Infections Of The Gu Tract - Wang

Front 1

T/F The urinary tract has normal flora

Back 1

False - normally sterile

organisms come from periurethral area

Front 2

Infection of the bladder is known as what?

Back 2

cystitis

Front 3

An upper urinary tract infection that begins with infection of the bladder and ascends to the kidneys

Back 3

pyelonephritis

Front 4

Urethritis, or infection of the urethra, is most commonly caused by what?

Back 4

STDs

Front 5

Infection of the prostate is called what?

Back 5

prostatitis

Front 6

Why do women get UTIs more frequently than men?

Back 6

In women, the urethra is anatomically contiguous with the vagina and the rectum leading to bacterial colonization of the periurethral area

Front 7

Uropathogenic bacteria use ___________ to adhere to the urethral tissue and cause infection

Back 7

fimbriae

Front 8

Two types of fimbriae

Back 8

-Type 1 fimbriae
-P fimbriae

Front 9

Which are mannose resistant and cause most cases of pyelonephritis?

Back 9

-P fimbriae

(Type 1 fimbriae bind to the mannose moeity on glycoproteins of bladder epithelial cells, mannose competes for the same site so the bacteria will release when exposed to it)

Front 10

T/F Cells in the upper urinary tract have no mannose moeity

Back 10

True - hence E. coli with P fimbriae responsible for most pyelonephritis

Front 11

What does the E. coli papG gene encode for?

Back 11

-papilli tip adhesins

Front 12

Uropathogenic E. coli downregulate what receptor that is responsible for transporting IgA into the urinary space (thereby decreasing immune function)?

Back 12

pIgR - polymeric Ig receptor

Front 13

Bacteria produce what to degrade urea to ammonia in the urine?

Back 13

Urease

(Urea makes hostile bacterial environment)

Front 14

What area of the kidney is especially susceptible to bacterial invasion?

Back 14

Medulla

Front 15

What two factors make it susceptible?

Back 15

-high ammonia - inactivates complement
-high osmolality - inhibits PMNs

Front 16

What kind of pH in urine makes it inhospitable to bacteria?

Back 16

low

Front 17

Why are diabetics more susceptible to UTIs?

Back 17

-glucose in urine - makes for better bacterial growth medium

Front 18

What kinds of bacteria are responsible for most UTIs?

Back 18

Gram negative - namely E. coli

Front 19

_____ - _____% of women will develop one or more symptomatic UTIs in their lifetime

Back 19

10-30%

Front 20

What is the incidence of UTIs in men?

Back 20

0.01% - if young male develops UTI requires a work-up for anatomical problem

Front 21

Recently medicare discontinued reimbursement for what?

Back 21

In-patient catheter associated UTIs not present at admission

Front 22

The symptoms of cystitis? A lack of what kind of symptoms is significant?

Back 22

-dysuria (burning with urination)
-frequency, urgency
-suprapubic pain

-LACK of systemic symptoms

Front 23

What are the symptoms of pyelonephritis?

Back 23

-cystitis symptoms PLUS
-fever/chills
-nausea, vomiting
-dehydration, hypotension
-CVA tenderness

Front 24

How might the symptoms of pyelonephritis be different in a diabetic patient? An elderly patient?

Back 24

-Diabetic - may present with only cystitis symptoms
-Elderly - may present with failure to thrive, decreased appetite, altered mental status

Front 25

What is one of the most important (mechanical) predisposing factors to UTI?

Back 25

Obstruction of urinary flow

Front 26

T/F Sexual intercourse facilitates movement of periurethral bacteria into the female urinary tract.

Back 26

True

(Diaphragm use also associated)

Front 27

What is the most common cause of UTI in hospitalized patients?

Back 27

Catheter use

Front 28

Symptomatically, urethritis can be distinguished from cystitis by lack of what?

Back 28

-frequency or urgency

(primary symptom is dysuria)

Front 29

Painful ulcers at the urethra are caused by what?

Back 29

Herpes Simplex Type II

Front 30

Discharge from the urethra is commonly caused by what two diseases?

Back 30

-Chlamydia
-Gonorrhea

Front 31

Non-infectious causes of urethritis do not cause what symptom?

Back 31

-pyuria

Front 32

What are the three components needed to diagnose a UTI?

Back 32

-presence of >10 WBCs w/ leukocyte esterase positive urine dipstick
-urine culture with one predominant bacteria >10^5 organisms/ml
-clinical symptoms c/w UTI

Front 33

In healthy, active, pre-menopausal women, which is not required to make a diagnosis of uncomplicated UTI?

Back 33

-urine culture

(dipstick with WBCs + symptoms only)

Front 34

How are UTIs treated?

Back 34

-3 days of:
-Trimethoprim-sulfamethoxazole (septra, bactrim)
-Fluoroquinolones (Cipro, Levaquin) or Beta-lactams (PCN)

Front 35

What is important to be aware of when choosing an antimicrobial to treat a UTI?

Back 35

resistance in the area

(Do not use TMP-SMX if resistance > 20%; no fluoroquinolones if resistance > 10%)

Front 36

If the infection does not respond, what should be done?

Back 36

Obtain a urine culture and choose another drug to which the bacterium is susceptible

Front 37

How is pyelonephritis treated?

Back 37

-Obtain a urine culture
-Treat with fluoroquinolones x 7 days
-Obtain another urine culture to ensure bacteria is sensitive

Front 38

Anyone except for what demographic require additional work up/imaging for the cause of the urinary tract infection?

Back 38

-healthy, pre-menopausal women/adolescents

Front 39

T/F Antibiotic prophylaxis can be used to prevent reinfection in individuals with recurrent UTIs

Back 39

True