UTI

Question 1

Female urethra length

Answer 1

4 cm

Question 2

Risk factors- Colonization

Answer 2

Sex, spermacides, estrogen depletion, antimicrobials

Question 3

Risk factors- Ascent

Answer 3

Catheter, incontinence, residual urine volume

Question 4

Reduced outflow

Answer 4

Obstruction- prostate, neurogenic bladder, inadequate fluid intake

Question 5

Cystitis- Eti

Answer 5

1 in 8 women yearly, genetic predisposition, altered vag. flora, contraceptive, post coital. Infection of lower Resp tract

Question 6

Not risk factors of UTI

Answer 6

Delayed voiding, DMI, douching, hot tubs, posttcoital urination, wiping, fluid consumption

Question 7

Cystitis- Sx

Answer 7

Irritative voiding symptoms, dysuria, increased urgency, frequency, hematuria. No vag discharge!

Question 8

Cystitis- Dx- Phys exam

Answer 8

no fever, no CVA tenderness, suprapubic tenderness

Question 9

Cystitis- Dx- Lab

Answer 9

Dip- leukocyte esteras & nitrites. Microscope: WBCs >5-20 per HPF, RBCs

Question 10

Cystitis- Causes

Answer 10

E. coli- 79%, Saprophyticus- 11%, Klebsiella- 3%

Question 11

Cystitis- Culture

Answer 11

Only if empiric therapy fails- Positive culture >10^5 CFU

Question 12

Cystitis- Tx

Answer 12

TMP- Sulfa x 3 days + urinary analgesic avoid quinalones if possible

Question 13

Recurrent cystitis

Answer 13

Ensure urine culture and sensitivity obtained, urology referral, tx 7-14 days

Question 14

Asymptomatic bacteriuria- Eti

Answer 14

Urine culture >10^5 without symptoms. Common in age, spinal cord injuries

Question 15

Asymptomatic bacteriuria- Tx

Answer 15

Only treat pregnant, prior to urologic intervention, hip replacement, becomes symptomatic

Question 16

Prostatitis- Eti

Answer 16

Common in 36-50, 10% of population. E coli, pseudomonas. urinary reflux, trauma, unprotected anal intercourse & uti most common causes

Question 17

Prostatitis Acute- Sx

Answer 17

Dysuria, pelvic pain “sitting on a ball”, exquisite prostatic tenderness- boggy feel

Question 18

Prostatitis- Chronic- Sx

Answer 18

Pyuria, no dysuria or tenderness, relapsing pattern of infection

Question 19

Prostatitis- Acute- Dx

Answer 19

Urine culture, no prosthetic massage

Question 20

Prostatitis- Chronic- Dx

Answer 20

Urine culture- prosthetic massage indicated- PSA

Question 21

Prostatitis- Acute- Tx

Answer 21

2-4 weeks fluoroqunalones or TMP-sulfa. Admit if acutely ill

Question 22

Prostatitis- Chronic- Tx

Answer 22

Refer to urologist- 2 glass urinary specimen analysis

Question 23

Epididymitis- Eti

Answer 23

Young men= STD, older men - prostatitis or UTI

Question 24

Epididymitis- Sx

Answer 24

Elevation of hemiscrotum, erythema, reactive hydrocele, tenderness

Question 25

Epididymitis- Dx

Answer 25

UA- Pyuria or bacteruria. Gonorrhea or chlamydia

Question 26

Epididymitis- Tx

Answer 26

Abx (ceftriaxon+ doxy or cipro), scrotal support, ice packs, anti inflammatory & analgesics

Question 27

Pyelonephritis- Eti

Answer 27

Gram negatives (E. coli, proteus…) ascend from lower tract.

Question 28

Pyelonephritis- Sx

Answer 28

fever, HA, N/V, flank pain, CVA tenderness

Question 29

Pyelonephritis- Dx

Answer 29

UA, culture, CBC & chem panel. US to RO obstruction

Question 30

Pyelonephritis- TX

Answer 30

flouroquinolone x 2wks. May require hospital

Question 31

Pyelonephritis- Complications

Answer 31

Abscess- not improving on abx, dx with CT, may need drain. Stones- severe flank pain, uro consult.