UTI

Question 1

How would a pt w cystitis present? (6)

Answer 1

Frequency, urgency
Dysuria, polyuria
Suprapubic pain
Haematuria

Question 2

How would a patient w acute pyelonephritis present? (5)

Answer 2

Fever
Chills
Nausea + vomiting
Flank pain
\+ associated cystitis symptoms

Question 3

How would a pt w prostatitis present? (3)

Answer 3

Pain: perineum, rectum, scrotum
Fever
Swollen/ tender prostate on PR

Question 4

What are the risk factors for UTIs? (5)

Answer 4

Females
Sex
Diabetes mellitus
Indwelling catheter
Pregnancy

Question 5

What bug commonly cause UTIs? (4)

Answer 5

E.coli
Klebsiella pneumoniae
Proteus mirabilis
Staphylococcus saprophyticus

Question 6

What investigations would you do in a pt suspected of having a UTI? (4)

Answer 6

MSU:

• dipstick: proteinuria, increased pH, pyuria (pus)
• microscopy: WBC, bacteria
• culture: E.coli, kleb, S. aureus

Question 7

How would you treat a non-pregnant female w suprapubic pain, frequency and dysuria? (3)

Answer 7

• Trimethoprim/ nitrofurantoin (3-day course)

- If above fails, MC&S urine then Tx accordingly

Question 8

How would you treat a pt w dysuria, frequency, flank pain and fever? (3)

Answer 8

Acute pyelonephritis

• Resus: fluids
• IV co-amoxiclav/ ciprofloxacin (broad-spec antibiotics) +/- gentamicin
• Consider hospitalisation (drain obstructed kidney, analgesia, catheter)

Question 9

Male pt comes in w dysuria, frequency and haematuria. Urine cultures come back +ve for E.coli. What treatment would you give?

Answer 9

7-day antibiotic - trimethoprim/ nitrofurnatoin

Question 10

70yo male w fever, pain in perineum, and tender prostate on PR. Urine dipstick showed haematuria. How would you treat this patient?

Answer 10

4-week course of fluoroquinolone (ciprofloxacin)

Question 11

Why wouldn’t you dipstick test a catheterized sample?

Answer 11

All catheterised pt’s are bacteriuric so no diagnostic value

Question 12

How and when would you send a urine sample from a catheterized patient?

Answer 12

Midstream urine (MSU) sample
Sent only if SYMPTOMATIC

Question 13

How would you diagnose pyelonephritis? (3)

Answer 13

• Costovertebral tenderness
• Bloods: raised WBC
• MSU dipstick: PYRUIA