General UT Infections - Unrein

Question 1

lower vs. upper UT infection

Answer 1

uretal opening of bladder

Question 2

urinary tract infection

Answer 2

predominant female

• shorter urethra
• spermicides, pregnancy, vaginal atrophy

Question 3

dysuria, frequency, urgency, strong urine odor, cloudy urine, suprapubic tender

Answer 3

urinary tract infection

Question 4

simple cystitis

Answer 4

with or without dip stick in young female

tx on that basis without culture

culture indication
-pregnant
antibiotic resistant
-drug sensitivity
-underlying medical complication

Question 5

complicated cystitis

Answer 5

any males - men rarely simple

require culture and structural evaluation

turbulent flow

Question 6

where do you palpate the kidneys

Answer 6

sandwich method

Question 7

pyelonephritis

Answer 7

appear toxic
-lloyds sign

elevated WBC with left shift

usually ascending bacteria
-also heme/lymph spread

Question 8

asymptomatic bacteriuria

Answer 8

usually not treated
-treat if symptomatic or if pregnant

goal of treatment - prevent upper tract disease

urine is not sterile

female, diabetics, elderly

Question 9

infection vs. colonization

Answer 9

if symptomatic

-dysuria, frequency, strong odor, etc.

Question 10

urosepsis

Answer 10

SIRS

• may have hypothermia before hyperthermia
• WBC with left shift
• rigors
• 30% fatality

need blood and urine culture

Question 11

pathogens in urine

Answer 11

gram negatives
gram positive

fungi - not routine cultures - candida

anaerobes - not on routine cultures

Question 12

staph epidermidis

Answer 12

prosthetic device

Question 13

enterococcus

Answer 13

group D strep

Question 14

IV druguser

Answer 14

staph aureus

Question 15

young women

Answer 15

staph saprophyticus

Question 16

gram positives

Answer 16

strep and staph

stain darker purple

gram negative - pink

Question 17

sterile pyuria

Answer 17

culture negative

mycobacterium tuberculosos
adenovirus
polyomavirus
CMV
anaerobes
fungal
interstitial cystitis

Question 18

evaluation for UTI

Answer 18

CBC, renal chem
urine dipstick
urine culture
imaging - US or CT
urology/referral

Question 19

positive dipstick for nitrites and leukocyte esterase

Answer 19

70-90% sensitive for UTI

negative - high negative predictive value

Question 20

nitrites vs nitrates

Answer 20

nitrate - eukaryotes

nitrite - prokaryote (bacteria)

Question 21

tx of UTI

Answer 21

nitrofurantoin - not good
TMP/SMX
FQs
beta-lactams
aminoglycosides

duration:

• simple cystitis 3 days
• complicated/pyelonephritis - 10-14 days

Question 22

achilles tendon rupture

Answer 22

fluoroquinolone

Question 23

side effect aminoglycosides

Answer 23

ototoxicity

nephrotoxicity

Question 24

cranberry

Answer 24

to reacidify urine

Question 25

UTI prevention

Answer 25

post-coital voiding

antibiotic prophylaxis - pregnant, diabetes, recurrent UTIs

topical estriol, cranberry, methenamine

Question 26

methenamine

Answer 26

form formaldehyde in urine

Question 27

fever and left flank pain
33yo M
sharing needles
elevated WBC count, aortic valve murmur, rash on palms

Answer 27

staph aureus

Question 28

64yo M HIV positive, burning urination, dipstick leukocyte esterase, TNTC WBCs, no culture growth, most likely organism

Answer 28

candida

-immunocompromised

Question 29

18yo F urinary burning and frequency, spermicide and condom us

Answer 29

simple cystitis

-no culture - treat empirically 3 days