DIP Episode 356 - The Clutch UTI Podcast (for Step 1-3)

Okay, welcome. My name is Divine. This is episode 356 of the Divine Intervention Podcasts. And into these podcasts I'm gonna title this the Clutch UTI Podcast. The Clutch UTI Podcast. It's gonna be a very high-alt podcast. It's gonna be short and sweet. We're gonna talk about a lot of really high-alt information. The first thing I want to say though is if you're taking the USMELIS step 2 CK or step 3 exams or the complex level 2 or 3 exams, you know around the end of January or February, I do have a 24-hour step 2 CK step 3 and you know also a place to comelex a course taking place from the 25th to the 20th of January 2022. It's from 70 M to 1pm mountain standard time each day. That's like 9 to 3 pm Eastern and then I have an MBME test against strategy scores on the 24th of January 2022. So if you're interested it's from 2 to 4 30 pm mountain time. That's like 4 to 3 6 30 pm Eastern. So if you're interested you should me an email through the website to reserve a spot. I'll use some more details on payment once payments are made. The spot is reserved. Again I've had tons of people take these courses if don't extremely well on the exams. Then you know next year, sometime next year this is a goal. I have a USMELIS school that I love to start next year. Something I'm thinking about my vision is something that is going to be like just insanely comprehensive, total, total, totally comprehensive for the USMELIS. Especially step 2 CK step 3.

Just a school idea but just something I'm thinking about. We'll see. Okay so let's just jump right into it. So we know UT is coming to flavors right? There is at least for the most part on MBME exams. There's Sestitis which is a bladder infection and then there's Pylon of Fritis which is a kidney infection. Now the thing is Sestitis can actually be something that they can present on MBME exams as a cause of urgent continents right? Because many times when people have a bladder infection they have this urge to pee right? So literally instead of one Sestitis as an answer they can just make up a question wearing some way shape of form. Urging continents is the right answer for Sestitis because it literally will cause urgent continents. It's just more of an acute nature after a treating infection the problem goes away. So what are some classic symptoms our friends at the MBME is love to throw for people that have UT Is. Well you know they'll have like pain with urination especially again if we're talking about Sestitis they'll have like pain with urination they'll have like urinary frequency they'll have urinary urgency right? Like increase urinary frequency one of urinary urgency again urgent continents you know for Pylon they'll put more flank being fever cost of a tuberlangol tenderness stuff like that right?

Now one thing I guess I want to point out again as we meet integrations across this podcast is that our friends at the MBM Es when you see an elderly person of the UTI many times I didn't say all the time but many times they love to give those people delirium they love to give them altered mental status and with the elderly again especially with UT Is they love this whole concept of anticholinergic causing problems right? Remember anticholinergic will make you not urinate if you don't urinate you're gonna have urinary steases if you have urinary steases you're gonna get a UTI right? So they give you a question about a lady has altered mental status low abdominal pain old lady and she's been taking over the countercode medicine again think of diving hydramine it has very powerful anticholinergic activity or basically cause your detrimental source to not work right? You're gonna have urinary steases you're gonna get a UTI from that and then remember in terms of causes right? So what is the most common cause of most UT Is? Well it's it's equalized right? Equalized the most common cause of UT Is the second most common cause actually staffs are perfidicus right? Especially in a sexually active young female but again there are some other epidemiological things our friends at the MBME is gonna target these days right?

So like if for example you look at hospital acquired infections you know with think of hospital acquired pneumonia and things like that actually the most common hospital acquired infection believe it or not the most common cause of no so comular infections is a catheter associated UT Is UTI right? So most people get UTI like if you see a person get an infection while in the healthcare system like a nursing home it's gonna be a UTI that's the most common right? And I guess if they give you a UTI again I'm just trying to make these 10 more scenario based because I feel like that's where you get a get a lot more from this if you get a if you see a person getting a UTI and the urine peach is super basic is like 8.5 9 9.5 just super crazy basic you know I want you to think of a urinary positive bug right? So something like prayers something like especially produce merabilis something like lepsiala something like ur plasma urillinacum they love to test ur plasma urillinacum a lot these these on the US Emily exams and also think of staffs are propheticus staffs are propheticus also happens to be your responsive again remember proteus especially really loves to cause these you know they'll show you like an x-ray image of a person's kidneys and boom you see like this white stuff that looks like almost like antlers or whatever it's called if you see that where you're thinking of us provide stones right? Remember those are your magnesium and monium phosphate stones right?

sometimes they call them staghorn calcula right? So again in our current NBME world one thing that has been important I'll say probably over the last like 18 months risk factors in me means the love love love love risk factors you you should expect to see many risk factor questions on your exams again I have podcasts for those right? episode 37 97 184 but let's talk about risk factors for person getting a UTI well I mean female anatomy remember if you're a woman your rethra is pretty short and your rethra is also pretty close to the ainess that's not a problem that may have unfortunately right? So it's almost like the bacteria is almost like instead of having to travel from the east coast to the west coast to cause UT Is in men for women the bacteria can just travel from the west coast to the west coast to cause UT Is right? So females you know you have a short URI thra your rethra is pretty close to the ainess which has a ton of bugs that's gonna increase your risk of having UT Is if you have diabetes your urine is very sweet since your urine is very sweet that's gonna cause a bacteria to grow essentially organizing a party for the bacteria that's gonna cause problems remember the SGLT2 inhibitors those diabetes drugs right? So colloquially flossing, dipadly flossing and impagly flossing so those drugs inhibit you from reabsorbing glucose at your at the level of the proximal convoluted tubio right?

So again that's gonna make your urine sweet that's gonna cause problems and don't forget those SGLT2 inhibitors specifically because they put so much sugar in your urine there'll be so much sugar in your perineum that can cause a very life-threatening infection of the perineum right? Like literally like necrotizing fasciitis of the perineum that's what we call phonyis gangrene phonyis f-o-u-r and i-e-r four years and you know post-rophion and s phonyis gangrene that can be something you may see in a person that has a stich in an SGLT2 inhibitor and then remember if you're pregnant right when you're pregnant you have this wonderful placenta in your uterus, a placenta is making a ton of progestin. Progestin is a very big time a smoke muscle relaxant, if you relax smoke muscles especially in the urethra that's gonna cause your inner is thesis you're gonna get a UTI from that and the thing is as you get older you're also gonna get you more UT Is right?

Well I mean young females but especially if you're sexually active you're gonna be getting a lot of UT Is but as a woman gets older right that predisposes her to UT Is because the thing is estrogen actually helps you maintain your vaginal floor right and you know if you have a certain kind of vaginal floor is almost like a survival of the fittest protects you against having a UTI right but once you kind of hit menopause your ovaries go away or you know become non-functional you don't make any estrogen anymore that's gonna cause a lot of problems with maintaining that vaginal floor you're gonna get a UTI right another risk factor for UT Is, a person that has had a stroke or some kind of spinal cord injury right? Especially people that spinal cord injuries right? The ablutter dysfunction again if your bladder doesn't work well you're gonna have a urinary state it'll be draining the bladder well gonna have a urinary thesis that's gonna cause a UTI right? And remember these people that have had spinal cord injury they tend to use catheters a lot to evacuate to get rid of the urine right? So that's gonna again predispose them to having a UT Is right? In fact the most common kind of infection in people's spinal cord injury is a UTI believe it or not right? And then also if you're a guy and you have BPH right?

If your prostate gets super big and then it kind of squishes your urethra you're not able to drain your bladder well again this is gonna cause urinary stasis this is gonna cause a UT Is again I think as you're seeing three things principally cause you to get UT Is you either have urinary stasis that's probably like the big one the second one is your urine is very sweet because you're diabetic or you're taking some of these oral hypochloricimics that dump a ton of sugar in your urine or you can just have an atomic or problems right like BPH female anatomy and stuff like that right? So how do we treat UT Is? Actually maybe if I can talk about this how do you diagnose UT Is? So in general UT Is are a clinical diagnosis or especially bladder infections propitiates like the classic signs and symptoms of a bladder infection or pylon arthritis you don't have to do any kind of diagnostic testing just go ahead and proceed to treatment I'll talk about how you treat it in a bit but there I'll see few populations of people who should consider doing some testing or what's that some testing? Well that some testing is a urinalysis and urine culture right? Your analysis and culture um that's for bladder infection and also for kidney infection for pylon but for pylon um in certain populations testing also means getting a CT scan of the abdomen and pelvis with with IV contrast right? So we'll talk about some of those some of those are populations right?

So some of those are populations so who so again I said in general if a person presents with a classic signs and symptoms of pylon or the classic signs and symptoms of cystitis just make your clinical diagnosis go ahead and treat right? So how do we go ahead and treat? Well the way we go ahead and treat for bladder infection is you can use back trim or you can use trimethyperum stuff in the thoxasol or you can use like nitroferentoid right? or you can even use amoxicillin clavolanic acid that's actually the correct answer believe it or not also nbim exams you can use a cephalosporine if you want those are your first line agents now let me tell you this your second line agent for UT Is in general on nbim exams is a fluoroquine alone if you see any of these other options I've mentioned in an answer stem as among your answer choices and you see a fluoroquine alone pick all these other things first before you pick a fluoroquine alone right? because again fluoroquine alone they can cause a lot of problems right they can cost tendonitis they can cause your rupture Achilles right and they cause problems at the level of the neuromuscular junction right? so they kind of worsen myestinia graves that's kind of a similar case as amino glycosides right? remember amino glycosides and neuromuscular blocking agents fluoroquine alone again they cause neuromuscular junction dysfunction right?

so if a person has myestinia if you're not be putting those people on fluoroquine alone or amino glycosides like gentamysen on an nbim exam that would not be a great idea but if you don't see any of these other options and you just see a fluoroquine alone you can pick a fluoroquine alone that's perfectly fine on your exams right? now so that's for bladder infection but for pylon arthritis on nbim exams though you can either try axon or try to get a fluoroquine alone or try to get a trimethroprams off of a thoxesol okay? so that's how you treat pylon on an nbim exams and most times you know pylon you're going to give IV antibiotics versus cystitis where you're going to do more oral antibiotics right? so so who are some of the populations where you're like okay let's let's make sure we do diagnostic testing right? let's give us your analysis, your enculture and then if it's a kidney infection like in addition to your your analysis and culture where like oh let's get a CT scan these are both have like complicated uti's right? so people that are like diabetic that's one classic group people that are immunocompromised that's another classic group like HIV patients people that are pregnant right? males if males get uti's that's a big cost for concern there's a massive cost for concern you you got to do something there right? so again those are just some key populations to kind of keep at the back of your mind for for exams right?

and again one other thing I will say about uti is as I begin to wrap up is remember if woman is not pregnant and she has no symptoms but you check a urine on urine contains a lot of bacteria you don't have to treat that's what we call this symptomatic bacteria urea right? you don't treat it symptomatic bacteria urea but if a woman is not pregnant and she has symptoms she's symptomatic they're good obviously you're going to treat right? now that case does not apply with pregnancy if you're pregnant it doesn't matter your symptomatic not symptomatic it literally doesn't matter is symptomatic bacteria even in pregnant women is treated right? I remember in treatment in pregnant people you have to do that diagnostic test you got to get your analysis get to get the urine culture you probably want to go ahead and avoid the CT scan so you don't get in trouble with you know radiation to the fetus you don't want to do that but you know you want to do your analysis your encounter in pregnant women you want to treat them usually with like 70s of therapy like you don't need to know that for exams but after that you need to do a test of cure you need to do a test of cure now the reason that OB-GYN doctors are very aggressive or the NV Me expects to be very aggressive with uti's during pregnancy is that they actually are risk factor for preterm labor right?

and the thing is in pregnant women the only drugs you should really be using for uti's are mitrofure and towing or sephalaxin you can use any of those drugs right? don't use backtrem in a pregnant woman you're gonna try to you don't want to be killing the fetus right? I mean backtrem is literally like a fully synthesis inhibitor that does sound like a very pristine idea for a pregnant woman now just some other quick things to be throwing in with uti's on exams that can get people in their own direction is if you notice that a person has a uti and you know you do a gramstay of the gramstay of the urine you don't see any bugs or you do a culture you don't grow anything and it's a young sexually active female I want you to think of a urethritis potentially as a infection right? usually it's gonna be like chlamydia on an NV Me exam or you may also see the bug on micro plasma genitalia those are the two-box they classically test with these uh um antecedents on NV Me exams in those circumstances all you're given is doxycycline or or is it through my sick? now let me tell you this the biggest risk factor for uti's in a young sexually active female is actually sexually intercourse this is actually very high you know right? you see many women that's why when they get married the first few months of marriage they're getting in a ton of uti's right? because it's just super I mean most people when they just get married they're like super sexually active right?

back and absolutely cause problems in those people right? so the biggest risk factor for uti's especially in a young sexually active female is a sexually intercourse itself right? and again if you see a child with a uti if a child is less than because I know there's like all these resources that use all these different uh uh cutoffs and whatever but if you see a child less than two years old and they have a uti you need to do a renal ultrasound um first and then after that you do avoid inciseterory throgram in those kids right? just to make sure they don't have any anatomic problems that is causing their uti uh you just want to make sure they don't have any anatomical problems causing their uti's and the thing with these kids is that uh when you see them they keep getting these recurring uti's those things unfortunately can cause like permanent renal damage so to prevent that permanent renal damage from happening one smart thing you can actually do is to just put them on daily antibiotic therapy right? daily antibiotic therapy and also remember if a woman gets uh uti's a lot like gets uti's a lot and you notice that uh it's associated with her having sex then you want you can potentially put her on like just daily suppressive therapy right?

and uh one other thing you can also do is you can also just give like post-coido antibiotics so daily suppressive therapy post-coido antibiotics are perfectly fine in uh in these women um it's something that certainly is pretty common in uh in primary care right? and when you're doing uh because the thing is most times adults are pretty good sample givers for uti if you want to diagnose a uti the thing is in kids if you're trying to make a diagnosis kids are not very liable right? so you have some very specific criteria you need to know naming exams for the urine samples you're getting from kids remember it needs to be a clean catch midstream sample right? so what do I mean by midstream? so the child will study urine eating and then midway through the air urination as the urine is still flowing you catch something and has to be a clean catch specimen although many times if the child is hospitalized you can just do a urinary catheter and just draw out urine that way so to wrap up I will just talk about one weird thing you may see on your exam right?

they can give you a question about a patient they tell you that oh this patient has had like you know dysuria frequency everything and then they are taking an over the counter pill to help with the pain and then they tell you that oh they've been taking this for like three days and then they develop like period or say anosis and you know they kind of uh shot a breath and all those things if you see this I want you to think of methemoglobinemia from finazopyridine right? so azophynazopyridine it's belt as a ph-e-n-e-z-o-p-y-r-i-d-i-n-e finazopyridine it can actually cause methemoglobinemia because remember no hemoglobin has iron in the two plus state methemoglobin is iron in the three plus state as well we just need another great thing right? because iron in the three plus state cannot bind to oxygen right? so obviously in those circumstances you're going to stop the easel you're going to give the person a methylene blue and you know maybe vitamin C to fix their problems remember vitamin C activates methemoglobin reductase as well right?

it makes it work better so you can get fe 3 plus back to fe 2 plus so I think I'm going to go ahead and stop here again as I do at the end of every podcast again I do offer one on one heroine for many exams step one step 2ck step 3 preclinical medical exams 30-year clerkship shelf exams I also offer you know these review courses especially the 24 hour view course for step 2ck and step 3 and the mbme testing strategies course and then I have these podcasts on Apple podcasts on Google podcasts on Spotify at least the most recent 150 if you want everything from episode one all the way to this great episode of episode 356 just go on the website divineinterventionpodcasts.com if you sign up with your Word Press account then you can get any middle notification whenever I make a new podcast and then I have a You Tube channel that's where I post my videos divine intervention usmly podcasts and videos and then I do have another website divineinterventionlifelessens.com in fact it actually has a podcast associated with it it's an Apple podcasts it's called the divine intervention life lessons podcast and I make like one or two podcasts a week that reflect on some life lesson that's pretty you know Bible based teaching gonna come onto humanity like a problem that many people face I started a new series to be actually on the law so in a rip-in so if that's something you're interested in just go to that website to have about 43 episodes right now and it's gonna keep growing every every week so have a wonderful Sunday God bless you I hope you really really enjoy your day and just you know stay warm stay safe wear your mask get your vaccine and I trust that all be well with you thank you okay bye

Dysuria (pain with urination), urinary frequency, and urgency.

Flank pain, fever, and costovertebral angle tenderness (CVAT).

Fluoroquinolones and Aminoglycosides.

Catheter-associated UT Is (CAUTI).

Urethritis, potentially caused by Chlamydia or Mycoplasma genitalium.

Decline in estrogen production post-menopause, leading to vaginal floor atrophy and altered flora.

Benign Prostatic Hyperplasia (BPH), spinal cord injury/neurological dysfunction, or bladder outlet obstruction.

Increased risk of perineal infection, potentially leading to Fournier's gangrene.

Renal ultrasound and avoiding cystoscopy/urogram initially (to rule out anatomical abnormalities).

Non-pregnant: Usually no treatment needed if asymptomatic. Pregnant: Always requires diagnosis and treatment regardless of symptoms or culture results.

Nitrofurantoin and Cephalexin (or other cephalosporins).

It oxidizes Fe²⁺ hemoglobin to Fe³⁺ methemoglobin. Antidote is Methylene Blue or Vitamin C.

Benign Prostatic Hyperplasia (BPH), spinal cord injury/neurological dysfunction, or bladder outlet obstruction.

Increased risk of perineal infection, potentially leading to Fournier's gangrene.

Renal ultrasound and avoiding cystoscopy/urogram initially (to rule out anatomical abnormalities).

Non-pregnant: Usually no treatment needed if asymptomatic. Pregnant: Always requires diagnosis and treatment regardless of symptoms or culture results.

Nitrofurantoin and Cephalexin (or other cephalosporins).

It oxidizes Fe²⁺ hemoglobin to Fe³⁺ methemoglobin. Antidote is Methylene Blue or Vitamin C.