Urinary Tract Infections

Question 1

Organs of the urinary system consist of

Answer 1

Two kidneys, two ureters, a single bladder and a single urethra
The bladder should be sterile

Question 2

Urethra in males and females

Answer 2

Females: only carries urine to to the exterior
Males: carries both urine and seminal fluid

Question 3

What is cystitis?

Answer 3

Infection of the urinary tract

Question 4

What is pyelonephritis?

Answer 4

Infection of the kidneys with a risk of bacteraemia. commonly caused when a UTI ascend to affect the kidney are termed pyelonephritis.

Question 5

Community-acquired UTIs are caused by what 80% of the time

Answer 5

E.coli gut flora

Question 6

Female reproductive organs:

Answer 6

Two ovaries, two fallopian tubes, the uterus (including the cervix, the vagina and external genitals.

Question 7

What do the ovaries do?

Answer 7

Produce female sex hormones and ova

Question 8

What happens during the process of ovulation?

Answer 8

Ovum is released, it enters a uterine/fallopian tube, where fertilisation may occur if viable sperm are present. the zygote then descends the tube and enters the uterus. it implants in the inner wall of the uterus.

Question 9

Why do women get UTIs more commonly than men?

Answer 9

Close proximity of the urethra to the vagina and short length of the urethra.
Men have a much longer urethra making UTIs more complex.

Question 10

What are the predominant bacteria in the vagina and what do they do?

Answer 10

Lactobacilii, produce lactic acid which maintains the acidic pH (3.8-4.5) of the vagina, inhibiting growth of other bacteria.

Question 11

What happens in a derangement of the careful balance of bacteria in the vagina?

Answer 11

Leads to bacterial vaginosis

Question 12

Male reproductive organs:

Answer 12

Two testes, a system of ducts accessory glands and the penis.

Question 13

What do the testes produce?

Answer 13

Sex hormones and sperm

Question 14

How do sperm cells exit the body?

Answer 14

Through a series of ducts: the epididymis, ductus deferens, ejaculatory duct and urethra.

Question 15

The male urethra is usually

Answer 15

Sterile, expect for a few contaminating microbes near the external opening

Question 16

What is a good urine specimen?

Answer 16

Midstream urine, should be bladder urine only (no menstrual blood, epithelial cells, bowel flora)

Question 17

What are you looking for when observing the urine?

Answer 17

Blood content, debris, unusual material

Question 18

What does a dipstick analysis look at?

Answer 18

Glucose, ketone, specific gravity, blood, pH, nitrate (due to nitrate reduction by e. coli), and leucocytes (an indication of infection)

Question 19

What do you look for in a microscopy?

Answer 19

WBC, RBC, Casts, crystals, bacteria

Question 20

What is currently the drug of choices for the empirical treatment of uncomplicated UTIs

Answer 20

Trimethoprim 300mg nocte 3 days. It is vital to detect resistance

Question 21

UTIs acquired in hospital tend to be caused by

Answer 21

More antibiotic-resistant organisms

Question 22

What should you always do to test for pyelonephritis?

Answer 22

Urine culture and perform dipstick analysis. Must rely on evidence of UTI as well as symptoms suggesting upper UTI, lower UTI symptoms may be absent

Question 23

When should you start antibiotics?

Answer 23

Before results are available

Question 24

Screening in Long-term care facilities

Answer 24

Not recommended for UTIs, although symptomatic UTIs need investigating

Question 25

UTIs are a result of what?

Answer 25

faecal flora spreading from the anus to the urethra leading to inflammation of the urinary tract.

Question 26

Investigation into UTIs can be classed into

Answer 26

Complicated and Uncomplicated.

Question 27

What is an uncomplicated UTI?

Answer 27

usually occur to women with classical presentation of symptoms and no complicating factors

Question 28

What are complicated UTIs?

Answer 28

are those that occur in men, children, pregnancy, people with suspected pyelonephritis, recurrence or persistence of symptoms, hospital acquired infection, catheterised patients, people with genitourinary tract abnormalities and those that are immunocompromised

Question 29

What is the difference between first pass urine and midstream urine?

Answer 29

First pass urine is from the urethra and midstream urine is from the bladder so technically.

Question 30

Why would the lab consider the specimen contaminated?

Answer 30

Epithelial cells wouldn’t be there if it was midstream. Enterococcus faecalis indicates it was already there.
Most UTIs are mono-microbial