UTIs

Question 1

What are the 2 locations of UTIs?

Answer 1

Upper (kidney)
Lower (bladder onwards)

Question 2

What is an upper tract UTI called?

Answer 2

Pyelonephritis

Question 3

What are 4 lower tract UTIs?

Answer 3

Cystitis
Prostatitis
Urethritis
Epididymo-orchiditis

Question 4

What pain is felt in prostatitis?

Answer 4

perianal pain when orgasming

Question 5

What organism cause UTIs?
What’s the acronym?

Answer 5

KEEPS
Klebsella
Enterobacter
E.Coli
Proteus
S.Saprophyticus

Question 6

What different organism causes 80% cases?

Answer 6

UPEC
Uropathic E.Coli

Question 7

Are males or females more affected and why?

Answer 7

Females much more affected as they have shorter urethras therefore closer to anus + easier for bacteria to colonise

Question 8

What are the lines of investigation (1st and GS) for UTIs?

Answer 8

1st line = urine dipstick
GS = midstream MS+C (microscopy, culture + sensitivity)

Question 9

What is seen in the urine dipstick?
What does this mean?

Answer 9

+ve leukocytes
+ve nitrites (bacteria breaking down nitrates to nitrites)
+/- haematuria
UTI likely

Question 10

Why is MC+S used ?

Answer 10

Confirm UTI + ID pathogen

Question 11

What is pyelonephritis?

Answer 11

Infection of renal parenchyma (pelvis) and upper ureter

Question 12

Where is infection from and to?
Which is the affecting organism?

Answer 12

ascending infection, from lower to upper

usually UPEC, can be KEEPS

Question 13

Who is affected?

Answer 13

Females <35

Question 14

RF for pyelonephritis?

Answer 14

Urine stasis (stones)
Renal structural abnormalities
catheters

Question 15

Sx for pyelonephritis?

Answer 15

Triad:
Loin pain
Fever
Pyuria (pus and WBC in urine)

Question 16

Dx of pyelonephritis?

Answer 16

1st = urine dipstick
GS = MC+S
Investigation for stones if suspected

Question 17

Tx fot pyelonephritis?

Answer 17

Analgesia / paracetamol

Abx = Ciprofloxacin or co amoxiclav (cefalexin if pregnant)

Question 18

What is cystitis?
Causative organism?
Gender most affected?

Answer 18

Infection of bladder
UPEC
Females

Question 19

RF for cystitis?

Answer 19

Urine stasis
bladder lining damage
catheters

Question 20

Sx of cystitis?

Answer 20

Suprapubic tenderness + discomfort
increased frequency + urgency
visible haematuria

Question 21

Dx of cystitis?

Answer 21

1st = urine dip
GS = MC+S

Question 22

Tx for cystitis?
when pregnant Tx?

Answer 22

Abx = trimethoprim or nitrofurantoin
(amoxicillin if pregnant)

Question 23

What is urethritis?

Answer 23

Inflammation of urethra +/- infection

Question 24

What is the MC cause?

Answer 24

a sexually acquired condition

Question 25

What are the Infective types of urethritis?

Answer 25

Gonococcal (Neisseria gonorrhoea) - LC
Non gonococcal (Chlamydia trachomatis) - MC

Question 26

What is non infective of urethritis?

Answer 26

Trauma

Question 27

RF for urethritis?

Answer 27

MSM
Unprotected sex

Question 28

What type of bacteria are Neisseria and chlamydia?

Answer 28

Neisseria = Gram -ve diplococcus
Chlamydia = Obligate intracellular gram -ve aerobe (bacillus)

Question 29

Sx of urethritis?

Answer 29

Dysuria (pain)
+/- Urethral discharge (blood/pus), urethral pain

Question 30

Dx of urethritis?

Answer 30

NAAT (nucleic acid amplification test) - detects STI
Urine dip (+ve if infectious STI indicated) + MC+S (will detect pathogen ID if UTI)

Question 31

Tx for NG and CT

Answer 31

NG = IM ceftriaxone + azithromycin

CT = Azithromycin (or doxycycline)

Question 32

Which disease is urethritis a Sx of?

Answer 32

Reactive arthritis
Can’t see (conjunctivitis) , can’t PEE (URETHRITIS), can’t climb a tree (arthritis)

Question 33

What is epididymo-orchitis?
due to what organisms depending on age?

Answer 33

Inflammation of epididymus , extending to testis
Usually due to:
Urethritis (STI) <35y
Cystitis (KEEPS) extension >35y
Elderly = due to catheter

Question 34

Sx of EO?

Answer 34

Unilateral scrotal pain + swelling
Pain relieved when ELEVATING TESTIS (+ prens sign)
Cremaster reflex intact

Question 35

What is a DDX and why?

Answer 35

Rule out testicular torsion (more acute, N+V, crytorchidism/bell clapper)

Question 36

Dx ?

Answer 36

NAAT, Urine dip, MC+S

Question 37

Tx ?

Answer 37

Dep on STI (NG/CT) or UTI , see above Abx Tx