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Nephrology Fellowship Reviewer > Urinary Tract Infection > Flashcards

Urinary Tract Infection Flashcards

1
Q

infection that recurs with a different organism

A

reinfection

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2
Q

infection where organism persists in the urinary tract despite antimicrobial therapy, same organism

A

relapse

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3
Q

interleukin involved in UTI

A

IL8 (pyruria) IL6 (severity of infection, fever)

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4
Q

symptomatic men, cut of in urine culture

A

10^3

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5
Q

in and out catheter

A

10^2

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6
Q

more active in acidic urine

A

penicillin, tetracycline, nitrofurantoin

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7
Q

more active in alkakine urine

A

aminoglycosides, fluoroquinolones, erythromycin

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8
Q

antibiotic penetrate poorly in the prostate gland because of

A

no active antibx transport mechanism

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9
Q

antibx that penetrate in the prostate well and remain active

A

fluoroquinolones and macrolides

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10
Q

cause of cystitis

A

e. coli

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11
Q

in cystitits, infection occurs via the

A

ascending route

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12
Q

second most frequent isolate and virtually unique to acute cystitis

A

S. saprophyticus

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13
Q

major risk factor for recurrent cystitis in women of any age

A

infection at a younger age

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14
Q

stongest association of recurrent acute cystitis in postmenopausal women

A

history of prior UTI

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15
Q

urine culture in cystitis should be obtained when (3)

A
  • clinical presentation not characteristic
  • failure to respond to appropriate empiracal antimicrobial therapy
  • early symptomatic recurrence after therapy
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16
Q

mainstay of empirical treatment of acute cystitis

A

TMP/SMX (3 days)

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17
Q

recommended for women who experience more than 2 episodes in 6 months of UTI

A

low dose prophylactic antimicrobial therapy

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18
Q

only feasible behavioral intervention for recurrent infection

A

avoid spermicide use

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19
Q

strongest association to pyelonephritis in premenopausal women

A

recent sexual intercourse

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20
Q

independent risk factor for pyelonephritis

A

diabetes

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21
Q

imaging in pyelonephritis is required for (3)

A

severe symptoms or
treatment failure or
early post treatment recurrence

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22
Q

initial imaging modality for pyelonephritis

A

ultrasonography

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23
Q

optimal diagnostic imaging for acute pyelonephritis

A

contrast enhanced CT

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24
Q

indications for hospitalization

A

pregnancy, unstable, compliance with oral, medical illness

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25
Q

preferred empirical regimen for pregnant women

A

ceftriaxone

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26
Q

clinical response after initiation of therapy

A

48-72 hours

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27
Q

recommended empirical antimicrobial for
Pyelonephritis

A

ciprofloxacin or levofloxacin

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28
Q

duration of treatment pyelonephritis

A

10-14 days

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29
Q

alternate microbial therapy for pregnant women when cephalosporin cannot be used

A

gentamicin

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30
Q

risk factors of a poor outcome for pyelonephritis
(4)

A

hospitalization, isolation of a resistant organism, DM, renal stones

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31
Q

major determinant of infection

A

host impairment

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32
Q

encrusted cystitis or pyelonephritis caused by

A

corynebacterium urealyticum

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33
Q

urease producing bacterium causing cystitis or pyelonephritis with urolithiasis

A

u. urealyticum

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34
Q

symptomatic UTI + repeatedly negative urine culture

A

fastidious organism

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35
Q

alkaline pH + pyuria + negative urine culture

A

urease producing organism

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36
Q

most frequent isolate in men older than 65

A

cons
E coli
enterococcus

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37
Q

screening and tx of asymptomatic bacteriuria

A

pregnant women and traumatic genitourinary tract procedure

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38
Q

when to screen pregnant for asymptomatic bacteriuria

A

end of 1st trimester

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39
Q

recommended regimen for asymptomatic bacteriuria in pregnant

A

5 or 7 day course of nitrofurantoid, 7 day course of amox, co-amox or cephalosporin

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40
Q

Urine CS should be done after treatment
In pregnant

A

monthly

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41
Q

urologic emergency with systemic manifestations

(UtI)

A

acute bacterial prostatitis

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42
Q

management of acute bacterial prostatitis

A
  • drainage of a urethral or suprapubic catheter

- antibx

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43
Q

first line therapy for acute bacterial prostatitis
(2)

A
  • B lactam + aminoglycoside
  • FQ 6 weeks
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44
Q

if no clinical response (acute prostatitis)
Next imaging of choice

A

CT or MRI and transrectal UTZ guided aspiration

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45
Q

diagnosis for chronic bacterial prostatitis

A

paired culture of midstream + post prostatic massage urine specimens

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46
Q

most common isolates for chronic bacterial prostatitis

A

enterbacteriacease and p. aeruginosa

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47
Q

first line for susceptible organisms in chronic bacterial prostatitis

A

ciprofloxacin and levofloxacin

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48
Q

second line drugs for chronic bacterial prostatitis and preferred for gram + infections

A

doxycycline and macrolides

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49
Q

chronic pelvic pain syndrome + negative culture

Treatment

A

4 week trial of antimicrobial

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50
Q

prophylaxis for the 1st 6 months after transplant for UTI

A

TMP/SMX

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51
Q

occupy the retroperitoneal fat and fascia around the kidney

A

perinephric abscess

52
Q

most likely originated with hematogenous spread

A

s. aureus

53
Q

preferred imaging modality for abscesses

A

CT

54
Q

Cut off size of abscess that responds to antibx without drainage

A

5 cm

55
Q

most effective in localizing infected cyst

A

PET with deoxyglucose F18

56
Q

optimal duration recommended for infected renal cysts

A

4 weeks of (cotri, chloramphenicol, quinolones, levox)

57
Q

acute necrotizing infections characterized by gas formation

A

emphysematous cystitis and pyelonephritis

58
Q

most common isolates in emphysematous cystitis

A

E. coli and K. pneumonia

59
Q

optimal imaging technique for emphysematous cystitis

A

CT

60
Q

destruction and replacement of the renal parenchyma by granulomatous tissue containing histocytes and foamy cells

A

xanthogranulomatous pyelonephritis

61
Q

vesicle empyema, purulent fluid collection in a nonfunctioning bladder

A

pyocystis

62
Q

early finding in GUTB
4

A

erosions of renal calyx,
papillary necorsis,
hydronephrosis,
cavitation

63
Q

thickened ureteric wall and strictures (distal 3rd)

A

ureteric TB

64
Q

reduced bladder volume with wall thickening, ulceration and filling defects

A

bladder TB

65
Q

most common finding on CT for GUTB

A

renal calcification

66
Q

diagnosis of GUTB

A

growth of M. TB in urine or tissue culture

67
Q

tx for GUTB

A

HRZE x 2 months then HR 4 months

68
Q

when is nephrectomy indicated in GITB (4)

A

intractable pain,
untreatable infection proximal to a stricture,
uncontrollable hematuria or
hypertension or drug resistance

69
Q

first line treatment for superficial bladder tumors and carcinoma in situ

A

intravesical vaccine instillation of BCG

70
Q

bcg bladder instillation followed by local irritative symptoms > 48 hours

A

BCG infection

71
Q

treatment of BCG infection

A

isoniazid for 14 days

72
Q

when to tx asymptomatic candiduria

A

neutropenia or before a traumatic urologic procedure

73
Q

most common fungi growth

A

candida albicans

74
Q

treatment of chocie for candida UTI

A

fluconazole 200-400 mg od x 2 weeks

75
Q

alternative tx for resistant strains (c. glabrata)

A

amphotericin 0.3 to 0.6 mkd for 7 days-2 weeks

76
Q

indicated for treatment of canida uti as a single agent

A

5-flucytosine

77
Q

most common viral cause of uti
(3)

A

adenovirus, parvovrus B1, CMV

78
Q

most common and important parasitic infestation of the urinary tract

A

schistosoma hematobium

79
Q

functional abnormality early in the disease of parasitic infestation

A

obstruction of the bladder neck

80
Q

risk factor for SCCA of the bladder

A

s. hematobium infection

81
Q

thickening of the bladder wall, granulomatous changes, hydronephrosis, bladder or ureteric calcification

A

s. hematobium

82
Q

time of maximal egg passage when urine specimen should be collected

A

1100-1300H

83
Q

diagnosis of parasitic infections

A

identification of parasite eggs in the urine or biopsy

84
Q

treatment of s. hematobium

A

one dose of praziquantel 40 mk

85
Q

follow up urine specimen for parasite examination should be done

A

after 3 months

86
Q

commonly transmitted sexually

A

t. vaginalis

87
Q

tx for t. vaginalis

A

metronidazole single dose 2 g or tinidazole 2 g

88
Q

incidental finding of a cyst in the kidneys, ureters, bladder or testes

A

echinococcus granulosus infestation

89
Q

recommended for patients with hyatid disease

A

peioperative albendazole therapy

90
Q

CS specimen
(4)

A
  1. clean catch voided specimen with no periurethral cleaning
  2. transport immediately if not refrigerate 4C
  3. short term cath: puncture port
  4. long term cath: replace
91
Q

major adhesions for ecoli

A

Type 1 Film H and P fim

92
Q

Marker found in cystitis, superficial infection

A

IgA

93
Q

most frequently isolated organism among premenopausal women causing acute cystitis

A

e coli

94
Q

most common isolate in post menopausal

A

K. pneumonia

95
Q

time dependent antibx

A

B lactam

96
Q

Concentration dependent

A

FQ, aminoglycoside

97
Q

necessary characteristic for bladder infection

A

FimH

98
Q

False positive nitrites

A

blood urobilunogen dyes

99
Q

false negative nitrite

A

non nitrate bacteria or short dwell time

100
Q

for esbl organisms

A

carbapenems

101
Q

marker for bacteremia, not predict outcome

A

procal

102
Q

Associated with prolonged hospitalization and post discharge recurrence

A

crp

103
Q

most impt rf for fungal uti
(3)

A

In dwelling cath/uro device
broad spectrum antibx
dm

104
Q

tx for fungus balls

A

Surgery

remove devices when possible

105
Q

Tx for cmv uti

A

Ganciclovir or foscarnet

106
Q

tx for adenovirus
4

A

cidofovor
vidarabine
ganci
rinbavirin

107
Q

adverse effect of nitrofurantoin

A

peripheral neuropathy

108
Q

major risk factor in home care

A

functional impairment

109
Q

most common organisms in stones

A

p. mirabilis

110
Q

most common lesion location of gi tb

A

distal 3rd ureter

111
Q

prostatitis syndrome class I

A

acute bacterial prostatitis

112
Q

class 2 prostate

A

chronic bacterial prostatitis

113
Q

Class III

A

chronic pelvic pain syndrome

114
Q

Class IIIa

A

inflammatory cpps

leukocytes in semen, in urine after prostate massage or in expressed prostate secretions

115
Q

Class IIIb

A

noninflammatory cpps

absence of leukocytes in specimens

116
Q

Class IV

A

Asymptomatic inflammatory prostatitis, leukocytes with no symptoms

117
Q

multiple bilateral and cortical abscesses cause

A

hematogenous route

118
Q

risk factors for abscesses

A

dm, aki, wbc >20k

119
Q

tx for emphysematous pyelo

A

percutaneous aspiration or open drainage vs partial nephrectomy

120
Q

tx for xanthogranulomatoys pyelo

A

Nephrectomy

121
Q

Cause of xanthogranulomatous pyelo

A

P. mirabilis, e coli

122
Q

histiocytes and foamt cells

A

xanthogranulomatous pyeloneph

123
Q

chyluria and lymphatic obstruction

A

filiarisis, w. bancroftu

124
Q

hyatid cyst in the kub

A

echinococcus

125
Q

tx for hyatid cyst

A

surgery

Nephrology Fellowship Reviewer (29 decks)

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