dysuria/UTI

Question 1

etiology of UTIs

Answer 1

E.coli (80-90%)
Other G-s (common in hospital, nursing home, immuen compromised, GU cath): proteus, klebsiella, pseudomonas
G+s: staph sapro, staph a., group B strep, enterococcus

Question 2

renal parenchyma infection

Answer 2

pylenephritis

Question 3

other causes of dysuria

Answer 3

menopausal: vaginal atrophy d/t loss of estrogen

Question 4

fever
flank pain
CVA tenderness
nausea, vomiting

Answer 4

upper tract UTI

Question 5

vaginal discharge
perineal pruritus
dysuria
reproductive age

Answer 5

vaginitis

Question 6

if women has:
nocturia
cloudy
smelly urine
urinary frequency or urgency
dysuria
suprapubic discomfort

Answer 6

high confidence that it is a lower UTI

Question 7

dysuria
urgency with decreased urine flow
tender and boggy prostate
hesitancy
\+/- fever

Answer 7

prostatisis

Question 8

high risk groups for UTI

Answer 8

• epithelium which e.coli adhere to

- uropathogens colonize vagina (d/t diaphgram, sponge, jelly)

Question 9

complicated infection red flags

Answer 9

male
infant, geriatric
sx > 7 days
immunosuppresed
acute pyelonephritis in last year
anatomic abnormality
DM
fever
flank pain or tenderness

Question 10

no fever or flank pain does/doesn’t eliminate possiblity of UTI

Answer 10

doesn’t

called occult pyelonephritis (just like lower UTI)

Question 11

dipstick portion of a UA

Answer 11

blood
nitrite (50% UTIs, high FN rate, converted by bacteria over several hrs, except G+s and pseudomonas, if vegetarian won't have nitrates to convert)
luekocyte esterase (75% UTIs, WBCs, high FP rate)

Question 12

dipstick results for a UTI

Answer 12

positive: either nitrite or LE positive
negative: both negative

Question 13

dipstick shows blood

Answer 13

rule in UTI (but FP: myoglobin, bacteria producing peroxidase)

Question 14

microscopy portion of UA

Answer 14

WBC count (women >2, men>5, kids >10)
RBC count
bacteria (if >10)
white cell casts

Question 15

standard for UTI diagnosis

Answer 15

positive urine culture: >100 cfu of bacteria

Question 16

use of urine culture only if

Answer 16

kid, men, older women, recurrent UTI in women

if healthy women: lack of prediction of response to Abx with culture

Question 17

treatment of

acute uncomplicated lower UTI in healthy women

Answer 17

self-limited in 1 week: 40% but still treat with 3 days of Abx: TMP/SMX, TMX, nitrofurantoin (need 7 days), FQ (ciprofloxacin)

Question 18

treatment of occult pyelonephritis

Answer 18

7 days of TMP/SMX or FQ

Question 19

management of recurrent UTIs is women

Answer 19

don’t need radiographic or urologic evaliuation

• urine cultures
• offer short course Abx when develop sx
• daily cranberry juice, increase fluid intake
• Abx after intercourse if 3 or more/year after intercourse

Question 20

women with recurrent infections: behavior modifications (front to back, postcoital voiding, no pantyhose)

Answer 20

do not prevent UTIs

Question 21

acute pyelonephritis in young women who is medically stable who maintains oral hydration

Answer 21

treat OP

• urine culture
• 14 days antibiotics

Question 22

acute pyelonephritis in hospitalized women (sepsis, abscess)

Answer 22

• blood culture before Abx
• IV FQ or pipercillin/tazobactam or 3rd gen cephalosporin
• continue until afebrile for 24 hrs
• 14 days antibiotics PO

Question 23

test of cure for pyelonephritis

Answer 23

urine culture 2-4 wks after end of Abx

Question 24

man with lower UTI or pyelonephritis

Answer 24

• urine culture

- 7-10 days FQ if UTI or 14 days if pyelonephritis

Question 25

imaging following pyelonephritis

Answer 25

women: if >1 pyelonephritis, postive urine culture after tx, childhood hx UTIs
men: 1 episode pyelo, >1 UTI

Question 26

check for pyelo if

Answer 26

2 yo with recurrent UTI

>2 yo with pyelonephritis