Best next step in UTI in males? - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 04-22-2012
usmledee's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 257
Threads: 69
Thanked 122 Times in 63 Posts
Reputation: 132
Kidney Best next step in UTI in males?

A man comes in with his first episode of Dysuria and frequency. You do UA and find increased WBC. You Dx him with UTI. He is previously healthy. What is your next step in Mx?

Do you Treat with TMP-SMX for 3 days? or
Do you decide to scan him to look for any obstructive lesions? or
Do you go ahead and treat him and decide to scan him if he comes in with a second episode of UTI?

This is not a question from some book... I am wondering what the actual answer is should we have a question like this.

Thanks.
Reply With Quote Quick reply to this message



  #2  
Old 04-23-2012
USMLE Forums Scout
 
Steps History: Not yet
Posts: 61
Threads: 7
Thanked 81 Times in 32 Posts
Reputation: 91
Default

First episode of UTI...so I would give TMP-SMX for 3 days and discharge.

Scanning should be done in case of Acute Pyelonephritis after antibiotic therapy. Also scanning should be done in pediatric pts after UTI to r/o Posterior urethral valve.

Culture done in 'complicated' cystitis after treatment. Complicated cystitis criteria include- very young, very old, pregnant, diabetic, immunocompromised.

Essentially it depends on which disease of the UTI spectrum you are investigating. Urethritis, Cystitis or APN.

Hope this helps.
Reply With Quote Quick reply to this message
The above post was thanked by:
usmledee (04-23-2012)
  #3  
Old 04-23-2012
usmledee's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 257
Threads: 69
Thanked 122 Times in 63 Posts
Reputation: 132
Default

So what you're saying is that we don't scan him the first time, we scan him the second time he comes in with the urinary tract infection and by urinary tract infection I mean that it's a cystitis that he was initially presented with.

What if this male patient was a child? Do we scan him the first time he presents with cystitis or do we wait for a recurrent episode of cystitis to scan for any anatomical abnormalities?

And yes we don't culture on initial presentation. If the patient develops recurrent infections or is not responding to the antibiotic therapy then we send urine for culture. We also consider doing imaging studies as well at that point.
Reply With Quote Quick reply to this message
  #4  
Old 04-23-2012
USMLE Forums Scout
 
Steps History: Not yet
Posts: 61
Threads: 7
Thanked 81 Times in 32 Posts
Reputation: 91
Default

Yes scanning should be done after second episode to r/o any underlying anatomic abnormalities. Coz its the most common cause of cystitis in males. During first presentation do UA (best initial test) and Urine culture (most accurate).

If its a pediatric pt with any UTI scan him!! Most common cause of UTIs in pediatric pts is PUV.

For the 3rd part I think I answered only partially. My bad. Culture is done for complicated cystitis(the criteria are mentioned in the prev thread), recurrent cystitis within 1 month of prev episode and persistent symptoms despite Rx. (combined from MTB 2CK and UWorld notes)
Reply With Quote Quick reply to this message
The above post was thanked by:
Novobiocin (04-25-2012), usmledee (04-23-2012)



Reply

Tags
Infectious-Diseases, Nephrology-

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Precocious Puberty in Males gargabhi2 USMLE Step 2 CK Forum 10 02-16-2012 04:00 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)