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Medicine > Genitourinary Infections/Sexually Transmitted Infections > Flashcards

Genitourinary Infections/Sexually Transmitted Infections Flashcards

1
Q

What are the classifications of genitourinary infections

A

UTIs
Genital tract infections

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2
Q

What is the most common GUI

A

UTI

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3
Q

UTIs are more common in women
True or false

A

True

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4
Q

Which bacteria are responsible for non-nosocomial uncomplicated UTI

A

Coliforms especially E. coli

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5
Q

What is an uncomplicated UTI

A

A symptomatic bladder infection with a normal urinary tract

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6
Q

What is a complicated UTI

A

A symptomatic infection of any part of the urinary tract with a functional or structural urinary

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7
Q

What are some host factors predisposing to UTI

A

Female sex
Sexual intercourse
Use of spermicides
Urinary stasis or BPH
Comorbities especially diabetes mellitus, Immunosuppression
Institutionalized patients
Increasing age
Eradication of vagina commensalism organisms
Urinary tract stones
Urinary catheter
Hugh concentrated urine (>800mOsmol/kg) or failed urinary acidification (pH>5)

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8
Q

Which bacteria cause UTIs

A

E. coli
Klebsiella
Enterococci
Pseudomonas
Proteus mirabilis
Citrobacter
Staphylococcus aureus
Coagulate negative staphylococci

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9
Q

Acute cystitis is an infection of which part of the body

A

Bladder

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10
Q

What are some symptoms of UTIs

A

Offensive urine
Suprapubic discomfort
Irritating voiding symptoms
Frank hematuria
In the elderly, UTI may present with confusion

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11
Q

What are some laboratory findings of cystitis

A

Urinalysis shows pyuria, bacteriuria and varying degrees of hematuria (the degree of pyuria and bacteriuria does not necessarily correlate with the severity of symptoms)
Urine culture is positive for the offending organism

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12
Q

To test for acute pylonephritis, what physical examination could you do

A

Renal angle tenderness

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13
Q

Mention some investigations of UTI

A

Dipstick urine
Clean catch MSU for microscopy
Urine culture
Imaging
WCC, CRP, serum creatine, U&E

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14
Q

What are some investigatory imaging for UTIs

A

USG to exclude obstruction with hydronephrosis and diagnose stones
Non-contrast CT
Pre and post-micturution images of the bladder to exclude
Urodynamic flow studies
Cytoscopy

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15
Q

Who needs a closer attention wrt UTIs

A

Males
Children (they might have posterior urethral valves so their pee does not come out regularly)
Recurrent UTI
Pregnant women
Immunocompromised
Kidney stones
Proteus UTI
Indwelling catheter or ureteric stent
Known abdominal UTI

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16
Q

What are some things to start while waiting for culture

A

Flouroquinolones (Ciprofloxacin)
Rehydration with 0.9% NaCl

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17
Q

What are things to do in an uncomplicated lower UTI (cystitis) when waiting for culture

(Mention the specific antibiotics)

A

Oral cephalosporins
Fosfomycin
Encourage high fluid intake

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18
Q

What sign in imaging confirms a xanthogranulomatous pyelonephritis

A

Bear paw sign

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19
Q

When the PSAs go up, what is feared but isn’t necessarily fixed to be that

A

Cancer of the prostate

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20
Q

A sterile inflammatory cystitis, presenting in females
What disease is this

A

Interstitial cystitis

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21
Q

Reactive arthritis is a triad which is made up of

A

Arthritis
Urethritis
Conjunctivitis

22
Q

What is asymptomatic bacteriuria

A

The isolation of >105 CFU ml of bacteria from an appropriately collected clean urine specimen

23
Q

What is the requirement of urine in asymptomatic bacteriuria for women

A

Two consecutive voided urine specimen

24
Q

Asymptomatic bacteriuria is more prevalent in what type of women

A

Pregnant women
Postmenopausal women
Diabetics
Persons > 70 years of age
Patients needing intermittent catheterization or in patients with an indwelling urinary catheter

25
Q

What are some lavatory findings in a asymptomatic bacteriuria

A

Urine culture is positive for the offending organism but colony counts exceed 105/ml are not required for the diagnosis
Patients with asymptomatic bacteriuria or colonization are expected to have positive urine cultures but do not require treatment except in pregnant women

26
Q

What are the initial assessments to determine if admission is necessary in acute pyelonephritis

A

Nausea and vomiting
Systemically unwell

27
Q

What are some treatment suggestions in an acute pyelonephritis patient whose urine culture awaits

A

Start fluoroquinolones (cipro and levo) for 14 days. Alternatives include co-amoxiclav IVI, then PO or a 3rd generation cephalosporin IVI then PO for 14 days
Consider an additional single dose gentamicin (3-5mg/kg IV)
Rehydration with 0.9% NaCl
Appropriate analgesia and antiemetics

(Acute pyelonephritis is to fluoroquinolones, cephalosporins and gentamicin)

28
Q

What is the treatment of catheter related UTI

A

Continue antimicrobials for a minimum of 7 days and remove the catheter if possible

29
Q

How is catheter related UTI diagnosed

A

Cultures positive for 710 cfu/ml and heavy pyuria (pyuria is not always a reliable marker of infection in this context)

30
Q

What is the best treatment for catheter related UTI

A

Prevention is best. Avoid catheterization or remove Cather as soon as possible after use

31
Q

What is emphysematous pyelonephritis

A

It is a necrotizing infection of the renal parenchyma and its surrounding areas that results in the presence of gas in the renal parenchyma, collecting system or perinephritic tissue

32
Q

What causes emphysematous pyelonephritis

A

Gas causing enterobacteriaceae and occurs predominantly in diabetic patients (90%) and presents as a severe pyelonephritis

33
Q

Which imaging could be used to investigate emphysematous pyelonephritis

A

KUB x-ray or CT

34
Q

Is mortality high in emphysematous pyelonephritis

A

Yes

35
Q

What are some ways of treating emphysematous pyelonephritis

A

Broad spectrum antibiotics
Urgent nephrectomies

36
Q

What is a xanthogranulomatous pyelonephritis

A

It is a chronic unilateral pyelonephritis associated with renal calculi or obstruction and causes widespread parenchyma destruction. It is more common in diabetes mellitus. Presents as a fever, nausea, anorexia, weight loss, flank pain and systemic upset. The affected kidney is often palpable

37
Q

What are some treatments for xanthogranulomatous pyelonephritis

A

Nephrectomy

38
Q

What are some imaging investigations to be done in xanthogranulomatous pyelonephritis

A

Urinalysis and MSU
UTI is usually proteus spp. or other gram negative bacteria
CT confirms diagnosis
Relapse is common
Treat initially for pyelonephritis

39
Q

What is hyperthermia

A

It is an unregulated rise in body temperature due to a failure of temperature homeostasis

40
Q

What is fever of unknown origin

A

Continous fever of at least 3 weeks duration with daily temperature elevation above 38.3 oC and remaining undiagnosed after a week of intensive study in hospital

41
Q

What are the four categories of FUO

A

Classical
Nosocomial
Immune deficient/Neutropenic
HIV associated

Each group has a unique differential diagnosis based on characteristics and vulnerabilities and, therefore, a different process of evaluation

42
Q

Typical subgroups used in the differential for classical FUO are

A

Infection
Malignancy
Non-infectious/Inflammatory diseases
Miscellaneous
Undiagnosed

43
Q

Mention some infections which cause PUO

A

Bacterial
TB
UTI
Abscesses
Sinusitis
Endocarditis
Viral

44
Q

What are some viral causes of PUO

A

CMV
EBV

45
Q

What are some granulomatous infections for PUO

A

TB
Fungal

46
Q

What are some pyogenic infections that could cause PUO

A

RUQ infections (Cholangitis, cholecystitis,liver abscess, subphrenic, subhepatic)
Abscess secondary to bowel diseases (Diverticulitis, appendicitis)
PID
Renal infections (pyelonephritis, perinephric, subhepatic abscesses)

47
Q

What are some miscellaneous infections that could cause PUO

A

Malaria
IMN
CMV disease
Amoebiasis
Coxsackie B diseases trichinosis
Q fever
AIDS

48
Q

What are some investigations to make in stage one of an FUO

A

FBC
ESR (erythrocyte sedimentation rate)
BF - Malaria parasites
Blood C/S
Sputum (cell type/ count, Gram stain, C/S, AFBs for TB)
Urine R/E & urine C/S
Blood urea, creatinine and electrolytes

49
Q

What are some investigations to make in stage two of an FUO

A

CT scan (chest/ abdomen/ pelvis)
Markers of connective tissue disease eg. Rh factor, ANA, etc
Tumor markers. Eg. PSA, CEA

50
Q

What are some investigations to make in stage three of an FUO

A

Invasive tests such specialised test eg echocardiography, electrocardiography, lumbar puncture, biopsy etc

51
Q

What are some history to take in an FUO patient

A

Sexual history
Travel history (including foreign travel)
IV drug use
Immunosuppressive illness
Contact history (people and animal contacts)

Medicine (38 decks)

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