Seminars

Question 0

Complications of pyelonephritis

X4

Answer 0

Acute papillary necrosis
Emphysematous pyelonephritis
Bacteremia with metastatic spread to other sites
Renal abscess

Question 1

Difference with UTIs in diabetics and non-diabetics?

X3

Answer 1

Several fold more a symptomatic bacteriuria
5-10X more acute pyelonephritis
More complications from pyelonephritis

Question 2

Metastatic complications from gram negative UTI

X4

Answer 2

Endopthalmitis
Osteomyelitis - NB verbatrae
Septic arthritis
Bacteremic gram neg pneumonia

Question 3

Name 4 microbes associated with UTIs and diabetes

Answer 3

Klebsiella pneumonia
Group B strep
Candida Albicans
Aeroccoccus spp.

Question 4

Where is klebsiella pneumonia acquired?

Answer 4

Hospital

Community

Question 5

Main difference with the clinical features of a UTI in a diabetic vs non-diabetic and why?

Answer 5

Decreased level of consciousness

Due to metabolic changes or sepsis

Question 6

Someone has a UTI. What do you do with the urine? And when?

Answer 6

Collect by catheter and then culture the urine
Urinalysis

BEFORE ABx Rx

Question 7

What do you do with the blood of a person with a UTI?

Answer 7

Culture that shit!

Question 8

If a patient is diabetic and has a UTI.

What extra studies need doing? And what are you looking for?

Answer 8

Imaging studies

Abdominal XRay
Ultrasound
Helical CT scan

Exclude renal emphysema

Question 9

4 methods of preventing a UTI in a diabetic/or just a person

Answer 9

1) Antibiotic prophylaxis
2) Decrease spermicide use
3) Optimal catheter care
4) CONTROL YOUR DAMN DIABETES

Question 10

Risk factors for an acute uncomplicated UTI in a woman

X4

Answer 10

Previous episode
Recent sex (within 48 hrs ⬆️ relative risk by 60)
Spermicide use - ⬆️ infection by E.Coli or S.Saprophyticus X2-3
⬆️ Risk with age and debility

Question 11

How does age put one at risk for uncomplicated UTIs?

X4

Answer 11

Impaired voiding
Poor perineal hygiene - dementia/neurological disease
Oestrogen deficiency - increase after menopause.
Helped by oestrogen cream.

Question 12

How does ones diagnostic process differ with acute uncomplicated vs with diabetes

Answer 12

No imaging studies
No culture
Just Dipstix - instead of urinalysis

Question 13

When do you culture urine when the infection seems acute and uncomplicated?

Answer 13

To look for resistant organisms when there is no response to treatment or the infection recurs within 2-4 weeks

Question 14

Treat an acute uncomplicated UTI

Drug, frequency, dose

Answer 14

Ciprofloxacin PO 250mg BD for 3 days

Question 15

Most common organism causing acute pyelonephritis?

Answer 15

Escherichia coli

Question 16

Sensitivity and specificity of combined leukocyte and nitrite urine test?

Answer 16

Sensitivity 75 to 84

Specificity 82 to 98

Question 17

Define pyelonephritis

Answer 17

An infection of the upper urinary tract including the renal parenchyma and renal pelvis

Question 18

Women vs men and pyelonephritis

With infection rate and mortality
And pregnancy

Answer 18

Women are 5 times more likely to get pyelonephritis but men are twice as likely to die from it. (7.3 per 1000 vs 16.5 per 1000)

1-2% of all pregnant ladies will get pyelonephritis - preemies and LBW

Question 19

Who is susceptible to haematogenously spread pyelonephritis?

X3

Answer 19

Debilitated, chronically Ill and those receiving immunosuppressant therapy

Question 20

Pyelonephritis causing organisms in the elderly

And why is it different

Answer 20

Use of catheters and instruments exposes to different bugs

Gram negs like klebsiella, serratia or pseudomonas

Question 21

Pyelonephritis causing organisms in the diabetic

Answer 21

Klebsiella, enterobacter, clostridium or candidia.

Question 22

When do you perform a blood culture with pyelonephritis?

Answer 22

Diagnostic uncertainty, immunosuppresion or a haemotogenous source suspected

Question 23

Causes of pre-renal failure?

Answer 23

Anything that decreases perfusion to kidney and then decreases GFR

Question 24

Hepatorenal syndrome - what is it?

Answer 24

Acute kidney dysfunction secondary to hepatic disease.

Blood gets pooled into the hepatic system because of splanchnic vasodilation causing a hypoperfusion