How do you create effective flashcards for a GUT-FNP review lecture covering urinary tract infections, hematuria, nephrolithiasis, incontinence, acute kidney injury, and rhabdomyolysis?

Effective Flashcards for GUT-FNP Review

Creating effective flashcards for this GUT-FNP review requires organizing key diagnostic criteria, treatment approaches, and clinical pearls for each condition in a concise, retrievable format.

Urinary Tract Infections

Front: What are the diagnostic criteria for UTI?

Back:

• 90% caused by E. coli (enterobacteria family)
• Positive indicators: nitrate reductase, WBCs, leukocyte esterase
• Pyuria without symptoms = asymptomatic bacteriuria (no antibiotics needed except in pregnancy)

Front: How are UTIs classified?

Back:

• Uncomplicated: localized to bladder
  • Symptoms: polyuria, dysuria, urgency, suprapubic pain, possible gross hematuria
  • Absence of vaginal pruritus/discharge
• Complicated: extends to kidneys (pyelonephritis)
  • Same symptoms as uncomplicated PLUS systemic symptoms (fever, chills, CVA tenderness)
  • Automatic classification: males, poorly controlled diabetes, pregnancy, children, elderly, immunocompromised, recurrent UTIs, kidney stones, obstruction, indwelling catheter

Front: What are first-line treatments for uncomplicated UTI?

Back:

• Cephalexin (first-line and safe in pregnancy)
• Nitrofurantoin (first-line in non-pregnant females)
  • Avoid if: suspected pyelonephritis, CrCl <30, pregnancy >36 weeks (risk of hemolytic anemia), first trimester if alternatives exist

Front: What antibiotics are safe in pregnancy? (CAMP-DMP)

Back:

• Cephalexin
• Azithromycin
• Metronidazole
• Penicillins
• Treat asymptomatic bacteriuria in pregnancy

Hematuria

Front: What defines microscopic hematuria?

Back:

• ≥3 RBCs per high-power field
• Positive urine dipstick (≥1+)
• Always confirm with microscopic examination

Front: When is imaging indicated for hematuria?

Back:

• Unexplained hematuria, especially in patients >35 years (increased risk of malignancy)
• 85% of bladder cancer presents with hematuria
• Major risk factor: smoking tobacco
• Recommended imaging: CT abdomen/pelvis with and without IV contrast
• Gold standard for diagnosing bladder cancer: cystoscopy

Front: What are common causes of hematuria?

Back:

• UTI
• Glomerular bleeding
• Pyelonephritis
• Kidney stones
• Mass
• Instrumentation/catheterization
• Trauma
• Exercise-induced hematuria

Nephrolithiasis (Kidney Stones)

Front: What are the characteristics of kidney stones?

Back:

• 80% are calcium stones (others: uric acid, struvite, cystine)
• Symptoms: renal colic/flank pain, hematuria, nausea, vomiting, dysuria, urinary urgency
• Diagnostic imaging: low-radiation CT abdomen/pelvis without contrast (preferred)
• Alternative: ultrasound of kidney/bladder with abdominal/pelvic radiography

Front: How are kidney stones managed based on size?

Back:

• <5mm: conservative management (most pass spontaneously)
• 5-10mm: tamsulosin for up to 4 weeks to facilitate passage

• 10mm: refer to urology

• All patients: pain management, hydration, strain urine for stone analysis
• Refer to urology if: stone >5mm with failed passage after 4 weeks OR poorly controlled pain

Urinary Incontinence

Front: What are the types of urinary incontinence?

Back:

• Stress incontinence: urine loss with increased intra-abdominal pressure (coughing, laughing, sneezing); no urge prior to leakage
• Urgency incontinence (overactive bladder): frequent small voids, nocturia, sudden urge with inability to reach bathroom
• Overflow incontinence: due to detrusor underactivity or obstruction; urine loss without warning/triggers
• Mixed incontinence: combination of types

Front: What are risk factors for urinary incontinence?

Back:

• Obesity
• Vaginal parity
• Older age
• Family history

Front: How is urinary incontinence managed?

Back:

• All patients: urinalysis (culture if UTI/hematuria suspected)
• Avoid alcohol and caffeine
• Pelvic floor exercises (Kegels) for stress and urgency incontinence
• Bladder training for urgency incontinence
• Continence pessaries for stress incontinence
• Topical vaginal estrogen for peri/postmenopausal women
• Complete initial therapy for 6 weeks before considering other treatments

Acute Kidney Injury

Front: What defines acute kidney injury (AKI)?

Back:

• Decrease in kidney function with sudden decline in GFR
• KDIGO criteria (any one):
  1. Increase in serum creatinine by ≥0.3 mg/dL within 48 hours
  2. Increase in serum creatinine to ≥1.5× baseline within 7 days
  3. Urine volume <0.5 mL/kg/hour for 6 hours

Front: What are the stages of AKI?

Back:

• Stage 1: Increase in serum creatinine to 1.5-1.9× baseline OR increase by ≥0.3 mg/dL OR urine output <0.5 mL/kg/hr for 6-12 hours
• Stage 2 and 3: More severe criteria requiring hospital management

Front: What are symptoms of AKI?

Back:

• Sudden oliguria
• Edema
• Weight gain
• Lethargy
• Nausea
• Loss of appetite

Front: When should AKI patients be referred to the ER?

Back:

• Stage 2 or 3 AKI
• Unclear etiology of any stage
• Concern for sepsis
• Significant comorbidities
• Essentially all patients except those with stage 1 AKI with known etiology

Front: How is AKI treated?

Back:

• Discontinue inciting medications (NSAIDs, ACE inhibitors)
• Treat hypovolemia/hypervolemia
• Correct electrolyte imbalances
• Refer to nephrology for co-management

Rhabdomyolysis

Front: What is rhabdomyolysis?

Back:

• Syndrome of muscle cell death with release of intracellular contents
• Release of creatine phosphokinase (CK), lactate dehydrogenase (LDH), and myoglobin
• Memory trick: "ICK DUMP" (Increased CK, Dark Urine, Muscle Pain)

Front: What causes rhabdomyolysis?

Back:

• Traumatic/muscle compression injury
• Non-traumatic exertional (extreme exertion in untrained individuals)
• Non-traumatic non-exertional (medications, infections, electrolyte disorders)

Front: What are the diagnostic criteria for rhabdomyolysis?

Back:

• CK levels ≥5× upper limit of normal (range: 1,500 to >100,000 IU)
• Classic symptoms: muscle pain, weakness, dark urine (myoglobinuria)
• Note: >50% of patients don't report muscular symptoms

Front: How is rhabdomyolysis managed?

Back:

• Hospital management with nephrology consultation
• Monitor for metabolic abnormalities (especially hyperkalemia and hypocalcemia)
• IV fluids to prevent AKI
• Monitor for development of AKI (occurs in 33-50% of cases)