Student with dysuria Flashcards
(34 cards)
What is dysuria?
Burning on urination
How common are UTIs in women?
50%
What differential diagnoses should be considered for dysuria?
Cystisis: pain on urination, urgency to void with blood in urine (hematuria)
Vulvovaginitis: caused by trichomonas vaginalis or candida; malodorous discharge and dysuria but no void urgency
Urethritis via STD, e.g. gonorrhoeae or chlamydia trachomatis; usually gradual onset, no discharge, associated with new sexual partner
What distinguishes complicated and uncomplicated UTI?
Uncomplicated = no signs of pyelonephritis
= fever and flank pain from infection involving upper urinary tract / kidney
What are the risk factors for UTIs?
Female
Sexually active
Previous UTIs
Use of spermicidal diaphragm
What fecal bacteria typically infect the urethra/blaffer?
Gram-negative rods: E coli (common), Klebsiella and pseudomonas aeruginosa (hospital UTIs), proteus mirabilis
Gram-positive cocci: enterococci (usually nosocomial); staph. saprophyticus (common in young women), strep. agalactiae (group B strep; mostly found in pregnant women)
What non-bacterial fecal flora infect the urethra/bladder?
Virus: Adenovirus (children)
Fungi: candida spp (usually diabetics, immunocompromised; catheters)
Parasites: schistosoma haemotobium - with a travel history
Mycobacterium tuberculosis - but not common!
What is a urine dipstick test?
Compared against color key to determine levels of various chemicals, proteins, cells
What does the presence of glucose in urine indicate? (Glycosuria)
Uncontrolled diabetes; excessive carb intake
What does the presence of proteins in urine indicate? (proteinuria)
suggests increased permeability of glomerular membrane =>
indicates hypertension, glomerulonephritis; poisons; kidney trauma; pregnancy
What does the presence of ketone bodies in urine indicate? (ketonuria)
Excessive production of fat intermediates
Suggests uncontrolled diabetes; starvation; low carb diets
What does the presence of RBCs in urine indicate? (hematuria)
Bleeding in tract; kidney stones; tumors; trauma; glumerulonephritis
What does the presence of hemoglobin in urine indicate? (hemoglobinuria)
hemolytic anemia, transfusion reactions, severe burns
What does the presence of nitrates in urine indicate? (nitrituria)
Produced by gram negative bacteria; suggests E Coli
What does the presence of bile pigments in urine indicate? (bilirubinuria)
Hepatitis, cirrhosis, gallstones
What does the presence of WBCs in urine indicate? (pyuria)?
UTIs, gonorrhea
What is the threshold for significant bacteruria?
10^5 cfu/ml with three or less microorganisms
What is the threshold for urine sample contamination?
10^5 cfu/ml with more than three microorganisms
What is a MacConkey Agar?
Contains bile salts – interferes with gram positive bacteria growth and favors gram negative, esp. enterobacteriaceae
Contains lactose and PH test for lactic acid
In sum: tests for gram negative lactose fermenters
What is an EMB agar?
Digested meat proteins for nutrients
Two indicator dyes - eosin and methylene blue
Lactose fermenters = metallic green/purple
Non lactose fermenters - colorless colonies
What are characeristic patterns on EMB agar for:
Klebsiella
Enterobacter
E Coli?
Klebsiella - mucoid colonies, lactose-fermenting
Enterobacter - moderately mucoid, lactose-fermenting
E Coli - lactose fermenting with green sheen
All are gram negative rods
What is the spot indole test?
Positive result with blue/green indole = E coli
Negative - red
How does ampicillin work?
interacts directly with PBPs, inhibits transpeptidase activity. A penicillin. Some gram negatives
How does ciprofloxacin work?
Inhibits activity of DNA gyrase, bloaks DNA replication. Broad spectrum against gram negative and gram positive bacteria – very commonly prescribed
