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Pediatrics I - OSCE > UTI > Flashcards

UTI Flashcards

1
Q
A
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2
Q

Host Factors contribuiting to UTI

A

+++ Anatomical factors

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3
Q

Host Factors contribuiting to UTI

  • Age
A

Higer in boys < 1 year & in girls < 4 years

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4
Q

Host Factors contribuiting to UTI

  • Sex
A
  • Females (2-4 folds higher)
  • This may be the result of the shorter female urethra.
    Because the incidence of UTI in male neonates is as high, if not higher, than female neonates
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5
Q

Host Factors contribuiting to UTI

  • Race
A

White children have 2-4 folds higher than black (for not completely understood reasons )

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6
Q

Host Factors contribuiting to UTI

  • Genetic
A
  • Higher in first degree relatives
  • Adherence of bacteria may be genetically determined.
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7
Q

Host Factors contribuiting to UTI

  • dysfunctuinal elimination
A
  • An abnormal elimination pattern (frequent or infrequent voids, urgency, constipation)
  • Bladder and/or bowel incontinence
  • Withholding maneuvers
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8
Q

Host Factors contribuiting to UTI

  • Circumcision
A

(Uncircumcised male infants with fever have 4-8 fold higher prevalence)

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9
Q

Host Factors contribuiting to UTI

  • Catheterization
A

(Increased Risk with Increased duration of bladder catheterization)

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10
Q

Host Factors contribuiting to UTI

  • Anatomical abnormalities
A
  • Urinary obstruction
  • Vesicoureteral reflux
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11
Q

Anatomical abnormalities contributing to UTI

  • Urinary Obstruction
A
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12
Q

Anatomical abnormalities contributing to UTI

  • VUR
A
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13
Q

RF for Renal Scarring

A
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14
Q

Use of Leucocyte Esterase

A
  • Suggestive of UTI
  • However, +ve result doesn’t always signal UTI
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15
Q

Test Principle of Leucocyte Esterase

A

-Leukocyte esterase is present in neutrophils and can be assayed in urine by dipstick strips

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16
Q

Sensitivity & Specifity of Leucocyte Esterase

A

Sensitivity: 84%

Specifity: 78%

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17
Q

False Positive in Leucocyte Esterase

A
  • Imipenem
  • Clavulanic acid
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18
Q

False negative in Leucocyte Esterase

A
  • Ascorbic acid
  • Boric acid
  • Gentamicin
  • Nitrofurantoin
  • Cephalexin
  • Proteinuria
  • Glycosuria
  • Urobilinogen
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19
Q

Use of Nitrite

A
  • Suggestive of UTI
  • Not identify gram +ve infection (Lack nitrate reductase enzyme)
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20
Q

Test Principle in Nitrite

A
  • bacterial enzyme nitrate reductase can convert urinary nitrate to nitrite.
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21
Q

Sensitivity & Specificity in Nitrite

A
  • 50%
  • 98% (Highly specific & low false +ve rate)
22
Q

Microscopic Examination in UTI

23
Q

Def of Pyuria

24
Q

Sensitivity of Pyuria

A

Sensitivity is 89 % which means it suggests infection, but infection can occur in absence of pyuria

25
Q

Specifity of Pyuria

A

Presence of WBCs in urine is not specific for UTI as pyuria can be present without UTI

26
Q

Causes of Sterile Pyuria (False Positive)

A
  • Renal TB
  • Urethritis
  • Inflammation near the bladder (appendicitis, Chrons disease)
  • Intestinal nephritis
27
Q

True UTI without +ve leukocyte esterase on dipstick analysis and > 5 WBC/HPF with standardized microscopy is …….

28
Q

Absence of pyuria in presence of significant bacteriuria may occur in …..

A
  • Early in the course of UTI (before the local inflammatory response develops
  • Bacterial contamination of the urine sample (e.g. from the urethra or periurethral)
  • Colonization of the urinary tract (e.g. asymptomatic bacteriuria)
29
Q

Pyuria & Bacteruria association

30
Q

….. is the gold standard for the diagnosis of UTI.

A

Urine culture

31
Q

Urine culture should be performed in the following groups, even if the dipstick and microscopic analysis are negative:

32
Q

Urine culture interpretation in UTI

33
Q

Imaging in Dx of UTI

  • value of US
34
Q

VCUG in UTI

  • Time
A

3-6 weeks after infection but can be done after completing of antibiotic therapy

35
Q

VCUG in UTI

  • Prophylactic Antibiotics
A
  • Prophylactic oral antibiotics should be given for 3 days with VCUG taking place on the 2nd day
36
Q

VCUG in UTI

  • Uses
37
Q

Technique of Tc-99m DMSA scintigraphy in UTI

38
Q

What is the gold standard test for diagnosing acute pyelonephritis and renal scars?

A

Tc-99m DMSA scintigraphy

39
Q

DMSA in UTI

  • Disadvantages
A

However, it doesn’t distinguish lesions that will spontaneously resolve from those which cause renal scarring

40
Q

DMSA in UTI

  • How to overcome the drawbacks?
A

Thus, a delay of 4 - 6 months is needed following acute pyelonephritis to allow acute reversible lesions to resolve in order to diagnose renal scarring

41
Q

TTT of UTI

  • Goals
42
Q

TTT of UTI

  • Hygeinic Measures
43
Q

TTT of UTI

  • Oral Antibiotics
44
Q

TTT of UTI

  • Duration of Antibiotics
45
Q

TTT of UTI

  • For pyelonephritis
46
Q

TTT of UTI

  • For Cystitis
47
Q

Suppressive Therapy in UTI

  • Indications
A

VUR → Till reflux resolves especially in children < 5 years of age.

48
Q

Suppressive Therapy in UTI

  • Duration
A

Antibiotic prophylaxis is continued for up to 6 months after surgical correction of VUR.

49
Q

Suppressive Therapy in UTI

  • Drugs
50
Q

DOC for suppressive therapy in UTI in first 3 months of life

A

Cephalexin

51
Q

Prognosis of UTI

A
  • Recurrent UTI
  • HTN
  • Renal scarring

Pediatrics I - OSCE (20 decks)

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