Infections

Question 1

What are the 4 classifications of UTIs?

Answer 1

Simple UTI
Complicated UTI
Upper UTI
Lower UTI

Question 2

What is considered a complicated UTI?

Answer 2

Men
Pregnancy
Surgically altered urinary tract
Atypical organisms (proteus, pseudomonas, klebsiella)

Question 3

What is an upper UTI?

Answer 3

Infection of:
-kidneys
-ureters

Question 4

What is a lower UTI?

Answer 4

Infection of:
-bladder
-urethra

Question 5

What are the 3 main symptoms of a UTI?

Answer 5

Dysuria
Frequency
Supra pubic pain

Question 6

What are the 2 important features looked for on a urine dip when it comes to a UTI?

Answer 6

Nitrites
Leukocyte esterases

Question 7

What is meant by a +leukocytes +nitrites?

Answer 7

Likely UTI treat if symptomatic

Question 8

What will UTIs always be positive for on urine dip?

Answer 8

Leukocytes

Question 9

Can a urine dip be +leukocytes -nitrites and still have a UTI?

Answer 9

Yes

Question 10

What is the likely causative organism if a urine dip is +leukocytes - nitrites?

Answer 10

Staphylococcus saprophyticus

Question 11

What is the significance of +leukocytes on urine dip?

Answer 11

May be a UTI
Not always indicative of a UTI (just indicates inflammation)

Look for symptoms

Question 12

When managing a patient with a UTI, what should always be done?

Answer 12

Collect a mid stream urine smaple for Microscopy, Cultures and sensitivity in case dont respond to empirical abx

Question 13

What is the management for an uncomplicated UTI?

Answer 13

3days oral trimethoprim or nitrofurantoin

Question 14

What is the management of complicated UTIs?

Answer 14

7-10 days nitrofurantoin or trimethoprim

Augmentin if dont work

Question 15

What medication given for multi drug resistant gram negative organisms (causing UTI?

Answer 15

IV meropenem

Or

Oral fosfomycin

Question 16

What scenarios do you treat asymptomatic bacteruria?

Answer 16

Pregnancy
Before urology surgery

Question 17

How do you manage recurrent UTIs in women without abx?

Answer 17

Exclude structural causes with Ultrasound KUB (residual volume estimate)

Can cystoscope if older

Advise fluid intake
Avoid synthetic pants
Shower rather than bath
Avoid perfumed soaps
Cranberry tablets
Topical oestrogens if post menopausal
D-mannose

Question 18

What are the abx managements of recurrent UTIs?

Answer 18

Single dose abx post coital
Self start abx at first sign of symptoms
Low dose 3-6months prophylactic abx course

Question 19

What is pyelonephritis?

Answer 19

Infection of the kidneys

Question 20

What is pyonephrosis?

Answer 20

An infected obstructed kidney where pus builds up in the. Renal pelvis

Question 21

What is the main difference between pyelonephritis and pyonephrosis?

Answer 21

Pyelonephritis can occur without obstruction usually due to an ascending UTI and happens bilaterally

Pyonephrosis is usually always due to an obstruction so is mainly unilateral

Question 22

How does pyelonephritis present?

Answer 22

Bilateral loin pain
Fever
Chills
N+V
Tachycardia

Question 23

What is more severe pyelonephritis or pyonephrosis?

Answer 23

Pyonephrosis

Question 24

How can patients be treated in community with pyelonephritis if it’s not septic?

Answer 24

7-10 days oral ciprofloxacin or augmentin(co-amoxiclav)

Question 25

What Ix are done for men with UTI?

Answer 25

Urine dip DRE U+Es Cystoscope Flow rate

Question 26

What is a flow rate used to assess?

Answer 26

Weather theres a bladder outflow obstruction

Question 27

What flow rate is suggestive of a bladder outflow obstruction?

Answer 27

<10ml/s

Question 28

What is acute prostatitis typically caused by?

Answer 28

Infection

Question 29

What are hte causes of chronic prostatitis?

Answer 29

Bacterial Non bacterial

Question 30

What is a non bacterial causes of chronic prostatitis?

Answer 30

Pelvic floor dysfunction

Question 31

What is the most common causative organism for acute prostatitis?

Answer 31

E.coli

Question 32

What is the most common causative organism for acute prostatitis?

Answer 32

E.coli

Question 33

What structural change can STIs cause in young men?

Answer 33

Urethral strictures

Question 34

What investigation do you send off when you suspect an STI?

Answer 34

NAAT

Question 35

What are the 2 most common organisms for STIs?

Answer 35

Chlamydia Gonorrhoea

Question 36

What is epididymo-orchitis?

Answer 36

Acute infection oof the testis/epididymis

Question 37

What is the most common cause of epididymo-orchitis in 16-30yr olds?

Answer 37

STIs (gonorrhoea or chlamydia)

Question 38

What is the most common cause of epididymo-orchitis in 60+ year olds?

Answer 38

Bladder outflow obstruction

Question 39

What investigations are done for orchitis?

Answer 39

Mid stream urine sample and NAAT USS to exclude abscess or Tumor

Question 40

What drugs are given for epididymo orchitis in 16-30yr olds?

Answer 40

10-14days Oral doxycycline with or without IM Ceftriaxone

Question 41

What drugs are given to 60+yr olds with epididymo orchitis?

Answer 41

10-14days ciprofloxacin

Question 42

How can you typically tell the difference between epididymo-orchitis and testicular torsion?

Answer 42

Testicular torsion = rapid onset, younger people, high lying laterally orientated testis

Question 43

How do you manage testicular torsion?

Answer 43

Emergency exploration