UTIs

Question 1

what does the timing of blood in urine suggest about the orygin:

Answer 1

 Urethral: blood seen at the start of the voiding
 Bladder/above: blood diffusely present
 Prostate/bladder base: blood at the end of micturition

Question 2

who should not be investigated further if blood is found on urin dipstick

Answer 2

menstruating females

Question 3

what is a normal excretion of protein in urine

Answer 3

up to 30mg/24h

Question 4

what is Microalbuminuria

Answer 4

albumin excretion between 30-300 mg/24h

Question 5

what paramiters are checked on urine dipstick

Answer 5

blood, glucose, proetin, nitrate, leukocyte esterase

Question 6

What worents a referal of UTI for USS

Answer 6

male, child, non-responsive to treatment/recurrent >2/year, pyelonephritis or unusual organisms, persistent haematuria

Question 7

what are the risk factors for UTI

Answer 7

• Female
• Sexual intercourse
• Exposure to spermicide (diaphragm or condom)
• Pregnancy (can be asymptomatic until pyelonephritis)
• Menopause
• Immunosuppression/DM
• Urinary tract: obstruction, stones, catheter, malformation

Question 8

what is the difference between UTI and bacteruria

Answer 8

Bacteruria: bacteria in the urine
UTI: The presence of a pure growth of >105 organisms per mL of fresh MSU

Question 9

What are the common organisms that cause UTIs

Answer 9

E.coli: most common i.e. 75-95% community case/41% hospital
Proteus mirabilis
Staphylococcus saprophyticus.

Question 10

what are the symptoms of pyelonephritis

Answer 10

Acute pyelonephritis:

• High fever, rigors, vomiting, loin pain and tenderness, oliguria (if AKI).

Question 11

what are the symptoms of UTI

Answer 11

Cystitis:

• Frequency, dysuria, urgency, haematuria, suprapubic pain.

Question 12

what are the signs of UTI

Answer 12

• Fever
• Abdominal/loin tenderness
• Foul-smelling urine
• May have distended bladder and enlarged prostate

Question 13

What is the difference between complicated and uncomplicated UTI

Answer 13

• Uncomplicated: normal renal tract and function i.e. usually women
• Complicated: abnormal renal/GU tract, obstruction, ↓ renal function

Question 14

what are the first line investigations for UTI

Answer 14

Urine dipstick: +ve nitrates and leukocytes

Question 15

Whata are the laboratory investigations for UTI and who should be investigated

Answer 15

male, pregnant, child, immunosuppressed
o Check for bacterial presence
o Check sensitivity to antibiotics
o Sterile pyuria (↑WCC + no infection): consider other causes

Question 16

What sort of preventive mthods can be used to avoid UTIs

Answer 16

good hydration, prophylactic antibiotics or antibiotic immidiet with start of symptoms, cranberry juice

Question 17

what is the managment for uncomplicated UTI

Answer 17

trimethoprim 200mg/12h PO 3d/7d in male

Question 18

what is the managment for pyalonephritis

Answer 18

co-amoxiclav 1.2g/8h IV 7d

Question 19

How is managment of UTI different in pregnant women

Answer 19

antibiotics with bacteuria regardless of symptoms

Question 20

what are the causes of sterile pyuria

Answer 20

o UTI treatment