26. Urinary Tract Infections

Question 1

above the vesicleurerteral vvalves

Answer 1

upper tract

Question 2

below the vesicoureteral valves

Answer 2

lower tract

Question 3

involvement of tissue structures with instruments or comorbidities, usually male

Answer 3

complicated

Question 4

pus in the kidney causing inflammed kidney, calyces, pelvis

Answer 4

pylenonephritis

Question 5

bladder inflammation

Answer 5

cystitis

Question 6

3 or more UTI/yearas

Answer 6

recurrence

Question 7

recurrence in a month with the same organism

Answer 7

relapse

Question 8

relapse but <1 month usually a different orgnanism

Answer 8

reinfection

Question 9

in this group, males predominate with urogenital malformations more common

Answer 9

neonates

Question 10

at this time, females predominate for UTI frequency at 80%

Answer 10

childbearing years

Question 11

prior history, uncircumcised, sexual intercourse especially with frequency, inherited factors like IgA deficiency, structural abnormalities associated with reflux like vesico-ureteral reflux and duplicated collection system, obstruction like prostate enlargement and ureteral stones, foreign body especially foley chronic indwelling catheter

Answer 11

risk factors for UTI

Question 12

10^5 CFU/mL sungle species in clean catch urine, e coli 80%, staph saprophyticus 15% particularly in sexually active females, other gram -

Answer 12

symptomatic UTI definition

Question 13

> 10^5 CFU/mL single species in clean catch urine, treat in pregnany, renal transplant, and before urogenital surgery, common in nursing home residents, don’t treat, do not treat or check with foley in place, UTI with/from foley can lead to sepsis, therefore is symptomatic*** UTI

Answer 13

asymptomatic UTI definition

Question 14

gram positive cocci catalase positive coagulase negative novobiocin resistant

Answer 14

staphylococcus saprophyticus

Question 15

gram negative rod lactose fermenting fast

Answer 15

escherichia coli

Question 16

random, first void, clean catch, catheter, will show pH specific gravity, protein, glucose, ketones, bilirubin, leukocyte esterase, results will show WBC, RBC, epithelial cells, bacteria, casts, crystals, squamous epithelial cells (epis) represent a urethral or labial wash but doesn’t tell you anything about the bladder thus is unimportant

Answer 16

urinalysis types

Question 17

gram positive cocci catalase negative alpha hemolytic optochin sensitive bile soluble

Answer 17

streptococcus pneumoniae

Question 18

gram positive cocci, catalase negative, alpha hemolytic, optochin and bile solubility negative,

Answer 18

streptococcus mutans and mitits

Question 19

gram positive cocci, catalase negative, gamma hemolytic, grows in 6.5% NaCl

Answer 19

enterococcus faecium/faecalis

Question 20

gram positive cocci, catalase negative, gamma hemolytic, doesn’t grow in 6.5% NaCl

Answer 20

streptococcus bovis

Question 21

gram positive cocci, catalase negative, beta hemolytic, bacitracin sensitive

Answer 21

streptococcus pyogenes

Question 22

pH 4.5-8 hints at potential genus, specific gravity 1.005-1.025 which identifies SIADH and solutes, glucose is usually negative unless diabetic patients, ketones are usually negative but can be elevaetd in dehydration and toxins, blood is negative specifically in hemoglobin (perioxidase cross reacts), bilirubin is usually negative (direct/conjugated) hepatic disease, protein is negative usually unless nephrotic syndrome or renal failure, urobilinogen is negative or small (Ehrlich U) identifies hemolysis ***

Answer 22

UTI UA dipstick

Question 23

gram positive cocci, catalase negative, beta hemolytic, not bacitracin sensitive

Answer 23

streptotoccus agalactiae

Question 24

gram positive rod, spore forming, anaerobic

Answer 24

clostridium/clostridiodies

Question 25

RBC between 0-5 is normal, need to be physical/intact, compare to dipstick, WBC between 0-5 is normal, correlated it with leukocyte esterase, few bacteria but is not a gram stain so not specific enough ***

Answer 25

UTI UA microbiology

Question 26

27 year old male presents with pain and burning on urination, differential cystitis and urethritis, work up with split urine first void then clean catch, on first void pH 6.5, specific grabity 1.015, negative glucose, ketones, bilirubin, urobilinogen, nitrite, protein, leukocyte esterase, moderate red blood cells, moderate white blood cells, ***, result I was pyuria, result II was clean, interpreted as urethritis with no cystitis, differential of sexually transmitted disease, mechanical, irritative, gonorrhea/chlamydia DNA by polymerase chain reaction

Answer 26

case I

Question 27

for urethritis, differentiate infection from irritation ***

Answer 27

UTIs by geography

Question 28

46 year old female with abdominal pain, initial UTI was pH 6.5, specific grabity of 1.005, negative glucose, ketones, bilirubin, urobilinogen, nitrites, protein, leukocyte esterase, trace RBC and WBC, 0-3 RBC, 5-10 WBC, 20-50 epithelial cells, no better after 3 days of TMP/SMX,

Question 29

18 year old female with pain and burning on urination, no other symptoms, negative past history, normal physicla exam, differential of cytitis and urethritis of various types including infectious, first UA, clean catch, *** caution on fluoroquinolones

Question 30

gram positive rod, spore forming, aerobic, motile, gelatin hydrolytic, hemolytic

Answer 30

bacillus cereus

Question 31

gram positive rods, spore forming, aerobic, non-motile, no gelatin hydrolysis, non-hemolytic

Answer 31

bacillus anthracis

Question 32

gram positive rods, not spore forming

Answer 32

corynebacterium/listera monocytogenes

Question 33

gram negative rod, slow lactose fermenting

Answer 33

citrobacter/serratia

Question 34

gram negative rod, non-lactose fermenting, oxidase positive

Answer 34

pseudomonas aeruginosa

Question 35

gram negative rod, non-lactose fermenting, oxidase negative, H2S positive

Answer 35

salmonella/proteus

Question 36

gram negative rod, oxidase negative, H2S negative

Answer 36

shigella/yersinia

Question 37

gram negative, curved rod, oxidase positive, urease positive

Answer 37

helicobacter pylori

Question 38

gram negative, curved rod, oxidase positive, growth at alkaline pH

Answer 38

vibrio

Question 39

gram negative, curved rods, oxidase positive, growth at 42C

Answer 39

campylobacter

Question 40

gram negative coccobacilli

Answer 40

haemophilus influenzae, pasturella, brucella, bordatella, franciscella, acinetobacter

Question 41

gram negative diplococci, aerobic, maltose positive

Answer 41

neisseria meningitidis

Question 42

gram negative diplococci, aerobic, maltose negative, uses glucose

Answer 42

neisseria gonorrhoeae

Question 43

gram negative, diplococci, aerobic, maltose negative, glucose negative

Answer 43

moraxella catarrhalis

Question 44

bacteria not usually gram stained, recticulate body and elementary body formation

Answer 44

chlamydia trachomatis/pneumoniae

Question 45

bacteria not usually gram negative, spirochete

Answer 45

borellia, treponema pallidum, leptospira

Question 46

bacteria not usually gram stained, no cell wall

Answer 46

mycoplasma

Question 47

bacteria not usually gram stained, unique cell wall

Answer 47

myobacterium