UTI/Kidney stone PBL

Question 1

Some risk factor for acute cystitis:

Answer 1

Recent use of a diaphragm with spermicide

frequent sexual intercourse

history of UTI

Question 2

Risk factors for UTI in healthy, post menopausal women:

Answer 2

sexual activity

diabetes mellitus

incontinence

Question 3

Risk factors for pyelonephritis in young healthy women:

Answer 3

frequent sexual intercourse

a new sexual partner

UTI in the previous 12 months

maternal history of UTI

diabetes

incontinence

Question 4

percent of recurrence in women with one UTI:

Answer 4

20-30%

Question 5

Diagnostic gold standard for UTI:

Answer 5

urine CULTURE

requires 24 hrs to obtain

**an additional 24 hrs may be required to identify specific organism

Question 6

First line abx for uncomplicated UTI in women:

Answer 6

nitrofurantoin

TMP-SMX

Question 7

First line abx for UTI in men:

Answer 7

fluoroquinolones (cipro)

TMP-SMX

Question 8

Three main mechs to keep urinary tract free of infx:

Answer 8

acidity of urine

act of urination

mucosal lining of the urinary tract

Question 9

Most common pathogen of UTI:

Answer 9

E. coli

Question 10

Three pathogens of uncomplicated UTI:

Answer 10

E. coli

Staph. saprophyticus

other enteric microorganisms

Question 11

Three major factors for colonization of the urinary tract:

Answer 11

Environment

Host

Microorganism

Question 12

E. coli adhesion VF that facilitates binding to renal epithelial cells:

Answer 12

P fimbriae

Question 13

type 1 pilus binds to_________ in bladder uroepithelial cells.

Answer 13

uroplakins

Question 14

Women with recurrent UTI are most likely to have had their first UTI before age__? And?

Answer 14

15

have maternal hx of recurrent UTI

Question 15

Gene polymorphism and subsequent IL-receptor abnormality associated with recurrent UTI?

Answer 15

CXCR1

IL-8 receptor

**impairs neutrophil host response

Question 16

Main symptom distinguishing cystitis from pyelonephritis:

Answer 16

fever

Question 17

Can uncomplicated UTI be treated on the basis of history alone?

Answer 17

Yes

Question 18

Urine dipstick looks for?

Answer 18

nitrites

leukocyte esterase

Question 19

Common UTI abx with risk of C. diff?

Answer 19

TMP-SMX

fluoroquinolones

ampicillin

Question 20

Common UTI abx without risk of C. diff?

Answer 20

nitrofurantoin

Question 21

Second line tx for uncomplicated UTI?

Answer 21

fluoroquinolones

Beta-lactams

Question 22

Use second line tx in regions where TMP-SMX resistance exceeds?

Answer 22

20%

Question 23

Which fluoroquinolone cannot be used in UTI?

Why?

Answer 23

moxifloxacin

doesn’t reach high enough conc in urine

Question 24

Drugs that increase risk of achilles tendon rupture?

Answer 24

fluoroquinolones

Question 25

First line for acute, uncomplicated pyelonephritis?

Answer 25

Fluoroquinolones

Question 26

Tx of UTI in early pregnancy? Do NOT give?

Answer 26

Nitrofurantoin, ampicillin, cephalosporins Don't give SMP or fluoroquinolones!!!

Question 27

Complicated UTI tx should be guided by:

Answer 27

urine culture results

Question 28

Stones that cannot be seen on XR?

Answer 28

Uric acid stones (rosettes) Cystiene (hexagonal)

Question 29

type 1 pilus

Answer 29

binds to bladder epithelial cells uroplakin **all strains posses the gene but not all express

Question 30

How to differentiate between E. coli and Klebsiella or P. mirabilis?

Answer 30

E. coli is urease negative

Question 31

Pathogen associated with struvite stones?

Answer 31

P. mirabilis

Question 32

Pathogens that alkalinize urine (>7.9)?

Answer 32

Mostly P. mirabilis (splits urea) some Klebsiella, Serratia