UTI/Epididymitis/Prostatitis/Pylenophritis

Question 1

What is one of the most common entities encountered in medical practice?

Answer 1

UTI

Question 2

What kind of bacteria is responsible for most UTI?

Answer 2

Coliform
E. coli being the most common

Question 3

What is the most common route of infection for a UTI?

Answer 3

Ascending infection from urethra

Question 4

What is acute cystitis?

Answer 4

Infection of the bladder

Question 5

What coliform bacteria cause acute cystitis?

Answer 5

E coli
Gram positive bacteria (enterocci)

Question 6

What is the most common route of infection for acute cystitis?

Answer 6

Ascending from urethra

Question 7

What is the concern for cystitis in men?

Answer 7

It is rare and suggests a pathologic process such as infected stones, prostatitis, chronic urinary retention requiring further investigation

Question 8

Female with irritative voiding sx, suprapubic discomfort and afebrile with hematuria after intercourse may have what condition?

Answer 8

Acute cystitis

Question 9

What UA lab results may be indicative of acute cystitis?

Answer 9

Pyuria, bacteriuria and various degrees of hematuria

Question 10

What imaging should be done if you suspect acute cystitis?

Answer 10

Abdominal ultrasonography or cystoscopy
CT

Question 11

Antibiotic treatment for acute cystitis

Answer 11

Women:
Ciprofloxacin 250mg q12hrs po x 3days
Nitrofurantoin (Macrobid) 100mg q12hrs PO x 5-7days
Bactrim 150mg PO q12hrs x 3days

Men:
Depends on etiology

Question 12

Urinary analgesics for acute cystitis

Answer 12

Phenazopyridine (pyrdium) 100-200mg q6h prn PO for MAX 3 days

Sitz baths may provide symptomatic relief

Question 13

Women can be considered for prophylactic antibiotic therapy if they have how many episodes of acute cystitis per year?

Answer 13

3 per year

Question 14

What are the prophylactic medications for acute cystitis?

Answer 14

Bactrim, Macrobid, Cephalexin

Question 15

When should prophylactic medications for acute cystitis be taken?

Answer 15

Single dose at bedtime or at time or intercourse

Question 16

What is pyelonephritis?

Answer 16

Infectious inflammatory disease involving the kidney parenchyma and renal pelvis

Question 17

What are the most common causative agents of pyelonephritis?

Answer 17

Gram-negative bacteria:
E coli, proteus, klebsiella, Enterobacter, pseudomonas

Question 18

What are less common causative agents of pyelonephritis?

Answer 18

Gram-positive bacteria:
Enterococcus faecalis, Staphylococcus aureus

Question 19

Pyelonephritis infection usually scends from which portion of the urinary tract? What is the exception?

Answer 19

Usually ascends from lower urinary tract

Exception of S aureus which is spread hematogenous route

Question 20

Patient presents with fever, flank pain, irritative voiding sx, shaking chills, n/v/d, tachycardia and CVA tenderness is likely to have what condition?

Answer 20

Pyelonephritis

Question 21

What labs should be done on a patient with pyelonephritis and what would be the results?

Answer 21

CBC: leukocytosis w/ left shift
UA: pyuria, bacteriuria, hematuria
Urine Culture: heavy growth of offending organism
Blood culture: positive

Question 22

What imaging should be done for pyelonephritis?

Answer 22

Renal ultrasound

Question 23

What inpatient treatment should be done for pyelonephritis?

Answer 23

Ampicillin 1g q6h and gentamicin 1mg/kg q8h IV x 14 days
IV antibiotics are continued 24hrs after fever resolves and oral antibiotics are given for 14 days

Question 24

What outpatient medications should be given for pyelonephritis?

Answer 24

Cipro 750mg q12h PO 7-14 days
Levofloxacin 750 mg daily PO 7-14 days

Question 25

What complications could arise from pyelonephritis?

Answer 25

Sepsis, shock Abscess formation Catheter drainage may be necessary if urinary retention

Question 26

What is acute prostatitis?

Answer 26

Inflammation and infection of the prostate gland

Question 27

What is the usual cause of acute prostatitis?

Answer 27

Gram negative rods E coli and pseudomonas

Question 28

What is less common cause of acute prostatitis?

Answer 28

Gram-positive organisms Enterococci

Question 29

Patient presents with perineal/sacral/suprapubic pain with fever, irritative void sx, urinary retention and warm and tender prostate on exam, what condition might they have?

Answer 29

Acute prostatitis

Question 30

Should prostatic massage be done on acute prostatitis?

Answer 30

No, its contraindicated

Question 31

What labs should be done for acute prostatitis and what would their results be?

Answer 31

CBC: leukocytosis with left shift UA: pyuria, bacteriuria, hematuria Urine culture: positive

Question 32

What inpatient treatment should be done for acute prostatitis?

Answer 32

Ampicillin 1g q6h and gentamicin 1mg/kg q8h IV x 14 days IV antibiotics are continued 24hrs after fever resolves and oral antibiotics are given for 4-6weeks

Question 33

What outpatient treatment should be done for acute prostatitis?

Answer 33

Cipro 750mg q12h PO 4-6 weeks Levofloxacin 750 mg daily PO 4-6 weeks

Question 34

If a patient with acute prostatitis has urinary retention, what should be done?

Answer 34

Percutaneous suprapubic tube is required Urethral catheterization is CONTRAINDICATED

Question 35

Can an IDC manage chronic bacterial prostatitis alone?

Answer 35

NOPE

Question 36

Patient presents with irritative voiding sx, low back and perineal pain, suprapubic discomfort and hx of UTIs with an unremarkable physical exam, what condition might they have?

Answer 36

Chronic bacterial prostatitis

Question 37

What labs should be done for chronic bacterial prostatitis and what would their findings be?

Answer 37

UA: normal or increased leukocytes

Question 38

What antibiotics should be given for chronic bacterial prostatitis?

Answer 38

Bactrim Cipro Levaquin

Question 39

What symptomatic relief can be given to a patient with chronic bacterial prostatitis?

Answer 39

NSAIDS Sitz baths

Question 40

What is epididymitis?

Answer 40

Inflammation and/or infection of the epididymis

Question 41

What are the 2 categories of epididymitis?

Answer 41

Sexually transmitted and non sexually transmitted

Question 42

What age and what causes sexually transmitted epididymitis?

Answer 42

Typically in men under 35 Results from chlamydia trachomatis or Neisseria gonorrhoeae

Question 43

What age and what causes non sexually transmitted epididymitis?

Answer 43

Older man Associated with UTIs and prostatitis Caused by gram-neg rods )e-coli, klebsiella)

Question 44

What is the route of infection of epididymitis?

Answer 44

Through urethra to the ejaculatory duct

Question 45

Patient presents with pain following physical strain in the scrotum and radiates along spermatic cord and to the flank with a fever. Upon PE, you note scrotal swelling, what might this patient have?

Answer 45

Epididymitis

Question 46

What is the difference in presentation of early and late epididymitis?

Answer 46

Early: epididymis may be distinguishable from testis Late: 2 may appear as one enlarged tender mass

Question 47

What is the prehn sign?

Answer 47

Elevation of scrotum above the pubic symphysis improves pain

Question 48

What laboratory studies and findings would be found with epididymitis?

Answer 48

CBC: Leukocytosis and left shift GC UA

Question 49

What imaging should be done for epididymitis?

Answer 49

Scrotal ultrasound

Question 50

How is sexually transmitted epididymitis treated?

Answer 50

Ceftriaxone (Rocephin) PLUS Doxycycline