Urinary tract infections

Question 1

What are the symptoms of urethritis and cystitis?

Answer 1

Dysuria, frequency, urgency

Question 2

What are symptoms of pyelonephritis?

Answer 2

Pain in the flanks, fever

Question 3

How are UTIs diagnosed?

Answer 3

Symptoms and dipstick test

Question 4

What kind of sample is required for UTI diagnosis?

Answer 4

Clean voided midstream urine

Question 5

What does a dipstick test look for?

Answer 5

Leukocyte esterase and nitrite

Question 6

What does a positive leukocyte esterase result indicate?

Answer 6

Pyuria (WBC in urine)

Question 7

What is the gram stain for enterobacteriaceae?

Answer 7

Gram negative

Question 8

What is the shape of enterobacteriaceae?

Answer 8

Rod

Question 9

What is the oxidase test for enterobacteriaceae?

Answer 9

Oxidase negative

Question 10

What is the catalase test for enterobacteriaceae?

Answer 10

Catalase positive

Question 11

Serology for enterobacteriaceae is based on what antigens?

Answer 11

O-polysaccharide of LPS, K and H antigens

Question 12

What are the virulence factors associated with enterobacteriaceae?

Answer 12

Endotoxin, capsule, T3SS, sequestration of growth factors, antigenic phase variation

Question 13

What is responsible for the degree of virulence of different strains of E. coli?

Answer 13

Acquisition of plasmids, prophages, and pathogenicity islands

Question 14

What is responsible for E.coli adherence to host mucosal surfaces?

Answer 14

Fimbriae or pili

Question 15

What can differentiate E. coli from salmonella or shigella?

Answer 15

Most E. coli spp. ferment lactose

Question 16

What is the most common gram negative rod isolated from patients with sepsis?

Answer 16

E. coli

Question 17

What is the most common cause of UTIs?

Answer 17

E. coli

Question 18

What is the reservoir in E. coli UTI?

Answer 18

Patient’s intestinal flora

Question 19

What are the virulence factors of E. coli UTI?

Answer 19

Adhesins, hemolysin, endotoxin

Question 20

What do most E. coli strains possess to aid in attachment to epithelial surfaces?

Answer 20

Type I pili

Question 21

What is the type I pili?

Answer 21

Present on most E. coli strains - binds to mannose residues commonly present on epithelial surfaces

Question 22

What is the P pili?

Answer 22

Expressed by some subpopulations of E. coli - binds sugar residues specifically on uroepithelial cells

Question 23

E. coli strains that cause pyelohnephritis usually possess which type of pili?

Answer 23

P pili

Question 24

What is the shape of staphylococcus?

Answer 24

Clusters

Question 25

What is the shape of streptococcus?

Answer 25

Pairs or chains

Question 26

What is the gram stain for staphylococcus?

Answer 26

Gram positive

Question 27

What is the second leading cause of UTIs?

Answer 27

S. saprophyticus

Question 28

How can S. saprophyticus be differentiated from other CoNS?

Answer 28

Novobiocin resistant

Question 29

What are the common hospital acquired UTI pathogens?

Answer 29

Proteus, pseudomonas, enterococcus

Question 30

What is the gram stain for proteus?

Answer 30

Gram negative

Question 31

What is the prevalence of proteus for UTI isolates in chronically catheterized patients?

Answer 31

20-45%

Question 32

How does proteus cause kidney stones?

Answer 32

1. Produces urease 2. Urease hydrolyzes urea to ammonia - alkalizes urine 3. Alkalinization leads to precipitation of organic and inorganic compounds - kidney stones

Question 33

Does proteus produce biofilms?

Answer 33

Yes

Question 34

What is the treatment for proteus?

Answer 34

TMP-SMX

Question 35

What is the gram stain for pseudomonas?

Answer 35

Gram negative

Question 36

What is the shape of pseudomonas?

Answer 36

Motile rod

Question 37

What is the oxidase test for pseudomonas?

Answer 37

Oxidase positive

Question 38

How can pseudomonas be differentiated from enterobactericeae?

Answer 38

Oxidase test

Question 39

Which bacteria produce a blue-green pigment?

Answer 39

Pseudomonas aeruginosa

Question 40

Pseudomonas aeruginosa is typically seen in what patient profile?

Answer 40

1. Long term indwelling catheters 2. Obstruction of GU system or urinary tract instrumentation / surgery 3. Multiple courses of abx

Question 41

Enterococcus are what group of streptococci?

Answer 41

Group D streptococci

Question 42

What is the gram stain for enterococcus?

Answer 42

Gram positive

Question 43

What is the catalase test for enterococcus?

Answer 43

Catalase negative

Question 44

How can enterococcus be differentiated from S. pneumoniae?

Answer 44

1. Tolerates high salt and bile 2. Not sensitive to optochin

Question 45

What are the risk factors for enterococcus?

Answer 45

1. Prolonged hospitalization 2. BSA

Question 46

What are the clinical diseases associated with enterococcus?

Answer 46

UTI, peritonitis, endocarditis

Question 47

What is the diagnosis for asymptomatic bacteriuria?

Answer 47

Significant bacteriuria on two successive urine cultures in women or from a single culture in men from catheterized urine specimen

Question 48

When is treatment for asymptomatic bacteriuria indicated?

Answer 48

1. Pregnant women 2. Prior to urologic surgery 3. After renal transplantation

Question 49

What is the treatment for uncomplicated cystitis?

Answer 49

Trimethoprim / sulfamethoxazole

Question 50

What is the treatment for pyelonephritis?

Answer 50

Aggressive - fluoroquinolones for gram negatives, amoxicillin for gram positives

Question 51

What is the treatment for asymptomatic bacteriuria?

Answer 51

Cephalexin, nitrofurantoin