Immunity And Infection Utis

Front 1

What organism is usually found in the distal urethra?

Back 1

Lactobacillus and skin flora

Front 2

What keeps the flow in the bladder unidirectional?

Back 2

Vesicoureteral valves

Front 3

What anatomical features keep UTIs from forming?

Back 3

Complete emptyiing of the full bladder washes bacteria away.
Vesicoureteral vavles and the length of urethra in men prevent ascent of bacteria.
Distal urethral colonization by normal flora prevents pathogens from gaining access.
Urine pH, osmolality, and chemical composition (lacks glucose)
Tamm-Horsfall protein secreted by cells in ascending loop of Henle (binds to E. coli strains to prevent epithelial attachment)

Front 4

What is the anatomical divison between the lower and upper urinary tract?

Back 4

Ureter

Front 5

What is an uncomplicated UTI?

Back 5

Cystitis in a nonpregnant, non-elderly, healthy adult woman with normal urinary tract anatomy and function.

Front 6

When are UTIs more common in males than females?

Back 6

First three months of life

Front 7

When does the incidence of UTIs spike in females? Males?

Back 7

Females = Over 35
Males = over 35

Front 8

What are the top two organisms that gause Uncomplicicated UTIs?

Complicated UTIs?

Back 8

Uncomplicated = E. coli and Proteus mirabilis

complicated = E. coli and Klebsiella

Front 9

What non bacterial pathogens cause UTIs?

Back 9

C. albicans, adenovirus type 8 and 11 (hemorrhagic cystitis), Schistosoma haematobium

Front 10

How are the E. coli that cause UTIs different from the ones in normal feces?

Back 10

Carry multi gene DNA segments that allow them to grow in urine.
Carry genes which synthesize adhesins and P fibriae that allow them to bind to blood group P antigens

Front 11

What are the 3 ways in which bacteria can enter the urinary tract? Which is most important?

Back 11

Ascending (most important), hematogenous, and lymphatic

Front 12

What type of infections is the hematogenous route most important?

Back 12

S. aureus and Candida NOT GNR!!!

Front 13

What symptoms will patients younger than 2 have with UTIs?

Back 13

Failure to thrive, vomiting, fever

Front 14

What symptoms will elderly patients have with UTIs?

Back 14

Loss of appetite, change in mental status, incontinence, respiratory distress/sepsis

Front 15

What symptom distinguishes an upper UTI from a lower UTI?

Back 15

Upper = fever
Lower = no fever

Front 16

What are the clinical manifestations of Cystitis?

Back 16

Dysuria, frequency, urgency
Suprapubic tenderness

Front 17

How do you diagnose cystitis?

Back 17

Urine analysis and culture

Front 18

What type of discomfort suggests pyelonephritis?

Back 18

flank discomfort

Front 19

What is the definition of pyuria?

Back 19

> 10 leukocytes per high power field on spun urine sample also can be diagnosed via urine dipstike for leukocyte esterase

Front 20

How is bacteruria defined?

Back 20

> 10^5 bacteria per mililiter for GNR or presence of one bacteria per oil field in an unspun, gram negative stained specimen (<10^5 may occur early in disease)

Front 21

What is the treatment for uncomplicated cystitis?

Back 21

Floroquinolone, doxycycline, trim-sulfa
For 3 days

Front 22

What is the treatment for complicated cystitis?

Back 22

Fluoroquinolone, doxycycline, trim-sulfa for 7-14 days

Front 23

Whenever a UTI is found in a male a ______ is required?

Back 23

Urologic work up to exclude a structural abnormality.

Front 24

What is the primary cause of urethritis?

Back 24

STDs (gonococcal or nongonococcal)

Front 25

When should you suspect vaginitis?

Back 25

Fishy smell, erythema, itching discharge

Front 26

Should you perform a rectal exam if you expect prostatis?

Back 26

NO, may induce bacteremia

Front 27

What are the symptoms of acute bacterial prostatis?

Back 27

fever, chills, lower back pain with dysuria, frequency urgency

Front 28

What are most prostatis cases caused by?

Back 28

GNR like E.coli (75%)
Rest gram positive

Front 29

How do you treat acute bacterial prostatis?

Back 29

Trim-sulfa or quinolones for at least 14 days.

Front 30

How do you diagnose/treat chronic bacterial prostatis?

Back 30

Urinary culture before and after prsotatic massage
Treat with trim-sulfa or quinolones for 6-12 weeks.

Front 31

What is the classic presentation for pyelonephritis?

Back 31

dysuria, frequency, urgency with viver and flank tenderness

Front 32

What are the less common symptoms of pyelonephritis?

Back 32

N/V diarrhea (cystitis signs may be absent)
Elderly may present with a septic picture.

Front 33

What are most pyelonephritis cases caused by?

Back 33

E. coli (85%)
also other enterobacteriaceae
Enterococcus

Front 34

How do you diagnose pyelonephritis?

Back 34

Pyuria, bacteruiria, and a positive urine culture.
May also have positive blood culture.

Front 35

How do you treat pyelonephritis?

Back 35

Ampicillin and aminoglycoside OR 3rd generation cephalosporin, fluoroquinolone, extended spectrum penicillin

Front 36

How quickly should a patient being treated for pyelonephritis improve? What if they don't?

Back 36

Should improve within 48 hours.
Urine should be sterile in 2-3 days.
Fever lasting more than 72 hours raises question of a renal abscess

Front 37

When does a renal abscess usually occur?

Back 37

Patients with diabetes, abnormal urinary tract or hematogenous route of infection (s. aureus)

Front 38

What is the common presentation of someone with a renal abscess?

Back 38

Fever, chills, flank pain

Front 39

True/False urine cultures can be sterile if someone has a renal abscess.

Back 39

TRUE! If it is not communicating iwth the urinary collection system.

Front 40

What organisms frequently cause pyelonephritis?

Back 40

E. coli, Enterobacterieae, S. aureus (indicates bacteremia)

Front 41

How do you diagnose a renal abscess?

Back 41

CT or ultrasound

Front 42

How do you treat a renal abscess?

Back 42

Extended spectrum penicillin, aminoglycosides, anti-staph penicilin, or cephalosporin, may need surgical drainage.

Front 43

What are the most common organisms that result from catheter related UTI?

Back 43

E. coli, Proteus, Pseudomonas, Enterococci

Front 44

What is the goal of treating catheter related infections?

Back 44

Treat symptomatic infections, bacteruria will frequently occur and is difficult/impossible to sterilize the urine.

Front 45

If a pregnant women presents with a UTI what should you treat with?

Back 45

7-10 days of amoxicillin, trim-sulfa, nitrofuratoin, cephalosporins
NO quinolones or doxycycline

Goal is ERADICATION

Front 46

If sterile pyuria consider_________

Back 46

renal tuberculosis

Front 47

How are UTIs spread in neonates?

Back 47

hematogenous spread

Front 48

What patients should be screened for structural abnormalities?

Back 48

Male child > 5
child < 5
wtih a UTI

Front 49

How can you determine if Proteus is the source of an infection and what complication can it cause?

Back 49

Raises urine pH that can lead to struvite stones (kidney)
A staghorn calculi can fill the entire renal pelvis.