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MJ- F3 E1: Urology > Urology 2- Infectious > Flashcards

Urology 2- Infectious Flashcards

1
Q

Is Cystitis an upper or lower UTI? Pyelonephritis?

A

Cystitis= lower

Pyelonephritis= Upper

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2
Q

The following are risk factors for what?

  • Immunocompromise (DM, HIV, steroids, etc)
  • Urinary stasis/obstruction (urinary retention, ureteral obstruction, vesicoureteral reflux, bladder diverticulum)
  • Congenital GU abn
  • Sex
  • Spermicide/diaphragm use
  • Urinary Incontinence
  • Cystocele/ pelvic prolapse
A

Cystitis

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3
Q

What role do the following play in cystitis?

  • Voiding after intercourse
  • Wiping from front to back
  • Tight clothing
  • Voiding as soon as feel urge
  • Hot tubs
  • Douches
  • Tampons
A

Non-factors of Cystitis

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4
Q

Presentation of what?

  • Irritative voiding sxs (dysuria, urgency, freq)
  • Malodorous urine
  • Suprapubic discomfort
  • Fever
  • Mental status change
A

Cystitis

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5
Q

What is the presentation of cystitis in a patient with a spinal cord injury? (2)

A

Autonomic dysreflexia

Increased muscle spasticity

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6
Q

What 4 findings are seen on urinalysis and is indicative of Cystitis?

A
  • Leukocyte esterase
  • Nitrite positive
  • Pyuria >5
  • Bacteria

**Urine culture is definitive dx)

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7
Q

What is seen on urine culture in cystitis? (2 things)

A

>100,000 organisms, monoculture

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8
Q

What is the MC pathogen causing cystitis?

A

E-coli

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9
Q

What 4 bacteria might be seen on a urine culture that are part of the normal perineal flora and are indicative of skin contamination, NOT UTI

A
  • Lactobacillus
  • Corynebacterium
  • Streptococcus
  • Staphylococcus epidermidus

(“Lazy Staph Stretch Epic Corny movie plots”)

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10
Q

How do you tx Cystitis? (2 options)

A
  • Trimethoprim/Sulfamethoxazole DS x3d
  • Nitrofurantoin x5-7d
  • (Ampicillin/Amox effective against enterococcus)
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11
Q

T/F: Fluoroquinolones (Ciprofloxacin, Levofloxacin) are NOT 1st line in the tx of cystitis?

A

TRUE (b/c of side effect profile including tendinitis/tendon rupture)

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12
Q

What are the 2 main options for empiric tx of cystitis?

A
  • Nitrofurantoin
  • SMX/TMP DS (if <20% resistance locally)
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13
Q

If you have a pt c/o persistent sxs after treatment of cystitis, what should you do in order to re-evaluate?

A
  • Ensure compliance
  • Re-culture
  • Check post void residual
  • Pelvic (vaginitis)
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14
Q

How do you tx a patient with persistent sxs post tx of cystitis? (symptomatic tx for urgency? dysuria? pelvic pain?)

A
  1. Patience (inflammation > infection)
    • Symtomatic tx for urgency- antimuscarinics
    • Symptomatic tx for dysuria- phenazopyridine
    • Symptomatic tx for pelvic pain- NSAIDS
  2. Diet
  3. Quercetin
  4. Constipation
  5. Stress
  6. Prevent re-infection (+/- topical vaginal estrogen, +/- abx prophylaxis, etc)
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15
Q

The following are indications of what?

  • Immunosuppression
  • Pregnancy
  • Male
  • Pediatric
  • Indwelling urinary catheter, stent, drain
  • Anatomic abnormality (ex: vesicoureteral reflux, etc)
  • Urinary obstruction
  • Urolithiasis
  • Renal insufficiency
A

Complicated Cystitis

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16
Q

T/F: In a patient with a chronic indwelling catheter, Bacteria/colonization in urine does NOT equal infection

(KNOW THIS)

A

TRUE

So don’t tx or do a urine on someone that is asymptomatic w/ a chronic indwelling catheter!

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17
Q

How do you tx a pt w/ a chronic indwelling catheter who has UTI sxs (ex: mental status changes)–> 3 steps

A
  1. Remove catheter (to remove biofilm)
  2. Replace catheter and obtain urine culture
  3. Antibiotics
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18
Q

What are 5 possible non-infectious causes of urethritis?

A
  1. Trauma
  2. Reiter’s
  3. Urethral stricture
  4. Urethral stone
  5. Urethral lesions

(“Reita Tries to teach _Les_sons and is Stone cold Strict”)

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19
Q

What are the common infectious causes of urethritis? (3)

A

Gonococcal (GNID’s)

Non-gonococcal= Chlamydia trachomatis, Mycoplasma genitalium

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20
Q

What are the 3 sxs of Urethritis?

A
  1. Dysuria

2. Urethral Discharge (profuse purulent if gonorrhea, clear/purulent/absent if chlamydia)

3. Urethral Pruritis

(highlight= how different from cystitis)

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21
Q

In a patient with urethritis, what is the difference in the urethral discharge change if the cause is gonorrhea vs chlamydia?

A

Gonorrhea: profuse purulent discharge

Chlamydia: Clear or purulent or absent discharge

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22
Q

What are the 2 lab options for evaluation of urethritis and what will each test show if positive?

A
  • First void urinalysis- Leukocyte esterase, >10 WBC
  • Gram stain of urethral discharge: >5 WBC
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23
Q

In order to test for gonorrhea or chlamydia as the cause of urethritis, how long after voiding should you wait before obtaining a culture (via swab) or NAAT (via urethral/cervical swab or urine)?

A

>1 hour

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24
Q

Evaluation of Urethritis:

When testing for Gonorrhea, what is the pro of obtaining a culture (via swab) vs using NAAT (via urethral/cervical swab or urine)?

A
  • Culture- gives sensitivities
  • NAAT- No sensitivities (usually doesn’t matter b/c can guess right with Ceftriaxone)
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25
Q

What are 2 ways you can test for Gonorrhea as the cause of Urethritis?

A
  • Gonorrhea culture via urethral swab
  • Nucleic Acid Amplified Test (NAAT) via urethral/cervical swab or urine
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26
Q

How do you treat Gonorrhea as the cause for urethritis?

A

Ceftriaxone IM x1 dose

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27
Q

How do you treat Chlamydia as the cause for Urethritis?

A

Azithromycin 1g PO x 1 dose

or

Doxycycline BID x 7 days

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28
Q

How long should you advise a patient to abstain from sex if they are being treated for gonorrhea/chlamydia as a cause of urethritis?

A

Until 7 days after treatment initiated

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29
Q

When should you follow up with a patient who has urethritis caused by gonorrhea if they received alternative treatment?

(Cefixime is alternative to Ceftriaxone)

A

Test of cure 1 week after treatment AND at 3 months after treatment

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30
Q

When should you follow up with a patient who has urethritis caused by gonorrhea if they received the recommended treatment (Ceftriaxone IM)?

A

Test of Cure- 3 months after treatment

(this is for both recommended AND alternative treatment)

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31
Q

When should you perform a test of cure in a patient who has uncomplicated urethritis caused by Chlamydia that was responsive to tx (Azithromycin 1g x1 dose)?

A

Follow up testing not necessary

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32
Q

When should you perform a Test of cure in a patient who has urethritis caused by Chlamydia if they are PREGNANT?

A

Test for cure 3-4 weeks after completion of treatment

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33
Q

T/F: In treatment of urethritis, you should refer sex partners for evaluation and tx those who had sexual contact w/in the 60 days before onset of patients sxs

A

TRUE

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34
Q

What is orchitis?

A

Inflammation of the testicle

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35
Q

What are the 3 causes of epididymitis?

A
  1. Behcet’s Disease (painful oral/genital ulcers, uveitis, non-mucous membrane skin lesions)
  2. Amiodarone (accumulation in epididymis)- RARE
  3. Testis or epididymal tumor
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36
Q

What is the MCC of epididymitis in men < 35y/o?

A

Neisseria gonorrhea or Chlamydia

37
Q

What is the MCC of Epididymitis in men >35y/o?

A

E. coli

38
Q

The following are causes of what condition?

  1. Acute bacterial infection ( <35= Gonorrhea/chlamydia, >35= E.coli)
  2. Viral
  3. Granulomatous (TB)
  4. Other (Fungus, ureaplasma, Trichomonas)
A

Epididymitis

39
Q

The following is the presentation of what condition?

  • Testicular pain
  • +/- urethral discharge and urethritis sx (if STD)
  • Edematous tender testicle, epididymis, spermatic cord
  • Hydrocele
A

Epididymitis

40
Q

Evaluation of what?

  • Diagnose on clinical findings, H&P
  • Urine culture
  • Test for STDs if STD suspected
A

Epididymitis

41
Q

How do you treat Epididymitis if STDs are suspected? (5)

A
  • Scrotal support
  • Analgesia
  • Cold
  • Empiric tx: Ceftriaxone and Doxycycline
42
Q

How do you treat Epididymitis if STDs are NOT suspected? (5)

A
  • Scrotal support
  • Analgesia
  • Cold
  • Levofloxacin (empiric)
43
Q

Chronic epididymitis last > ____ months

A

> 3 months

44
Q

How do you evaluate chronic epididymitis? (5)

A
  • H&P
  • UA
  • Urine C&S and other cultures as indicated
  • Scrotal ultrasound w/ doppler
  • CT (e.g. stones)
45
Q

The following are conservative treatment options for what?

  • Analgesics
  • Pain clinic
  • Scrotal support
  • Modification of activities
  • Moist heat
  • Spermatic cord block
  • Antibiotics

(“SPASM in the AM”)

A

Chronic Epididymitis

46
Q

What are the 5 surgical options used to treat chronic epididymitis?

A
  • Testicular Dennervation
  • Removal of sperm granuloma
  • If obstruction- vasovasostomy or epididymectomy
  • If intermittent torsion- bilateral orchiopexy
  • Inguinal orchiectomy
47
Q

What surgery do you perform if chronic epididymitis is due to obstruction (2)

A

Vasovastostomy or epididymectomy

48
Q

What surgery do you perform if chronic epididymitis is due to intermittent torsion?

A

Bilateral orchiopexy

49
Q

What is the difference between Acute and Chronic epididymitis in regards to duration of sxs?

A

Acute= < 3 months

Chronic= >3 months

50
Q

What are the 4 types of prostatitis?

A
  1. Acute Bacterial Prostatitis
  2. Chronic Bacterial Prostatitis
  3. Inflammatory Chronic Pelvic Pain Syndrome (Non-bacterial Prostatitis)
  4. Non-inflammatory Chronic Pelvic Pain (Prostatodynia)
51
Q

What is the hallmark sx of prostatitis?

****know this*****

A

Prostatic pain

52
Q

What condition?

  • Fever
  • Irritative sx (freq, urgency, etc)
  • Warm boggy tender prostate
  • Young men
  • E. coli
A

Acute Bacterial Prostatitis

53
Q

T/F: In a patient with suspected Acute Bacterial Prostatitis, you should always perform a prostate massage prior to obtaining urine culture

A

FALSE

(you only do a urine culture post prostate massage in CHRONIC bacterial prostatitis)

54
Q

T/F: It is important to NOT perform a vigorous prostate exam on a patient with suspected acute bacterial prostatitis

A

TRUE

55
Q

What 4 things do you do to evaluate a patient for acute bacterial prostatitis

A
  1. H&P (no vigorous prostate exam)
  2. Urine culture (NOT post-prostate massage)
  3. CBC
  4. Blood cultures
56
Q

How do you tx acute bacterial prostatitis if there is significant fever, highly elevated WBC, sepsis?

A
  • Admit for IV abx
  • When no longer acutely toxic switch to PO abx
  • Discharge and tx w/ abx for 4-6 wks
57
Q

What should you order if you have a patient with acute bacterial prostatitis that is persistently febrile?

A

CT to r/o prostatic abscess

58
Q

Which condition?

  • pain in genitals, urinary tract, perineum, low back
  • Irritative urinary sxs
  • Pain w/ ejaculation
  • Older men
  • E. coli
A

Chronic bacterial prostatitis

(acute is more common in younger men)

59
Q

MCC of chronic prostatitis?

A

E. coli

60
Q

Someone with chronic bacterial prostatitis often will report a history of what? What will be seen on physical exam?

A
  • Hx of recurrent UTIs
  • Physical exam: Tender boggy prostate
61
Q

What two tests are used to evaluate for chronic bacterial prostatitis?

A
  • Expressed prostatic secretion
  • Post prostate massage urine culture
62
Q

How do you treat chronic bacterial prostatitis? (4)

A
  • Empiric- Flouroquinolones, SMX/TMP (adjust based on culture) x8-16 weeks
  • NSAIDs
  • Alpha blockers (“-zosins”)
  • Anticholinergics/antimuscarinics (for relief in freq/urgency)
  • Other: phytotherapy (Saw Palmetto), stress management, etc
63
Q

In a patient with Inflammatory chronic pelvic pain syndrome what will the patient report a history of?

A

History of chronic UTI’s but w/ negative cultures (b/c not bacterial)

64
Q

How do you tell the difference b/w inflammatory chronic pelvic pain syndrome and chronic bacterial prostatitis?

A

Similar sxs

Inflammatory chronic pelvic pain syndrome: Prostatic fluid with leukocytes, but cultures neg. for bacteria

65
Q

What is seen on labs in inflammatory vs noninflammatory chronic pelvic pain syndrome?

A

inflammatory: (-) bacteria, (+) leukocytes

Non-inflammatory: (-) bacteria, (-) leukocytes

66
Q

How is inflammatory and non-inflammatory chronic pelvic pain syndrome similar to chronic bacterial prostatitis? How are they different?

A
  • Similar presentations: (recurrent prostatic infections, pain in genitals/urinary tract/perineum/low back, irritative urinary sxs, pain w/ ejaculation), prostatic tenderness
  • Differences (labs):
    • Inflammatory- Prostatic fluid w/ leukocytes and no bacteria on culture
    • Non-inflammatory- No leukocytes in prostatic fluid and no bacteria on culture
67
Q

Treatment for what?

Palliative measures:

  • NSAIDs
  • Anticholinergics for urinary urgency
  • Alpha blockers
  • Sitz baths
  • Stress reduction
  • Prostate massage
  • Dietary (caffeine, alcohol, spicy food)
  • Benzos
  • Tricyclic antidepressent
  • Analgesics, pain specialist consult
A

Noninflammatory Chronic Pelvic Pain Syndrome (AKA Prostadynia)

68
Q

Definition of Pyelonephritis:

______ (upper or lower?) tract urinary infection involving kidney’s
renal ______

A

Upper tract urinary infection involving kidney’s
Renal Parenchyma

69
Q

Presentation of what?

  • Fever
  • Flank pain
  • N/V
  • CVA tenderness
  • If ascending infection: dysuria, urinary frequency/urgency, hematuria
  • If hematogenous spread: no urinary sxs
A

Pyelonephritis

70
Q

What are the 2 routes of infection for pyelonephritis?

A
  • Ascending infection along urinary tract from bladder
  • Hematogenous spread (IVDA, cutaneous infections)
71
Q

What do you see on UA in pyelonephritis?

A

WBCs and WBC casts

72
Q

When should you order imaging for evaluation of pyelonephritis? (7)

A
  • If very ill, unstable
  • septic
  • DM
  • immunocompromised
  • Structural abnormality of urinary tract
  • Urinary obstruction, urinary stones
  • Unresponsive to abx
73
Q

What 2 types of imaging do you order for further evaluation of pyelonephritis (if indicated)?

A
  • CT Urogram
  • Renal U/S
74
Q

What 4 findings would you see on CT Urogram in a patient with Pyelonephritis?

A
  • Perinephric stranding
  • Kidney enlargement
  • Decreased nephrogram
  • Renal collecting system dilated but not obstructed
75
Q

What 2 findings would you see on Renal U/S in a patient with Pyelonephritis?

A
  • Kidney enlargement (hydronephrosis)
  • Abn kidney echogenicity
76
Q

How do you treat a patient with pyelonephritis who is mildly ill?

A
  • Outpatient
  • Fluoroquinolone x7d
  • Consider admission if febrile >72hrs or if not sufficient clinical improvement
77
Q

How do you treat a patient with pyelonephritis who is moderately/severely ill (high fever, high WBC, Vom, dehydration, sepsis)?

(7 steps)

A
  • Admit
  • IV abx (e.g. FQ, AMG, etc)
  • Imaging for renal abscess
  • adjust abx based on C&S
  • PO when afeb x24-48hrs
  • D/C home w/ 2wk PO abx
  • F/U C&S after completed
78
Q

Pyelonephritis is first on a spectrum with what 2 other conditions?

A

Acute bacterial nephritis and Renal abscess

(if a pt w/ suspected pyelo is not improving, consider dx of ABN or renal abscess)

79
Q

What is the definition of Acute Bacterial Nephritis?

A

Bacterial interstitial nephritis of the renal cortex, causing a renal mass, but no liquifaction

80
Q

What is a renal abscess?

A

Purulent fluid collection of kidney (perinephritic abscess is adjacent to kidney)

81
Q

What patienst are renal abscesses often seen in?

A

DM, immunocompromised

82
Q

Are most common pathogens that cause renal abscess gram negative or positive?

A

negative

(if hematogenous route- gram positives like staph aureus)

83
Q

How do you treat a renal abscess? (4 steps)

A
  • IV abx
  • +/- percutaneous drainage
  • Surgical drainage
  • Follow patients clinical course and follow w/ imaging to ensure resolution
84
Q

What is chronic pyelonephritis? What is it a result of?

A
  • Scarred, atrophic, poorly functioning kidney
  • Result of prior infections
85
Q

How can chronic pyelonephritis result in HTN?

A

Kidney is scarred, atrophic and poorly functioning–> low flow, high renin

86
Q

What is the clinical presentation of Chronic Pyelonephritis? (5)

A
  • HTN
  • Anemia of chronic disease
  • Proteinuria
  • Renal insufficiency
  • Recurrent UTIs
87
Q

What is a radiographic finding of Chronic Pyelonephritis?

(*Will be on exam*)

A

Calceal blunting

88
Q

What are the 3 treatments for Chronic Pyelonephritis?

A
  • Manage UTI risk factors
  • Control HTN
  • Nephrectomy

MJ- F3 E1: Urology (12 decks)

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