Urinary Tract Infections

Question 1

most common source of UTI?

Answer 1

escherichia coli

Question 2

is hematogenous spread or ascending infection more common with UTI?

Answer 2

ascending infection

Question 3

what does uncomplicated cystitis imply with males?

Answer 3

infected stones, prostatitis, or chronic urinary retention

Question 4

signs and SX of acute cystitis?

Answer 4

irritative voiding symptoms
suprapubic discomfort (may be TTP)
afebrile usually

Question 5

what are some causes of noninfectious cystitis?

Answer 5

chemo
pelvic radiation
interstitial cystitis

Question 6

findings on UA of UTI?

Answer 6

pyuria
bacteriuria \
various degrees of hematuria

urine will be positive if culture is done for the offending organism

Question 7

imaging that is indicated with men with cystitis (being that it is rare)

Answer 7

abdominal ultrasound
cytoscopy
CT scan if indicated with associated sx of pyelonephritis or recurrent infections.

Question 8

TX for men with UTI

Answer 8

Cipro
Nitrofuratoin
trimethropin/sulfamethoxas (bactrim)

Question 9

what are your urinary analgesics?

Answer 9

phenazopyridine (pyridium)

sitz bath may provide symptomatic relief

Question 10

what is pyelonephritis?

Answer 10

infectious inflammatory condition of the kidney

Question 11

signs and sx of pyelonephritis?

Answer 11

fever
flank pain
CVA tenderness
irritative voiding sx
shaking chills
N/v

Question 12

CBC results on pyelonephritis?

Answer 12

leukocytosis with left shift

Question 13

UA results of pyelonephritis?

Answer 13

pyuria
bacteriuria
hematuria
white cell casts

culture will have heavy growth of the offending organism

Question 14

what may be seen on renal ultrasound with pyelonephritis?

Answer 14

hydronephrosis (fluid in the kidneys)

Question 15

what is the treatment for pyelonephritis?

Answer 15

Inpatient:
Ampicillin, Gentamicin

Outpatient:
Cipro, Levo

pyridium as analgesis

Question 16

disposition of a pyelonephritis?

Answer 16

MEDEVAC

especially with:
sepsis
no improvement in 48hrs
evidence of obstructions

Question 17

what is acute prostatitis

Answer 17

inflammation and infection of the prostate gland

Question 18

what is the most likely route of infection of the prostate?

Answer 18

ascent up the urethra
reflux

lymphatic and hematogenous routes are rate

Question 19

signs and SX of acute prostatitis?

Answer 19

perineal, sacral, and suprapubic pain.
fever
obstructive symptoms (urinary retention)
warm and exquisitely tender prostate

Question 20

Treatment for acute prostatitis

Answer 20

inpatient
ampicillin and gentamicin

outpatient
cipro, levo
trimethropin (bactrim)

Question 21

labs for acute prostatitis

Answer 21

same as other UTI

Question 22

pain management for acute prostatitis

Answer 22

tylenol
NSAIDS
stool softeners

Question 23

same as the other UTI’s, what should you do if urinary retention develops?

Answer 23

percutaneous suprapubic tube is required, urethral catheterization is CONTRAINDICATED

Question 24

disposition of acute prostatitis

Answer 24

MEDEVAC

Question 25

can chronic bacterial prostatitis be managed by the IDC alone?

Answer 25

no

Question 26

signs and symptoms of chronic bacterial prostatitis

Answer 26

varying degree of irritative voiding symptoms
low back and perianal pain
suprapubic discomfort
HX of UTI

Question 27

how may the prostate be with acute bacterial prostatitis

Answer 27

normal
boggy
indurate

Question 28

laboratory findings of chronic prostatitis

Answer 28

UA: normal unless secondary cystitis is present

Expressed prostatic secretions: increased number of leukocytes

Culture of prostatic secretions: demonstrate the offending pathogen

Question 29

imaging for chronic prostatitis:

Answer 29

not necessary. but pelvic radiograph/transrectal ultrasound may show prostatic calculi

Question 30

treatment of chronic prostatitis

Answer 30

Trimethoprim-sulfamethoxazole (bactrim)

cipro
levo

Question 31

What is epididymitis?

Answer 31

inflammation of infection of the epididymis.

Question 32

what are the categories that infectious epididymitis can be divided into?

Answer 32

Sexually transmitted forms:
men under 40, associated w urethritis
from chlamydia or gonorrhoeae

Non Sexually transmitted:
older men
associated with UTI and prostatitis
caused by gram negative rods

Question 33

signs and symptoms of epididymitis

Answer 33

may follow sex, trauma, heavy lifting

urethritis
cystitis
pain develops in the scrotum and may radiate along the spermatic cord or to the flank
fever
scrotal swelling

Early on: epididymitis distinguishable. Later: one large tender mass

Prehn sign (elevation of the scrotum above the pubic symphysis

Question 34

treatment of epididymitis

Answer 34

STI: Ceftriaxone (rocephin) + Doxy

Non Sexually Transmitted: Trimethoprim/sulfamethoxaz (bactrim); Cipro; Levo

Question 35

how do you provide symptomatic relief of epididymitis?

Answer 35

bed rest
scrotal support
ice packs
NSAIDS