1: Infections of the kidney (cystitis, acute pyelonephritis, urethral syndrome)

Question 1

How are UTIs classified

Answer 1

1. Upper or lower UTI

2. Simple or complicated UTI

Question 2

How are UTIs classified

Answer 2

1. Upper or lower UTI

2. Simple or complicated UTI

Question 3

What counts as upper urinary tract

Answer 3

• Kidneys

- Ureters

Question 4

What is infection of the upper urinary tract called

Answer 4

Pyelonephritis

Question 5

What is classed as lower urinary tract

Answer 5

• Bladder
• Urethra
• Prostate in males

Question 6

What is infection of the bladder

Answer 6

Cystitis

Question 7

What is infection of the urethra

Answer 7

Urethritis

Question 8

What population is a simple UTI

Answer 8

Non-pregnant pre-menopausal Immunocompetent women

Question 9

Who is classified as a complicated UTI

Answer 9

• Males
• Post-menopausal females
• Immunocompromised
• Diabetes
• Pregnant
• Anatomical abnormalities of the urinary tract
• Recent history instrumentation

Question 10

What counts as upper urinary tract

Answer 10

• Kidneys

- Ureters

Question 11

What is infection of the upper urinary tract called

Answer 11

Pyelonephritis

Question 12

What is classed as lower urinary tract

Answer 12

• Bladder
• Urethra
• Prostate in males

Question 13

What is infection of the bladder

Answer 13

Cystitis

Question 14

What is infection of the urethra

Answer 14

Urethritis

Question 15

What population is a simple UTI

Answer 15

Non-pregnant pre-menopausal Immunocompetent women

Question 16

Who is classified as a complicated UTI

Answer 16

• Males
• Post-menopausal females
• Immunocompromised
• Diabetes
• Pregnant
• Anatomical abnormalities of the urinary tract
• Recent history instrumentation

Question 17

What is acute pyelonephritis

Answer 17

Inflammation kidney

Question 18

What causes 90% of pyelonephritis

Answer 18

E.coli

Question 19

What are two rare causes of pyelonephritis

Answer 19

• Pseudomonas

- Klebsiella

Question 20

In which gender is pyelonephritis more common and why

Answer 20

Females - due to shorter urethra meaning a shorter distance to travel

Question 21

What are 4 risk factor categories for pyelonephritis

Answer 21

• Increase bacteria
• Increase binding
• Decrease urinary flow
• Increase bacterial growth

Question 22

What 4 factors increase bacterial inoculation

Answer 22

• Sexual activity
• Urinary incontinence
• Faecal inconitnence
• Constipation

Question 23

What increases binding of uropathogenic bacteria

Answer 23

Spermicide

Low oestrogen: menopause

Question 24

What decreases urinary flow

Answer 24

Urinary tract obstruction

Dehydration

Question 25

What increase bacterial growth

Answer 25

``` DM Pregnancy Immunocompromised Obstruction Renal tract malformation ```

Question 26

How does pyelonephritis present clinically

Answer 26

- Flank pain - Haematuria - Rigors - Vomiting - Symptoms of cystitis

Question 27

What is found on examination in pyelonephritis

Answer 27

- Tenderness over costa-vertebral angle

Question 28

How can pyelonephritis occur

Answer 28

- Ascending infection | - Haematogenously

Question 29

What investigations are ordered in suspected pyelonephritis

Answer 29

Urinalysis MC+S FBC, U+E, CRP, BC USS

Question 30

What will be seen on urinalysis

Answer 30

leucocytes nitrites haematuria

Question 31

What will be found on MSU culture

Answer 31

WCC >10(^5)

Question 32

How will FBC present in pyelonephritis

Answer 32

Leucocytosis

Question 33

How will CRP present in pyelonephritis

Answer 33

Raised

Question 34

What % of individuals with pyelonephritis have a positive blood culture

Answer 34

10-20

Question 35

What imaging is ordered in pyelonephritis

Answer 35

USS

Question 36

When are individuals with pyelonephritis admitted to hospital

Answer 36

Severe | Indicators of systemic illness (eg. sepsis)

Question 37

How are non-pregnant women, men or those with an indwelling catheter managed for pyelonephritis

Answer 37

7-10d Cefalexin | Co-amoxiclav, Trimethoprim and Ciprofloxacin are all alternatives

Question 38

How are pregnant women with pyelonephritis managed

Answer 38

Cefalexin 7-10d

Question 39

What are 4 complications of acute pyelonephritis

Answer 39

- Chronic pyelonephritis - Perinephric abscess - ESRD - Renal abscess

Question 40

When does chronic pyelonephritis occur

Answer 40

Due to recurrent acute pyelonephritis

Question 41

What is cystitis

Answer 41

inflammation of the bladder

Question 42

how is cystitis divided

Answer 42

- Complicated UTI | - Uncomplicated UTI

Question 43

what is a uncomplicated UTI

Answer 43

Normal urinary tract function and structure

Question 44

what is a complicated UTI

Answer 44

- Male - Pregnant women - Structural abnormalities urinary tract: stones, congenital anomalies, renal transplant

Question 45

in which gender is cystitis more common and why

Answer 45

Females- due to a shorter urethra

Question 46

what causes 80% of cystitis

Answer 46

E. coli

Question 47

what indicates cystitis due to proteus mirabilis

Answer 47

Alkaline urine | As proteus mirabilis produces urease causing ammonia smell

Question 48

how does cystitis present clinically

Answer 48

- Urinary frequency - Urgency - Dysuria - Haematuria - Supra-pubic pain

Question 49

when is investigation not required for UTI

Answer 49

Non-pregnant female under 65-years with more than 3-symptoms of UTI

Question 50

when is urinalysis indicated for UTI

Answer 50

Non-pregnant female under 65 years with less than 3 symptoms

Question 51

when should urinalysis not be used to diagnose UTI

Answer 51

Male Pregnant Children

Question 52

what is present in urinalysis in UTI

Answer 52

Haematuria Leucocytes Nitrites

Question 53

what finding on urinalysis indicates proteus mirabilis is causing infection

Answer 53

pH >7 | Due to proteus mirabilis producing ammonia which increases urinary pH

Question 54

what is second-line (in some) and first line (in others investigation for UTI

Answer 54

MSU

Question 55

what MSU indicates UTI

Answer 55

>10 (^5)

Question 56

when is USS indicated for cystitis

Answer 56

- Recurrent (more than 2 a year) - Atypical organism - Persistent haematuria despite treatment - Failure to respond to treatment

Question 57

How is uncomplicated UTI managed

Answer 57

3-days nitrofurantoin

Question 58

What is a CI to nitrofurantoin use

Answer 58

eGFR <45

Question 59

If nitrofurantoin cannot be used what is used

Answer 59

trimethoprim

Question 60

what is used for complicated UTI

Answer 60

7days nitrofurantoin

Question 61

explain antibiotics for UTI in pregnant women

Answer 61

- Trimethoprim is anti-folate so can't be used in first trimester - Nitrofurantoin cannot be used in third trimester - Amoxicillin generally preferred

Question 62

what are two complications of cystitis

Answer 62

- Acute pyelonephritis | - Prostatitis

Question 63

what are two complications of UTI in pre-term

Answer 63

IUGR | Pre-term delivery

Question 64

what is prostatitis

Answer 64

Ascending infection infiltrates the prostate gland

Question 65

what are four risk factors for prostatitis

Answer 65

- UTI - Recent biopsy - Instrumentration - Recurrent catheterisation

Question 66

what are symptoms of prostatitis

Answer 66

- Obstructive symptoms - Pain referred to perineum - Fevers

Question 67

how will DRE present in prostatitis

Answer 67

Tender, boggy prostate

Question 68

what should be screened for in prostatitis

Answer 68

STI

Question 69

how is prostatitis managed

Answer 69

14d Fluroquinolones

Question 70

define asymptomatic bacteria

Answer 70

presence >10(^5) bacteria in urine

Question 71

when is asymptomatic bacteruria screened for

Answer 71

screened for in pregnancy due to risk of pre-mature delivery

Question 72

what is urethral syndrome

Answer 72

symptomatic abacteruria

Question 73

what causes sterile pyuria

Answer 73

- GU TB - Urethritis (Chalmydia) - Renal stones - Appendicitis - Cancer - ADPKD