UTI, pyelo, IC

Question 1

What pathogen accounts for 75-95% of cases of UTI

Answer 1

Escherichia coli

Question 2

What are the other pathogens of UTI

Answer 2

• gram negative
  
  • Klebsiella
  • Proteus
  • Pseudomonas aeruginosa
• gram positive
  
  • staph saprophyticus
  • enterococcus

Question 3

Differentiate between upper and lower tract infections

Answer 3

• upper tract
  
  • Pyelonephritis
• lower tract
  
  • Cystitis
  • urethritis
  • prostatitis

Question 4

Name the risk factors for UTI

Answer 4

1. reduced urine flow
2. promote colonization
3. facilitate ascent

Question 5

what are some causes of reduced urine flow that makes a person at risk for UTI

Answer 5

• outflow obstruction
• inadequate fluid intake
• neurogenic bladder

Question 6

what are some causes of things that promote colonization that makes a person at risk for UTI

Answer 6

• sexual activit, spermicide use
• estrogen depletion
• recent antimicrobial use

Question 7

what are some things that facilitate ascent that makes a person at risk for UTI

Answer 7

• catheterization
• urinary incontinence

Question 8

Name the characteristics that make a UTI uncomplicated

Answer 8

• immunocompetent
• no comorbidies
• no known urologic abnormalities
• not pregnant
• premonopausal

Question 9

what is cystitis

Answer 9

infection of the bladder

Question 10

acute cystitis has what 3 characteristic symptoms

Answer 10

1. dysuria
2. frequency
3. urgency

• can also have hematuria and/or suprapubic discomfort

Question 11

probability of cystitis increases in women who have dysuria and frequency without

Answer 11

vaginal discharge/irritation

Question 12

what parameter on urine dipstick is most specific for UTI

Answer 12

+ leukocyte esterase

Question 13

nitrite can have a false positive with what medications

Answer 13

• phenazopyridine (Azo, pyridium)

Question 14

when are urine cultures recommended

Answer 14

• suspect complicated infection
• suspect acute pyelonephritis
• symptoms that do not resolve
• symptoms that recur
• atypical presentation

Question 15

what number of colony-forming units per mL is diagnostic for acute cystitis

Answer 15

• > or = 10³
  
  • ^​10² is + is women with typical symptoms

Question 16

what should be given in addition to antimicrobial therapy for UTI

Answer 16

• Phenazopyridine (Pyridium) 200 mg TID x 2 days

Question 17

What is the first line treatment options for acute, uncomplicated cystitis in women

Answer 17

1. Timethoprim/Sulfamethozazole (Bactrim) 160/800 mg BID x 3 days
2. Nitrofurantoin (Macrobid)
3. Fosfomycin (Monurol): single dose

Question 18

why would you not give bactrim for acute, uncomplicated cystitis in women

Answer 18

• prevalence of resistant > 20%
• used for UTI in previous 3 months

Question 19

What is the second line treatment options for acute, uncomplicated cystitis in women

Answer 19

1. Fluoroquinolones
   
   1. Ciprofloxacin
   2. Cipro XR
   3. Levofloxacin
   4. Ofloxacin

Question 20

What is the third line treatment options for acute, uncomplicated cystitis in women

Answer 20

• oral beta-lactams

Question 21

What is the first line treatment options for acute, complicated cystitis in nonpregnant women

Answer 21

• Fluoroquinolones

Question 22

What is the first line treatment options for acute, uncomplicated cystitis in men

Answer 22

1. bactrim or
2. fluoroquinolones

Question 23

What is the first line treatment options for acute cystitis in pregnant women

Answer 23

1. Macrobid
2. Augmentin

• ***Avoid fluoroquinolones!!!!!

Question 24

patient education for acute cystitis

Answer 24

• push fluids
• void when feel urgency
• void before and after sexual intercourse
• complete course of Abx
• signs of pyelonephritis

Question 25

What is pyelonephritis? what conditions can it lead to

Answer 25

infection of the kidney * can lead to * renal abcess * sepsis * shock * ARF

Question 26

These UA results are consistent with * pyuria (\> 10 leukocytes/micoL) * bacteriuria * +/- hematuria * **white blood cell casts**

Answer 26

pyelonephritis

Question 27

When is imaging indicated in acute pyelonephritis? what imaging is indicated

Answer 27

* complicated pyelonephritis or * appear severely ill * CT +/- contrast

Question 28

Tx for mild-moderate acute pyelonephritis (outpatient management)

Answer 28

* **Fluoroquinolones x 1 week** * if local resistance in Ecoli \> 10 % * add _Ceftriaxone (rocephin)_ * **Must f/u in 24-48 hours**

Question 29

What are the indications to admit a patient with acute pyelonephritis

Answer 29

* concerns about compliance * comorbid conditions * hemodynamic instability * male * metabolic derangement (acidosis) * pregnancy * severe pain * toxic appearance * unable to take liquids by mouth * very high fever (\>103 F)

Question 30

inpatient tx for nonpregnant women with acute pyelonephritis

Answer 30

* fluoroquinolone

Question 31

What is interstitial cystitis? What patient population does it commonly affect

Answer 31

* **bladder pain syndrome; diagnosis of exclusion** * women * \>40 yo * often coexists with other chronic pain conditions: fibromyalgia, IBS

Question 32

What is the most important central finding in interstitial cystitis

Answer 32

**altered urothelium** * **Glycosaminoglycan (GAG)** layer commonly damaged * impedes urothelial growth -\> chronic inflammation -\> mast cel activation -\> upregulation of sensory innervation -\> pain

Question 33

as interstitial cystitis progesses, fibrosis can occur, what sign is common

Answer 33

Glomerulations: bladder hemorrhages

Question 34

What is the percentage breakdown of interstitial cystitis in terms of ulcerative and nonulcerative type

Answer 34

* nonulcerative type: 90% * ulcerative type: 10%

Question 35

clinical presentation * highly variable * **suprapubic bladder pain** * **​worse with bladder filling, relieved with voiding** * increased urinary frequency * Dyspareunia (difficult or painful sexual intercourse), relationship of pain to menstruation * males: +/- painful ejaculation

Answer 35

interstitial cystitis

Question 36

How is interstitial cystitis diagnosed

Answer 36

**clinically** * sx duration \> or = 6 weeks * location, character of pain * PMH: prior recurrent UTIs, pelvic trauma, surgery, radiation

Question 37

Since interstitial cystitis is a diagnosis of exclusion, what are tests you should run to make sure something else is going on

Answer 37

1. UA with microscopy and urine culture * check for chlamydia 2. urine cytology if + smoking history 3. +/- postvoid residual urine volume * r/o bladder outlet obstruction or neuro disorder 4. +/- cytoscopy -\> indicated if in doubt

Question 38

for interstitial cystitis treatment, what should be done to establish baseline symptoms

Answer 38

1. voiding log 2. O'Leary-Sant symptoms and problem questionnaire 3. Pelvic pain and urgency/frequency questionnaire

Question 39

First line tx for interstitial cystitis

Answer 39

1. Lifestyle changes: avoid citrus, spicy food, caffeine, ETOH, carbonated beverages 2. Behavior modification: bladder retraining 3. Low impact exercise 4. support groups

Question 40

second line tx for interstitial cystitis

Answer 40

* oral medication * \***Tricyclic antidepressant (Amitriptyline)** * **Pentosan Polysulfate (Elmiron)** * may take 3-6 months to respond

Question 41

indications for referral with interstitial cystitis

Answer 41

* hematuria * complex symptoms (pain with incontinence) * incomplete bladder emptying * neurologic disorder that affects bladder function * prior pelvic radiation or surgery * not responding to initial tx with oral meds

Question 42

clinical presentation * fever * flank pain * N/V * CVA tenderness

Answer 42

pyelonephritis

Question 43

what must you do prior to initiating Abx for all pyelonephritis cases

Answer 43

must culture