Micro of the Genitourinary system Flashcards
(146 cards)
1
Q
It is the presence of uropathogens in the urinary tract resulting to variety of signs and symptoms.
A
Urinary Tract Infection
2
Q
T/F. Dysuria/frequency/urgency are common in upper tract.
A
False (In the lower tract)
3
Q
T/F. All bacteria in urine are pathogenic.
A
False (Not all)
4
Q
T/F. Fever and chills are always present in lower UTI.
A
False (Upper UTI, and may even be the only manifestation of pyelonephritis)
5
Q
T/F. Hematuria is usually found in upper UTI.
A
False (Lower tract, urethritis)
6
Q
T/F. Conventionally, urine CS with growth of at least >105 colonies/mL of uropathogens indicates infection.
A
True
7
Q
T/F. Colony count of 102 to 104 colonies/mL (wherein sample was obtained through suprapubic aspiration or catheterization) does not indicate infection.
A
False (May indicate infection, esp. if it’s a uropathogen and there are other risk factors)
8
Q
Presence of bacteria in urine
A
Bacteriuria
9
Q
Significant bacteriuria without symptoms
A
Asymptomatic bacteriuria (seen in pregnancy, DM with neurogenic bladder, elderly with recurrent UTI)
10
Q
T/F. Urine in bladder is not considered naturally sterile
A
False (contaminated by genital flora it goes out)
11
Q
Anatomic classification of UTI which is above the bladder.
A
Upper UTI
12
Q
Symptomatic infection of bladder
A
Cystitis
13
Q
Symptomatic infection of kidneys
A
Pyelonephritis
14
Q
Epidemiologic classification of UTI spontaneously appearing especially in females who are very predisposed to develop this infection
A
Community-acquired UTI
15
Q
Epidemiologic classification of UTI acquired in hospital and is symptomatic
A
Catheter-associated UTI
16
Q
Epidemiologic classification of UTI acquired in hospital and is asymptomatic
A
Catheter-associated bacteriuria
17
Q
UTI in a structurally and neurologically normal urinary tract
A
Uncomplicated UTI
18
Q
UTI with functional or structural abnormalities
A
Complicated UTI
19
Q
T/F. UTI in men is considered uncomplicated.
A
False (Complicated. Unlike women, it is not usual for men to have UTI due to the structure of the GUT.)
20
Q
T/F. UTI in pregancy is considered complicated.
A
True
21
Q
T/F. Recurrent UTI is automatically considered complicated
A
False (Individual episodes could be uncomplicated)
22
Q
T/F. Complicated UTI has more resistant pathogen thus needs weaker antibiotics
A
False (Stronger antibiotics)
23
Q
This determines whether tissue invasion and symptomatic infection will ensue
A
Interplay of host, pathogen and environment
24
Q
Most important route in most UTI especially on feamles
A
Ascending route
25
Most common cause of UTI and is gram negative
E. coli (75%-90% of cases)
26
T/F. Catheterization (as well as condom cath), spermicide use, and estrogen deficiency can cause bacterial colonization
True
27
Access of bacteria to UT through blood
Hematogenous spread (<2% of UTI cases and usually by Salmonella or S. aureus)
28
T/F. Staph and Candida cause bacteremia and seeding in other organs
True
29
T/F. Females are more prone to UTI
True (esp. 1 - ~50 y.o.)
30
T/F. UTI is common in females in neonatal period
False (males due to congenital anomalies)
31
T/F. Most common cause of UTI in men is obstruction due to prostatic hypertrophy
True
32
Infection where bacteria is introduced to bladder during sexual intercourse
Honeymoon cyctitis
33
T/F. Urine and urinary tract has antibacterial properties and activities
True
34
T/F. Advice UTI px to increase fluid intake to increase micturition
True as long as not C/I
35
Urinary inhibitors of bacterial adherence
Tamm Horsfall protein, Bladder mucopolysaccharide, Low molecular weight oligosaccharide, Secretory IgA
36
T/F. UTI can cause premature labor
True
37
T/F. Pregnancy is a risk factor for UTI
True (get baseline urinalysis on 1st visit
38
T/F. VUR is not common in children
False (common)
39
Risk factor for UTI in diabetic px
Neurogenic bladder dysfunction; impaired cytokine secretion leads to ASB in women
40
T/F. Diabetic women have less risk to UTI than non diabetic women
False (2-3x risk)
41
Gram negative that may cause recurrent UTI
Klebsiella
42
UTI pathogens in immunocompromised and diabetic px
Enterobacter, Serratia, Pseudomonas
43
Strain of E. coli in UTI
Extra intestinal pathogenic E. coli (ExPEC)
44
E. coli characteristic on EMB
Has metallic sheen
45
E. coli on lactose
Fermenter
46
E. coli on indole test
Positive
47
Facilitates tissue invasion of E. coli in pyelonephritis
Hemolysin
48
Iron scavenging protein and facilitates E. coli invasion and changes in UT epithelium
Aerobactin
49
It protects E. coli from leukocytic phagocytosis and allows attachment to upper tract
K Ag
50
Facilitates adherence and strongly associated to acute disease severity
P pilus/P fimbrae
51
E. coli structure involved in cystitis
Type 1 fimbrae/pilus
52
E. coli structure involved in biofilms
Type 3 fimbrae
53
E. coli strains resistant to penicillins and 3rd/4th cephalosporins but responsive to carbapenems or quinolones
Extended spectrum beta-lactamase producing E. coli
54
Adjunct to carbapenems
Aminoglycosides
55
ESBL negative strains are sensitive to
Ciprofloxacin and coamoxiclav
56
Community acquired proteus UTI
P. mirabilis
57
Nosocomial proteus UTI
P. vulgaris and P. penneri
58
Virulence factors of proteus
adhesins, flagellae, IgA protease, urease
59
Cases of proteus complicated UTI
10-15%; up to 20-45% (long term cath)
60
Allows proteus to move and swarm
Peritrichous flagella
61
This hydrolyzes urea to form ammonia
Urease
62
Suspected cause when urine is alkaline
Proteus
63
Result of alkaline urine by ptoteus
Formation of struvite and carbonate-apatite crystals (always assoc. with stone formation)
64
Imaging for stones
UTZ KUB/X-ray
65
This develops along renal pelvis and leads to obstruction and can manifest as back pain
Staghorn calculus
66
2nd most common cause of UTI in diabetic px and 2nd most common ESBL producing pathogen
Klebsiella pneumoniae
67
Drug of choice for ESBL
Carbapenems
68
T/F. Kleb is not a lactose fermenter
False
69
Kleb colonies on nutrient agar and blood agar
Mucoid colonies
70
Kleb colonies on MacConkey agar
Dark pink or fuchsia
71
T/F. Gram positive are common causes of UTI
False (rare)
72
Most common Gram + cause of UTI in 5-15% of population (common in females) and is coagulase negative and novobiocin resistant
S. saprophyticus
73
How is S. epidermidis different from S. saprophyticus
Novobiocin sensitive
74
Most frequent fungi found in urine
Candida
75
Antibiotics when there is fungus ball
Amphotericin B and echinocandins
76
Candida on gram stain
Pseudohyphae and budding yeast cells
77
Used to identify albicans vs non albicans
Germtube
78
Presence of Candida in urine regardless of colony count improperly collected urine specimen on 2 separate occasions at last 2 days apart
Candiduria
79
Tx of choice for Candida
Fluconazole
80
Invasion of Candida in blood
Candidemia
81
There is no growth in urine culture but has symptoms
Sterile pyuria with acute symptoms
82
Pathogens in sterile pyuria
Neisseria gonorrhoea, chlamydia trachomatis, herpes simplex
83
T/F. Diagnosis of ABU can be considered only when the patient does not have local or systemic symptoms referable to the urinary tract
True
84
Typical symptoms are dysuria, urinary frequency, and urgency
Cystitis
85
T/F. Unilateral back or flank pain is not indicated in upper tract involvement
False (indicated)
86
Low-grade fever with or without lower-back or costovertebral-angle pain
Mild pyelonephritis
87
High fever, rigors, nausea, vomiting, and flank and/or loin pain
Severe pyelonephritis
88
Pattern of fever in pyelonephritis
High spiking picket-fence
89
Main feature distinguishing cystitis and pyelonephritis
Fever
90
Presents as asymptomatic episode of cystitis or pyelonephritis in a man or woman with an anatomic predisposition to infection, with a foreign body in the urinary tract, or with factors predisposing to a delayed response to therapy
Complicated UTI
91
Organisms in sterile pyuria with chronic course
Mycobacterium TB
92
UTI that presents as acute dysuria either at start or terminal part of flow
Urethritis
93
Systemic symptoms are present in this UTI.
Acute pyelonephritis
94
Cause of costovertebral angle tenderness
Inflammatory process inside the kidney
95
How to elicit CVA tenderness
Kidney punch test or Goldflam’s test
96
Pathognomonic lab finding in pyelonephritis
Leukocyte casts
97
Obstructions leading to pyelonephritis
Tumor, stones, strictures
98
Kidney is distended because the flow of urine is obstructed and urine backs up to the kidneys.
Hydronephrosis
99
T/F. Antibiotics can tx hydronephrosis
False (remove obstruction)
100
Worst complication of kidney infection and is not responsive to antibiotics
Urosepsis
101
Bacteria transferred thru lumen of catheter
Intraluminal route
102
Bacteria transferred thru around of catheter
Periurethral route
103
T/F. Usually, immune compromised px have fever
False (no fever)
104
Used in neurogenic bladder every 6 hours to drain bladder
Frequent straight catheterization
105
Formation of biofilm
Attachment, expansion, maturation, resistance
106
T/F. In a mature biofilm, extensive shedding of bacteria and microorganisms does not take place
False (takes place)
107
Duration of antibiotic use in complicated upper tract infection
10-14 days
108
Bacterial invasion of the renal parenchyma or rupture of abscess to the perinephric space; complication of pyelonephritis
Renal and perinephric abscess
109
Imaging for Renal and perinephric abscess
UTZ and CT Scan
110
Almost always occurs and most common predisposing factor is uncontrolled diabetic patients often associated with obstruction
Emphysematous pyelonephritis and cystitis
111
Imaging for Emphysematous pyelonephritis and cystitis
Ct Scan and KUB X-Ray (not UTZ)
112
T/F. Emphysematous pyelonephritis and cystitis is not a surgical emergency
False (emergency!)
113
Tx for Emphysematous pyelonephritis and cystitis
Emergency nephrectomy
114
Diagnosis of UTI via urinalysis
Pyuria >5 wbc/hpf spun urine (5-8 for F; 0-2 for M)
115
Rapid test to demonstrate presence of enzyme that is indicative of pyuria
Dipstick leukocyte esterase test
116
Gold standard in ddx of UTI
Urine culture and sensitivity
117
T/F. Gram stain helpful in unspun urine
False (not very helpful)
118
Done if there is sepsis
Blood culture and sensitivity
119
For uncomplicated UTI, concentrates well in the urine, we don’t use it for other indications.
Fosfomycin 3g, single dose at most 2 doses
120
A urinary anti-septic, locally acting on the UT, not given to pyelonephritic cases
Nitrofurantoin, 50-100 mg tid-qid
121
For complicated UTI, has good urinary level
Quinolone and aminoglycoside
122
Antibiotic with nephrotoxicity thus use in px without kidney problem or adjust dose if ever there is problem
Aminoglycoside
123
Also cover for gram (-) organisms esp. Pseudomonas aeruginosa
Ceftazidime (3rd Gen. cephalosporins)
124
Beta lactam/Beta lactamase inhibitor combinations
Piperacillin/Tazobactam, Ampicillin/Sulbactam
125
“Ecological adverse effects” of antibiotic therapy
Collateral damage
126
In intermittent catheterization, you must do sterile evacuation every
4-6 hours
127
T/F. Pre-tx urine CS is recommended in acute uncomplicated cystitis.
False (not recommended)
128
T/F. Urine microscopy and dipstick leukocyte esterase and nitrite tests are not pre-requisites for tx in acute uncomplicated cystitis.
True
129
T/F. Nitrofurantoin must be given for 3 days
7 days
130
Defined as the presence of at least 100,000 cfu/mL of 1 or more uropathogens in 2 consecutive midstream urine specimens or in 1 catheterized urine specimen in the absence of symptoms of UTI
ASB
131
Antibiotic to avoid in pregnancy
Quinolone
132
Safe in pregnancy
Beta lactam
133
Antibiotic prophylaxis in recurrent UTI in women
Continuous low dose for 6-12 months
134
T/F. In diabetic px, failure to respond to appropriate therapy within 48 to 72 hours warrants a plain radiograph of the KUB, renal ultrasound or CT scan
True
135
T/F. Significant pyuria in uncomplicated systitis is defined as at least 10WBC/cumm of or at least 5 WBC/hpf in a clean- catch midstream urine
True
136
First line drugs in uncomplicated cystitis in men
Nitrofurantoin and fosfomycin
137
Acute prostitis
<1 month
138
Chronic prostitis
>1 month
139
Refers to various inflammatory conditions affecting the prostate
Prostitis
140
Females are affected more than males and this may cause infertility if fallopian tubes and endometrium are affected
Genitourinary TB
141
T/F. Suspect TB in culture negative pyuria in alkaline urine
False (acidic urine)
142
Imaging for EPTB
IV pyelography, abdominal computed tomography (CT), or magnetic resonance
imaging (MRI)
143
Tx for EPTB
HRZE
144
Marker of response in EPTB
ESR
145
T/F. Urosepsis with obstruction and DMrequire surgery
True
146
May form in chronic recurrent pyelonephritis
Renal Scars
