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STEP 2 Cardio + Renal > Renal. UTI (08-03) > Flashcards

Renal. UTI (08-03) Flashcards

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1
Q

FA. what is the way of UT infection?

A

Ascending

Urethra –> prostate (prostitis) –> bladder (cystitis) –> kidney (pyelonephritis) –> systemis (urosepsis)

Due to this ascention these infections share common microbiologic profiles.

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2
Q

FA. Cystitis presentation?

A

Dysuria, frequency, urgency, suprapubic pain, WBC in urine (BUT NOT WBC CASTS).

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3
Q

FA. fundamental Pyelonephritis symtoms?

A

CVA tenderness, flank pain
hematuria, WBC CASTS
Systemic symptoms: fever, chills

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4
Q

FA. Uncomplicated UTI criteria.

A

Lower UTI is acute, simple cystitis (symptoms in other card) in otherwise healthy, nonpregnant woman who has not failed a/b therapy

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5
Q

FA. Uncomplicated UTI treatment.

A

TMP-SMX for 3 days
Nitrofurantoin for 5-7 days - only for cystitis, if suspected pyelo, when clearance < 60 ml/min or complicated UTI, dont use nitrof.

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6
Q

FA. Uncomplicated UTI. When culturing?

A

ONLY when treatment failed

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7
Q

UW. Uncomplicated UTI. when avoid TMP-SMX?

A

When locaql resistance > 20 proc.

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8
Q

UW. Uncomplicated UTI. What single shot drug?

A

Fosfomycin single dose

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9
Q

UW. Uncomplicated UTI. When fluoroquinolones?

A

Only when previously mentioned options cannot be used (TMP-SMX, nitrof, fosfomycin)

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10
Q

FA. Complicated UTI. criteria? summarized

A

summarized: one that does not meet criteria for uncomplicated.

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11
Q

FA. Complicated UTI. criteria detailed.

A

Symptoms same as in uncomplicated.
Everything depends on populations which are at higher risk for complexity.

pregnant
patient with comorbidities (such as diabetes),
infants and toddlers, and male sex;

immu­nocompromise or stents or urinary catheters, as well as those with recurrent or refractory UTls

A complicated UTI would also be any patient with systemic symptoms of UTI that might suggest pyelo­ nephritis.

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12
Q

FA. Complicated UTI. treatment? stable

A

fluroqui­nolones, third-/fourth-generation cephalosporins,
or TMP-SMX
Peroral is hemodinamically stable and can be treated outpatient

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13
Q

FA. Complicated UTI. treatment? unstable

A

Unstable hemodynamic - iv a/bs

IV third-/fourth-generation cephalosporins
typically given, or fluroquinolones

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14
Q

UW. Complicated UTI. treatment?

A

Fluoroquinolines (5-14 days)
extended spectrum eg ampic-sulbactam for more severe

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15
Q

UW. Complicated UTI. sampling

A

Obtain prior treatment and adjust ab if needed

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16
Q

UW. Uncomplicated UTI. nitrofurantoin complication HY?

A

Nitrofurantoin induced pulmonary injury 3-9days after drug + rashes + eosinophilia + lung findings

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17
Q

UW. Complicated UTI. what ab dont use and what use instead in pregnancy?

A

dont use fluoroquinolones
considercefpodoxime, cephalexin, amoxiclave, fosmomycin

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18
Q

UW complicated UTI in cases?

A

DM, pregnancy, renal failure, indwellin cath, urinary procedure (eg cystoscopy), urinary tract obstruction, immunosupression and hospital acquired.

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19
Q

FA. pregnancy UTI.
what is routinely performed and why in pregnant?

A

Urinalysis is routinely performed to screen for asymptomatic bacteriuria

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20
Q

FA. pregnancy UTI. increased risk for what?

A

patients are at increased risk for pyelonephritis and urosepsis

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21
Q

FA. pregnancy UTI.
asymptomatic bacteriuria treatment?

A

normally does not require treatment;
BUT, due to increased risk for com­ plications, pregnant women with asymptomatic bacteria are treated with either nitrofurantoin
or amoxicillin

Treatment of cystitis and pyelonephritis would be as for
treatment of complicated UTI

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22
Q

FA. pregnancy UTI.
asymptomatic bacteriuria. what to do after treatment?

A

follow-up culture to confirm
resolution

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23
Q

FA. pregnancy UTI. cystitis treatment?

A

as for complicated UTI.
But dont give fluoroquinolones in pregnancy, choose other drug

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24
Q

UW. pyeolonephritis. treatment outpatient?

A

Fluoroquinolones (ciprofloxacin, levofloxacin)

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25
UW. pyeolonephritis. treatment inpatient?
iv ab's fluoroquinolone, aminoglycoside+/- ampicillin
26
UW. pyeolonephritis. sampling?
obtain prior abs and adjust abs as needed
27
FA. prophylaxis for UTI. what patients?
Recurrent UTls (two or more infections in 6 months or three or more infections in 1 year);
28
FA. prophylaxis for UTI. What are methods? 3
behavioral modifications are first line and include i fluid intake (promoting urinary flow so that microbes cannot as easily ascend the urinary tract), postcoital voiding/stoppage of spermicide use, and vaginal estrogen in postmenopausal females
29
FA. what is recurrent UTI. criteria?
two or more infections in 6 months or three or more infections in 1 year
30
FA. prophylaxis for UTI. what if behavioral is not effective?
Antibiotic prophylaxis (TMP-SMX or nitrofurantoin) after inter­course, first sign(s) of symptoms; the physician can prescribe antibiotics at a low dose for 3-6 months or continuously
31
FA. Bladder pain syndrome (BPS) + UTI mimics. what is other name for BPS?
Interstitial cystitis = bladder pain syndrome
32
FA. Bladder pain syndrome + UTI mimics. What symptoms?
CHRONIC suprapubic pain/discomfort, dysuria, frequency, dys­pareunia, pelvic pain, relief after voiding that lasts >6 weeks without an underlying medical cause;
33
FA. Bladder pain syndrome + UTI mimics. in what patients?
classi­cally in women with psychiatric disease (analogous to fibromyalgia, IBS)
34
FA. Bladder pain syndrome + UTI mimics. treatment?
!!!!First-line treatment: Avoid dietary triggers Amitriptyline, pain management (phenazopyridine or methenamine), bladder hydrodistention
35
FA. what is UTI mimics? what diseases? 3
Bladder pain syndrome hemorrhagic cystitis (after cyclophosphamide) bladder irritation from radiation therapy to pelvis
36
FA. common UTI bugs. Mneumonic
SEEKS PP Serratia E.Coli Enterobacter Klebs. pneumonia Staph. saprophyticus Pseudomonas Proteus mirabilis
37
FA. UTI m/os. Leading cause?
E Coli
38
FA. UTI m/os. leading second cause, esp.in sexually active females?
Staph. saprophyticus
39
FA. UTI m/os. third leading cause?
Klebs. pneumonia
40
FA. UTI m/os. healthcare associated and drug resistant. red pigment
Serratia marcescens
41
FA. UTI m/os. healthcare associated and drug resistant? 2 mo/s
Enterococcus pseudomonas aeruginosa
42
FA. UTI m/os. produces urease, assoc. with struvite stones
Proteus mirabilis
43
FA. UTI m/os. diagnostic markers? 2
Leukocyte esterase = evidence of WBC activity Nitrite test - reduction of urinary nitrates by GRAM NEGATIVE m/os.
44
FA. UTI in what patients more common?
in females (shorters urethras colonized by fecal microbiota)
45
FA. UTI. risk factors?
Obstructio (stones, enlarged protate), kidney surgery, catheter, congenital malformations (vesicoureteral reflux), DM, pregnancy
46
FA. What symptoms absent in uncomplicated UTI/ simple cystitis?
systemic such fever
47
FA. uncomplicated UTI/ simple cystitis triad?
frequency, suprapubic pain, dysuria (burning)
48
FA. uncomplicated UTI/ simple cystitis. Diagnostics?
Clinical diagnosis is sufficient
49
FA. uncomplicated UTI/ simple cystitis. First line abs? 2
TMP-SMX (3d) or nitrofurantoin (5-7d)
50
FA. uncomplicated UTI/ simple cystitis. drugs for pain relief? 2
Pentosan (relieves cystitis pain) Phenazopyridine (relieves urinary tract pain)
51
FA. Complicated UTI form - pyelonephritis. what specific symtoms?
systemic (fever, chills, tachy) CVA tenderness + flank pain
52
FA. Complicated UTI form - pyelonephritis. Algo. if suspect it, what further steps?
Collect urine +/- blood culture --> then urinalysis
53
FA. Complicated UTI form - pyelonephritis. Algo. If Urinalysis normal - unlikely pielonephritis IF Urinalysis shows WBC --> likely pielonephritis. whats next? 3 groups of patients
High complication risk --> Imaging (CT, US) to assess for anatomic causes eg abscess Hemodinamically stable, can tolerate p/os --> outpatient oral theraphy ALL OTHER PATIENTS --> iv therapy
54
FA. Complicated UTI form - pyelonephritis. 3 main steps?
Cultures - prior ab Urinalysis - same as in cystitis + WBC CASTS Imaging (US, CT) - for pts who have high risk of complications
55
FA. Complicated UTI form - pyelonephritis. what examines imaging?3
anatomic causes+abscess formation+emphysematous pyelonephritis
56
FA. Complicated UTI form - pyelonephritis. algo what if iv treatment fails?
do Imaging
57
FA. Complicated UTI form - pyelonephritis. Complications?3
Abscesses Emphysematous pyelonephritis Chronic pyelonephritis
58
FA. Complicated UTI form - pyelonephritis. Abscesses. where forms? 2
In the renal parenchyma and/or perirenal fat (perinephric abscess)
59
FA. Complicated UTI form - pyelonephritis. Abscesses. when do we suspect? symptoms
persistent fever + abdominal pain despite ab treatment
60
FA. Complicated UTI form - pyelonephritis. Abscesses. what to do to evaluate?
CT/UG --> diagnose abscess --> drainage (all perinephric, > 5cm renal) + continue abs
61
FA. Complicated UTI form - pyelonephritis. Emphysematous pyelonephritis. what causes and in what patients?
gas producing bacteria. In DM or immunocompromise
62
UW. Dipstic proteinuria (albumin). trace?
15-30 mg/dl
63
UW. Dipstic proteinuria (albumin). +1
30-100 mg/dl
64
UW. Dipstic proteinuria (albumin). +2
100-300 mg/dl
65
UW. Dipstic proteinuria (albumin). +3
300-1000mg/dl
66
UW. Dipstic proteinuria (albumin). +4
> 1000 mg/dl
67
FA. Chronic pyelonephritis. causes?
recurrent pyelonephritis (in children with vesicouretheral reflux) Obstruction in adults (stones, BPH, cervical carcinoma)
68
FA. Chronic pyelonephritis. anatomic changes?
blunted calyces + corticomedullary scarring of the kidneys (on imaging)
69
FA. Chronic pyelonephritis. what is imaging characteristic for vesicouretheral reflux?
seen upper/lower pole scarring
70
FA. Chronic pyelonephritis. Pathologic findings?
Interstitial fibrosis and thyroidization of kidney (athrophic tubules filled with eosinophilic proteaceous materials)
71
FA. Chronic pyelonephritis. what is xantogranulomatous pyelonephritis?
severe form of chronic pyelonephritis.
72
FA. Chronic pyelonephritis. xantogranulomatous pyelonephritis. causes?
infected kidney stone obstruction
73
FA. Chronic pyelonephritis. xantogranulomatous pyelonephritis. seen on imaging?
infected kidney stone obstruction --> granulomatous inflammation --> multiple, dar round areas on CT (Bear Paw sign)
74
FA. key fact abs. Nitrofurantoin and fosfomycin only achieve therapeutic concentrations where?
bladder + urine they do not penetrate renal parenchyma, so they should be used only to treat cystitis, NOT PYELONEPHRITIS
75
FA. Complicated UTI form - pyelonephritis. treatment HD stable, peroral. abs?
Outpatient Fluoroquinolones or 3-4th generation cephalosporin or TMP-SMX 7-14d.
76
FA. Complicated UTI form - pyelonephritis. treatment HD unstable, critically ill, urinary obstruction. iv, abs?
inpatient ceftriaxone, ampicillin-sulbaktam, piptaz, fluoroquinolones guided by culture and sensitivity patterns
77
UW. Bladder pain syndrome = interstitis cystitis. epidemiology? 3
women 1.assoc. with psychiatric disorder 2.pain disorders - fibromyalgia, irritable bowel syndrome) 3. history of UTI
78
UW. Bladder pain syndrome = interstitis cystitis. clinical presentation?3
bladder pain exacerbated with filling, exercise, sexual intercourse, alchohol, prolonged sitting. Relief with voiding incr. urinary frequency, urgency Dyspareunia aka Lower urinary tract symtoms
79
UW. Bladder pain syndrome = interstitis cystitis. diagnosis? 2
CLINICAL DIAGNOSIS bladder pain with no other cause >= 6 weeks normal urinalysis
80
UW. Bladder pain syndrome = interstitis cystitis. treatment? main idea
not curative, focus on improving quality of life
81
UW. Bladder pain syndrome = interstitis cystitis. conservative treatment? first line
FIRST LINE - behavioral modification, avoidance of triggers, physical therapy
82
UW. Bladder pain syndrome = interstitis cystitis. treatment drugs?
amitriptyline (for refractory), pentosan polysulfate sodium analgetics for acute exacerbations
83
FA. protatitis - form of complicated UTI. how ascends infection?
infection from urethra + reflux of infected urine --> prostate (acute or chronic prostatitis)
84
FA. protatitis - form of complicated UTI. pathogens - predominant UTI. most common e coli.
.
85
FA. protatitis - form of complicated UTI. acute in what patients?
young < 40 yo males high-risk sexual behaviour incr. risk of n. gonorea or c. trachomatis
86
FA. protatitis - form of complicated UTI. chronic in what patients?
older males 40-70 y/o. may result from acute prostatitis
87
FA. protatitis - form of complicated UTI. Acute - symptoms?
ill appearance systemic + prostatitis symptoms (perineal pain, low back pain, defecation pain + irritative urinary symptoms (dysuria) + frequency + urgency --> urinary retention.
88
FA. protatitis - form of complicated UTI. Acute - DRE?
exquisitely tender + boggy prostate Prostate massage should be avoided as ir can cause bacteremia. its clinical diagnosis, so DRE can be even skipped
89
FA. protatitis - form of complicated UTI. Chronic - symptoms?
patient does not appear ill less symptomatic, fever usually absent. Prostatitis symptoms - dull, poorly localized pain in lower back+ perineal+scrotal+ suprapubic + recurrent urinary symtoms (dysuria, frequency, urgency, obstructive symptoms, ED +/- bloody semen) with repeated isolation of the same m/o/.
90
FA. protatitis - form of complicated UTI. DRE in chronic?
Enlarged, non-tender
91
FA. protatitis - form of complicated UTI. How confirmed acute?
urinalysis (Sheets of WBC + bacteria) + urine culture (e coli).
92
FA. protatitis - form of complicated UTI. Acute. in what patients obtain blood culture?
in very ill or HD unstable
93
FA. protatitis - form of complicated UTI. Chronic. suggested by what lab?
WBC in prostatic secretions
94
FA. protatitis - form of complicated UTI. Chronic. when positive urine culture?
positive - in chronic bacterial prostatitis negative - in chronic nonbacterial prostatitis.
95
FA. protatitis - form of complicated UTI. Chronic. what test used to determine location?
four glass
96
FA. protatitis - form of complicated UTI. Chronic. diagn. first glass?
initial urine = urethra sample
97
FA. protatitis - form of complicated UTI. Chronic. diagn. second glass?
midstream urine = bladder sample
98
FA. protatitis - form of complicated UTI. Chronic. diagn. third glass?
prostatic massage - prostate sample
99
FA. protatitis - form of complicated UTI. Chronic. diagn. glass?
after prostatic massage - another prostatic sample
100
FA. protatitis - form of complicated UTI. Chronic. alternatevely can be used 2 glass test - atitinka 4 glass paskutinius du zingsnius, kur meginys is prostatos
.
101
FA. protatitis - form of complicated UTI. Acute - treatment 2. severe?
hospitalization + iv abs (fluoroquinolones +/- 3th-4th gen. cephalosporins)
102
FA. protatitis - form of complicated UTI. Acute - treatment. mild?
outpatient TMP-SMX or fluoroquinolones (ciprofloxacin or levofloxacin) for 4-6 weeks to achieve therapeutic levels in prostate.
103
FA. protatitis - form of complicated UTI. Acute - mild. what treatment if men in high-risk sexual activity?
consider N gonorrhoe and C trachomatis coverage (ceftriaxone + azitromycin or doxycyline)
104
FA. protatitis - form of complicated UTI. Chronic prostatitis --> treatment?
TMP-SMX or fluoroquinolone (ciprof or levofluoc) for 6-8 weeks --> to achieve therapeutic levels in prostate. Treatment is difficul, UTI recurrences are common.
105
UW. use fluoroquinolones. what adverse may occur?
Tendinopathy. esp. achilles. also in rotator cuff, biceps, thumb, hand C/P: pain and/or tenderness 2-6 cm above the posterior calcaneous in achilles tendinopathy.
106
UW. Recurrent UTI table. Definition? 2
>= 2 infections in 6 months >=3 infections in 1 year
107
UW. Recurrent UTI table. risk factors? 4
history of cystitis at =< 15 y/o spermicide use new sexual partner Postmenopausal status
108
UW. Recurrent UTI table. evaluation?2
urinalysis urine culture
109
UW. Recurrent UTI table. prevention?3
Behavioral modification Postcoital or daily ab prophylaxis Topical vaginal estrogen for postmenopausal patients
110
UW. Recurrent UTI table. what ab is choice to prevent?
TMP-SMX
111
UW. UTI After 48 hours of symptomatic improvement, most hospitalized patients (complicated UTI) can be transitioned to culture-guided oral antimicrobials.
.
112
UW. Renal abscess. Risk factors. 5
Pyelonephritis, complicated UTI. Renal calculi DM Anatomic abnormality (tumor, PKD) Pregnancy
113
UW. Renal abscess. Clinical? 3 1 ryskus yra
Fever, chills Flank/abdominal pain NO IMPROVEMENT ADTER 48-72h of broad spectrum antibiotics
114
UW. Renal abscess. diagnosis. 2
Renal UG CT scan of abdomen
115
UW. Renal abscess. treatment? 2
I/v ab +/- drainage
116
UW acute pyelonepf.
117
UW acute pyelonepf. Uncomplicated 4 facts:population, mo, abs
otherwise healthy, nonpregnant Ecoli ORAL FLUOROQUINOLONES (preff), tmp-smx I/v abs if VOMITING, elderly, septic
118
UW acute pyelonepf. complicated. 3 facts: patiets, incr risk for what and treatment?
DM!!!!, urinary obstruction, renal failure, immunosupression, hospital acquired incr. risk of abs resistance/treatmetn failure I/V!!! fluoroquinolones, AMG, extended spectrum beta lactam/cephalosporin

STEP 2 Cardio + Renal (55 decks)

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