Quiz 3 Flashcards
UTI is really an umbrella term for what? (3)
cystitis
pyelonephritis
urethritis
This bugger, when presenting in a male - incubates for 3-10 days, it creates symptoms of copius, purulent urethral d/c (yellow-brown), dyuria, and urethral itching IF it presents with sx, it could be asymptomatic. Upon inspection you may find meatal edema and urethral tenderness - if it has spread to the prostate pt will complain of freq, urg, noct
what is this and what labs will you order?
GCU - Neisseria Gonorrhea
- MC in Low SES, and men who have sex with men
Labs: Urine NAAT PCR (sensitive) DNA Probe (not as sens) culture (rectum and pharynx if indicated) urethral smeal (gram neg. diplococci)
This bug - in males - can incubate from 2-35 days - it creates scant, white to clear watery urethral discharge, dysuria, urethral itching. Upon inspection you may find meatal edema and ERYTHEMA - what is this and what labs would you order?
NGU - non-gonococcal
- chlamydia (28% F - asx)
- ureaplasma
- trichomonas
Labs:
Urine NAAT PCR
Gram Stain
DNA Probe (Chlamydia is intracellular)
What are mandatory if you suspect or confirm a gonoccocal urethritis or chlamydia?
Gonococcal
- ceftriaxone (250mg IM) AND
- azithromycin (1g singly dose)
Chlamydia
- azithromycin (1g single) or
- doxycycline 7-14 days (CI pregnancy)
NO SEXUAL ACTIVITY UNTIL RESOLUTION
What is a common complication of NGU?
prostatitis!
as well as:
epididymitis
proctitis
Reactive Arthritis (can’t pee!)
What is unusual about chlamydia when found as the culprit of acute urethritis in women and what should be used to treat this?
chlamydia shows pyuria but NO organisms with culture and smear
- Antibiotic tx promptly
Tetracyclines and fluoroquinolones are CI in pregnancy so DOXY IS NOT OK, use Azithro instead
This condition is VERY common, it spreads from cervical or vaginal infxn, STI, indwelling catheter or contaminated diapers. when ptc is resembles cycstitis with clear urine. dysuria, freq, noct and urethral discomfort while walking may be present - what is this common condition?
Chronic urethritis
- urine (pus and bacteria, if early. Mid sample will not have pus)
- WBCs w/out bacteria = NGU
The classic presentation of this common condition is
- dysuria, frequency, urgency, suprapubic pain, RARELY fever or back pain.
- what condition is this and how do people get it?
Cystitis
- ASCENDING is MC cause from periurethral area
- uncommon in men, if present <50 consider obstruction of prostate
This causes 80-90% of all cystitis - what is it?
E. coli
- produce hemolysin (initiates invasion into the tissue)
What are the two types of fimbriae in e.coli?
type 1
- bind mannoside residues in uroepithelial cells causing adherence (this is where d-mannose is effective)
type 2
- bind glycoprotein receptors on uroepithelial cells and renal tubular cells
- RESISTANT to D-mannose
This bug is the MC cystitis agent in kiddos, while this one is most common for nosocomial infections
klebsiella - kiddos
pseudomonas, staph - nosocomial
For kiddos with fever of unknown origin what do you rule out first and then second?
rule out
URI then UTI
- fever alone can cause pyuria
patient ptc with symptoms of fever, chills, anorexia, N/W, dysuria, body aches, and flank pain. They appear toxic, temp is 101-104, tachycardic, have a positive CVA tenderness, and abdominal guarding is present - which condition is this and what will you see that is not quite pathognomonic but and interesting thing that commonly occurs iwth this condition on UA
Pyelonephritis
- GLITTER cells will be present on UA
CBC - elevated WBC, left shift
UA - WBC and pos. LE, nitrities
IF protein on UA - suggests nephron damage
When should you consider hospital referral when treating pyelo?
toxic patients DM immune compromised suspect bacteremia persistent NV suspected obstruction PG
This is an extremely common outcome of pyelonephritis - what is it and what causes it?
renal scarring from type 1 fimbriated e. coli
65% of all pts, esp kiddos
