Urinary Tract Infection

Question 1

def in men

Answer 1

inflammatory reaction of urinary tract epithelium in response to pathogens (commonly bacteria)

Question 2

how is UTI confirmed in men

Answer 2

symptomatic male demonstrates growth of a significant amount of organism

Question 3

epi

Answer 3

very common in elderly

females>males

Question 4

what is the most common cause of UTI in men and women

Answer 4

E.coli

Question 5

aetiology in men

Answer 5

pathogens enter the urinary tract by ascending the urethra, indwelling catheters are often implicated
E.coli (most common)
Gram negative bacteria (klebsiella) + positive
enterococcus, staphylococcus, psuedomonas (hospital)

Question 6

what disrupts the balance between host defence mechanisms and virulence of pathogens

Answer 6

immunodeficiency (HIV)

urine flow which normally washes out pathogens is disrupted (prostate disorders, renal stones)

Question 7

who are complicated UTIs associated with

Answer 7

males

Question 8

what are complicated UTIs

Answer 8

UTI with presence of factors which hinder efficacy

Question 9

risk factors in men

Answer 9

benign prostatic hypertrophy
urinary tract stones
catheterisation
age

Question 10

history in men

Answer 10

dysuria (difficult or painful urination)
increased urgency and frequency
suprapubic pain

hesitancy and nocturia is associated with BPH

Question 11

examination in men

Answer 11

none

Question 12

investigations in men

Answer 12

1 dipstick urinalysis
-positive leukocyte esterase +/ nitrate
2 urine microscopy + culture
-identifies leukocytes + bacteria
->10^2 colony-forming units indicates UTI in symptomatic men

Question 13

a 59y/o man complains of urinary frequency, urgency and dysuria for several days/ NO haematuria or penile discharge but does have 3 episodes of nocturia most nights. PMH includes benign prostatic hyperplasia.

Answer 13

UTI

Question 14

management of UTI in men

Answer 14

if asymptomatic or mild symptomatic
-oral antibiotic therapy with levofloxacin or ciprofloxacin
if symptomatic and severe
-IV antibiotics with levofloxacin or ciprofloxacin

Question 15

complications in men

Answer 15

prostatitis

pyelonephritis

Question 16

prognosis in men

Answer 16

prognosis decreases with age

Question 17

def in women

Answer 17

infection of the kidneys, bladder, urethra

Question 18

what is the most common type of UTI in women

Answer 18

infectious cystitis (bacterial infection of the bladder)

Question 19

aetiology in women

Answer 19

commonly uncomplicated cases
1 e.coli (most common)
2 staphylococcus saprophyticus

Question 20

what are uncomplicated UTIs

Answer 20

acute cystitis

Question 21

risk factors in women

Answer 21

sexual activity (strongest factor)
spermicide use
post-menopause
FHx

Question 22

history in women

Answer 22

dysuria, frequency, haematuria, back pain

patient may complain of urgency or supra-pubic pain and tenderness

Question 23

examination in women

Answer 23

costovertebral angle tenderness (pain on percussion of the area on the back)

Question 24

investigations in women

Answer 24

1 urine dipstick
-positive nitrate and leukocyte esterase
2 urine microscopy, culture + sensitivity
-bacteria, WBCs, possibly RBCs
-<10^5 colony-forming units per ml and pyuria is present (>20WBC/mm3) or symptomatic

Question 25

what is the most specific and sensitive test for UTI in women

Answer 25

urine culture + sensitivity

Question 26

A 27y/o healthy, sexually active woman presents with pain on urination and recent onset of urinary frequency and urgency

Answer 26

UTI

Question 27

management of uncomplicated UTI in women (cystitis)

Answer 27

nitrofurantoin or trimethoprim

if resistance ciprofloxacin or levofloxacin

Question 28

management of complicated UTI in women (pylonephritis)

Answer 28

oral ciprofloxacin or levofloxacin

Question 29

management for recurrent UTIs in women

Answer 29

post-coital antibiotics (nitrofurantoin) in pre-menopausal women plus intra-vaginal oestrogen therapy (eastradiol vaginal)

Question 30

prognosis in women

Answer 30

good