GU

Question 1

2 Categories of UTI

Answer 1

Pyelonephritis & Cystitis

Question 2

Pyelonephritis vs. Cystitis - Location

Answer 2

Pyelonephritis - infection of kidney; upper urinary tract

Cystitis - infection of bladder; lower urinary tract

Question 3

Cystitis - Epidemiology

Answer 3

most common
more common in women
gram - bacteria
infection of bladder & urethra

Question 4

Cystitis - Pathogens

Answer 4

most common E.coli (75-95%)
Lactobacilli, group B strep, enterococci
Contamination

Question 5

Cystitis - Pathogenesis

Answer 5

colonization of introitus
structural issue
ascends urethra into bladder

Question 6

Cystitis - Clinical Manifestations

Answer 6

dysuria
frequency
urgency
suprapubic pain
hematuria

Question 7

Cystitis - Labs

Answer 7

UHCG
U/A
Dipstick
+/- urine culture

Question 8

Cystitis - most valuable diagnostic test

Answer 8

Dipstick

Question 9

What do dipsticks detect?

Answer 9

Leukocyte esterase - enzyme released by leukocytes - reflects pyuria
Nitrites - presence of enterobacteria- converts urinary nitrate into nitrite; false + with bladder analgesics
WBC
RBC
Protein

Question 10

Cystitis - DDx

Answer 10

Vaginitis
Urethritis
Structural urethral abnormalities
Painful bladder syndrome
PID
Nephrolithiasis

Question 11

Cystitis - Txt (Uncomplicated Pt)

Answer 11

Macrobid
Bactrim
Cipro

Question 12

Cystitis - Symptomatic Txt

Answer 12

Phenazopyridine-pyridium

2-3 days

Question 13

Pyelonephritis - Epidemiology

Answer 13

Less common than acute cystitis
Annual incidence is 12-13 cases per 10,000 women
Infectious inflammatory dz
Involves the kidney parenchyma & renal pelvis
Gram - bacteria most common cause

Most cases uncomplicated
Complicated assc. w/ underlying dz

Question 14

Pyelonephritis - Complications

Answer 14

Diabetes
Pregnancy
Urinary tract obstruction
Indwelling urinary catheter
Renal transplant
Immunosuppression
Renal failure

Question 15

Pyelonephritis - Pathogens

Answer 15

most common E.coli
Other:
K.pneumoniae
P.mirabilis

Question 16

Pyelonephritis - Pathogenesis

Answer 16

begins w/ colonization of the vaginal introitus w/ fecal flora
ascends into bladder, ureters, kidney
can have seeding from bacteremia

Question 17

Pyelonephritis - Clinical Manifestations

Answer 17

dysuria
frequency
urgency
suprapubic pain
hematuria
fever
chills
flank pain
CVA tenderness
nausea
vomiting
asymptomatic

Question 18

Pyelonephritis - Labs

Answer 18

U/A
urine culture
CBC - elevated w/ left shift

Question 19

Pyelonephritis - DDx

Answer 19

Influenza
LBP - musculoskeletal
PID

Question 20

Pyelonephritis - Txt (uncomplicated outpatient)

Answer 20

Fluoroquinolones only oral recommendation for outpatient
Cipro
Levo
IV loading dose Rocephen

Question 21

Pyelonephritis - Txt (inpatient)

Answer 21

IV fluoroquinolone - Levo, Cipro
IV aminoglycoside - streptomycin, gentamycin
Local resistance patterns
Institutional guidelines

Question 22

Pyelonephritis - Symptomatic txt

Answer 22

Phenazopyridine
Motrin, acetaminophen
Anti-emetics - zofran
IV fluids

Question 23

UTI in pregnancy - Txt (Outpatient)

Answer 23

acute cystitis generally considered complicated
most asymptomatic
Fluoroquinolones should be avoided

Macrobid
Augmentin
Cefpodoxime
Fosfomycin

Question 24

Why are UTIs common in pregnancy?

Answer 24

d/t anatomic changes during pregnancy - pressure on bladder, increase in size of ureters d/t smooth muscle relaxation, immunosuppression

Question 25

UTI in pregnancy - Txt (Inpatient)

Answer 25

traditionally treated inpatient for at least 24 hrs

IV beta-lactams
Penicillin derivatives
CPNs - cefazolin, ceftriaxone
Fluoroquinolones - category D

Question 26

Asymptomatic Bacteriuria - Epidemiology

Answer 26

isolation of bacteria w/o signs or sxs
urine is normally sterile
prevalence increases w/ age
most common in pregnant women
rare in young, healthy men

Question 27

Asymptomatic Bacteriuria - Txt

Answer 27

appropriate to txt and screen in pregnant women & pts undergoing urologic procedures

use of antibiotics same as cystitis