Term
| How many office visits per year are due to UIT? |
|
Definition
|
|
Term
|
Definition
by anatomy
cystitis
urethritis
prostatitis
epididymitis
pyelonephritis |
|
|
Term
| What classifies an uncomplicated UTI? |
|
Definition
no structural abnormalities
no functional abnormalities
otherwise healthy patient |
|
|
Term
| What population is uncomplicated UTI most common in? |
|
Definition
| young, sexually active females |
|
|
Term
| How long is the treatment course for bacterial UTI? |
|
Definition
|
|
Term
T/F
One day treatments for bacterial UTI are less effective than longer treatments. |
|
Definition
|
|
Term
| Why do we use 1 day treatments for bacterial UTI if they are less effective than longer treatments? |
|
Definition
| longer treatments have higher risk for adverse effects and are not very much more effective. |
|
|
Term
| What things classify a complicated UTI? |
|
Definition
pregnancy
DM or renal disease
male
predisposing factors - bladder stones, indwelling catheter, urethral stricture, BPH, neuropathic bladder
upper urinary tract involvement - fever, CVA tenderness |
|
|
Term
| How long is the treatment course for complicated UTI? |
|
Definition
7-14 days
except Nitrofurantoin 7-10 days - safe to use in pregnant women |
|
|
Term
| What are the signs and symptoms of UTI? |
|
Definition
| dysuria, frequency of urination, hematuria, back pain or CVA tenderness |
|
|
Term
| What are findings that decrease the likelihood of UTI? |
|
Definition
| vaginal discharge, vaginal irritation, absence of dysuria |
|
|
Term
| What are the symptoms of pyelonephritis? |
|
Definition
| fever, chills, flank pain, CVA tenderness |
|
|
Term
| What is purple urine bag syndrome? |
|
Definition
| non-pathological syndrome in which bacteria convert the indoxyl sulphate (from typtophan) to indoxyl which chemically converts to indigo and indirubin in alkaline urine causing a purple color |
|
|
Term
| Name 2 predisposing factors for purple urine bag syndrome. |
|
Definition
| chronically catheterized and consitpated |
|
|
Term
| What is a urine dip test done to detect? |
|
Definition
| presence of leukocyte esterase, presence of blood, presence of nitrates |
|
|
Term
| How sensitive is the presence of leukocyte esterase? |
|
Definition
75-97%
trace is less likely
but small, moderate, or large is definitely positive |
|
|
Term
| How specific is the presence of nitrates? |
|
Definition
|
|
Term
| When are nitrates absent from a urine dip even in the presence of a UTI? |
|
Definition
enterococci, Staph. saprophyticus, acinobacter
false negative in dilute urine |
|
|
Term
| What is the most common cause of uncomplicated UTI? |
|
Definition
|
|
Term
T/F
E. coli is gram negative and stains pink. |
|
Definition
|
|
Term
| Name some bacteria that may be the cause of complicated urinary tract infection. |
|
Definition
| Staphylococcus saprophyticus (gram +), enterobacteria (Klebsiella or Proteus) |
|
|
Term
| What % of complicated UTIs are caused by Staph. saprophyticus? |
|
Definition
|
|
Term
| What is the empiric treatment for women with suspected UTI? |
|
Definition
trimethoprim/sulfamethoxazole 3 days
ciprofloxacin 3 days |
|
|
Term
T/F
One day treatments for UTI have high failure rates. |
|
Definition
|
|
Term
T/F
Treatment longer than 3 days for uncomplicated UTI is necessary |
|
Definition
|
|
Term
T/F
History and physical exam trump dipstick analysis when it comes to diagnosing UTI. |
|
Definition
|
|
Term
| What should you do if there are negative results in the H & P and in the dipstick results? |
|
Definition
| perform microscopic analysis |
|
|
Term
| In microscopic analysis, what # of WBCs and RBCs indicate infection? |
|
Definition
|
|
Term
| If after H&P, dipstick analysis, and microscopic analysis there are still no positive results for UTI, what is done next? |
|
Definition
| Culture and sensitivity, microanalysis, and consider other causes (treat empirically for STD, do pelvic exam, do KOH prep) |
|
|
Term
|
Definition
| Pyridium - a urinary analgesic |
|
|
Term
| What are contraindications for urinary analgesic (phenzopyridine)? |
|
Definition
| renal insufficiency and severe liver disease |
|
|
Term
| How many days should you prescribe urinary analgesic? |
|
Definition
| 2 days - otherwise risk kidney problems and it could mask pyelonephritis, renal abscess, or urinary outlet obstruction |
|
|
Term
| What is the treatment for acute uncomplicated cystitis? |
|
Definition
trimethoprim/sulfamethoxazole 800/160 mg bid x 3days
ciprofloxacin 250 mg bid x 3 days
fosfomycin 1 day
nitrofurantoin 100 mg bid x 7 days
cephalexin
amoxicillin/clavulanate |
|
|
Term
| What is the mechanism of action of nitrofurantoin? |
|
Definition
| inhibits intracellular metabolism |
|
|
Term
| What % of nitrofurantoin is bioavailable? |
|
Definition
| 40-50% - enhanced with food |
|
|
Term
| How is nitrofurantoin cleared from the body? |
|
Definition
| kidneys, so do not prescribe with creatinine clearance < 40 ml/min |
|
|
Term
| What are the side effects of nitrofurantoin? |
|
Definition
nausea and vomiting - 17% of patients
rash - 1%
rare
pulm hypersensitivity: acute fever, cough, dyspnea, myalgias, eosinophilia, infiltrates
pulm fibrosis: insidious onset, nonproductive cough, dyspnea, interstitial infiltrates
hemolytic anemia
peripheral neuropathy |
|
|
Term
| What 3 abx used for the treatment of UTI are pregnancy category B? |
|
Definition
| nitrofurantoin, fosfomycin, and cephalexin |
|
|
Term
| Which abx is the treatment of choice for UTI in pregnant women? Why? |
|
Definition
Nitrofurantoin - cat. B and cheap
fosfomycin is more expensive
cephalexin isn't as effective |
|
|
Term
T/F
Resistance of E. coli to nitrofurantoin is minimal. |
|
Definition
|
|
Term
| What are some minor complications in acute complicated cystitis? |
|
Definition
older women - at least 7 days abx
men
diabetic patients |
|
|
Term
| How does the treatment plan change for acute complicated cystitis? |
|
Definition
| 7-14 days of therapy and follow up with a dipstick analysis |
|
|
Term
| What do you do if treatment of uncomplicated UTI fails? |
|
Definition
do a urine culture or treat empirically with a different class of abx
consider urology referral |
|
|
Term
| How does a UTI presentation differ in the elderly? |
|
Definition
| no fever, asymptomatic bacteriuria, altered mental status, change in eating habits, GI complaints |
|
|
Term
T/F
It is always imperative to find the source of hematuria. |
|
Definition
|
|
Term
| How do you treat significant (max on urine dip) hematuria? |
|
Definition
| urinalysis, 10 days of tx with TMP/SMX and RTC to repeat urine dip |
|
|
Term
| What do you do if a patient has hematuria on follow up? (hasn't gone away) |
|
Definition
change abx for another 10 days
urine for culture and analysis
RTC in 10 days
if no growth on culture - refer to urology for cystoscopic exam |
|
|
Term
| How many cases of pyelonephritis are there each year? |
|
Definition
| 250,000 (100,000 are hospitalized) |
|
|
Term
| What is the most common cause of pyelonephritis? |
|
Definition
|
|
Term
| What % of Staph saprophyticus UTIs involve the upper urinary tract? |
|
Definition
|
|
Term
T/F
Diabetic patient tend to have polymicrobial pyelonephritis. |
|
Definition
|
|
Term
| What can happen if pyelonephritis progresses? |
|
Definition
| renal abscess, sepsis, or renal failure |
|
|
Term
| What are the signs and symptoms of pyelonephritis? |
|
Definition
| fever, chills, flank pain, back pain, CVA tenderness, nausea/emesis |
|
|
Term
| What symptoms suggest during pyelonephritis suggest that cystitis may be present also? |
|
Definition
| dysuria, frequency/urgency, suprapubic pain |
|
|
Term
| What is the treatment for pyelonephritis in an immunocompetant patient that can tolerate oral therapy? |
|
Definition
ceftriaxone and levofloxacin
follow up in 24-72 hours |
|
|
Term
| What is xanthogranulomatous pyelonephritis? |
|
Definition
| severe, chronic infection of the kidneys with destruction of the renal parenchyma and presence of granulomas, abscesses and foam cells |
|
|
Term
| What does xanthogranulomatous pyelonephritis mimic on aspiration cytology? |
|
Definition
|
|
Term
| What does the history of a xanthogranulomatous pyelonephritis patient usually include? |
|
Definition
| hx of renal colic and recurrent UTI |
|
|
Term
|
Definition
| a drug found in the herbal remedies tropaeli majoris herba and armoracieae rusticanae radix that may help prevent recurrent UTIs |
|
|
Term
| Why are cranberries recommended to prevent recurrent UTIs? |
|
Definition
| cranberry compounds prevent bacteria from adhering to the bladder wall |
|
|
Term
|
Definition
a parasitic nemotode worm that is not seen in the US
2nd most important parasitic disease (after malaria)
Causes hematuria, chronic cystitis |
|
|
Term
| How do you treat schistosomiasis? |
|
Definition
|
|
Term
| How does acute prostatitis present? |
|
Definition
| similarly to pyelo, DRE for tender, tense, or indurated prostate |
|
|
Term
| What is the treatment for acute prostatitis? |
|
Definition
| trimethoprim/sulfamethoxazole |
|
|
Term
| What is the treatment for chronic prostatitis? |
|
Definition
| same as UTI, but longer (4 weeks - 3 months) |
|
|
Term
| What % of hematospermia are infectious? |
|
Definition
|
|
Term
| What are some causes of hematospermia? |
|
Definition
| excessive masturbation, rigorous sex, prolonged sexual abstinence, infection |
|
|
Term
| What is the treatment for infectious hematospermia? |
|
Definition
| 2 weeks of quinolone, trimethoprim/sulfamethoxazole, or doxycycline |
|
|
Term
| What are the signs and symptoms of epididymitis? |
|
Definition
| gradual onset of pain, symptoms of lower UTI, pain relief with testicular elevation |
|
|
Term
| Between age 14-35 what are the most common causes of epididymitis? |
|
Definition
| N. gonorrhea or Chlamydia |
|
|
Term
| What is the most likely cause of epididymitis in men older than 35? |
|
Definition
|
|
Term
| How do you rule out testicular torsion when you suspect epididymitis? |
|
Definition
| pain with testicular elevation, acute onset of pain, epididymis appears normal, decreased blood flow on doppler |
|
|
Term
| What is interstitial cystitis? |
|
Definition
chronic pelvic pain with dyspareunia or urinary frequency; no results to support UTI
similar to endometriosis; can coexist |
|
|
Term
| What % of interstitial cystitis patients have therapeutic results from evaluation by hydrodistension? How long do the effects last? |
|
Definition
| 30-60% and last 2-8 weeks |
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