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Nephrology > UTIs > Flashcards

UTIs Flashcards

1
Q

what are the most common pathogens assoc. w/ cute bacterial prostatitis?

A

young adults: chlamydia trachomatis & neisseria gonorrhoeae
older adults: E. coli & pseudomonas

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2
Q

What UTI pathogen grows well on chocolate agar?

A

N. gonorrhoeae

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3
Q

MacConkey Agar is primarily for what class of bacteria?

A

Enteric Family

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4
Q

what enteric bacteria produce colorless colonies on MacConkey Agar?

A

Non-Lactose fermenters: Salmonella, Shigella, & Proteus

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5
Q

what enteric bacteria grow pink colonies on MacConkey Agar?

A

Lactose Fermenters: E. coli, Klebsiella, Enterobacter

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6
Q

what pathogen is the most common UTI?

A

E. coli

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7
Q

what allows E. coli to cause UTI?

A

minor trauma allows UPEC: P-pili is the key component for attachment & colonization

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8
Q

Describe the distinct characteristics of proteus mirabilis.

A

+ urease; highly motile; assoc. w/ struvite stones

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9
Q

list the distinct characteristics of staphylococcus saprophyticus.

A

Catalyze positive; coagulates negative; Novobioson resistant; non hemolytic

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10
Q

list the distinct characteristics of serratia marcescens.

A

Slow lactose fermenter (three to 4 days); red colonies; catalase positive; also causes effective endocarditis and ivy drug users

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11
Q

Describe the distinct characteristics of enterococci.

A

esculin hydrolysis in bile; Catalyze negative; optochin resistant; Causes soft tissue infections

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12
Q

What helps to distinguish pseudomonas aeruginosa from other enterobacteriaceae/

A

+ oxidase

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13
Q

What are distinguishing characteristics of N. gonorrhoeae?

A

ferments only glucose; iga protease is the virulent factor; often found in PMNs; oxidase positive; can also cause pelvic inflammatory disease

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14
Q

Why Can chlamydia not be seen on a gram stain?

A

it is an Obligate intracellular pathogen ; Must use Giemsa stain; iodine stain reacts with glycogen

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15
Q

describe The growth cycle of chlamydia

A

elementary body found in extracellular compartments; Elementary body transforms to the reticulate body once It enters the cell; cytoplasmic inclusions develop when the reticulate bodies grow inside the host cell and become mature

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16
Q

What unusual UTI forms caseating granulomas

A

TB usually latent phase

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17
Q

What are distinct characteristics of salmonella

A

Produces H2S; S flagellated

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18
Q

Describe the pyrogenic pathogenesis of strep A

A

impetigo, Cellulitis, pharyngitis, sepsis

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19
Q

Describe the toxagenic pathogenesis of strep a

A

Scarlet fever and toxic shock

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20
Q

describe the immune mediated Pathogenesis of strep a

A

rheumatic fever, acute glomerulonephritis which typically occurs a few weeks after an untreated sore throat

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21
Q

What kind of what pathogen is schisotosoma haematobium

A

trematode worm

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22
Q

How is schistosoma haematobium transmitted?

A

freshwater exposure through the skin; snails are the natural reservoir

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23
Q

What are the early stages of schistosoma haematobium.

A

Dermatitis, allergic reaction, fever, Malese, hematuria, dysuria, urinary frequency; egg deposition in the bladder wall leads to scarring; associated with squamous cell carcinoma of the bladder

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24
Q

In what regions is schistosoma haemoatobium most common?

A

North and Central African countries

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25
Q

What is the appropriate treatment for an uncomplicated case of acute cystitis

A

Trimethoprin-sulfamethoxazole for 3 days

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26
Q

What is the appropriate treatment for a complicated case of acute cystitis

A

TMP/SMX for 10-14 days

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27
Q

What are antibiotic alternatives for those that have a sulfa allergy

A

nitrofurantoin or flurorquinolones

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28
Q

What are appropriate antibiotics for UTI treatment in pregnant women

A

amoxicillin, cephalosporin, nitrofurantoin are usually 1st line

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29
Q

Should an asymptomatic UTI be treated during pregnancy

A

YES!!!!!!!!!!

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30
Q

What are the main physical exam findings of acute pylo nephritis

A

costa vertebral angle tenderness, fever, back pain

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31
Q

What are common complications associated with acute pylo nephritis and diabetic patients

A

Obstructive neuropathy associated with acute papillary necrosis and emphysematous pyelonephritis

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32
Q

Under what circumstances should a patient with symptoms of acute pylon nephritis be hospitalized

A

intractable vomiting, evidence of shock, severe dehydration; treatment should last 10 days with a follow up five days after treatment completion

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33
Q

Underwood circumstances should imaging for pylon nephritis be considered

A

On certain diagnosis, immunocompromised status, worsening renal function, suspected kidney stone or other urinary tract obstruction, relapsing pylon nephritis, failure to improve after 72 hours of antibiotics

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34
Q

What is the clinical criteria for acute bacterial prostitutes

A

White blood cell count greater than 10; + on voided specimen

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35
Q

what is the clinical criteria for chronic bacterial prostatitis

A

WBC count > 10; - Specimen; expressed prostatic secretions will be positive

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36
Q

What are common physical exam findings for acute bacterial prostatitis

A

Rectal pain, tents boggy prostate, purulent discharge on prostate massage, positive urine culture: most commonly gram negative organisms such as E coli or klebsiella

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37
Q

What our first line treatments for acute bacterial prostatitis

A

Quintalones are first line; TMP/SMX for Sensitive Organisms

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38
Q

What should be considered if there is pyurio without bacteria

A

order giemsa stain for chlamydia

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39
Q

And what circumstances would A UTI case indicate referral to a specialist

A

anatomical abnormalities; infections assoc. w/ nephrolithiasis; Persistent interstitial cystitis and painful water syndrome

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40
Q

Under what circumstances should you admit a non-pregnant patient to a specialist

A

Severe pain that requires parental medication; impaired ambulation For urination; dysuria associated with urinary retention or urinary obstruction; Polynephritis with ureole obstruction

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41
Q

What is the clinical criteria for uncomplicated uti

A

For the non pregnant patient’s: Acute cystitis or polynephritis without anatomic abnormalities or instrumentation of the urinary tract; for the male patient: urethritis

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42
Q

What are common symptoms of urethritis?

A

dysuria & urethral discharge

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43
Q

What are common Symptoms of cystitis

A

of the mucosal surface and the urethra and bladder; urinary frequency and urgency; Superpubic pain and Tenderness

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44
Q

What are common symptoms of poly nephritis

A

Flank pain and fever; cost over teabral tenderness; rigors, diarrhea, and tachycardia

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45
Q

What are common symptoms of prostatitis

A

Lower back pain, pererectal pain, testicular pain, and urinary retention

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46
Q

Describe the vesicoureteral reflux & complications

A

retrograde urine flow from the bladder back into the upper urinary tract; induces severe nephropathy; Voiding cystourethrogram is gold standard for diagnosis

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47
Q

Describe the normal physiologic process Of urine peristalsis

A

From kidneys to the bladder:

the ureteric pressure increases which subsequently opens the orifice to allow passage of urine into the bladder

The process of urine storage:
ureteric pressure drops while the intra vesicle pressure rises to close the Orifice

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48
Q

Under what circumstances will the uritic orifice remain open?

A

Will remain open if the ratio of intramural tunnel length to the ureteral diameter is less than 5

49
Q

Describe VUR Grade 1

A

Reflex only into the non dilated ureter

50
Q

Describe VUR grade 2

A

reflex into the ureter and the renal pelvis without Dilatation

51
Q

Describe VUR grade 3

A

Reflux with mildly dilated ureter and pyelocalyceal system

52
Q

Describe VUR grade 4

A

reflux with tortuous and moderately dilated ureter with blunting of renal fornixes
papillary impression preserved!!!!!!!!!

53
Q

Describe VUR grade 5

A

Reflex with tortuous and severely dilated ureter, dilation of pylocalises with loss of fournixes and papillary impression

54
Q

Describe the pathogenesis of a double ureter

A

ureteric bud from the mesonephric (wolffian) duct Either split or there are two buds present
Another mechanism is Incomplete fusion of kidney lobules:
the kidney is divided into 2 parts with an upper and lower lobe Due to intermingling of the collecting tubules

55
Q

What is the most common cause of hydro nephrosis in infants and children?

A

ureteropelvic junction obstruction

56
Q

Describe the pathogenesis of ureteropelvic junction obstruction

A

Abnormal organization of smooth muscle bundles

excess stromal deposition of Collagen

extrinsic compression of upj by abnormal renal Vasculature

57
Q

What are histologic findings of ureteritis follicularis

A

accumulation of limbo sites and sub epithelial region; this causes slight elevation of the surrounding Mucosa

58
Q

What are the histologic findings of ureteritis cystica

A

Nests of transitional epithelium growth downward into the lamina propria Which forms a central cystic space; Described as multiple small glistening bombs on the surface of a cut open ureter

59
Q

What are a risk factors for ureteritis cystica

A

Diseases of chronic inflammation; however this condition is usually asymptomatic

60
Q

How is sclerosing retroperitoneal fibrosis defined clinically

A

It is a fibrotic inflammatory process that encases retroperitoneal structures causing hydro nephrosis

61
Q

what patient population is sclerosing retroperitoneal fibrosis most commonly found

A

Middle to late aged males

62
Q

While most cases of SRF are idiopathic, what are secondary causes of SRF?

A

Drug-Induced: Ergot derivatives and beta blockers
inflammatory conditions: vasculitis, diverticulitis, and Crohn’s disease
malignant sees: lymphoma and urinary tract carcinomas

63
Q

What are the histologic characteristics of SRF?

A

Infiltrate of lymphocytes within a germinal center that contains also plasma cells and eosinophils

64
Q

Fibro epithelial polyps are most commonly seen in what patient population?

A

Pediatric patients

65
Q

Describe the histologic characteristics of fibro epithelial polyps

A

Loose vascularized connective tissue overlay by urothelium

66
Q

What are the most common type of primary malignant tumors in the bladder

A

uraithelial carcinomas

67
Q

Cancers of the bladder commonly occur during which decades of life?

A

6th and 7th decades of life

68
Q

Describe the pathogenesis of congenital diverticulitis

A

development of bladder musculature Or can be secondary to a primary urinary tract obstruction

69
Q

describe the physiology of acquired diverticular

A

Secondary urinary outflow obstruction increases intravascular pressure which causes outpouching of the bladder wall and formation of a diverticular

70
Q

What is the most common cause of acquired diverticula?

A

prostatic hyperplasia

71
Q

What is exstrophy of the bladder

A

Direct communication between bladder and the abdominal surface

72
Q

What are complications of exstrophy of the bladder?

A

granular metaplasia; chronic infection

73
Q

What happens if the uracus remains fully patent

A

formation of a bladder umbilicus fistula

74
Q

What forms when only a central region of the patent uncus persists

A

formation of a uracos cyst lined by either urethere or metaplastic granular epithelium

75
Q

Patients with uracal cysts are at increased risk for what?

A

adenocarcinoma

76
Q

What are predisposing factors to cystitis?

A

bladder calculi, The urinary obstruction, diabetes mellitus, immune deficiency, instrumentation

77
Q

Why are women more susceptible to UTIS than men?

A

women have shorter ureters

78
Q

What are common atypical UTI pathogens?

A

adenovirus, mycoplasma, schistosomiasis, and tuberculosis cystitis after renal tuberculosis

79
Q

What are gross characteristics of acute Cystitis?

A

hyperemia with small hemorrhagic areas

80
Q

What are histologic characteristics of acute cystitis?

A

uthelial ulceration with inflammatory infiltrate above sub urethelial lymphoid follicles

81
Q

What are histologic characteristics of chronic cystitis?

A

Friable, mucosa with some congestion and ulcerations; extensive fibrosis

82
Q

What are epidemiological factors of malakoplakia?

A

Acquire defects of phagocyte function; chronic inflammatory reaction and infection by E coli or Proteus species for renal transplant recipients

83
Q

Describe the histologic characteristics of malakoplakia.

A

Large foamy macrophages with abundant granular cytoplasm; laminated deposition of calcium in enlarged lysosomes referred to as michaelis-gutmann bodies; raised mucosal plaques

84
Q

What are the most common causes of secondary bladder outlet obstruction in men and women respectively?

A

men: BPH
women: cystocele of the bladder

85
Q

What are histologic characteristics of bladder outlet obstruction?

A

early stages: thickening of bladder wall Due to smooth muscle hypertrophy

later stages: muscle bundles are greatly enlarged and produce trabeculation of the bladder wall

86
Q

What are common risk factors 4 Urothelial neoplasms?

A

Cigarette smoking; industrial exposure to aryl amines; Schistosoma haematobium infections; Long term use of analgesics; Long term exposure to cyclophosphamide; irrradiation

87
Q

Describe the pathogenesis of noninvasive papillary cancers

A

gain of function alterations in grwoth factor receptor pathways:

Amplifications of FGFR3 tyrosine Kinase receptor genes
Activating mutations in genes encoding RAS & PI 3-kinase

88
Q

Describe the pathogenesis of progression of late stage non-invasive papillary cancer to muscle invasive bladder cancers

A

p53 & RB mutations

89
Q

Muscle invasive bladder cancers Arise from early manifestation of what cancer

A

flat non-invasive carcinoma

90
Q

what aryl amines increased risk of urothelial neoplasms?

A

2-naphthylamine

91
Q

How long after the initial exposure of aryl amines will a neoplasm develop?

A

15 to 40 years

92
Q

schistosoma haematobium Is endemic to what countries?

A

Egypt and Sudan

93
Q

schistosoma haematobium infections Cause chronic inflammation. This promotes the development of what?

A

progressive mucosal dysplasia leading to neoplasia; 70% of cancers are squamous

94
Q

What urothelial pathologies create flat lesions?

A

urothelial proliferation; urothelial dysplasia; urethelial carcinoma in situ

95
Q

What urothelial pathologies create exophytic papillary lesions?

A

Papilloma; Urothelial proliferation of papillary hyperplasia; papillary urothelial Neoplasms of low malignant potential; Low and high grade pepillary urethelial carcinoma

96
Q

Describe the histologic characteristics of Papillomas.

A

Loose fibrovascular tissue Covered by epithelium that is histologically identical to normal urothelium

97
Q

Papillary uothelial neoplasms of low malignant potential are very similar to papillomas. what are key distinctions?

A

Thicker urothelium with greater density of cells; generally larger than papillomas

98
Q

Describe the histologic characteristics of low grade papillary urethelial carcinomas

A

Normal tissue structure; Scattered hypochromatic nuclei

99
Q

The histologic characteristics of high gray papillary uothelial carcinoma Would be the same as low grade papillary carcinoma. What is different?

A

disarray of tissue structure w/ marked cytologic atypia: hyperchromasia and prominent nucleoli

100
Q

Unlike many of the urothelial carcinomas, high grade papillary urothelial carcinoma has a significant potential for metastasis. To which regions does it typically metastasize to?

A

Lymph nodes To liver and lungs

101
Q

How would you describe carcinoma in situ of the uroepithelium in a histologic context?

A

multi-focal (distinctive layers of distribution); enlarged pleomorphic nuclei; mucosal reddening, granularity & thickening

102
Q

How are stages of invasive urethelial carcinoma measured?

A

Depth of invasion in the bladder wall at the initial time of diagnosis

103
Q

What is an indication for radical treatment of invasive urethelial carcinoma

A

Invasion of the muscularis propria layer

104
Q

What cancers commonly metastasize to the bladder?

A

Cervix, uterus, prostate, rectum, lymphoma

105
Q

What are pathogens associated with nongonococcal urethritis?

A

Chlamydia trachomatis

106
Q

What is a common pathogen associated with gynecological urethritis?

A

N. gonorrhoeae

107
Q

Microscopy of a suspected N. gonorrhoeae would reveal what?

A

PMNs containing diplococci

108
Q

urethritis is Often accompanied by what and women and what and men

A

cystitis and women and prostitutes and men

109
Q

If a patient with urethritis Also complaints of arthritis and presents with conjunctivitis,, What is the most likely diagnosis

A

non infectious urethritis: AKA reactive arthritis/Reiter syndrome

110
Q

urethral caruncles Presents as what and is commonly associated with what Population?

A

Small, red, painful-inflammatory mass; typically occurs in older females

111
Q

Describe the histologic features of urethral caruncle.

A

inflamed granulation tissue covered by friable mucosa with ulcerations and bleeds

112
Q

What are common benign epithelial tumors of the urethra?

A

Urothelial papilloma, inverted Urothelial papillomas, condylomas

113
Q

where are urethral caruncles located anatomically?

A

external urethral meatus

114
Q

What is the Definition of inverted urothelial papilloma

A

Urothelial Invagination into the lamina propria

115
Q

condyloma Consists of what??

A

hyper plastic papillary fronds of squamous epithelium and koilocytosis caused by hpv

116
Q

What carcinomas are associated With the Proximal urethra?

A

Urothelial carcinomas

117
Q

What are carcinomas associated with the distal urethra?

A

Squamous cell carcinomas and HPV related Cancers

118
Q

Adino carcinomas are infrequent in the urethra but what population is this most common in/

A

women

119
Q

Describe the histologic characteristics of Swamis cell carcinomas of the urethra

A

Hyperchromatosis of nuclei and nucleoli below the basement membrane with atypical mitosis

Nephrology (11 decks)

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