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Block 19 Nephro Module 2 > Micro of the Genitourinary system > Flashcards

Micro of the Genitourinary system Flashcards

1
Q

It is the presence of uropathogens in the urinary tract resulting to variety of signs and symptoms.

A

Urinary Tract Infection

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2
Q

T/F. Dysuria/frequency/urgency are common in upper tract.

A

False (In the lower tract)

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3
Q

T/F. All bacteria in urine are pathogenic.

A

False (Not all)

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4
Q

T/F. Fever and chills are always present in lower UTI.

A

False (Upper UTI, and may even be the only manifestation of pyelonephritis)

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5
Q

T/F. Hematuria is usually found in upper UTI.

A

False (Lower tract, urethritis)

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6
Q

T/F. Conventionally, urine CS with growth of at least >105 colonies/mL of uropathogens indicates infection.

A

True

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7
Q

T/F. Colony count of 102 to 104 colonies/mL (wherein sample was obtained through suprapubic aspiration or catheterization) does not indicate infection.

A

False (May indicate infection, esp. if it’s a uropathogen and there are other risk factors)

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8
Q

Presence of bacteria in urine

A

Bacteriuria

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9
Q

Significant bacteriuria without symptoms

A

Asymptomatic bacteriuria (seen in pregnancy, DM with neurogenic bladder, elderly with recurrent UTI)

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10
Q

T/F. Urine in bladder is not considered naturally sterile

A

False (contaminated by genital flora it goes out)

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11
Q

Anatomic classification of UTI which is above the bladder.

A

Upper UTI

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12
Q

Symptomatic infection of bladder

A

Cystitis

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13
Q

Symptomatic infection of kidneys

A

Pyelonephritis

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14
Q

Epidemiologic classification of UTI spontaneously appearing especially in females who are very predisposed to develop this infection

A

Community-acquired UTI

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15
Q

Epidemiologic classification of UTI acquired in hospital and is symptomatic

A

Catheter-associated UTI

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16
Q

Epidemiologic classification of UTI acquired in hospital and is asymptomatic

A

Catheter-associated bacteriuria

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17
Q

UTI in a structurally and neurologically normal urinary tract

A

Uncomplicated UTI

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18
Q

UTI with functional or structural abnormalities

A

Complicated UTI

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19
Q

T/F. UTI in men is considered uncomplicated.

A

False (Complicated. Unlike women, it is not usual for men to have UTI due to the structure of the GUT.)

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20
Q

T/F. UTI in pregancy is considered complicated.

A

True

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21
Q

T/F. Recurrent UTI is automatically considered complicated

A

False (Individual episodes could be uncomplicated)

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22
Q

T/F. Complicated UTI has more resistant pathogen thus needs weaker antibiotics

A

False (Stronger antibiotics)

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23
Q

This determines whether tissue invasion and symptomatic infection will ensue

A

Interplay of host, pathogen and environment

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24
Q

Most important route in most UTI especially on feamles

A

Ascending route

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25
Q

Most common cause of UTI and is gram negative

A

E. coli (75%-90% of cases)

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26
Q

T/F. Catheterization (as well as condom cath), spermicide use, and estrogen deficiency can cause bacterial colonization

A

True

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27
Q

Access of bacteria to UT through blood

A

Hematogenous spread (<2% of UTI cases and usually by Salmonella or S. aureus)

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28
Q

T/F. Staph and Candida cause bacteremia and seeding in other organs

A

True

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29
Q

T/F. Females are more prone to UTI

A

True (esp. 1 - ~50 y.o.)

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30
Q

T/F. UTI is common in females in neonatal period

A

False (males due to congenital anomalies)

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31
Q

T/F. Most common cause of UTI in men is obstruction due to prostatic hypertrophy

A

True

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32
Q

Infection where bacteria is introduced to bladder during sexual intercourse

A

Honeymoon cyctitis

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33
Q

T/F. Urine and urinary tract has antibacterial properties and activities

A

True

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34
Q

T/F. Advice UTI px to increase fluid intake to increase micturition

A

True as long as not C/I

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35
Q

Urinary inhibitors of bacterial adherence

A

Tamm Horsfall protein, Bladder mucopolysaccharide, Low molecular weight oligosaccharide, Secretory IgA

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36
Q

T/F. UTI can cause premature labor

A

True

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37
Q

T/F. Pregnancy is a risk factor for UTI

A

True (get baseline urinalysis on 1st visit

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38
Q

T/F. VUR is not common in children

A

False (common)

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39
Q

Risk factor for UTI in diabetic px

A

Neurogenic bladder dysfunction; impaired cytokine secretion leads to ASB in women

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40
Q

T/F. Diabetic women have less risk to UTI than non diabetic women

A

False (2-3x risk)

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41
Q

Gram negative that may cause recurrent UTI

A

Klebsiella

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42
Q

UTI pathogens in immunocompromised and diabetic px

A

Enterobacter, Serratia, Pseudomonas

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43
Q

Strain of E. coli in UTI

A

Extra intestinal pathogenic E. coli (ExPEC)

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44
Q

E. coli characteristic on EMB

A

Has metallic sheen

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45
Q

E. coli on lactose

A

Fermenter

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46
Q

E. coli on indole test

A

Positive

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47
Q

Facilitates tissue invasion of E. coli in pyelonephritis

A

Hemolysin

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48
Q

Iron scavenging protein and facilitates E. coli invasion and changes in UT epithelium

A

Aerobactin

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49
Q

It protects E. coli from leukocytic phagocytosis and allows attachment to upper tract

A

K Ag

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50
Q

Facilitates adherence and strongly associated to acute disease severity

A

P pilus/P fimbrae

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51
Q

E. coli structure involved in cystitis

A

Type 1 fimbrae/pilus

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52
Q

E. coli structure involved in biofilms

A

Type 3 fimbrae

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53
Q

E. coli strains resistant to penicillins and 3rd/4th cephalosporins but responsive to carbapenems or quinolones

A

Extended spectrum beta-lactamase producing E. coli

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54
Q

Adjunct to carbapenems

A

Aminoglycosides

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55
Q

ESBL negative strains are sensitive to

A

Ciprofloxacin and coamoxiclav

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56
Q

Community acquired proteus UTI

A

P. mirabilis

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57
Q

Nosocomial proteus UTI

A

P. vulgaris and P. penneri

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58
Q

Virulence factors of proteus

A

adhesins, flagellae, IgA protease, urease

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59
Q

Cases of proteus complicated UTI

A

10-15%; up to 20-45% (long term cath)

60
Q

Allows proteus to move and swarm

A

Peritrichous flagella

61
Q

This hydrolyzes urea to form ammonia

62
Q

Suspected cause when urine is alkaline

63
Q

Result of alkaline urine by ptoteus

A

Formation of struvite and carbonate-apatite crystals (always assoc. with stone formation)

64
Q

Imaging for stones

A

UTZ KUB/X-ray

65
Q

This develops along renal pelvis and leads to obstruction and can manifest as back pain

A

Staghorn calculus

66
Q

2nd most common cause of UTI in diabetic px and 2nd most common ESBL producing pathogen

A

Klebsiella pneumoniae

67
Q

Drug of choice for ESBL

A

Carbapenems

68
Q

T/F. Kleb is not a lactose fermenter

69
Q

Kleb colonies on nutrient agar and blood agar

A

Mucoid colonies

70
Q

Kleb colonies on MacConkey agar

A

Dark pink or fuchsia

71
Q

T/F. Gram positive are common causes of UTI

A

False (rare)

72
Q

Most common Gram + cause of UTI in 5-15% of population (common in females) and is coagulase negative and novobiocin resistant

A

S. saprophyticus

73
Q

How is S. epidermidis different from S. saprophyticus

A

Novobiocin sensitive

74
Q

Most frequent fungi found in urine

75
Q

Antibiotics when there is fungus ball

A

Amphotericin B and echinocandins

76
Q

Candida on gram stain

A

Pseudohyphae and budding yeast cells

77
Q

Used to identify albicans vs non albicans

78
Q

Presence of Candida in urine regardless of colony count improperly collected urine specimen on 2 separate occasions at last 2 days apart

A

Candiduria

79
Q

Tx of choice for Candida

A

Fluconazole

80
Q

Invasion of Candida in blood

A

Candidemia

81
Q

There is no growth in urine culture but has symptoms

A

Sterile pyuria with acute symptoms

82
Q

Pathogens in sterile pyuria

A

Neisseria gonorrhoea, chlamydia trachomatis, herpes simplex

83
Q

T/F. Diagnosis of ABU can be considered only when the patient does not have local or systemic symptoms referable to the urinary tract

84
Q

Typical symptoms are dysuria, urinary frequency, and urgency

85
Q

T/F. Unilateral back or flank pain is not indicated in upper tract involvement

A

False (indicated)

86
Q

Low-grade fever with or without lower-back or costovertebral-angle pain

A

Mild pyelonephritis

87
Q

High fever, rigors, nausea, vomiting, and flank and/or loin pain

A

Severe pyelonephritis

88
Q

Pattern of fever in pyelonephritis

A

High spiking picket-fence

89
Q

Main feature distinguishing cystitis and pyelonephritis

90
Q

Presents as asymptomatic episode of cystitis or pyelonephritis in a man or woman with an anatomic predisposition to infection, with a foreign body in the urinary tract, or with factors predisposing to a delayed response to therapy

A

Complicated UTI

91
Q

Organisms in sterile pyuria with chronic course

A

Mycobacterium TB

92
Q

UTI that presents as acute dysuria either at start or terminal part of flow

A

Urethritis

93
Q

Systemic symptoms are present in this UTI.

A

Acute pyelonephritis

94
Q

Cause of costovertebral angle tenderness

A

Inflammatory process inside the kidney

95
Q

How to elicit CVA tenderness

A

Kidney punch test or Goldflam’s test

96
Q

Pathognomonic lab finding in pyelonephritis

A

Leukocyte casts

97
Q

Obstructions leading to pyelonephritis

A

Tumor, stones, strictures

98
Q

Kidney is distended because the flow of urine is obstructed and urine backs up to the kidneys.

A

Hydronephrosis

99
Q

T/F. Antibiotics can tx hydronephrosis

A

False (remove obstruction)

100
Q

Worst complication of kidney infection and is not responsive to antibiotics

101
Q

Bacteria transferred thru lumen of catheter

A

Intraluminal route

102
Q

Bacteria transferred thru around of catheter

A

Periurethral route

103
Q

T/F. Usually, immune compromised px have fever

A

False (no fever)

104
Q

Used in neurogenic bladder every 6 hours to drain bladder

A

Frequent straight catheterization

105
Q

Formation of biofilm

A

Attachment, expansion, maturation, resistance

106
Q

T/F. In a mature biofilm, extensive shedding of bacteria and microorganisms does not take place

A

False (takes place)

107
Q

Duration of antibiotic use in complicated upper tract infection

A

10-14 days

108
Q

Bacterial invasion of the renal parenchyma or rupture of abscess to the perinephric space; complication of pyelonephritis

A

Renal and perinephric abscess

109
Q

Imaging for Renal and perinephric abscess

A

UTZ and CT Scan

110
Q

Almost always occurs and most common predisposing factor is uncontrolled diabetic patients often associated with obstruction

A

Emphysematous pyelonephritis and cystitis

111
Q

Imaging for Emphysematous pyelonephritis and cystitis

A

Ct Scan and KUB X-Ray (not UTZ)

112
Q

T/F. Emphysematous pyelonephritis and cystitis is not a surgical emergency

A

False (emergency!)

113
Q

Tx for Emphysematous pyelonephritis and cystitis

A

Emergency nephrectomy

114
Q

Diagnosis of UTI via urinalysis

A

Pyuria >5 wbc/hpf spun urine (5-8 for F; 0-2 for M)

115
Q

Rapid test to demonstrate presence of enzyme that is indicative of pyuria

A

Dipstick leukocyte esterase test

116
Q

Gold standard in ddx of UTI

A

Urine culture and sensitivity

117
Q

T/F. Gram stain helpful in unspun urine

A

False (not very helpful)

118
Q

Done if there is sepsis

A

Blood culture and sensitivity

119
Q

For uncomplicated UTI, concentrates well in the urine, we don’t use it for other indications.

A

Fosfomycin 3g, single dose at most 2 doses

120
Q

A urinary anti-septic, locally acting on the UT, not given to pyelonephritic cases

A

Nitrofurantoin, 50-100 mg tid-qid

121
Q

For complicated UTI, has good urinary level

A

Quinolone and aminoglycoside

122
Q

Antibiotic with nephrotoxicity thus use in px without kidney problem or adjust dose if ever there is problem

A

Aminoglycoside

123
Q

Also cover for gram (-) organisms esp. Pseudomonas aeruginosa

A

Ceftazidime (3rd Gen. cephalosporins)

124
Q

Beta lactam/Beta lactamase inhibitor combinations

A

Piperacillin/Tazobactam, Ampicillin/Sulbactam

125
Q

“Ecological adverse effects” of antibiotic therapy

A

Collateral damage

126
Q

In intermittent catheterization, you must do sterile evacuation every

127
Q

T/F. Pre-tx urine CS is recommended in acute uncomplicated cystitis.

A

False (not recommended)

128
Q

T/F. Urine microscopy and dipstick leukocyte esterase and nitrite tests are not pre-requisites for tx in acute uncomplicated cystitis.

129
Q

T/F. Nitrofurantoin must be given for 3 days

130
Q

Defined as the presence of at least 100,000 cfu/mL of 1 or more uropathogens in 2 consecutive midstream urine specimens or in 1 catheterized urine specimen in the absence of symptoms of UTI

131
Q

Antibiotic to avoid in pregnancy

132
Q

Safe in pregnancy

A

Beta lactam

133
Q

Antibiotic prophylaxis in recurrent UTI in women

A

Continuous low dose for 6-12 months

134
Q

T/F. In diabetic px, failure to respond to appropriate therapy within 48 to 72 hours warrants a plain radiograph of the KUB, renal ultrasound or CT scan

135
Q

T/F. Significant pyuria in uncomplicated systitis is defined as at least 10WBC/cumm of or at least 5 WBC/hpf in a clean- catch midstream urine

136
Q

First line drugs in uncomplicated cystitis in men

A

Nitrofurantoin and fosfomycin

137
Q

Acute prostitis

138
Q

Chronic prostitis

139
Q

Refers to various inflammatory conditions affecting the prostate

140
Q

Females are affected more than males and this may cause infertility if fallopian tubes and endometrium are affected

A

Genitourinary TB

141
Q

T/F. Suspect TB in culture negative pyuria in alkaline urine

A

False (acidic urine)

142
Q

Imaging for EPTB

A

IV pyelography, abdominal computed tomography (CT), or magnetic resonance
imaging (MRI)

143
Q

Tx for EPTB

144
Q

Marker of response in EPTB

145
Q

T/F. Urosepsis with obstruction and DMrequire surgery

146
Q

May form in chronic recurrent pyelonephritis

A

Renal Scars

Block 19 Nephro Module 2 (3 decks)

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