Icm Fall Uti

Front 1

what is...

1. when you cant hold your bladder
2. peeing
3. peeing excessively at night
4. lots of volume
5. peeing often
6. painful urination
7. difficult urination
8. bacteria in urine
9. pus in urine
10. infection anywhere in the UT

Back 1

1. ENURESIS: when you cant hold your bladder
2. MICTURATION: peeing
3. NOCTURIA peeing excessively at night
4. : POLYURIA: : lots of volume
5. FREQUENCY: peeing often
6. DYSURIA: painful urination
7. DYSURIA: difficult urination
8. BACTURIA: bacteria in urine, cal also have asymptomatic bacturia
9. PYURIA: pus in urine, WBC means infection usually
10. UTI: infection anywhere in the UT

Front 2

what is
acute cystitis?
Acute Pyelonephritis?
Chronic Pylonephritis?
Acute bacterial prostatitis?
Chronic bacterial prostatitis?

Back 2

acute cystititis- infected bladder epithelium

Acute Pyelonephritis- infection of renal parynchema

Chronic Pylonephritis- inflammation/scarring of renal parynchema. seen in kids with chronic UTI/vesicurectal reflux

Acute bacterial prostatitis- uropathogens cause infection, prostate is tender, sx of cystitis

Chronic bacterial prostatitis- recurrent prostatic infection

Front 3

what is a complicated UTI

Back 3

anyone who is not a healthy young non pregnant woman

**complications: may have fever, nausea, flank pain,
DM
Old
Pregnant
men
vesicourethral reflux
catheter
obstruction

Front 4

what is a relapse of UTI?


what is reinfection of UTI?

Back 4

recurrence of bug in original isolate within 2 weeks after tx ends


new bacteria

Front 5

what are some natural ways we prevent UTI

Back 5

1. peeing at regular frequency
2. emptying bladder completely
3. mucopolysaccharide layer of bladder that is anti adherant/antibacterial
4. angled uretocystic junction- prevents reflux from bladder into ureter
5. Urethra- keeps the buggy outside away from the sterile bladder

Front 6

what are some thigns that increase UTI in male and female

Back 6

MALE:
old, DM, anal, uncircumsized, catheter, neuro issues, anatomical/obstruction

FEMALE:
same but diaphragm, spermicide, pregnant

Front 7

why the increase risk of UTI with diaphragm adn spermicide

Back 7

alter normal flora so that bugs can attach easier

Front 8

what are most uncomplicated UTI's caused by

Back 8

E coli

**it migrates from the rectum to urethro

Front 9

Recurrent or complicated UTI's are associated with what?

what bug/

Back 9

long term catheterization, recent AB use

*Proteus- urea splitter, urine pH >8
pseudomonas
Klebsiella
Serratia
Providencia
Enterobacter
Enterococcus

Front 10

what can cause pyelonephritis

Back 10

organsims ascend from outside to kidney

**infection of renal parynchema

Front 11

why ask UTI pt about location and character of pain/discomfort

Back 11

flank pain indicates pyelonephritis

itching when pee- vaginitis

burning when you pee- cystitis, urethritis

pain that comes and goes (colicky) and radiates to groin- stone

Front 12

why ask how long a pt has been in pain when you think its UTI

Back 12

sx >7 days pyelonephritis, non bacterial urethtitis, vagninis

Front 13

what 3 things might present a little like UTI but last way longer (7 days or more)

Back 13

1. Vaginitis
2. pyelonephritis
3. non bacterial urethritis

Front 14

if a pt presents with UTI like things and has... does your ddx change

1. fever, vomit,

2. vaginal/penile dischagre

Back 14

1. pyelonephritis

2. vaginitis/STD

Front 15

why do you ask a pt if they have taken AB

Back 15

it will make a test (-)
it increases likelihood of resistance

**sometimes pts take their left over AB they have around the house

Front 16

why ask a pt with UTI sx if they have had it before

Back 16

find out when and determine if you have relapse (same bug 2 weeks after tx) or reinfection (new infection)

Front 17

you always need to get the whole story, including PMH. whats the dignificance of tehse assoiated with UTI

1. DM

2. Sickle Cell/NSAIDS

Back 17

1. DM increases risk of asocaited kidney issues (abcess, papillary necrosis)

2. papillary necrosis, ureter onstruciton

Front 18

on physical exam for a pt presenting with UTI what does it mean if they have

1. Fever
2. Tachycardia, hypotension, altered mental status

Back 18

1. pyelonephritis (also have CVA tenderness)
2. sepsis, volume depletion

Front 19

what might you think if a pt has CVA tenderness with UTI sx

Back 19

pyelonephritis (also fever)

Front 20

what are the 2 things you are looking for on abdominal exam for person with UTI sx

Back 20

1. Kidney: enlargement may indicate polycystic kidney

2. Bladder, shouldnt be percussable or palpable. if its full of pee you can

Front 21

why do a pelvic for pts with sx of UTI

Back 21

if they have vaginal discharge/odor, painful sex, itching or pain do a pelvic

1. can be VD: gonorrhea, chlamydia, PID, cystocele, urethrocele

Front 22

what is the presentation for acute cystitis

Back 22

1. dysuria
2. frequency
3. urgency
4. suprapubic pain
5. hematuria
**common in pregnant ppl

Front 23

so if we have dysuria, frequency, ugency, we may think acute cyctitis, what if there is also: fever, flank pain, nausea, vomit, malaise

Back 23

acute pyelonephritis

if they dont have flank pain its prbly something else!

dangerous for kids nad oldies

Front 24

whats the big word for stones. whats hte presentation for stones?

Back 24

Nephrolithiasis, Ureterolithiasis

Colicky flank pain that radiates to groin

dysuria, hematuria,

Front 25

Acute Pyelonephritis:

Clinical Findings
Dx Test Results

Back 25

Clinical: fever, flank pain, CVA tenderness

Dx: UA shows pyuria, bacteriuria, white cell clasts

**infection of renal parynchema

Front 26

when do you see white cell clasts

Back 26

in the urine of ppl with acute pyelonephritis, infection of renal parynchema

**not always seen though bc the speciman is handled rough and they break all apart

Front 27

Cystitis:

Clinical Findings:
Dx test results:

Back 27

Clinical: suprapubic pain, dysuria, uegency, frequency, some hematuria

Dx: Pyuria, bacteriurea

Front 28

Urethritis-Chlamydia

Clinical Presentation
Dx test

Back 28

Clinical: new sexual partner, discharge, dyruria

Dx: pyuria WITHOUT bacteruria. positive chlamydia test

Front 29

Urethritis- Gonococcal

Clinical Findings
Dx test

Back 29

Clinical: cervical or penile discharge, hx of gono in pt or partner

Dx: gram - intracellular diplococci (pyuria WOTHOUT bacteruria)

Front 30

prostatitis

Clinical Findings
Dx test results

Back 30

Clinical: super tender prostate, perineal or suprapubic pain, dysuria, fever, urinary retention. deep ache with LBP

Dx: pyuria, bacteruiria, leukocytosis, L shift

Front 31

Epididymitis

Clinical Findings
DX

Back 31

Clinical: enlarged epididymis, dysuria, painful, discharge if STD

Dx: leukocytosis, L shift, pyuria, bacteruiria. if STD will have + std test

Front 32

Stones

Clinical Presentation
Dx test

Back 32

Clinical: Flank pain that may radiate to groin (if stone in ureter), colicky, hematuria, dysuria,

Dx: hematuria WITHOUT bacteriura/ + IVP or CT for stones

Front 33

Vaginitis

Clinical Presetation
Dx test

Back 33

Clinical: vaginal discharge, itch, irritation

Dx test: culture- yeast, trichomonadas

Front 34

ok so you can tx UTI on histroy alone and can even do telephone treatment. what needs to be the sx

Back 34

1. dysuria
2. frequency
3. NO VAGINAL DISCHARGE/Irritation

** good way to treat uncomplicated UTI

Front 35

how shoudl you collect UA for cystitis and pyelonephritis

Back 35

clean catch,

wipe, collect midstream for "sterile" urine

Front 36

what is normal urine pH, what if its higher?

Back 36

5-9

more basic indicates proteus, this is an ammonium splitter that makes the pee more basic

Front 37

what does nitrites in the urine mean

Back 37

bacteria

**they spilt nitrates into nitrites, nitrites not normally found

Front 38

what does leukocyte esterase on dipstick indicate

Back 38

WBC

Front 39

how can you tell if there is bacteruiria?
what about pyuria

Back 39

Bacteriura: nitrite (bugs convert nitrite to nitrate)

Pyuria; leukocyte esterase (indicates WBC)

Front 40

what sthe best way to ID pyuria? what can be used as an alternative?

Back 40

microscopic
can use leukocyte esterase in dipstick analysis as alternate

Front 41

what do you tthink if leukocyte esterase is negatine

Back 41

think non infectious cause

Front 42

so its good to lookfor WBC on microscopy, what about bacteria

Back 42

not really, they are too tiny!

Front 43

what values give us good reason to suspect an infection?

Back 43

pyuria nad bacteruira seen together!

when its just pyuria it may be STD

Front 44

what does a comtaminated speciman look like

Back 44

Epithelial cells on microscopic exam

Front 45

is a urine culture necessary for UTI

Back 45

not for an uncomplicated one (non pregnant female)

But shoudl take a culture for:
1. men
2. recurrent/relapse
3. complicated UTI
4. pyelonephritis
5

Front 46

when take a CBC for pt presenting with dysuria

Back 46

looking for systemic infection

*fever, flank pain, nausea/vomit,

Leukocytosis/left shift indicate systemic infectino

Front 47

what additional tests might you order if you think a pt has sepsis

Back 47

1. CBC
2. Blood Culture
3. Renal fx test

Front 48

why might you order imaging for dysuria

Back 48

1. recurrent pyelonephritis
2. relapsed cystitis
3. stone
4. fever >72 hrs after tx
5. male
6. in a child with UTI

Front 49

when do you US a kid with UTI

Back 49

always!!

when they have thier first bladder infection it can indicate a problem in the urinary tracy, do US on the whole thing

Front 50

how do we manage fever and pain for UTI

Back 50

1. Fever: should go away with tx, if its there for more than 72 hours maybe a resistant orgamism

2. Pain: phenazopyridine (pyridium), 2 days

Front 51

what is the tx plan for out patient acute pyelophritis?

what about in patiend

Back 51

1. Ciprofloxacin or Fluoroquinolone for 7-14 days. no systemic effects (can have low fever and slight WBC elevation)

2. In Patient: if vomiting, IV meds until the fever is gone for 24 hrs, continue on oral AB

Front 52

how is an uncomplicated acute cystitis treated

Back 52

3 days of oral AB:

TMP-SMX
nitrofurantoin monohydrate
flouroquinolones

Front 53

how long do you treat?

uncomplicated UTI
Complicated UTI

Back 53

3 days (TMX-SMX, flouroquinolens, nitrofurantoin)

7 days (broad spectrum AB)

Front 54

Drugs to tx pyelonephritis?

Drugs to tx cystitis

Back 54

fluoroquinolone- ciprofloxacin


flouroquinnolones (cipro andothers), TMP-SMX (bactrum)

Front 55

e coli causes what?
proteus causes what

Back 55

Uncomplicated UTI
Basic Urine

Front 56

can you tx UTI prophylatically

Back 56

yep, if they have more than 3 UTI/year and dont have other things goind on

can take a pill after sex or every night (TMX-SMX, Nitrofurantoin, Cephalaxin)

Front 57

what is self initiated UTI therapy

Back 57

woman can administer AB herself if she knows she has one

Front 58

how is estrogen cream used for UTI

Back 58

keeps the pH normal in post menopausal women

Front 59

should we screen for asymptomatic bacteruria in,,,


1. Preggos
2. men
3. non preg woman

Back 59

1. yes (canbe asymptomatic
2. no
3. no

**screen with a culture
**Tx asymptomatic bacteruria in preggos and ppl about to have urologic procedure

Front 60

if a child presents with back pain, abd pain, and dysuria/frequency and you are thinking UTI what can abother sx be that adults dont ahve

Back 60

incontinence