UTI- unrein

Question 1

level of bifurcation of upper and lower UTI

Answer 1

urethral orifices of bladder

Question 2

risk facotrs UTI

Answer 2

female
spermicides
pregnancy
vaginal atrophy

Question 3

Sx UTI

Answer 3

dysuria, frequency, urgency, strong urine odor, cloudy urine, suprapubic tenderness on PE
absence of vaginal discharge or vaginal pain

Question 4

underlying risk factors for UTI

Answer 4

neurogenic bladder
DM
urinary instrumentation
structural abnormalities like cystocele

Question 5

when is culture indicated even if suspect simple cystitis

Answer 5

pregnancy
antibiotic resistant organisms
multiple drug sensitivities
underlying complicating medical condition

Question 6

complicated cystitis

Answer 6

recurrent in female
ANY male
urethral malformations
strictures or obstructions
neurogenic bladder
immunocompromised
renal disease
pregnancy
DM
catheterization
upper tract disease

Question 7

presentation pyelonephritis

Answer 7

fever and toxic appearance
lloyds sign
elevated WBC with lef tshift

Question 8

what causes pyelonephritis

Answer 8

most common- ascending bacteria from residual urine and reflux
hematogenous or lymphatic spread- endocarditis, osteomyelitis, injeciton drug users

Question 9

where do you palpate kidney

Answer 9

anterior hand, should not be able to palpate kidney in normal individual

Question 10

do you Tx asymptomatic bacteriuria

Answer 10

not usually

Question 11

indications for Tx asymptomatic bacteriuria

Answer 11

pregnancy
urinary outflow obstruction
anticipated urinary instrumentation
when the goal is to prevent upper tract disease

Question 12

what is urosepsis

Answer 12

septic
tachy, fever or low temp
elevated WBC left shfit
rigors

Question 13

what to order for urosepsis

Answer 13

blood and urine cultures and imaging

Question 14

pathogens in urine normally

Answer 14

gram - bacteria

gram + bacteria

Question 15

what bacteria found in young women

Answer 15

staphylococcus saprophyticus

Question 16

what grows on prosthetic devices

Answer 16

staph epidermidis

Question 17

what staph occurs in injection drug users

Answer 17

aureus

Question 18

what is sterile pyuria

Answer 18

doesn’t grow on regular agar

Question 19

what pathogens are “culture negative”

Answer 19

mycobacterium TB
adenovirus
polyomavirus
cytomegalovirus
anaerobes
fungal
interstitial cystitis

Question 20

what will a urine dipstick tell you

Answer 20

+ nitrites and leukocyte esterase in for UTI

negative nitrites and leukocyt high negative predictive value!!

Question 21

use of urine cultures in lab eval

Answer 21

colony counts

antibiotic sensitivity patterns

Question 22

what imaging is used for lab evals

Answer 22

US and CT scan

Question 23

what cells make nitrites? nitrates?

Answer 23

nitrites prokaryotic cells

nitrates eukaryotic cells

Question 24

Tx UTI that is bacteriostatic

Answer 24

nitrofurantoin

Question 25

bactericidal antibiotics used for UTI

Answer 25

TMP/SMX
fluoroquinolone
beta-lactam antibiotics

Question 26

side effects fluorquinolones

Answer 26

achilles tendon rupture

Question 27

what antibiotic is variably bacetriostatic vs bactericidal

Answer 27

aminoglycosides

Question 28

how long to Tx for simple cystitis

Answer 28

3 days

Question 29

how long to Tx complicated cystitis/pyelonephritis

Answer 29

10-14

Question 30

common complications aminoglycosides

Answer 30

ototoxicity

nephrotoxicity

Question 31

non-antibiotic prophylaxis

Answer 31

topical estriol replacement
cranberry
methenamine

Question 32

prevention UTI

Answer 32

post coital voiding

double/triple voiding

Question 33

when to use antibiotic UTI

Answer 33

pregnancy
DM
recurrent UTIs

Question 34

33 M IV drug user with fever and left flank pain
shares needles
trades sex for drugs
elevated WBC count, endocarditis, splinter hemorrhages and rash on palms
HIV negative
most likely etiology of his pyelonephritis to be?

Answer 34

staph aureus

Question 35

64 M + HIV on broad beta lactam for pneumonia
has burning with urination, urinary frequency and urinary urgency
+ leukocyte esterase and TNTC WBC
no growth on cultures
most likely causative organism of his urinary tract infection?

Answer 35

candida