UTI, Pyelo, and ABs

Question 1

Urethritis is often associated with?

Answer 1

STI

Question 2

Culture and Senstivity does not…

Answer 2

pick up GC and Chlamydia in a timely fashion

Question 3

What are some predisposing factors for UTIs?

Answer 3

use of spermicide (as with diaphragm for contraception)

frequent sexual intercourse

*20-30% will have recurrence

Question 4

What pt is at a greater risk of UTIs?

Answer 4

diabetic women - 2-3x higher incidence

Question 5

If a post-menopausal women has recurrent UTIs, what are her predisposing factors?

Answer 5

hx of premenopausal UTIs

anatomic factors affecting bladder emptying (cystoceles, urinary Incontinence, residual urine)

tissue effect of estrogen depletion

Question 6

What are predisposing factors for UTI in men?

Answer 6

prostatic hypertrophy

non-circumcised

Question 7

What is ABU?

Answer 7

Asymptomatic bacteriuria

urine sample is obtained for another reason & shows bacteria on microscopic evaluation

*generally do not treat unless sx develop

Question 8

What qualifies an uncomplicated UTI?

Answer 8

• Non-pregnant female
• No anatomic abnormalities
• No instrumentation of the urinary tract

Question 9

What qualifies a complicated UTI?

Answer 9

• ANY pregnant female since
  
  • 2 patients
  • can lead to premature labor
  • low birth-weight babies
• Anatomic variant (ex. single kidney)
• Foreign body in the urinary tract
• Extrinsic compression of ureter/bladder
• Immune suppression conditions (diabetes)

Question 10

What are the contributing factors for interstitial cystitis?

Answer 10

• Chronic bladder infection
• Inflammatory factors
• Unusual pain sensitivity
• Functional co-morbidities

Question 11

What organisms are in the ddx for:

1. Urethritis
2. Vaginitis
3. Cervicitis

Answer 11

1. Gonorrhea, Chlamydia, Herpes
2. Candida, Trichomonas
3. Chlamydia, Neisseria

Question 12

If urine dip and urine microscopic are negative, do you need a urine culture?

Answer 12

no - unless you’re thinking STI

Question 13

What ABs are used for GC?

Answer 13

Ceftriaxone and Azithromycin

Question 14

What ABs are used for chlamydia?

Answer 14

Azithromycin or doxycycline

Question 15

How do you tx cystitis? pyelonephritis?

Answer 15

1. Trimethoprim-Sulfamethoxazole
2. Fluorquinolone–eg levofloxacin

Question 16

What sx are seen with pyelonephritis?

Answer 16

• Generally sicker
• Fevers/chills
• Body aches (esp back pain)
• Typically ascending from lower tract infection
• Positive CVA tenderness

Question 17

What are the most common precursors of pyelonephritis?

Answer 17

• Same as UTI (most commonly ascending from lower tract)
  
  • Most common organism is E. Coli
• Can be hematogenous spread to kidney instead of ascending, but very rare
  
  • Candida, Salmonella, Staph aureus

Question 18

What are the three big complications of pyelonephritis?

Answer 18

1. Papillary Necrosis
2. Emphysematous pyelonephritis
3. Xanthogranulomatous pyelonephritis

Question 19

What is emphysematous pyelonephritis?

Answer 19

production of gas in nephric and perinephric area

*almost exclusively in diabetic pts

Question 20

What happens in xanthogranulomatous pyelonephritis?

Answer 20

suppurative destruction of renal tissue

can lead to abscess formation

Question 21

What is sepsis? what is septic shock?

Answer 21

1. Suspected or documented infection and an acute increase in organ failure
   
   1. Dysregulated host response to infection
2. Progressive organ dysfunction leading to marked increase in mortality

Question 22

What are the signs of shock?

Answer 22

• fever or hypothermia
• tachycardia
• tachypnea
• hypotension (can be unresponsive to fluid resuscitation)
• circulating cytokines
• endothelial injury
• edema
• decreased oxygenation of tissues
• build up of lactic acid

Question 23

What are preventative measurements for UTIs?

Answer 23

1. AB therapy
2. pee after sex
3. wipe front to back
4. shower > bath
5. cranberry products
6. vitamin C
7. increased fluid intake