M - UTIs

Question 1

Define uncomplicated UTI

Answer 1

Infection of the urinary tract without any structural or functional abnormality

Question 2

Define complicated UTI

Answer 2

infection of the urinary tract with functional or structural abnormalities

Question 3

Complicated UTI is generally an infection in which kind of patients?

Answer 3

Male
pregnant
Indwelling catheters
Children

Question 4

Prevalence of bacteriuria in young non-pregnant women?

Answer 4

1-3%

Question 5

List the 4 most common bacterial causes of UTI

Answer 5

E. Coli
Staph. Saprophyticus
Proteus
Klebsiella

Question 6

Clinical features of lower UTI in diff patients?

Answer 6

Generally: dysuria, frequency, urgency, haematuria

Children - vague (fever, irritability, vomiting,FTT)

Elderly - asymptomatic

Question 7

Clinical features of pyelonephritis

Answer 7

Fever
Rigors
Flank pain

Question 8

Gram +ve, coagulase -ve, UTI

• name 2 common causes

Answer 8

S. Saprophyticus
S. Epidermis (prostheses)

Question 9

Extra renal causes of urinary tract obstruction

Answer 9

BPH, Calculi

Question 10

Intrarenal causes of urinary tract obstruction

Answer 10

PCKD
SCD
Hypokalemic nephropathy?!

Question 11

Neurogenic causes of renal tract obstruction

Answer 11

Poliomyelitis
Diabetic neuropathy
Spinal cord injury

Question 12

Haematogenous route of UTI - what tends to cause this?

Answer 12

S. aureus bacteremia or endocarditis

Question 13

If urine dip shows +ve leukocytes alone, what step should you take next?

Answer 13

Urine culture
Treat if severe Sx

Question 14

what culture result is diagnostic of UTI?

^exception to this rule?

Answer 14

Culture of single organisms >10^4 colony forming units/mL

Accept lower number if E.Coli or S. saprophyticus

Question 15

Urine microscopy - which cells, if you saw them, would be indicative of sample contamination

Answer 15

squamous epithelial cells

Question 16

Causes of sterile pyuria (WBCs present and nothing on culture)

Answer 16

Prior treatment with Abx = top cause

calculi
catheterisation
bladder ca
TB or STD (not grown in normal culture)

Question 17

Tx of pyelonephritis

Answer 17

Coamoxiclav +/- gentamicin

Question 18

Uncomplicated UTI in female - tx?

Answer 18

Cephalexin or nitrofurantoin

Question 19

UTI in man - Tx?

Answer 19

Cephalexin or ciprofloxacin

Question 20

Catheter associated UTI - tx?

Answer 20

Gentamicin or amikacin

Question 21

In whom would you consider a 7 day abx course for uncomplicated lower UTI ? list 3

Answer 21

1. Men
2. previous UTI with resistant organism
3. > 7 days of Sx

Question 22

Candida UTI - main cause?

Answer 22

Indwelling catheter

Question 23

Complications of pyelonephritis - state 4

Answer 23

Chronic pyelonephritis
Abscess
Acute papillary necrosis
Septic shock

Question 24

name the only staph bug to commonly cause UTI

Answer 24

staph saprophyticus

Question 25

which bug causes stones in UTI

Answer 25

proteus mirabilis

Question 26

which bug do you get in hospital with a cather

Answer 26

klebsiella aerogenes

Question 27

which type of bacteria cause ascending UTI

Answer 27

gram -

Question 28

which bug causes UTI via haematageneous route

Answer 28

staph aureus

Question 29

LUTI Sx

Answer 29

Dysuria, frequency, urgency, pain suprapubic / on peeing

Question 30

UTI Sx

Answer 30

fevers, rigors, flank pain, varied, some LUTI Sx too

Question 31

features on urine dip to suggest UTI

Answer 31

leucocytes and nitrites

Question 32

Ix for complicated UTI

Answer 32

Renal USS and IV urography

Question 33

Cut off for lab to say bacteria has been grown?

Answer 33

Between 10^4 and 10^5 cfu/mL

Question 34

Squamous epithelium in UTI sample. Meaning?

Answer 34

Poorly taken sample, as has cells from lower 1/3rd urethra

Question 35

High WCC on microscopy but no bacteria grown. Meaning?

Answer 35

TB - not tested for routinely in microscopy so not grown

Question 36

Sampling methods for UTI

Answer 36

MSU, catheterisation, suprapubic aspiration

Question 37

Normal length of ABx Tx for UTI

Answer 37

3 days

Question 38

List Abx to avoid in UTI in pregnant women

Answer 38

Nitrofurentoin and trimethoprim

Question 39

Tx for UTI with catheter?

Answer 39

Take out catheter

Question 40

Tx for fungal UTI

Answer 40

No Tx if no Sx - fluconazole is not effective

Question 41

complications of pyelonephritis

Answer 41

Perinephritic abcess Chronic pyelonephritis Sepsis Acute papillary necrosis

Question 42

Prophylaxis for UTI?

Answer 42

No - controversial as can lead to resistance and adverse effects