UTI, cystitis + pyelonephritis

Question 1

What are the causes of sterile pyuria?

Answer 1

Appendicitis, calculi, prostatitis, TB, UTI

Question 2

Management of UTI in women

Answer 2

Non pregnant = nitrofurantoin or trimethoprim for 3 days Pregnant = 7 day course

Question 3

Management of pyelonephritis

Answer 3

Hospital admission if severe

Ciprofloxacin, trimethoprim, co-amoxiclav

Question 4

Presentation of urinary retention

Answer 4

10x more common in men Lower abdo pain, lower abdo mass, not passing urine, dull to percuss

Question 5

Management of urinary retention

Answer 5

Most resolve spontaneously Catheterisation: TWOC (removing catheter shortly after)

Question 6

RF for UTIs in men

Answer 6

BPH, urinary tract stones, urethral stricture
Catheterisation
Previous urinary tract surgery
Immunocompromised state

Question 7

Complications of UTIs in men

Answer 7

Renal function impairment 
Prostatitis 
Pyelonephritis 
Sepsis 
Urinary stones

Question 8

UTI management in men

Answer 8

Trimethoprim or nitrofurantoin for 7 days

Question 9

Management of recurrent UTIs

Answer 9

Urine culture before starting abx
Consider abx prophylaxis - trimethoprim 100mg at night
Refer to urology if male

Question 10

RF for complicated UTI

Answer 10

Structural or neuro abnormalities 
Pregnancy 
Urinary catheterisation 
Atypical or resistant organisms 
Immunosuppression

Question 11

When should urine be sent for culture in women?

Answer 11

Pregnancy 
>65 y/o 
Persistent symptoms 
Recurrent UTI 
Catheterised 
Haematuria

Question 12

What is acute cystitis?

Answer 12

Infection confined to bladder

Question 13

Common bacteria causing cystitis

Answer 13

E coli
Klebsiella
Proteus mirabilis

Question 14

S+S of cystitis

Answer 14

Dysuria, urinary frequency, urinary urgency, suprapubic pain

Question 15

Complications of pyelonephritis

Answer 15

Sepsis 
Parenchyma renal scarring
Recurrent UTI 
Renal abscess formation 
Preterm labour in pregnancy 
Emphysematous pyelonephritis

Question 16

S+S of pyelonephritis

Answer 16

S+S of UTI

+ new onset of fever, nausea, flank pain

Question 17

When should a case of pyelonephritis be referred?

Answer 17

Men with any single episode without a cause

Women with recurrent pyelonephritis

Question 18

S+S of BPH

Answer 18

Storage symptoms (increased daytime frequency, nocturia, urgency, urinary incontinence)
Voiding symptoms (slow stream, splitting or spraying of stream, intermittent stream, hesitancy, straining to void)

Question 19

What bacteria commonly cause UTIs?

Answer 19

Klebsiella, E coli, Enterobacter, Proteus mirabilis, Pseudomonas, S saphrophyticus

Question 20

RF for complicated UTIs

Answer 20

Male
Pregnancy 
Functional abnormality of tract 
CKD 
DM 
Immunosuppression 
Indwelling catheter

Question 21

When should renovascular HTN be suspected?

Answer 21

Sudden onset HTN >55 or <30 
Presence of abdo bruit 
HTN resistant to >3 drugs 
Rise IN cr of >30% 
Other atherosclerotic disease 
Recurrent pulmonary edema