Chapter 91: Urinary Tract Infection and Hematuria

Question 1

asymptomatic bacteriuria

Answer 1

1. The presence of >100,000 (>10x5) colony-forming units (CFU)/mL of a single pathogen on two successive clean-catch urine cultures in a woman without symptoms.
2. The presence of >100,000 (>10x5) CFU/mL on one clean-catch urine culture in asymptomatic men.
3. The presence of 100 CFU/mL of a single isolate in a catheterized urine specimen in a patient without symptoms.

Question 2

prevalence of asymptomatic bacteriuria in patient with indwelling catheter for more than a month

Answer 2

100%

Question 3

T or F: Treatment of asymptomatic bacteriuria is recommended only in pregnant women and patient to go on invasive urinary procedure

Answer 3

True

Question 4

where does cystitis starts?

Answer 4

urethritis what colonized by pathogen form GI system

Question 5

how cystitis diagnosed?

Answer 5

dysuria, urinary frequency, and hematuria

Question 6

what is the difference in diagnosis of urethritis to cystitis?

Answer 6

in urethritis their is presence of discharge

Question 7

patient presented with flank pain or costovertebral angle tenderness, with or without fever, in the setting of a positive urine culture of 105 CFU/mL what is your diagnosis?

Answer 7

pyelonephritis

Question 8

3 pattern of renal infection as complication of pyelonephritis

Answer 8

acute bacterial nephritis
renal abscess
emphysematous pyelone- phritis

Question 9

T or F:
The traditional diagnostic criterion dating from 1960 of uncomplicated UTI had been a positive urine culture of 105 CFU/mL; however, in symptomatic patients, low-colony-count infections with ≥102 to 103 CFU/mL are clinically valid

Answer 9

True

Question 10

T or F:

recurrent infection alone is a criterion for complicated UTI.

Answer 10

False

recurrent infection alone is not a criterion for complicated UTI.

Question 11

complicated UTI diagnostic criteria in terms of urine culture

Answer 11

isolation of 105 CFU/mL of urine culture

Question 12

this refers to the clinical syndrome of fever and flank pain or tenderness with or without vomiting in a woman with an anatomically normal urinary tract without comorbidities

Answer 12

Uncomplicated pyelonephritis

Question 13

Catheter-associated UTI (CAUTI) refers to a UTI occurring in a per- son whose urinary tract is currently catheterized, or has been within the previous ___

Answer 13

48 hours

Question 14

how recurrent UTI diagnosed?

Answer 14

Recurrent UTI is defined as two uncomplicated UTIs in 6 months or three or more uncomplicated UTIs in the preceding 12 months

Question 15

2 categories of recurrent UTI

Answer 15

relapse

reinfection

Question 16

category of recurrent UTI that happen within 2 weeks of treatment completion caused by the same organism from a focus within the urinary system

Answer 16

relapse recurrent UTI

Question 17

category of recurrent UTI that caused by a different bacterial isolate or by previously isolated bacteria after a negative intervening culture or a period of >2 weeks between infections

Answer 17

reinfection recurrent UTI (more common than relapse)

Question 18

The strongest behavioral risk factors for recurrent UTI (in women) are the frequency of ___

Answer 18

sexual intercourse and the use of a diaphragm and spermicide

Question 19

mechanism to get UTI?

Answer 19

ascending infection (most common)
hematogenous
lymphatic

Question 20

37 year old male presents dysuria with a urethral discharge. what is the diagnosis?

Answer 20

urethritis

Question 21

In women, Chlamydia infection should be suspected in the following settings

Answer 21

new sexual partners
partner with urethritis
examination findings of cervicitis
low grade pyuria (no bacteria in urinalysis)

Question 22

T or F:
A history of vaginal discharge or irritation is more often associated with vaginitis, cervicitis, or pelvic inflammatory disease than with UTI

Answer 22

true

Question 23

Approximately ___ of patients treated for sepsis have an etiology from the genitourinary system

Answer 23

10% to 19%

Question 24

T or F:
Bacteria in urine double each hour at room temperature, so urine should be refrigerated if not sent directly to the laboratory

Answer 24

True

Question 25

urinalysis result that are uncentrifuged or dipstick test

Answer 25

leukocyte esterase | nitrate

Question 26

E. coli will convert nitrate to nitrites in urinalysis. what bacteria do not?

Answer 26

enterococcus pseudomonas acinetobacter species

Question 27

T or F: A positive urinary dipstick nitrite or leukocyte esterase test result supports the diagnosis of UTI, but a negative test result does not exclude it in the correct clinical presentation

Answer 27

True

Question 28

A WBC count of ___ in a centrifuged specimen from a symptomatic patient is abnormal

Answer 28

>5 cells/high-power field (HPF)

Question 29

T or F: | In men, >3 or 4 WBCs/HPF in a centrifuged specimen can be significant when bacteria are present

Answer 29

False | In men, >1 or 2 WBCs/HPF in a centrifuged specimen can be significant when bacteria are present

Question 30

T or F: The presence of any bacteria on a Gram-stained specimen of uncentrifuged urine (>1 bacterium/HPF or 1000×) is significant and highly correlates with culture results of >105 CFU/mL

Answer 30

True

Question 31

accurate predictors of a UTI

Answer 31

dipstick test positive for nitrates moderate pyuria and/or bacteriuria

Question 32

Urine culture should be performed for the following patients

Answer 32

complicated UTI pyelonephritis sepsis recent antimicrobial therapy

Question 33

The primary indication for blood cultures in patients with suspected UTI is clinical ___

Answer 33

clinical sepsis

Question 34

renal ultrasound is indicated with the following patient

Answer 34

``` male elderly diabetic Beverly ill acute worsening of renal function (GFR <40mL/min) ```

Question 35

Plain film radiography and US have poor sensitivity for detection of intrarenal gas formation in ___

Answer 35

emphysematous pyelonephritis

Question 36

CT is the best imaging modality for the following diseases

Answer 36

kidney or ureteral stones | emphysematous pyelonephritis

Question 37

how many residual volume predisposes to bacteriuria?

Answer 37

>180mL

Question 38

guidelines in treatment of UTI including pyelonephritis in divided into 3 groups which are

Answer 38

1. uncomplicated lower tract disease 2. complicated UTI or pyelonephritis 3. women with UTI symptoms in whom coexistent urethritis cannot be excluded

Question 39

this drug continues to be recommended due to its limited adverse effects

Answer 39

Trimethoprim-sulfamethoxazole

Question 40

T or F: | A 5-day course of extended-release nitrofurantoin is as effective as 3 days of trimethoprim-sulfamethoxazole therapy

Answer 40

True

Question 41

first-line drug of choice for uncomplicated UTI

Answer 41

single 3 gram dose fosfomycin

Question 42

Both nitrofurantoin and fosfomycin are recommended oral agents in the event of ___

Answer 42

extended-spectrum β-lactamase– producing E. coli infection

Question 43

Third-generation cephalosporins are highly effective against ___, whereas first-generation cephalosporins are more effective against ___

Answer 43

enterobacteria | staphylococci

Question 44

why the CDC do not recommend Fluoroquinolones as treatment for both cystitis and urethritis?

Answer 44

because of N. gonorrhoeae infection

Question 45

antibiotic for adult female with lower (cystitis) uncomplicatied?

Answer 45

1. Nitrofurantoin monohydrate/macrocrystals, 100 milligrams twice a day × 5 days 2. TMP-SMX DS (160/800 milligrams), 1 tab twice a day × 3 days 3. Fosfomycin, 3 grams in single dose or (where available) 4. Pivmecillinam, 400 milligrams twice a day × 5 days - urine culture not required

Question 46

antibiotic for adult male with lower (cystitis) or adult female with upper (pyelonephritis), complicated?

Answer 46

1. Ciprofloxacin, 500 milligrams twice a day × 5–7 days 2. Levofloxacin, 750 milligrams once a day × 5–7 days -urine culture required

Question 47

antibiotic for adult female with lower (urethritis)

Answer 47

1. Ceftriaxone, 250 milligrams plus Azithromycin, 1-gram single dose or Doxycycline, 100 milligrams twice a day × 7 days

Question 48

Men with UTI without immunocompromise may have improved outcomes with therapy for ___, rather than 14 days

Answer 48

7 days

Question 49

treatment plan for CAUTI other than antibiotic?

Answer 49

replacement of catheter prior to start of antibiotic and collection for culture

Question 50

The decision to admit a patient with UTI is based on ___

Answer 50

age, host factors, and response to initial ED interventions

Question 51

oral bladder analgesics that reduced dysuria

Answer 51

phenazopyridine 200 mg PO TID

Question 52

in pregnant women. First-line treatment for asymptomatic bacteriuria and simple cystitis is either ___

Answer 52

1. amoxicillin 500 milligrams PO two to three times daily for 3 to 7 days or 2. cephalexin 500 milligrams two to four times daily for 3 to 7 days.

Question 53

avoid nitrofurantoin in what trimester of pregnancy?

Answer 53

1st

Question 54

initial antibiotic for patient with UTI and HIV AIDS

Answer 54

Fluoroquinilones