UTI

Question 0

Cystitis – necessary number of colony forming units during midstream catch?

Answer 0

100,000

Question 1

Most common cause of septic shock in pregnancy?

Answer 1

Pyelonephritis

Question 2

Urethritis – most common cause?

Answer 2

Chlamydia

Question 3

Urethral syndrome?

Answer 3

Urgency and dysuria caused by urethral inflammation of unknown etiology (negative urine cultures)

Question 4

Types of UTIs?

Answer 4

Urethra – ureteritis
Bladder – cystitis
Kidneys – pyelonephritis

Question 5

Bacteria that cause UTIs?

Answer 5

1. E. coli (80%)
2. Staphylococcus saprophyticus

Klebsiella, Pseudomonas, Proteus, Enterobacter, GBS, chlamydia

Question 6

Symptoms of lower tract infection (cystitis)?

Answer 6

Dysuria, urgency, urinary frequency

Question 7

Gross hematuria should raise suspicion of?

Answer 7

Nephrolithiasis or hemorrhagic cystitis

Question 8

Significant bacteriuria?

Answer 8

100,000 – if midstream
10,000 if catheterized
1000 – if symptomatic

Question 9

Drugs for simple cystitis? Don’t use which drug?

Answer 9

Bactrim, nitrofurantoin, norfloxacin, ciprofloxacin, cephalosporins

Don’t use ampicillin because of resistance from E. coli

Question 10

Urethritis versus cystitis - signs/symptoms?

Answer 10

Both have urgency, frequency, dysuria

Urethritis may also have tender urethra and purulent drainage

Question 11

Organisms that cause urethritis?

Answer 11

Chlamydia, gonococcus, trichomonas

Question 12

Patients with typical UTI symptoms, but sterile culture and no response to standard anabiotics – consider? Tests? Treatment?

Answer 12

Urethritis; gonococcus/chlamydia cultures; Ceftriaxone or doxycycline respectively

Question 13

Signs of pyelonephritis? Tx?

Answer 13

Fever, flank pain, nausea/vomiting

Bactrim or fluoroquinolone for 10-14 days

Question 14

When to hospitalize for pyelonephritis? Tx?

Answer 14

1. Unable to take oral medications
2. Pregnant
3. Immunocompromised

Ampicillin and gentamicin OR cephalosporin

Question 15

Difference in treating pregnant women with acute Pyelonephritis?

Answer 15

Following resolution of fever and symptoms, continue to treat with suppressant antimicrobial therapy (nitrofurantoin 100 mg daily) for rest of pregnancy

Question 17

Patient under treatment for pyelonephritis presents with dyspnea tachycardia – diagnosis?

Answer 17

ARDS from endotoxin released from bacterial lysis

Question 19

ARDS?

Answer 19

Alveolar and endothelial injury leading to leaky pulmonary capillaries, causing

1. hypoxemia
2. large Aa gradient
3. loss of lung volume

Question 20

If there’s no clinical improvement after 72 hours of appropriate antibiotic therapy for pyelonephritis, suspect?

Answer 20

Ureterolithiasis or perinephric abscess

Question 21

Endotoxin release from bacterial lysis in pregnant pts can result in?

Answer 21

1. ARDS

2. Uterine contractions and preterm labor

Question 22

Treatment of ARDS?

Answer 22

Supportive, with careful fluid management

Question 23

If pregnant patient is not giving suppressive therapy after resolution of pyelonephritis, recurrence rate?

Answer 23

One third