UTI

Question 1

Define bacteruria

Answer 1

presence of bacteria in urin

Question 2

define pyuria

Answer 2

presence of leukocytes in urine

Question 3

what is an uncomplicated UTI

Answer 3

UTI caused by expected pathogens with normal kidney + tract function and no comorbids

Question 4

what is a complicated UTI

Answer 4

Uti with inc chance of complications such as persistent infection

Question 5

what are the most common UTI pathogens

Answer 5

* Ecoli
* Proteus
* Klebsiella
* Enterococci
* staph saptophyticus
* S. aeres
* Psydomonas aeruginosa

Question 6

what are common symptoms of Upper UTI’s UNIFINISH

Answer 6

loin pain
Fevers
Haemturia

Question 7

What are common symptoms of Lower UTI’s UNFINISH

Question 8

How is UTI investigates

Answer 8

Dipstick - urinalysis
Microscopy
Culture

Question 9

What is the golf standard urine sample

Answer 9

Mid stream

Question 10

If a urina sample is analyser and wbc are found at 10^4wbc/ml, what is this called

Answer 10

Pyuria

Question 11

during a urinalysis counts of 10^5 CFU/ml would indicate what

Answer 11

infection

Question 12

what can cause sterile pyuria

Answer 12

• STI’s
• TB
• interstitial cystitis
• chlamydia
• carcinoma in situ of the bladder
• cystitis
• Patient has taken courese of antibiots before testing

Question 13

what is first line treatment for lower UTI in non pregnant patient

Answer 13

Nitrofurantoin

-not ciprofloxacin due to being broad speccy

Question 14

when should nitrofurantoin not be used

Answer 14

• third trimester due toneonatal haemolysis
• egfr greater than 45

Question 15

T/F, we treat asymptomatic bacterium in the over 65’s

Answer 15

no

Question 16

Mrs A Virde (24) has been complaining of dysuria, urgenct and freq urine. Has been treated with cephalexin. while waiting for urinalysis what do you treat with

Answer 16

nitrofurantoine

Question 17

what are the most common health casre acquired infections

Answer 17

UTI

Question 18

how does a catheter associated UTI occur

Answer 18

• Insertion may carry organisms into bladder
• infectoin risk 24hours post removal
• biofilms
• incomplete voiding - stasis of urine

Question 19

howis a catheter UTI prevented

Answer 19

• Intermittent/suprapubic catheterisation
• preventin of bacteriuria - keeping closed and removed ASAP
• Not treating when asymptomatic

Question 20

Case 3
Mr E.Home is an 84 year-old man who has become confused and agitated. He has been sent to the frailty unit and you assess him. Other than the confusion, the only significant finding from history and examination is that he has a long-term urinary catheter.
The nurse uses a dipstick to assess the urine. This will give her an indication if an infection is present or not:

Answer 20

no

Question 21

When a UTI is suspected in pregnancy what is preferred.

a)dipstick
b)culture

Answer 21

b

Question 22

what antibiotic should not be used in pregnancy

Answer 22

trimethoprim

Question 23

what infection are pregnant woman at risk of in UTI

Answer 23

PYELONEPHRITIS

Question 24

What is the location of pyelonephritis

Answer 24

renal parenchyma and soft tissues of renal pelvis

Question 25

what is the triad for pyelonephritis

Answer 25

fever
loin pain
nausea/ vomiting

Question 26

what investigations would be done for suspected pyelonephritis

Answer 26

abdo exam
-tender loin
-renal angle tenderness

Bloods + vultures
-U andE, FBC

Mid stream Urine sample

Question 27

hoe is pyelonephritis treated

Answer 27

• Broad IV antibiotics (often presenting unwell without time to wait for testing) e.g Co- amoxiclav
• Catheter
• Analgecis
• 7-14 days of antibiotics
• if kidney obstructed, drain it

Question 28

what are complication of pyelonephritis

Answer 28

Renal abcsess
-imaging
-common for diabetics

Emphysematough pyelonephtis
-rare