urinary tract infections

Question 1

define a upper urinary tract infection,

Answer 1

kidney till above the bladder

Question 2

define a lower urinary tract infection.

Answer 2

bladder to the end of the urethra.

Question 3

Is the bladder sterile or a non-sterile site.

Answer 3

sterile

Question 4

Are the kidneys and ureters a sterol or non sterol site.

Answer 4

sterile

Question 5

Is the urethra a sterile or non sterile site.

Answer 5

not sterile

perineal flora from the skin or bowel.

Question 6

what flora does perineal flora consist of

Answer 6

skin flora- predominantly coagulase (negative staphylococci)

Lower GI tract flora- anaerobic bacteria, aerobic bacteria (Enterobacteriaceae), gram +ve cocci

Question 7

Is cystitis a lower or upper tract infection.

Answer 7

lower urinary tract infection

Question 8

symptoms does cystitis present with

Answer 8

dysuria- pain when passing urine
urinary frequency
urgency
supra pubic pain
polyuria, nocturia, haematuria.

Question 9

is pyelonephritis a upper or lower urinary tract infection

Answer 9

upper urinary tract infection

Question 10

symptoms of of pyelonephritis

Answer 10

loin, abdominal pain and tenderness, fever, rigours, nausea, committing, diarrhoea,

Question 11

what 2 measures will be elevated in pyelonephritis

Answer 11

elevated CRP and WBC.

Question 12

what age group does urethral syndrome typically effect

Answer 12

30-50 year olds

Question 13

what are the causes of urethral syndrome

Answer 13

symptoms of a upper urinary tract infection without infection

hormonal imbalance
inflammation of Skene glands and the paraurethral glands.
foods
environmental chemicals (bubble batch, condoms, gel)
Hypersensitivity following urinary tract infection
traumatic sexual intercourse.

Question 14

what criteria determines where there is significant bacteria

Answer 14

Kass

Question 15

what does significant bacteria indicate

Answer 15

upper respiratory tract infection.

Question 16

what number is class as significant bacteria

Answer 16

10 ^5 cfu(colony forming units)/mL

Question 17

limitations of using a figure to determine whether a patient has or doesn’t have significant bacteruria.

Answer 17

o Many symptomatic females have bacterial counts of

Question 18

define asymptomatic bcteriuria

Answer 18

more than 10^5 cfu/ml, but no symptoms are present.

Question 19

most common cause os asymptomatic bacteruria in elderly

Answer 19

catherisation.

Question 20

define sterile pyuria

Answer 20

pus cells in urine (WBC).

no organism grown in culture.

Question 21

what are the predisposing factors for developing a UTI

Answer 21

female
urinary stasis-pregnancy and prostatic hypertrophy.
Instrumentation
sexual intercourse
fistulae
congenital abnormalities- most commonly vesico-ureteric reflux (VUR)

Question 22

3 most common sources of infection

Answer 22

perineum instrumentation
fistulae
haematogenus

Question 23

which organism most commonly causes UTI’s

Answer 23

E.coli

Question 24

which is the second most common organ to cause UTI

Answer 24

staphylococcus saprophyticus

Question 25

3 causes of sterile pyuria

Answer 25

inhibition of bacterial growth
fastidious (hard to grow) organisms
Urinary tract inflammation (stones)

Question 26

prevention of bacteracemia form cauterisation.

Answer 26

antibiotic prophylaxis

Question 27

what is the difference between the colonisation of bacteria do to catheter and infection

Answer 27

colonisation- bacteria present but no symptoms

infection- bacteria and symptoms are present.

Question 28

what investigations are carried out when determining as UUTI or LURI

Answer 28

dipstick, blood test, microbiological and imaging.

Question 29

what does a dipstick test

Answer 29

Blood, Protein, Nitrite, White blood cells (leucocyte esterase

Question 30

dipstick testing not diagnostic for a patient using what form of equipment.

Answer 30

for a patient with indwelling urinary catheter.

Question 31

what microbiological investigations are undertaken

Answer 31

URINE
•	Mid-stream (MSU)
•	Catheter urine (CSU)- from the bag.
•	“Clean catch”- common in children.
•	Supra-pubic aspirate (SPA)- invasive, needle into bladder, because they cannot wee due to swollen prostate.
BLOODS
pyelonephritis.

Question 32

further investigations other than microbial investigations

Answer 32

– Renal tract ultrasound scan- congenital abnormalities, kidney stones.
– Specialised tests
• Isotope scans (DMSA, DTPA, MAG3), micturating cystourethrogram

Question 33

what treatment is provided to treat urinary tract infections.

Answer 33

Antibiotics

Question 34

what are the requirements of antibiotics used to treat a urinary tract infection.

Answer 34

present in urine
minimally toxic
effective
easily administered cheap

Question 35

examples of commonly used antibiotics in UTI’s

Answer 35

– Nitrofurantoin- typically used
– Pivmecillinam- new
– Trimethoprim- typically used
– Fosfomycin- new.

Question 36

treatment for pyelonephritis

Answer 36

cefuroxime and ciprofloxacin

7-14 dyas

Question 37

define cystitis

Answer 37

inflammation of the bladder

Question 38

which groups of patients are treated for asymptomatic bacteurinia

Answer 38

pregnant
infant- prevent pyelonephritis and renal damage
prior to a urological procedure-• prevention of UTI/bacteraemia

Question 39

what is used to determine what antibiotic is used to treat a patient

Answer 39

sensitivities.

Question 40

when are further investigations carried out (nor just microbiology)

Answer 40

– Recurrent UTI
– Any UTI in male patient
– Any UTI in childhood
– Pyelonephritis