Urinary tract infections

Question 1

epidemiology of UTIs

Answer 1

girls>boys due to poor wiping technique and short urethra

most common in sexually active females

Question 2

pathophys of UTIs

Answer 2

via urethra bacteria ascends up urethra
-fecal bacteria
-lowered host defenses
-residual urine
nosocomial: instrumentation
via blood/lymph/fistual

Question 3

etiology of UTIS

Answer 3

E. coli most common,

proteus, klebsiella, serratia, enterobacter, staph saprophyticus, pseudomonas

Question 4

risk factors for UTIs

Answer 4

• recurrent/previous UTI
• FH
• Intercourse
• indwelling catheter
• pregnancy
• personal hygiene
• contraceptive use
• atrophy
• obstruction
• incontinence
• urinary retention
• anatomic variant
• antibiotic use
• DM/immunosuppression

Question 5

signs and symptoms of UTI

Answer 5

frequency, urgency, dysuria, suprapubic pain/tenderness, hematuria, odiferous urine

Question 6

evaluation of UTI

Answer 6

physical: ab exam, CVA tenderness, pelvic exam, GU and DRE

Question 7

labs for uti

Answer 7

UA/UC: clean catch, suprapubic aspiration, catheterization

Question 8

Urinalysis findings UTI

Answer 8

positive leukocyte esterase
positive nitrites
micro: pyuria

Question 9

UC findings

Answer 9

gold standard: 10^5 colonies or single species

Question 10

indications for UC

Answer 10

young, old, recurrent, pregnant, immunosupression, pyelonephritis, prolonged sxs, recent abx use

Question 11

other diagnostic tests for UTI

Answer 11

excretion urography (IVP): determines functional/anatomic abnormalities.
KUB w US: to define emptying, stones/obstructions
VCUG: determines abnl bladder emptying, reflux
cystoscopy: to exclude bladder lesions

Question 12

patient education

Answer 12

describe ds
pharm: OTC/abx
fluids
frequent/postcoital void
proper wiping
avoid constipation
return if..

Question 13

complicated UTI

Answer 13

abnormality -structure or function
can cause severe sequelae
septicemia more common
increased risk treatment failure

Question 14

UTI sequelae

Answer 14

recurrent UTI-morbidity, renal disease
urosepsis
pyelonephritis
proteinuria/HTN/renal function decline
pregnancy complications

Question 15

when do you refer UTI

Answer 15

recurrent childhood infections
any UTI in males
certain females
-relapsing/recurrent/persistent
-painless hematuria

Question 16

recurrent UTI

Answer 16

sexually active female
>2 UTIs/6 mos
>3 UTIs/12 mos
review nonpharm
prophylactic abx (continuous vs. postcoital)

Question 17

pyelonephritis

Answer 17

acute: infection of upper urinary system (kidneys)
chronic: progressive inflammation with destructive changes

Question 18

pathophys of acute pyelo

Answer 18

extension of UTI: ascending bacterial spread ureters

hematogenous spread

Question 19

Pathogens for pyelo

Answer 19

e. coli, proteus, kelbsiella, pseudomonas, enterococcus, mycoplasma, staph aureus/saprophyticus, anaerobes

Question 20

risk factors for pyelo

Answer 20

• ureterovesicular reflux
• dilated/hypotonic ureters
• indwelling catheters
• nephrolithiasis
• immunosuppression
• intrarenal reflux
• previous pyelo
• elderly, instituitionalized
• pregnancy
• neurogenic conditions

Question 21

signs and symptoms of pyelo

Answer 21

F/C, N/V
dysuria, frequency, urgency
flank/loin/back pain/tenderness
may have rapid onset
Fever, CVA tenderness, tender abdomen

Question 22

UA/UC findings for pyelo

Answer 22

LE, nitrites, proteinuria, hematuria, pyuria, WBC casts

Question 23

treatment acute pyelo

Answer 23

outpatient abx otc analgesics

inpatient: always pregnancy, elderly, comorbidities

Question 24

pyelo sequelae

Answer 24

sepsis, pregnancy complications, scarring/inflammation of renal cortex, ARF/CRF, perinephritic abscess, emphasematous pyelo, chronic pyelo

Question 25

urethritis

Answer 25

sexually transmitted infection in men: Gon/chlamydia/trichomonas/HSV
SXS: dysuria, pruritis, discharge
DX: urethral swab, first void urine