Infections

Question 1

what is an UTI

Answer 1

presence of micro-organism in the urinary tract that are causing clinical infections

Question 2

where is bacteria found in the urinary system, what types

Answer 2

lower end of the urethra

coliforms and enterococci from large bowel

Question 3

what are the gram negative causes of UTI

Answer 3

e.coli
klebsiella
enterobacter
pseudomonas 
proteus

Question 4

what is pathogen causes UTI in catheters

Answer 4

pseudomonas

Question 5

what does proteus produce, what does this result in

Answer 5

urease which breaks down urea to ammonia causing increased urinary pH resulting in precipitation of salts (urolithiasis)

Question 6

what are the gram positive causes of UTI

Answer 6

enterococcus faecalis
enterococcus faceium
staph saphrophytics
staph aureus (rare)

Question 7

what pathogen is associated with bacteraemia

Answer 7

staph aureus

Question 8

what is pathogen has the buzzword urolithiasis

Answer 8

proteus

Question 9

what is a lower tract UTI, what is it also known as

Answer 9

infection confined to the bladder

cystitis

Question 10

what is a upper tract UTI, what is it also known as

Answer 10

infection involving the ureters ± the kidney

pyelonephritis

Question 11

what is a complicated UTI

Answer 11

UTI complicated by systemic symptoms of urinary structural abnormalities/stones

Question 12

what are the symptoms of an UTI

Answer 12

pain/dysuria
frequency
nocturia
haematuria

Question 13

what are the symptoms of an upper tract UTI

Answer 13

fever/chills
back/flank/loin pain
rigors

Question 14

what are the investigations of an UTI

Answer 14

urine sample
dipstick
microscopy
culture

Question 15

who would you not dipstick if UTI was suspected

Answer 15

elderly

catheterised

Question 16

what would you expect to find on dipstick in UTI, what do they indicate

Answer 16

leukocyte esterase = WBC

nitrites = coliform bacteria

Question 17

what organisms don’t produce nitrites

Answer 17

enterococcus
staph
pseudomonas

Question 18

what quantity of bacteria signals a probable UTI

Answer 18

> 10 organisms/ml

Question 19

what is the treatment of a lower female UTI

Answer 19

trimethorpim OR nitrofurantoin 3 day oral course

Question 20

what is the treatment of a male UTI

Answer 20

trimethorpim OR nitrofurantoin 7 day oral course

Question 21

what is the treatment of a complicated UTI or pyelonephritis in the community

Answer 21

Co-amoxiclav OR co-trimoxazole 14 days

Question 22

what is the treatment of a complicated UTI or pyelonephritis in hospital

Answer 22

amoxicillin/co-trimoxazole and gentamicin IV for 3 days

Question 23

what is the treatment of a UTI with catheter

Answer 23

no antibiotics unless symptoms are present

Question 24

what investigation must be done in a male UTI

Answer 24

culture

Question 25

what is the treatment of a coliform

Answer 25

Gentamicin IV Amoxicillin (40%) Trimethoprim = lower tract If resistant = aztreonam

Question 26

what is the treatment of enterococci

Answer 26

Amoxicillin IV Co-trimoxazole If resistant = vancomycin

Question 27

what is abacterial cystitis, what is it also known as

Answer 27

patient has symptoms of uTI and pus cells in urine but no growth on culture urethral syndrome

Question 28

what are the causes of abacterial cystitis

Answer 28

``` early phase of UTI urethral trauma (honeymoon cystitis) STI = chlamydia, gonorrhoea ```

Question 29

what is asymptomatic bacteriuria

Answer 29

significant bacteriuria (>10) but patient is asymptomatic

Question 30

what is the treatment of asymptomatic bacteriuria

Answer 30

none pregnant - antibiotics due to risk of complications

Question 31

what is emphysematous pyelonephritis

Answer 31

acute necrotising parenchymal and peirirenal infection usually occurring in diabetes

Question 32

what causes emphysematous pyelonephritis

Answer 32

gas-formic uropathogens (e.coli)

Question 33

what are the symptoms of emphysematous pyelonephritis

Answer 33

fever vomiting flank pain often associated with ureteric obstruction

Question 34

what are the investigations of emphysematous pyelonephritis, what would you expect to find

Answer 34

kidney, ureter, and bladder Xray = gas | CT

Question 35

what is the treatment of emphysematous pyelonephritis

Answer 35

emergency nephrectomy

Question 36

what causes a perinephric abscess

Answer 36

rupture of acte cortical abscess | haematogenous seeding from site of infection

Question 37

what are the symptoms of perinephric abscess

Answer 37

insidious onset may be pyrexial mass in flank (50%)

Question 38

what are the investigations of perinephric abscess

Answer 38

CT high WCC high serum CK

Question 39

what is the treatment of perinephric abscess

Answer 39

antibiotics + percutaneous/surgical drainage