UGI 1

Question 1

only areas of the urogenital tract that are colonized by bacteria

Answer 1

anterior urethra and vagina

everywhere else is sterile

Question 2

host defense of urogenital tract

Answer 2

high volume urinary flow so less residual volume, lining of bladder, exfoliation of uroepithelial cells, structures that prevent backflow

Question 3

amount of urine we let out a day

Answer 3

1.5L per day

Question 4

symptoms of urethritis

Answer 4

burning with urination

Question 5

symptoms of cystitis (inflammation of bladder)

Answer 5

pelvic pressure, lower abdomen discomfort, frequent painful urination, low grade fever

Question 6

symptoms of acute pyelonephritis

Answer 6

upper back and side (flank) pain
high fever
shaking and chills
nausea and vomiting

Question 7

big difference between presentation of acute pyelonephritis and cystitis

Answer 7

acute pyelonephritis presents with high fever while cystitis presents with low grade fever

Question 8

normal flora of urethra

Answer 8

lactobacillus, coagulative neg staph, strep

Question 9

normal flora of vagina

Answer 9

compromised mainly of lactobacillus

Question 10

when does lactobacillus become more prominent in vagina

Answer 10

at puberty hence vaginal flora is very diverse before puberty and after menopause

Question 11

features of lactobacillus

Answer 11

gram positive rods that are non spore forming
facultative or strick anaerobe
produces lactic acid thereby making pH of vagina 4

Question 12

who is more prone to UTIs and why

Answer 12

women because of shorter urethra

Question 13

why is it that women in the US who develop a UTI are more likely to have reoccurence

Answer 13

immune status and genetics

Question 14

what happens with pregnant women with untreated UTI

Answer 14

increased risk of delivering a low birth weight or preemie infant

Question 15

why are pregnant women more prone to UTIs

Answer 15

smooth muscle relaxation
urethral dilation
greater chance to progress to acute pyelonephritis

Question 16

which type of UTI is more common

Answer 16

ascending UTI so microorganism travels from urethra –> bladder –> kidney

Question 17

UTIs present with malaise, burning sensation when urinating, frequent urge to urinate, or even asymptomatic. What does it signify if UTI presents with fever

Answer 17

microorganism has traveled all the way to the kidney

Question 18

why do nearly all patients with indwelling catheter with open drainage for more than 48 hours get a UTI

Answer 18

bypassing all host defenses

Question 19

most common microbe that causes UTI

Answer 19

E. coli and when there is a re-infection, it is with a new strain of E. coli

Question 20

what is reasoning for difference between complicated and uncomplicated UTI

Answer 20

complicated UTI has predisposing anatomic, functional, or metabolic abnormalities hence requires more aggressive evaluation and follow up

Question 21

other than UTI, what are other complications of long term use of catheters

Answer 21

• obstruction –> bacterial glycocalyx
• encrustation and infection stones containing urea
• local infections like urethritis, periurethral abscesses etc

Question 22

what are biofilms

Answer 22

microorganisms growing on surfaces encased in slime like catheters

Question 23

microorganisms in uncomplicated UTI

Answer 23

E. coli, S. saphrophyticus, Klebsiella pneumoniae, Proteus mirabilis

KEPS

Question 24

microorganisms in complicated UTI

Answer 24

E. coli, K. pneumoniae, P. mirabilis, enterococcus species, pseudomonas aeruginosa

KEEPP

Question 25

virulence factors contributing to UTI

Answer 25

– Adhesins (pili, fimbriae, etc.) – Ig proteases – Hemolysins (get cytokine release, inflammation) – Ureases (i.e. P. mirabilis) – Siderophore expression – Factors promoting colonization and movement

Question 26

primary cause of UTIs

Answer 26

uropathogenic e. coli (UPEC)

Question 27

key virulence factors of UPEC (uropathogenic e. coli) and additional

Answer 27

key: Type I (cystitis) and P pili (pyelonephritis) additional: alpha hemolysin, siderophore, pathogenicity islands

Question 28

within the lumen of the bladder, what are the host defense

Answer 28

- antimicrobial peptides - competition with iron sequestering proteins - Tamm-Horsfall Protein

Question 29

function of Tamm-Horsfall Protein

Answer 29

- binds specifically to type I fimbriated e. coli - it is basically a key urinary anti adherence factor that serves to prevent type I fimbriated e. coli from binding to the urothelial receptors

Question 30

when does lactobacillus decrease

Answer 30

bacterial vaginosis and helps control overgrowth of other bacteria that can cause disease/UTI

Question 31

organisms predominantly responsible for remaining UTIs

Answer 31

``` – Staphylococcus saprophyticus – Proteus mirabilis – Klebsiella species – Mycoplasma and Ureaplasma – Candida ```

Question 32

staphylococcus saprophyticus is cause of UTIs in what population

Answer 32

young sexually active women

Question 33

what time of the year is s. saphrophyticus usually seen

Answer 33

summer

Question 34

pathogenicity of s. saphrophyticus is due to what

Answer 34

- UREASE - redundant uro-adaptive transport systems - novel cell wall anchored adhesins

Question 35

virulence factors of Proteus Mirabilis

Answer 35

* Proteases * Haemolysins * Biofilm formation * Urease production

Question 36

what does the urine in proteus mirabilis smell like and why? what is the importance of that?

Answer 36

- smells like ammonia because urease turns urea to ammonia - increase in pH due to ammonia causing precipitation of certain compounds out of the urine; also increased pH is toxic to the kidney

Question 37

mycoplasma genitalium causes UTI more commonly in what population

Answer 37

men -- it is symptomless in women

Question 38

since there is no clear diagnostic test for mycoplasma genitalium, what situations will make you suspect mycoplasma genitalium

Answer 38

- persistent/recurrent urethritis - persistent/recurrent cervicitis - PID: pelvic inflammatory diseases