WBR1056: Difference between revisions

Jump to navigation Jump to search
(Created page with "{{WBRQuestion |QuestionAuthor={{AK}} |ExamType=USMLE Step 2 CK |MainCategory=Internal medicine, OB/GYN |SubCategory=Genitourinary, Infectious Disease |MainCategory=Internal me...")
 
m (refreshing WBR questions)
 
(One intermediate revision by one other user not shown)
Line 1: Line 1:
{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{AK}}
|QuestionAuthor= {{AK}}
|ExamType=USMLE Step 2 CK
|ExamType=USMLE Step 2 CK
|MainCategory=Internal medicine, OB/GYN
|SubCategory=Genitourinary, Infectious Disease
|SubCategory=Genitourinary, Infectious Disease
|MainCategory=Internal medicine, OB/GYN
|SubCategory=Genitourinary, Infectious Disease
|SubCategory=Genitourinary, Infectious Disease
|MainCategory=Internal medicine, OB/GYN
|SubCategory=Genitourinary, Infectious Disease
|SubCategory=Genitourinary, Infectious Disease
|MainCategory=Internal medicine, OB/GYN
|MainCategory=Internal medicine, OB/GYN
|SubCategory=Genitourinary, Infectious Disease
|SubCategory=Genitourinary, Infectious Disease
|MainCategory=Internal medicine, OB/GYN
|SubCategory=Genitourinary, Infectious Disease
|SubCategory=Genitourinary, Infectious Disease
|MainCategory=Internal medicine, OB/GYN
|SubCategory=Genitourinary, Infectious Disease
|SubCategory=Genitourinary, Infectious Disease
|MainCategory=Internal medicine, OB/GYN
|SubCategory=Genitourinary, Infectious Disease
|SubCategory=Genitourinary, Infectious Disease
|MainCategory=Internal medicine, OB/GYN
|MainCategory=Internal medicine, OB/GYN
|SubCategory=Genitourinary, Infectious Disease
|SubCategory=Genitourinary, Infectious Disease
|Prompt= A 32 year old woman G1P1 comes to the clinic complaining of urgency, frequency and burning during urination for the last 4 days. She never had this problem before. She denies any fever, night sweating or pain. Her past medical history unremarkable except for caesarian section 3 years ago. She doesn’t smoke, drinks alcohol occasionally and sexually active with her husband, her vitals are Temperature: 37, 1 , heart rate: 78 , respiration: 17,  blood pressure: 134/67. The physical examination is normal except for mild tenderness over the pubic area.  Tapping on Costco vertebral angel doesn’t show any tenderness.  No  
|Prompt=A 32 year old woman G1P1 comes to the clinic complaining of urgency, frequency and burning during urination for the last 4 days. She never had this problem before. She denies any fever, night sweating or pain. Her past medical history unremarkable except for caesarian section 3 years ago. She doesn’t smoke, drinks alcohol occasionally and sexually active with her husband, her vitals are Temperature: 37, 1 , heart rate: 78 , respiration: 17,  blood pressure: 134/67. The physical examination is normal except for mild tenderness over the pubic area.  Tapping on Costco vertebral angel doesn’t show any tenderness.  No vaginal discharge.
vaginal discharge.
What’s the preferred treatment for this patient?
What’s the preferred treatment for this patient?  
|Explanation=The clinical presentation is typical for acute uncomplicated cystitis, e.coli is the most common cause of this infection, and empiric treatment initiated with out urine culture unless  it is complicated infection or during pregnancy.
|AnswerA=Nitrofurantoin
|AnswerA=Nitrofurantoin
|AnswerAExp=Correct, nitrofurantoin is the preferred antibacterial to treat acute cystitis.
|AnswerAExp=Correct, nitrofurantoin is the preferred antibacterial to treat acute cystitis.
Line 28: Line 18:
|AnswerBExp=Incorrect. Broad spectrum antibiotics are reserved for intolerance or failure of first line antibacterials.
|AnswerBExp=Incorrect. Broad spectrum antibiotics are reserved for intolerance or failure of first line antibacterials.
|AnswerC=Ceftriaxone
|AnswerC=Ceftriaxone
|AnswerCExp=Incorrect. Beta-lactams is not recommended because of the increasing resistance, in addition to their adverse effects and poor efficacy.  
|AnswerCExp=Incorrect. Beta-lactams is not recommended because of the increasing resistance, in addition to their adverse effects and poor efficacy.
|AnswerD=Doxycycline  
|AnswerD=Doxycycline
|AnswerDExp=Incorrect. Doxycycline is used to treat chlamydiae, but is not as effective to treat e.coli which is the most common cause of simple cystitis.
|AnswerDExp=Incorrect. Doxycycline is used to treat chlamydiae, but is not as effective to treat e.coli which is the most common cause of simple cystitis.
|AnswerE=Erythromycin
|AnswerE=Erythromycin
|AnswerEExp=Incorrect. not effective to treat acute cystitis.
|AnswerEExp=Incorrect. not effective to treat acute cystitis.
|References=IDSA guidelines for acute cystitis.<ref name="pmid21292654">{{cite journal| author=Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG et al.| title=International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. | journal=Clin Infect Dis | year= 2011 | volume= 52 | issue= 5 | pages= e103-20 | pmid=21292654 | doi=10.1093/cid/ciq257 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21292654  }} </ref>
|EducationalObjectives=*Acute uncomplicated cystitis definition includes  Premenopausal, nonpregnant women with no known urological abnormalities or comorbidities,[[postmenopause|postmenopausal]] women or well-controlled diabetic female patients.<ref name="pmid21292654"> {{cite journal| author=Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG et al.| title=International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. | journal=Clin Infect Dis | year= 2011 | volume= 52 | issue= 5 | pages= e103-20 | pmid=21292654 | doi=10.1093/cid/ciq257 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21292654  }} </ref>
 
*The decision to use antimicrobials should be case baesd, in other words it should depend on the patients specifics like allergy and compliance history, availability and cost of treatment and resistant rates at the local community.
 
*Being the most common cause of cystitis (75-90%), [[E.Coli]] susceptibility should be considered to choose the appropriate empirical antimicrobial.  Other organisms like [[Proteus mirabilis]], [[Klebsiella pneumoniae]] and [[Staphylococcus saprophyticus]]  are less common.
 
*[[Nitrofurantoin]], [[fosfomycin]] and [[mecillinam ]]are prefered as first line treatment  because have less resistance among other antibacterials <ref name="Kahlmeter-2003"> {{Cite journal  | last1 = Kahlmeter | first1 = G. | title = An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS Project. | journal = J Antimicrob Chemother | volume = 51 | issue = 1 | pages = 69-76 | month = Jan | year = 2003 | doi =  | PMID = 12493789 }}</ref><ref name="Naber-2008"> {{Cite journal  | last1 = Naber | first1 = KG. | last2 = Schito | first2 = G. | last3 = Botto | first3 = H. | last4 = Palou | first4 = J. | last5 = Mazzei | first5 = T. | title = Surveillance study in Europe and Brazil on clinical aspects and Antimicrobial Resistance Epidemiology in Females with Cystitis (ARESC): implications for empiric therapy. | journal = Eur Urol | volume = 54 | issue = 5 | pages = 1164-75 | month = Nov | year = 2008 | doi = 10.1016/j.eururo.2008.05.010 | PMID = 18511178 }}</ref>with similar efficacy.
|References=IDSA guidelines for acute cystitis.<ref name="pmid21292654"> {{cite journal| author=Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG et al.| title=International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. | journal=Clin Infect Dis | year= 2011 | volume= 52 | issue= 5 | pages= e103-20 | pmid=21292654 | doi=10.1093/cid/ciq257 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21292654  }} </ref>
|RightAnswer=A
|RightAnswer=A
|WBRKeyword=Cystitis, E.coli, Antibiotic resistance,  
|WBRKeyword=Cystitis, E.coli, Antibiotic resistance,
|Approved=No
|Approved=No
}}
}}

Latest revision as of 02:28, 28 October 2020

 
Author [[PageAuthor::Abdurahman Khalil, M.D. [1]]]
Exam Type ExamType::USMLE Step 2 CK
Main Category
Sub Category SubCategory::Genitourinary, SubCategory::Infectious Disease
Prompt [[Prompt::A 32 year old woman G1P1 comes to the clinic complaining of urgency, frequency and burning during urination for the last 4 days. She never had this problem before. She denies any fever, night sweating or pain. Her past medical history unremarkable except for caesarian section 3 years ago. She doesn’t smoke, drinks alcohol occasionally and sexually active with her husband, her vitals are Temperature: 37, 1 , heart rate: 78 , respiration: 17, blood pressure: 134/67. The physical examination is normal except for mild tenderness over the pubic area. Tapping on Costco vertebral angel doesn’t show any tenderness. No vaginal discharge.

What’s the preferred treatment for this patient?]]

Answer A AnswerA::Nitrofurantoin
Answer A Explanation AnswerAExp::Correct, nitrofurantoin is the preferred antibacterial to treat acute cystitis.
Answer B AnswerB::Ciprofloxacin
Answer B Explanation AnswerBExp::Incorrect. Broad spectrum antibiotics are reserved for intolerance or failure of first line antibacterials.
Answer C AnswerC::Ceftriaxone
Answer C Explanation AnswerCExp::Incorrect. Beta-lactams is not recommended because of the increasing resistance, in addition to their adverse effects and poor efficacy.
Answer D AnswerD::Doxycycline
Answer D Explanation AnswerDExp::Incorrect. Doxycycline is used to treat chlamydiae, but is not as effective to treat e.coli which is the most common cause of simple cystitis.
Answer E AnswerE::Erythromycin
Answer E Explanation AnswerEExp::Incorrect. not effective to treat acute cystitis.
Right Answer RightAnswer::A
Explanation [[Explanation::The clinical presentation is typical for acute uncomplicated cystitis, e.coli is the most common cause of this infection, and empiric treatment initiated with out urine culture unless it is complicated infection or during pregnancy.

Educational Objective: *Acute uncomplicated cystitis definition includes Premenopausal, nonpregnant women with no known urological abnormalities or comorbidities,postmenopausal women or well-controlled diabetic female patients.[1]

  • The decision to use antimicrobials should be case baesd, in other words it should depend on the patients specifics like allergy and compliance history, availability and cost of treatment and resistant rates at the local community.

References: IDSA guidelines for acute cystitis.[1]]]

Approved Approved::No
Keyword WBRKeyword::Cystitis, WBRKeyword::E.coli, WBRKeyword::Antibiotic resistance
Linked Question Linked::
Order in Linked Questions LinkedOrder::
  1. 1.0 1.1 Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG; et al. (2011). "International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases". Clin Infect Dis. 52 (5): e103–20. doi:10.1093/cid/ciq257. PMID 21292654.
  2. Kahlmeter, G. (2003). "An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS Project". J Antimicrob Chemother. 51 (1): 69–76. PMID 12493789. Unknown parameter |month= ignored (help)
  3. Naber, KG.; Schito, G.; Botto, H.; Palou, J.; Mazzei, T. (2008). "Surveillance study in Europe and Brazil on clinical aspects and Antimicrobial Resistance Epidemiology in Females with Cystitis (ARESC): implications for empiric therapy". Eur Urol. 54 (5): 1164–75. doi:10.1016/j.eururo.2008.05.010. PMID 18511178. Unknown parameter |month= ignored (help)