Week 4 (1) Flashcards by Joanna Lowrie

Is urine normally sterile?

Yes

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What is the lower end of the urethra colonised by?

Coliforms and enterococci from the large bowel

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Name some causal organisms of UTI

Coliforms:
E.coli
klebsiella
enterobacter
proteus

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What coliform is associated with the formation of stones (calculi)?

Proteus

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What does proteus smell like?

Foul

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What does proteus produce?

Urease which breaks down urea to form ammonia, which increases urinary pH - precipitation of salts

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Name two enterococcus spp. that cause UTI - they are present in hte GI tract

Enterococcus faecalis

2. Enterococcus faecium

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What organism affects women of child bearing age?

Staphylococcus saphrophyticus - coagulase negative staph

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What type of organism is pseudomonas aeruginosa?

Gram negative bacillus

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What is pseudomonas aeruginosa associated with?

Catheters and UT instrumentation

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What antibioitic treats pseudomonas aeruginosa (orally)?

Ciprofloxacin

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Give three symtpoms and signs of UTI?

Dysuria
Frequency
Haematuria

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What is a Boricon container?

Contains boric acid (preservative) to stop bacteria multiplying - for urine

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How long is there to deliver a urine sample in an sterile universal container?

2 hours

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What - found of dipstick - ma indicate the presence of leukocytes in the urine?

Leukocyte esterase

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What do nitrites found on dipstick suggest?

Presence of bacteria in urine

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When doing microscopy of urine what should be looked for?

Presence of polymorphs (pus cells), bacteria and red cells

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What is the Kass’s criteria?

Descibes the likelihood of UTI from a mid stream urine specimen

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What does > 10^5 organisms in urine suggest?

Significant/probable UTI

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What causes resistance to antibioitics in UTI?

ESBL - extended spectrum beta-lactamase

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What is ESBL resistant to?

ALL cephalosporins and almost all penicillins

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Where does ESBL come from?

Imported chicken

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What antibiotics might be useful in ESBL UTI?

Nitrofurantoin
Pivmecillinam
Fosfomycin
Temocillin,. meropenem and ertapenem (IV)

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Name organisms resistant to meropenam?

Carbapenemase-producing enterobacteriaceae (CPE) - gram negative coliform bacilli

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What mediates resistance in CPE and what are they resistant to?

ALL current antibiotics and resistance is plasmid-mediated

Name four first line antibiotics for treating a UTI?

1. Amoxicillin 2. Trimethoprim 3. Nitrofurantoin 4. Gentamicin

What antibiotic inhibits bacterial folic acid synthesis?

Trimethoprim (oral)

When should trimethoprim be avoided?

In first trimester (3months) of pregnancy

What is there a risk of with co-trimoxazole?

SJS syndrome from sulphonamide

When should nitrofurantoin be avoided?

In late pregnancy (can cause neonatal haemolysis), breast feeding and children

When should gentamicin be avoided?

In pregancy. Risk of toxicity causing renal and 8th nerve damage

Does gentamicin treat pseudomonas?

Yes - should be prescribed for 3 days only

What antibiotic is 2nd line for UTIs, very betalactamase stable and is esterified form of mecillinam?

Pivmecillinam

What can cefalexin (broad spectrum) cause?

C.diff

What does ciprofloxacin (C.diff) inhibit?

DNA gyrase which prevents supercoiling of bacterial DNA

Name the only oral pseudomonas antibiotic?

Ciprofloxacin

What is the empirical treatment for Female lower UTI?

Trimethoprim or nitrofurantoin orally (3days)

What is the empitical treatment for uncatheterised male UTI?

Trimethoprim or nitrofuratoin orally (7days)

What is the empirical treatment for complicated UTI or pyelonephritis?

Co-amoxiclav or co-trimoxazole

What is the empirical treatment for complicated UTI or pyelonephritis (hospital)?

Amoxicillin and gentamicin IV (3 days)

Do you treat aysmptomatic bacteriuria?

Not if you dont have to, but treat in pregnancy

If asymptomatic bacteriuria in pregnancy is not treated - what two complications result?1

1. 20-30% lead to pyelonephritis | 2. Intra uterine growth retardation/premature labour

What are three causes of abacterial cystitis/urethral syndrome?

1. Early phase of UTI 2. Honeymoon cystitis 3. / Chlamydia or gonorrhoea

How might abacerial cystitis symtoms be relieved?

Alkalising the urine

When should you give antibiotics to a catheter related UTI case?

ONLY if with fever or symptoms

Whast renal tumours are found in renal pelvis?

TCC

What renal tumours are found in renal parenchyma?

RCC

Name an embryonic renal tumour?

Nephroblastoms (Wilm's tumour)

What causes a central scar on CT?

Oncocytoma

What is RCC classic triad?

1. Loin pain 2. Renal mass 3. Haematuria

What staging is used for RCC?

Robson - mets: lungs, liver, bone and brain

Name two pre-malignanty penile cancer cutaneous lesions?

1. Balanitis xerotica obliterans | 2. Leukoplakia

What is balanitis xerotica obliterans?

White patches, fissuring, bleeding and scarring

What is erythroplasia of Queyraty?

SCC in situ on glans, prepuce or shaft

What are red velvety pathes on peis related to?

Zoon's balanitis

What can be used to treat SCC in situ on penis?

Topical 5 fluorouracil

Give three clinical features of carcinoma of penis?

1. Red raised area penis 2. Fungating mass, foul smelling 3. Phimosis

What investigation is advisable for primary tumour carcinoma of penis?

Ultrasound

When is peak incidence of carcinoma of penso?

80 years

In relation to carcinoma of penis - what lymph nodes might need to be sentinel biopsied or removed?

Inguinal

How are testicular tumpurs diagnosed?

Ultrasound and markers - AFT, HCG and LDH

What does HCG mark?

5-10% pure seminoma | 60% teratoma

What does AFP mark?

Never raised in pure seminoma

What increases the risk of testicular tumours?

X30 with undescended testis

What do 100% of trophoblastic teratomas have raised?

HCG

What does heavy proteinuria present with?

Frothy urine

Is uraemia with pericarditis serious?

Yes

What should be examined in the presentation of renal disease?

BP and urinalysis

What should you mention in a renal systemic enquirey?

1. Dyspepsia 2. Dyspnoea 3. Joint pains and arthralgia 4. Skin rashes

What drug is hyperkalcaemia ia side effect of?

ACE inhibitors and arbs

What type of examinatin can cause acute kidney injury?

Radiology contrast

What is leukonychia?

White bands on nails suggesting hypoalbuminuria

What do granular urinary casts suggeset?

Indicative of chronic disease

What GFR in stage 1 kidney damage?

> 90

What GFR in stage 2 kidney damage

60-89

What GFR in stage 3 kidney damage?

30-59

What GFR in stage 4 kidney damage?

15-29

What GFR in stage 5 kidney damage?

Kidney failure

What is the nephrotic syndrome triad?

1. Proteinuria 2. Hypoalbuminaemia 3. Oedema

What is defined as acute kidney injury, oliguria, oedema, hypertension and active urinary sediment?

Nephritic syndrome