UTIs (and random pregnancy questions)

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University of Calgary Medicine Class of 2014 Hellbenders

Define the upper and lower urinary tract:

Upper: Kidneys and Ureters
Lower: Bladder and Urethra

Name two conditions in which you would be concerned about asymptomatic bacteriuria.

Pregnancy (can cause premature labour)
Urologic surgery

T/F: Urethritis is defined as a UTI.

False, it is an STI

Complicated UTIs involve the _______ urinary tract(s) and are associated with __________ and prone to complications. The most common types of complicated UTIs are _______ and ______.

Upper and lower
Kidney disease, structural/functional abnormalities, foreign devices, co morbid diseases.
-------
Catheters
DM-related

Onset of UTI symptoms less than 4 weeks after a 'resolved' UTI is a ___________ UTI. Longer than this is a ________ UTI

<4wks = relapse
>4 weeks = re-infection

9/10 UTIs are caused by __________ which uses it __________ to gain traction in the urinary tract.

E. Coli
Pilli (Classed as 'Type I' or 'P')

A patient presents with flank pain, fever, nausea and costovertebral tenderness. You suspect a ______ UTI.

Upper.

A patient presents with painful burning urine and wakes multiple times at night to go pee. You suspect:

Lower UTI

T/F: Hematuria is common in UTIs

False, but it is possible and could indicate a viral cause.

An elderly patients presents with confusion, N/V, abdominal pain and SOB/cough. You remember this slide deck is about _______s so you test _________.

UTIs
Dipstick for pyruria/nitrites, , urine culture

Name two key complications that might arise as a result of chronic UTIs:

Hypertension
Renal failure (scarring)

A urine dipstick comes back positive for protein, and an alkaline pH. To rule out a UTI, you would also check

Pyruia, NItrites, WBCs,

An uncomplicated UTI may be empirically treated with:

3-day Cotrimaxazole I or 3-day floroquinalone (-floxacin)
Single high dose Amoxicillin or Cotrimoxazole II

WBC clumps in the urine would be more indicative of __________ (infection) where as WBC casts would be more indicative or __________.

Clumps = cystitis
Casts = pyelonephritis

A patient presents with painful burning urine and wakes multiple times at night to go pee. You suspect a ________ UTI. But don't forget similar symptoms may be a result of _____ and _____.

Lower UTI
Urethritis and prostatitis

The key differentiating symptom between a UTI and urethritis is ________. While two noticably ABSENT signs in urethritis would be:

Urethral discharge (pus)
Strangury/frequency/urgency -> bladder infection
Perineal pain, hematospermia -> prostate involvement

Which has whiter and more pus, gonorrhea or chlamydia?

Gonorrhea

Which is more frequent chlamydia or gonorrhea?

Chlamydia is 10x gonorrhea.

Gonorrhorea on a gram stain is

Gram negative diplococci

You see a patient whose gonorrhea test has just come back positive, what do you do?

Should have treated them on clinical suspicion!
Single dose therapy for BOTH Gonorrhea and chlamydia
Contact sexual contacts

Treatements for chlamydia and gonnhorea =

Chlamydia (1 dose Azythromycin (macrolide) )
Gonnhorea (3rd gen cephalosporin)

Prostatitis is a usually _______ infection that is [often|seldom] subtle. It can be hence treated with ________. Chronic infections can take ______ to clear.

bacterial
seldom subtle (dysuria + discharge)
Antibiotics
Weeks/months

A pregnant woman has asymptomatic bacteruria, you:

treat immediately to prevent premature labour.
(Would do nothing in a non pregnant woman)

A pregnant woman finds out on US that she has dilated ureters and some mild hydronephrosis, you:

leave it alone, normal.

How does the normal for proteinuria differ between pregnancy and non-pregnancy

Pregnancy < 300mg/24hours
Normal < 150 mg/24hours

Renal plasma flow and GFR peak at ____ weeks gestation so you would expect _____ to go down.

20
creatinine

In pregnancy, serum bicarb [increases|decrease], so as such mild metabolic __________ is normal. That said, respiratory ________ is also normal and will further drive _______ bicarb, the end result being .

decreases
mild metabolic acidosis
alkalosis, drives down
normal respiratory alkalosis, with bicarb down by 4

In pregnancy the thirst threshold is ______ resulting in a lower normal for _______.

Lower thirst threshold
Serum osmolarity and [Na+] (130-140)

In pregnancy blood pressure ______.

Drops by 10-15mmHg (think that 75 then could be normal)

a 27F with proteinuria as a result of T1DM comes in to discuss her blood pressure. You presrcribe an ACEi, and with your hand on the doorknob, she mentions she's trying to get pregnant. You.

Splash iodine in your eyes and prescribe a CCB or BB.

The mainstay of pharmacologic treatement for overactive bladder is_________ side effects of which are:

Anticholinergics (block parasympathetic detrussor contraction).
Dry mouth, dry eyes, constipation, drowsiness (rest and digest blocked)

The most common cause of incontinence is ______ incontinence and is treated first _______, then with ______.

Stress incontinence
Exercise, quit smoking, others
Surgical sling

T/F: Erectile dysfunction is primarily a result of low testosterone.

False. Poor vascularization.

Medications that may result in ED

#1 Thiazide diuretics (opposite effect of Viagra PDE5...)
Beta blocker

Erection is governed by the _________ whereas ejaculation the _______.

Erection: Parasympathetic (S2,3,4 keeps your penis off the floor)
Ejaculation: Sympathetic (L1, L2)

T/F: Viagra in men without ED will help to enhance sexual performance?

False, only side effects. e.g. headache, flushing

You are seeing a 67M post MI in your family practice. He says he wants to return to sexual activity with his wife but can't get an erection. He's worried it might put him at risk of a heart attack. You respond _____, then ask if he is taking _______.

No additional risk unless you can't excercise.
Any nitrate drug (CONTRAINDICATED)

The number one risk factor for bladder cancer is ______. Except in Egypt where it is ______.

Smoking
Schistosomiasis

Everything from the calyces to the urethra is lined with ________.

Transitional cells

State the normal PSA values for men
40s
50s
60s
70s

40s < 2.5
50s < 3.5
60s < 4.5
70s < 6.5

What happens to PSA if you:
are asian
are african
are taking propecia/proscar/avagar

less at risk
more at risk
halves your PSA (so need to double in these cases)

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