of plasma cells becomes cancerous and multiplies. The disease can damage the bones, immune system, kidneys, and red blood cell count. Bone pain often is the first symptom people notice.)

Manage kidney stone pain with:

NSAID (make sure pt doesn't have kidney disease or dehydration) OPIOIDS ALPHA BLOCKER (Flomax - Tamsulosin) CCB (Nefidipine) - (make sure they don't have GERD, CHF)

Uncomplicated UTIs (Acute Simple Cystitis in Healthy Adult Females) treat with:

Nitrofurantoin (Macrobid) 100 mg BID for × 5 days Trimethoprim-sulfamethoxazole (Bactrim, Septra) BID × 3 days Fosfomycin 3 g × 1 dose

Bacterial resistance >20% or sulfa-allergic IN uNCOMPLICATED UTI:

Nitrofurantoin BID × 5 days, or Fosfomycin 3 g × one dose, or Augmentin 875/125 mg BID × 5 to 7 day ALTERNATIVES: Ciprofloxacin (Cipro) BID or levofloxacin (Levaquin) daily (age 18 years or older) × 3 days

Males with UTI. How will NP proceed to treat?

Order urinalysis and urine culture pretreatment about 1 week after completing antibiotic treatment. Treat with antibiotics for 7-day duration.

Eye infections are most commonly seen with a diagnosis of Gonorrhea, not Chlamydia. Untreated chlamydia can lead to a wide host of complications including _______________. That is why it is so important that it is treated promptly.

PID, ectopic pregnancy, urethral strictures (scarring that narrows the tube that carries urine out of your body (urethra), and infertility.

what does Shift to the left mean?

Presence of bands or stabs (immature neutrophils) means serious infection

What is the priority intervention for patients with stage 3 Renal Failure?

Priority interventions include weight management, diet control, and strict blood pressure control. If the patient is diabetic, strict blood sugar control is also a priority.

A 65-year-old woman who has had type 2 diabetes for 20 years is concerned about her kidneys. She has a history of three urinary tract infections (UTIs) within the past 8 months but is currently asymptomatic. The nurse practitioner will:

Recheck urine during the visit, send a urine specimen for culture and sensitivity, and refer to a nephrologist.

A 25-year-old patient comes in complaining of unilateral testicular pain. Upon examination, his scrotum is swollen and hot, and there is relief of pain when elevating the testicle. Which of the following would be the best treatment plan for this patient?

This is a classic case of epididymitis. The key findings here are the positive Phren's sign and the unilateral, swollen scrotum. For patients under 35, doxycycline is the drug of choice. For patients over 35, we choose ciprofloxacin.

A wet mount that reveals too many white blood cells to count is indicative of an infection, such as A wet mount that reveals too many white blood cells to count is indicative of an infection, such as ___________

chlamydia or gonorrhea. DO NOT CONFUSE WITH BV - clue cells, or squamous epithelial cells with blurred margins coated with bacteria, that may resemble peppered eggs.

Calcium oxalate stones are the most common type of kidney stone. When a patient consumes too many foods that are high in oxalate, it is difficult for the kidneys to filter it out efficiently which leads to the oxalate binding with calcium. This binding then leads to the formation of kidney stones. Foods high in oxalate include items such as _________

chocolate, spinach, rhubarb, beans, tangerines, coffee, cranberries, etc.

Large amounts of squamous epithelial cells in a urine sample indicate _________

contamination

For stones that are >5 mm, how are these patients managed?

extracorporeal shock wave lithotripsy (ESWL).

just a tid bit

female pt. who comes in for UTI sxs should have an abdominal assessment too.

When reviewing voiding cystourethrogram (VCUG) results, grade I reflux _______, grade II _____ but _____ dilate, and grade III is when ______ starts to be seen.

fills the ureter fills the ureter, does not mild dilation

glomerulus and Bowman's capsules are responsible for_____

filtering blood and reabsorption back into the bloodstream and are affected by disorders such as glomerulonephritis and diabetic nephropathy.

When reviewing voiding cystourethrogram (VCUG) for grades I and II, 80% of patients will have spontaneous recovery by age _____ regardless of the age of onset or unilateral versus bilateral presentation. Grade III through grade IV should be ______.

five referred to urology.

Physical therapy for __________ and strengthening is for functional incontinence.

gait training

The factors that affect serum creatinine are ________, ______, _______(GRM_

gender (males have higher levels), race (African Americans have more muscle mass), and muscle mass.

When adolescent boys are getting TALLER, which tanner stages should we consider?

growth spurt usually occurs in tanner stage III.

Older females: Symptoms can be subtle, but onset of new _______can be a sign of a UTI.

incontinence

Urinary tract infections are never expected in _______ and can be due to a structural abnormality like vesicoureteral reflux. Therefore an ultrasound should be ordered to rule out any structural causes of the infection.

infants

WBC casts: May be seen with________, ________

infections (pyelonephritis) or inflammation (interstitial nephritis)

Initial imaging for kidney stones?

is renal ultrasonography

The presence of _________ in urine is always abnormal in males (infection)

leukocytes (pyuria)

The solid mass noted on the patient's ultrasound in conjunction with his symptoms is highly suspicious of possible testicular cancer. This type of cancer commonly occurs ___________ and classically presents as a singular-sided "heaviness." Transillumination is not needed as the ultrasound confirmed the possible suspicion and need for referral.

males 15-35 years old

The nurse practitioner orders a urine dipstick test for an elderly diabetic patient to assess their renal function. Which of the following results is the most sensitive for renal function on a urine dipstick specifically?

microalbuminuria is best detected in a urine dipstick

Sildenafil has actually been shown in studies to potentially reduce respiratory muscle weakness and lung fibrosis. Therefore, it is not contraindicated to use sildenafil in patients with _____________________.

muscular dystrophy.

Any signs of puberty before the age of _____ in males and _____ in females is considered precocious puberty and warrants an immediate referral to endocrinology for further investigation.

nine eight

Antibiotics that contain sulfa such as Bactrim, may cause Stevens-Johnson syndrome so these patients need to be sure to follow up if any new __________develops.

rash

Complicated pyelonephritis present if underlying renal disease, male gender, kidney stone, anatomic urinary tract abnormality, or immunosuppression; what should NP do with these sensitive pts?

refer for hospitalization.

Red urine not due to bleeding can be caused by some medications (e.g____, _______,) and ingestion of certain foods (e.g., beets, rhubarb, senna, food dyes).

rifampin, phenytoin (Dilantin - anti-seizure)

A 21-year-old woman complains to you of a 1-week episode of dysuria, frequency, and a strong odor to her urine. This is her second episode of the year. The previous urinary tract infection occurred 3 months ago. What should NP do next?

second urinary tract infection for the year and the last episode was 3 months ago, the best action is to order the urinalysis and urine C&S to identify the organism causing the infection. Start empiric treatment with an antibiotic for a 7-day duration (do not use a 3-day regimen).Ciprofloxacin (Cipro) 500 mg BID or 1,000 mg extended release once daily or levofloxacin 750 mg once a day × 5 to 7 days

Oxybutynin (Ditropan) is an appropriate medication to trial for older women with ________ Another option is imipramine, a tricyclic antidepressant (TC

urinary incontinence

UTIs in children need further evaluation. About 2.5% of all children will get a UTI. May indicate _______ reflux or even possible sexual abuse.

vesicoureteral

How will recurrent POSTCOITAL UTI in female be treated to prevent recurrent infection?

(SINGLE dose immediately after intercourse): Nitrofurantoin (Macrobid) 100 mg, Bactrim DS one tablet, trimethoprim 100 mg, cephalexin (Keflex) 250 mg

Testicular cancer commonly occurs in males 15-35 years old, and classically presents as a singular sided _______

"heaviness."

For complicated UTI requires at least how many days of dosing?

10-14days

A UTI is defined as the presence of _____

100,000 organisms per milliliter of urine in asymptomatic patients or >100 organisms per milliliter of urine with pyuria (>7 white blood cells [WBCs]/mL) in a symptomatic patient.

(Bactrim DS) is appropriate for treating gram-negative bacteria such as Escherichia coli , It is also appropriate for patients older than ______

2 months.

Acute bacterial infection of the kidney(s) is most commonly due to gram-negative _______

Enterobacteriaceae such as E. coli (75%-95%), Proteus, and Klebsiella.

Stage 3 renal failure values are between:

30-59 SXS: fatigue, dry skin, edema, pallor, hematuria, nocturia, and even mood changes will begin

Treat UTI in pregnant women with antibiotics for how long?

4 to 7 days' duration.

A father brings his 4-year-old daughter to the clinic today. He notes that his daughter has been complaining of abdominal pain and pain with urination. He reports that she seems to be using the bathroom more frequently and has begun having accidents despite being fully toilet-trained. This is not the first time she has presented to the clinic with these concerns. What is the most likely diagnosis?

Vesicoureteral (VUR) More common in females than males can cause symptoms including urinary urgency, burning with urination, frequent urination, fever, abdominal or flank pain, urinary accidents, and constipation. This patient is presenting with the classic symptoms of VUR. Since this is not her first episode, it is likely an ultrasound has been completed and if so, a voiding cystourethrogram (VCUG) should be ordered.

What is the confirmatory test for HIV?

Western blot test or NAT Screen test is ELISA and if found reactive, then u order a western blot due to false positives can occur with ELISA

The period within 3 months after HIV? exposure is termed ________

Window period Fourth-generation assays (ELISA) detect HIV IgM and IgG antibodies while third-generation assays detect IgM ANTIBODIES only Concerns for con-infection with HEP C is also considered

Chronic kidney disease: eGFR <60 mL/min for at least _______

3 months (or longer)

When HIV antiviral therapy is proven effective and pt is stable. When should pt return for next cd4 count?

3-6 mos UNLESS the patient status and condition changes 2-8wks is usually check after starting or changing therapy

Normal CD4 count is

500-1500

Infants with cryptorchidism will likely resolve on its own without intervention by 4 months of age. The American Academy of Family Physicians suggests that if it has not been resolved by _____ months of age, then the child should be referred to urology for possible surgical intervention.

6

Complicated urinary tract infections in males, uncontrolled diabetic patients, pregnant or elderly women, and patients who are immunocompromised require medication treatment for a minimum of ____

7 days

Herpes is treated with antivirals for how long?

7-14 days For multiple outbreaks - suppressive therapy is initiated and dosed daily for up 1 year

What is normal CD4 count?

800-1050/mm3 CD4 decreases about 50/mm3 per year with HIV infection

The following statements are true about Wilms' tumor:

A.The most frequent clinical sign is a palpable abdominal mass. MUST never be palpated, once diagnosed, to avoid spread of the tumor cells. B.It is a congenital tumor of the kidney C.Microscopic or gross hematuria is sometimes prese

You are seeing a 31 year old patient who is 28 weeks pregnant for a routine check up. She reports doing well, however her routine urine screen came back positive for leukocytes and nitrites. What is the most appropriate plan for this patient?

At 28 weeks along, she is now in the third trimester making cephalexin (Keflex) the most appropriate and safe choice as it is category B and safe throughout the entire pregnancy. 500mg BD or TDS PO x 7 days Upper UTI (pyelonephritis) in pregnancy: Ceftriaxone 1g daily until 48 hours afebrile then oral cephalexin 500mg QDS for 10 days Cefazolin 1g or 2g TDS until 48 hours afebrile then oral cephalexin 500mg QDS for 10 days Ceftriaxone 1g IM for 2 doses then oral cephalexin 500mg QDS for 10 days(Wing et al., 1999, Millar et al., 1995) Consider adding in gentamicin if the patient is systemically unwell, having rigors or has hypotension

Which oral antibiotic will the nurse practitioner prescribe for an 18-month-old infant with a symptomatic urinary tract infection?

BACTRIM first-generation cephalosporins (Keflex) amoxicillin-clavulanate In children younger than 24 months, the AAP recommends empiric treatment of suspected UTI. If the child is being treated with oral antibiotics, first-line choices include trimethoprim-sulfamethoxazole, first-generation cephalosporins, and amoxicillin-clavulanate, although due to resistance to amoxicillin, this may be avoided as a first line.

Elderly male patient (median age at diagnosis: 73 years) who smokes presents with painless hematuria. WHAT CANCER COMES TO MIND?

BLADDER CANCER, ASK ABT: The hematuria may only appear at the end of voiding. May have irritative voiding symptoms (dysuria, frequent urination, nocturia) that are not related to a UTI. ADVANCE DISEASE: lower abdominal or pelvic pain, perineal pain, low-back pain, or bone pain. ORDER: urinalysis (UA), urine culture and sensitivity (C&S), and urine for cytology.

Seroconversion for detection of HIV positive can be delay up 6 months if they are co-infected with ______

HEP C

WARTY painless growth on penis maybe

HPV