Urinary Tract Infections

Question 1

coagulase _____ staphylococci is part of the normal microflora of the urethra

Answer 1

coagulase NEGATIVE staphylococci

Question 2

the proportion of ________ (microorganism family) in the vagina varies with new borns, pre pubescent, pubescent, and menopause

Answer 2

lactobacilli

Question 3

imbalance in _______ (microorganism) can lead to UTI’s

Describe the biology of this organism

Answer 3

lactobacilli
gram postive rods, NON spore foring
anaerobes, produce lactic acid;
can lead to UTI’s when the pH is ↑

Question 4

UTI’s with a fever is indicative of _____ (organ) involvement

Answer 4

kidneys (pyelonephritis)

Question 5

______ (organism) is the most common culprit in the majority of UTI’s

Answer 5

E. coli; especially in uncomplicated UTI

Question 6

in addition to UTI’s, what are other long term complications of urinary catheterization

Answer 6

• obstruction → bacterial glycocalyx (biofilm formation)
• formation of encrustations and infection stones
• local infections

Question 7

what are the key virulence factors of UPEC (uropathogenic E. coli)

Answer 7

• Type I pili (cystitis)
• P pili (Pyelonephritis)

α hemolysin, siderophores and pathogenicity islands;

Question 8

O/K serogroup is used to classify UPEC

Answer 8

O serogroup

Question 9

UPEC with Type I pili will most likely cause ________ (type UTI)

Answer 9

cystitis

P pilli = pyelonephritis

Question 10

what are 3 host defenses against UTI’s within the lumen of the bladder?

Answer 10

• anti microbial peptides
• competition with iron sequestering proteins
• tamm horsfall protein which binds to type 1 fimbriated E. coli and prevents it from adhering to the urothelial receptors

Question 11

Tamm horsfall proteins are found in ________ and its function is ______

Answer 11

found in the lumen of the bladder and binds to type 1 fimbriated E. coli and prevents their adhesion to the bladder epithelium (type P pili E. coli bind to the the renal epithelium and cause pyelonephritis)

Question 12

post sex cystitis most likely pathogen is _______

Answer 12

staph saprophyticus “honeymoon cystitis”; has urease

it is a coagulase negative staph (another coagulase negative staph is staph epidermidis)

Question 13

“swarming” colonies on agar is used to describe what pathogen that can cause UTI’s

Answer 13

Proteus mirabilis; motile activity due to flagella

Question 14

what type of renal stones are likely to be formed due to UTI’s from organisms such as proteus mirabilis?

Answer 14

struvite crystals because they both contain urease which makes the urine more alkaline due to ammonia production

Question 15

what are some virulence factors of Proteus mirabilis

Answer 15

• protease
• hemolysin
• biofilm formation
• urease production

it is a gram negative facultative anaerobic rod

Question 16

Proteus mirabilis is found in uncomplicated/complicated UTI’s

Answer 16

complicated

Question 17

a patient has had a UTI and later develops a renal stone. The stone’s composition is found to be a urine struvite crystal. what is the most likely causal pathogen of his UTI?

Answer 17

proteus mirabilis

Question 18

a positive leukocyte esterase test is indicative of ______

Answer 18

inflammation because it is released by WBC’s

Question 19

urine analysis showed ↑ nitrites (due to nitrates being converted to nitrites) what can you conclude from this test?

Answer 19

• E. coli and Proteus miribilis have the ability to convert nitrate → nitrite so most likely a bacterial cause of UTI

Question 20

what are the three major infections in vaginitis and which one can be transmitted sexually?

Answer 20

• bacterial vaginosis (most common)
• vulvovaginal candidasis
• trichomoniasis (sexually transmitted)

Question 21

when examining a histolgicla slide of vaginal discharge, you see presence of “clue cells” which are bacteria adhering to periphery of epithelial cells. what is the most likely diagnosis

Answer 21

bacterial vaginosis (clue cell = BV)

the organism typically adhering to the vaginal epithelium is Gardenerella

Question 22

women with BV is mono/polymicrobial and have fewer/greater than normal vaginal lactobacilli

Answer 22

polymicrobial and have FEWER than normal lactobacilli

Question 23

bacterial ph _______ is suggest of bacterial vaginosis

Answer 23

pH > 4.5

Question 24

describe the discharge that can sometimes be present in someone with bacterial vaginosis

Answer 24

homogenous, non viscous, milky white discharge adherent to vaginal walls

Question 25

what are the 4 diagnostic criteria in the Amsel Criteria?

Answer 25

• vaginal pH > 4.5
• homogeneous, non viscous milky white discharge
• presence of “clue cells”
• positive amine / “whiff” test (fish odor)

ONLY NEED 3 OF THE 4 FOR DIANGOSIS OF BV

Question 26

Nugent criteria looks at _______

Answer 26

the amount of lactobacilli and if there is presence of mixed flora

normal has nugent score = 0

Question 27

Candida albicans has pseudohyphae, dimorphic, and has a +/- germ tube test

Answer 27

positive germ tube test

Question 28

risk factors for women acquiring vaginal candidiasis include pregnancy, _______, _________ or _______

Answer 28

diabetes mellitus, use of broad spectrum antibiotics or corticosteroids

Question 29

Amsel criteria is used in the diagnosis of _______

Answer 29

bacterial vaginosis

Question 30

clumpy, cottage cheese, white discharge is indicative of ______

Answer 30

vaginal candidiasis

can also have secondary oral candidiasis

Question 31

what are the three most common STI’s in the USA

Answer 31

• chlamydia
• gonorrhea
• syphilis

Question 32

_______ (UTI) presents with suprapubic tenderness

Answer 32

cystitis

Question 33

gram postive cocci are less common pathogens that can cause which UTI: cystitis or pyelonephritis?

Answer 33

cystitis;

both can be caused by gram negative rods: klebsiella and proteus

Question 34

drug resistance is a major threat to the impact of which STI?

Answer 34

gonorrhea