Which Neisseria species is associated with urological infections?
Click to see answer
N. gonorrhoeae.
Click to see question
Which Neisseria species is associated with urological infections?
N. gonorrhoeae.
What is the gold standard for identifying bacteriuria?
Urine culture.
What are common findings in urinalysis (UA) for pyelonephritis?
Pyuria, bacteria, and large amounts of granular or leukocyte casts.
How do most uncomplicated UTIs resolve?
With a short course of oral therapy.
Which drug class inhibits bacterial cell wall synthesis?
b-Lactams (penicillins, cephalosporins, aztreonam) and Vancomycin.
What type of bacteria is Chlamydia?
Obligate intracellular bacteria.
What precautions should be taken when using Nitrofurantoin?
Do not use in patients with low creatinine clearance (< 50 mL/min), monitor long-term patients closely, avoid concomitant probenecid, magnesium, or quinolones.
What pathogens does Fosfomycin target?
Enterococci and most Enterobacteriaceae (not P. aeruginosa).
What precautions should be taken when using Trimethoprim-sulfamethoxazole?
Avoid in pregnant patients and those receiving warfarin due to elevated prothrombin time.
What is a key symptom for diagnosing a UTI?
Acute onset of dysuria with positive urinalysis and culture.
What should be done for patients allergic to cephalosporins?
Treat with azithromycin 2 g orally and either oral gemifloxacin 320 mg or intramuscular gentamicin 340 mg.
When should blood cultures be obtained in pyelonephritis patients?
In patients with systemic toxicity, those requiring hospitalization, or with risk factors such as pregnancy.
What imaging techniques can show focal swelling in acute pyelonephritis?
Ultrasound (US), CT, and MRI.
What are some sequelae of pelvic inflammatory disease?
Tubal scarring, infertility, ectopic pregnancy, and chronic pelvic pain.
What is the recommended treatment for pregnant women with acute pyelonephritis?
Ampicillin and gentamicin 1–2 g every 6 hours for 10–14 days.
What is the dosage for Levofloxacin in inpatient treatment of acute pyelonephritis?
500–750 mg every 24 hours for 10–14 days.
What is the outpatient treatment duration for pyelonephritis?
7–10 days.
Which antimicrobial is effective against Staphylococcus (not MRSA) and enterococci?
Nitrofurantoin.
What type of antibiotic is commonly used for outpatient treatment of pyelonephritis?
Fluoroquinolone.
What should be done if there is no improvement in pyelonephritis within 72 hours?
Consider hospitalization and review cultures and sensitivities.
What is the recommended oral treatment for moderately ill outpatient women with acute pyelonephritis?
TMP-SMX DS 160–800 mg every 12 hours for 14 days.
What is the recommended minimum amount of PAC in cranberry pills for UTI prevention?
Ideally minimum 36 mg PAC.
How can acute pyelonephritis infections be subdivided?
Into uncomplicated infections not requiring hospitalization, uncomplicated infections needing hospitalization, and complicated infections.
What should be added to the treatment if Gram stain identifies gram-positive cocci?
Ampicillin or amoxicillin for better enterococcal coverage.
How do quinolones work?
By inhibiting bacterial DNA gyrase.
What indicates a positive Gram stain in symptomatic men?
Polymorphonuclear leukocytes with intracellular gram-negative diplococci.
What type of organisms are typically implicated in renal abscesses?
Gram-negative organisms.
What serious risk is associated with fluoroquinolone use?
Tendon rupture.
What is the significance of CT in patients with fever lasting longer than 72 hours?
It is helpful for ruling out obstruction and identifying renal and perirenal infections.
What characterizes Emphysematous Pyelonephritis (EP)?
An acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens.
What are classic symptoms of acute pyelonephritis?
Acute onset of fever, chills, flank pain, and/or costovertebral tenderness.
What percentage of blood cultures are positive in uncomplicated pyelonephritis in women?
25%.
What is the difference between bacteriostatic and bactericidal agents?
Bacteriostatic agents inhibit bacterial growth, while bactericidal agents kill bacteria.
What is the most common pathogen causing UTIs?
Escherichia coli.
What is the preferred method for detecting N. gonorrhoeae and C. trachomatis?
Nucleic-acid amplification tests (NAATs).
Why might antimicrobial therapy be necessary before surgery for XGP?
To stabilize the patient preoperatively.
When should AB be treated?
In pregnant women and patients undergoing procedures with anticipated transmucosal bleeding.
What makes surgery for XGP difficult?
The surrounding inflammatory reaction.
What comorbidities should be considered in urinary tract infection evaluations?
Comorbidities such as diabetes or other chronic conditions.
What percentage of women are asymptomatic within 72 hours after starting antimicrobial therapy?
Approximately 90%.
What precautions should be taken when using Amoxicillin with clavulanic acid?
Increased risk of rash with concomitant viral disease and allopurinol therapy.
How do Type P pili differ from Type 1 pili in terms of mannose?
Type P pili are mannose resistant, while Type 1 pili are mannose sensitive.
What defines an uncomplicated urinary tract infection (UTI)?
An infection in a healthy patient with a structurally and functionally normal urinary tract.
What is Asymptomatic Bacteriuria (AB)?
AB occurs when bacteria are identified in a urine sample without signs or symptoms of UTI.
What is the initial antibiotic treatment for emphysematous cystitis?
Broad gram-negative coverage.
What are postcoital antibiotics used for?
To prevent urinary tract infections related to intercourse.
What should be checked to evaluate urinary retention?
Post void residual (PVR).
What are common adverse reactions associated with fluoroquinolones?
Mild GI effects, dizziness, lightheadedness, and photosensitivity.
What behaviors are recommended to reduce UTI recurrence?
Hydration and frequent voiding.
How is a recurrent UTI defined?
Two UTIs in a 6-month period or three UTIs in a 12-month period.
What are some indications for radiologic investigation in acute pyelonephritis?
Potential ureteral obstruction, history of calculi, potential papillary necrosis, history of genitourinary surgery, poor response to antimicrobial agents, diabetes mellitus, polycystic kidneys, neuropathic bladder, and unusual infecting organisms.
What are common adverse reactions associated with Amoxicillin or Ampicillin?
Hypersensitivity (immediate or delayed) and gastrointestinal upset.
What anatomical factors are relevant in urinary tract infection assessments?
Anatomic urologic abnormalities.
What should be considered if a patient has negative culture but UTI symptoms?
Other diagnoses should be considered.
What physical examination should be performed for recurrent UTIs?
Pelvic examination.
What defines a complicated UTI?
A UTI occurring in a patient with a compromised urinary tract or caused by a very resistant pathogen.
What is the purpose of blood and urine cultures in pyelonephritis?
To evaluate for complicating factors and guide treatment.
What are common adverse reactions associated with Nitrofurantoin?
Peripheral polyneuropathy, GI upset, hemolysis with G6PD deficiency, pulmonary hypersensitivity reactions.
What is the primary treatment for XGP?
Surgical excision of the infected kidney and surrounding inflammatory tissue.
Which species of Mycoplasma are relevant for urological infections?
M. hominus and M. genitalium.
What is a renal abscess?
A collection of purulent material confined to the renal parenchyma.
What is the significance of Treponema in urological infections?
T. pallidum is a relevant pathogen.
What is a common mechanism of drug resistance for b-lactams?
Production of b-lactamase.
Which pathogen accounts for 80% of acute pyelonephritis cases?
E. coli.
Where does XGP typically begin?
Within the pelvis and calyces.
What is the function of Type P pili in E. coli?
Exhibit tropism to the kidney and are found in most strains causing pyelonephritis.
What may urine cultures show in cases of renal abscess?
No growth or a microorganism different from that isolated from the abscess.
What is the most frequently reported infectious disease in the United States?
Chlamydia, caused by C. trachomatis.
What is a significant adverse reaction of Antistaphylococcal penicillins?
Acute interstitial nephritis, especially with methicillin.
When should imaging and cystoscopic evaluation be performed in women with recurrent UTIs?
In women with risk factors for a complicated UTI.
What should be monitored when using Antipseudomonal penicillins?
Hypernatremia, as these drugs are given as sodium salt.
What was established in the cystogram of the 2-year-old girl?
An atrophic left kidney with marked reflux.
What are the common symptoms and signs of pyelonephritis?
Fever, flank pain, and leukocytosis.
What is the criteria for AB in women?
Same bacteria identified in quantitative counts of ≥ 100,000 CFUs in two consecutive voided samples.
What are some risk factors for recurrent urinary tract infections (UTIs)?
Sexual activity, new sexual partner within the past year, family history of UTI in first-degree female relative, recent antimicrobial use, spermicide use, history of UTI before menopause, menopause, incontinence, elevated postvoid residual, cystocele.
What is an important step in the uropathogenesis of E. coli?
Bacterial adherence with appendages (pili or fimbriae) to the surface urothelium.
What are the common adverse reactions of Trimethoprim-sulfamethoxazole?
Hypersensitivity, rash, GI upset, photosensitivity, hematologic toxicity (especially in patients with AIDS).
What are the primary factors involved in the pathogenesis of XGP?
Nephrolithiasis, obstruction, and infection.
When is surgical intervention considered for emphysematous cystitis?
For those who respond poorly to initial medical management or have severe necrotizing infections.
What should be done with dosages for all treatments mentioned?
All dosages should be adjusted for renal function.
What factors should influence antimicrobial selection?
Efficacy, safety, cost, and compliance.
What does fosfomycin inhibit?
Bacterial cell wall synthesis.
In which patients should fluoroquinolones be avoided?
Children and pregnant patients.
What symptoms are commonly experienced by patients with XGP?
Flank pain, fever, chills, and persistent bacteriuria.
Which organism is most commonly involved in XGP?
Proteus, followed by E. coli.
What should be done if a patient fails to respond to UTI therapy?
Repeat urine cultures should be performed.
What do blood tests often reveal in patients with XGP?
Anemia and possibly hepatic dysfunction.
Which bacteria are classified as nonfermenters?
Pseudomonas and Acinetobacter.
What is the threshold value for defining significant bacteriuria in dysuric patients?
10^2 colony-forming units (CFU)/mL of a known pathogen.
What is the treatment regimen for severely ill inpatient women with possible sepsis?
Ampicillin and gentamicin 1–2 g every 6 hours for 10–14 days.
How can Gram-positive infections occur in patients with multiple skin carbuncles?
Via hematogenous seeding.
How many positive samples are needed to diagnose AB in men?
Only one positive, clean-catch sample is necessary.
What symptoms may patients with a renal abscess present with?
Fever, chills, abdominal or flank pain, and occasionally weight loss and malaise.
What laboratory finding is typically marked in patients with renal abscess?
Leukocytosis.
What is the mechanism of action of trimethoprim-sulfamethoxazole?
Antagonism of bacterial folate metabolism.
What are possible first-line antimicrobial therapies for uncomplicated cystitis?
Nitrofurantoin and trimethoprim.
What is the significance of having ≥ 3 UTI episodes in 12 months?
It indicates a pattern of recurrent urinary tract infections.
What is the recommended treatment for chlamydial urethritis?
Single-dose oral azithromycin 1 g or oral doxycycline 100 mg twice daily for 7 days.
What is the recommended dosage for Nitrofurantoin monohydrate/macrocrystals?
100 mg bid for 5 days.
What is the role of Mycobacteria in urological infections?
M. tuberculosis is a relevant pathogen.
What is the dosage and frequency for Ciprofloxacin in outpatient treatment of acute pyelonephritis?
500 mg every 12 hours for 7 days.
What is Xanthogranulomatous Pyelonephritis (XGP)?
A rare, severe, chronic renal infection resulting in diffuse renal destruction.
What recent medical history is important in evaluating urinary tract infections?
Recent infections/antibiotic use.
What characterizes XGP histologically?
Accumulation of lipid-laden, foamy macrophages.
What are Type 1 pili sensitive to?
Mannose.
Why is intraoperative frozen section unreliable in XGP?
Lipid-laden macrophages associated with XGP resemble clear cell adenocarcinoma.
What are some resistant species that should be suspected in recurrent UTI cases?
Proteus, Klebsiella, Pseudomonas, Serratia, Enterobacter, Citrobacter.
What conditions may indicate potential ureteral obstruction?
Stone, ureteral stricture, or tumor.
What is the recommended oral treatment for pregnant women with acute pyelonephritis?
Cephalexin 500 mg every 6 hours.
What are some poor prognostic factors associated with Emphysematous Pyelonephritis?
Hypoalbuminemia, shock, bacteremia, hemodialysis requirement, thrombocytopenia, altered mental status, and polymicrobial infection.
What was the outcome of the prophylactic therapy for the 15-year-old girl?
Reinfections ceased with prophylactic therapy.
What symptoms are associated with acute pyelonephritis?
Fever, chills, flank pain, costovertebral-angle tenderness, nausea, vomiting, and malaise.
What was the serum creatinine level of the 18-year-old girl?
0.9 mg/dL.
What characterizes a complicated UTI?
Associated with factors that increase the chance of acquiring bacteria and decrease the efficacy of therapy.
What is the primary pathway for ascending infections in renal abscesses?
Tubular obstruction from prior infections or calculi.
What is the mechanism of action of aminoglycosides?
Inhibition of ribosomal protein synthesis.
What percentage of community-acquired UTIs is caused by E. coli?
85%.
What is acute pyelonephritis?
Inflammation of the kidney due to an infection of the renal parenchyma.
What is the treatment regimen for gonorrhea?
Ceftriaxone 250 mg intramuscularly and azithromycin 1 g orally.
What is indicated if there is a need to rule out complicating factors in pyelonephritis?
Optional radiologic evaluation.
What type of bacteria is Staphylococcus?
Gram-positive aerobic cocci.
What is a common adverse reaction associated with Vancomycin?
Red-man syndrome.
What should be considered when diagnosing a woman with acute uncomplicated cystitis?
Alternate diagnoses such as pyelonephritis or complicated UTI.
What is the significance of urine culture in the management of pyelonephritis?
To guide treatment and monitor for resistance.
Who should not be treated for Asymptomatic Bacteriuria?
Premenopausal women, nonpregnant patients, patients with diabetes, older community dwellers, and others listed in Box 12.5.
What should be monitored in patients taking fluoroquinolones and antidiabetic agents?
Glucose levels, due to reported hypoglycemia and hyperglycemia.
What is the role of parenteral antimicrobials in complicated UTIs?
They should be administered based on the susceptibility patterns of known uropathogens.
What is EP in the context of urologic emergencies?
EP is a urologic emergency where most patients are septic and require intensive care.
What is the duration of treatment for Ciprofloxacin (extended release) in outpatient settings?
1000 mg every 24 hours for 7 days.
What is the recommended approach if there is an obstruction or abscess in pyelonephritis?
Drain the obstruction or abscess.
What effect can fluoroquinolones have on theophylline levels?
They can significantly increase theophylline plasma levels.
What is a mechanism of resistance for aminoglycosides?
Aminoglycoside-modifying enzymes.
What is the typical duration of therapy for complicated UTIs?
10–14 days on culture-specific antibiotics.
What does a CT scan typically show in cases of XGP?
Unilateral renal enlargement with little or no function and a large calculus in the renal pelvis.
How is M. genitalium primarily transmitted?
By direct genital-genital mucosal contact.
When is early percutaneous drainage recommended for perinephric abscesses?
For abscesses larger than 3 cm in diameter.
What are some patient-applied topical therapies for anogenital warts?
Imiquimod cream, podofilox solution, and sinecatechins ointment.
What is the preferred duration of therapy for women with uncomplicated UTIs?
Three days.
What imaging technique is the diagnostic procedure of choice for renal abscess?
CT scan.
What should be included in the medical history for recurrent UTIs?
Prior number of infections, frequency, culture results, associated symptoms, and identifiable triggers or risk factors.
What are some factors that suggest a complicated urinary tract infection?
Functional or anatomic abnormality of the urinary tract, male gender, pregnancy, older adult patient, diabetes, immunosuppression, spinal cord injury, childhood urinary tract infection, recent antimicrobial agent use, indwelling urinary catheter, urinary obstruction, urinary tract instrumentation, hospital-acquired infection, symptoms for 7 days at presentation.
How does a history of pediatric voiding dysfunction relate to UTIs?
It may indicate a higher risk for recurrent urinary tract infections.
In which patients does Emphysematous Pyelonephritis usually occur?
Patients with diabetes and urinary tract obstruction.
What are the common adverse reactions of Cephalosporins?
Hypersensitivity, gastrointestinal upset, positive Coombs test, and decreased platelet aggregation.
Which pathogens are treated by Ampicillin with sulbactam?
Staphylococcus (not MRSA), Enterococci, P. mirabilis, H. influenzae, and Klebsiella spp.
What are common causes of a perinephric abscess?
Rupture of an acute cortical abscess, extravasated infected urine, infection of a perinephric hematoma, or hematogenous seeding.
What is the treatment for persistent or recurrent NGU if azithromycin was used initially?
Moxifloxacin 400 mg PO QD × 7 days.
What are nonnitrite producing bacteria?
All gram positives and pseudomonads, such as Pseudomonas and Acinetobacter.
What is the treatment for Fournier gangrene?
A combination of broad-spectrum antibiotics and extensive surgical debridement.
What characterizes uncomplicated cystitis?
Acute onset of dysuria and change in baseline voiding symptoms.
What are the precautions for using Vancomycin?
Caution with other potentially nephrotoxic and ototoxic drugs due to risk of nephrotoxicity and/or ototoxicity.
What role does family history play in urinary tract infection evaluations?
Family history can indicate genetic predispositions to urinary tract issues.
Which patients are at risk for potential papillary necrosis?
Patients with sickle cell anemia, severe diabetes mellitus, or analgesic abuse.
What is the role of vaginal estrogen in UTI management?
It may help in postmenopausal women to reduce UTI recurrence.
What additional pathogens does Amoxicillin with clavulanate target?
P. mirabilis and Klebsiella spp.
What should painless gross hematuria raise suspicion for?
Urologic malignancy.
Which pathogens are targeted by First-generation cephalosporins?
Streptococcus, Staphylococcus (not MRSA), Escherichia coli, P. mirabilis, and Klebsiella spp.
What is the recommended treatment for Trichomonas vaginalis?
A single dose of oral metronidazole 2 g or tinidazole 2 g.
What is Fournier gangrene?
A potentially life-threatening progressive infection of the perineum and genitalia.
Which group of Streptococcus is known for causing infections?
S. pyogenes (group A) and S. agalactiae (group B).
What are the recommended classes of antibiotics for treating uncomplicated cystitis?
Fluoroquinolones or Beta-lactams (with caution).
Which pathogens are covered by Amoxicillin or Ampicillin?
Streptococcus, Enterococci, and Proteus mirabilis.
Which patient population has a higher incidence of adverse reactions to Trimethoprim-sulfamethoxazole?
Patients with AIDS and older adults.
What are common adverse reactions associated with fosfomycin?
Headache, GI upset, and vaginitis.
What is the role of Tc-99m DMSA in diagnosing XGP?
It may be used to confirm and quantify the differential lack of function in the involved kidney.
What is the coverage of Antistaphylococcal penicillins?
Streptococcus and Staphylococcus (not MRSA).
What are common adverse reactions associated with pivmecillinam?
Rash and GI upset.
What is Trichomonas vaginalis?
A flagellated parasite that infects the urethra in men and the urethra, vagina, and vulva in women.
What is the coverage of Aztreonam?
Most gram-negative pathogens, including P. aeruginosa.
Why might testing for Trichomonas vaginalis not be warranted in the initial workup for NGU?
Due to the low prevalence of T. vaginalis in NGU.
What symptoms may men experience with gonococcal urethritis?
Urethritis, epididymitis, prostatitis, and proctitis.
What is the role of nitrofurantoin in treating bacterial infections?
Inhibition of several bacterial enzyme systems.
What is the initial treatment for patients diagnosed with a renal abscess?
IV antibiotics.
What type of bacteria does Enterobacteriaceae include?
Gram-negative aerobic rods.
What conservative management may be employed for clinically stable patients with small abscesses?
Antibiotics and careful observation.
What percentage of nongonococcal urethritis cases is caused by M. genitalium?
15%–20%.
What symptoms are associated with cystitis?
Dysuria, frequency, urgency, suprapubic pain, hematuria, and fever.
What should be avoided when prescribing Trimethoprim-sulfamethoxazole?
If resistance prevalence exceeds 20% or if used for UTI in the previous 3 months.
What is Emphysematous Cystitis (EC)?
A rare and potentially life-threatening form of complicated cystitis associated with high mortality.
Which bacteria produce nitrites in urine?
All Enterobacteriaceae, including E. coli, Klebsiella, Enterobacter, Proteus, Citrobacter, Morganella, and Salmonella.
What initial procedures may be performed for patients with EP?
Placement of a ureteral stent or percutaneous nephrostomy tube.
What pathogens do Second-generation cephalosporins (cefamandole, cefuroxime, cefaclor) cover?
Streptococcus, Staphylococcus (not MRSA), E. coli, P. mirabilis, H. influenzae, and Klebsiella spp.
What urine dipstick findings are most helpful in diagnosing a UTI?
Positive nitrites, leukocyte esterase, and blood.
What is the primary treatment for Emphysematous Cystitis?
Medical therapy alone, which consists of IV antibiotics.
What is the coverage of Fluoroquinolones?
Streptococcus and most gram-negative pathogens, including P. aeruginosa.
What procedural treatments are available for anogenital warts?
Cryotherapy, surgical excision, and acid applications.
What can significantly decrease the oral absorption of fluoroquinolones?
Concomitant use of antacids, iron, zinc, or sucralfate.
What is a poor response to treatment in acute pyelonephritis?
Poor response to appropriate antimicrobial agents after 5–6 days of treatment.
What are indications for further investigation of recurrent UTIs?
Previous urinary tract trauma or surgery, previous bladder or renal calculi, gross hematuria after resolution of infection, obstructive symptoms, high post-void residual, urea-splitting bacteria on culture, previous abdominopelvic malignancy, bacterial persistence after treatment, diabetes or immune compromise, pneumaturia, fecaluria, history of diverticulitis, repeated pyelonephritis, asymptomatic microhematuria after resolution of infection.
What is the classic triad of symptoms for severe acute pyelonephritis?
Fever, vomiting, and flank pain.
What is the purpose of urologic evaluation in UTI management?
To evaluate for bacterial persistence and other underlying issues.
What is a precaution for using fosfomycin?
Hypersensitivity to fosfomycin.
What is the alternative treatment for NGU if azithromycin is not used?
Erythromycin base 500 mg PO qid × 7 days, erythromycin ethylsuccinate 800 mg PO qid × 7 days, levofloxacin 500 mg QD × 7 days, or ofloxacin 300 mg PO bid × 7 days.
What does the absence of nitrites in urine indicate?
It does not mean bacteria are not present, as not all bacteria produce nitrites.
What imaging technique is used to diagnose Emphysematous Pyelonephritis?
CT scan, which shows mottled gas in the renal parenchyma.
What is the treatment for persistent or recurrent NGU if doxycycline was used initially?
Azithromycin 1 g PO × 1 dose plus metronidazole 2 g PO × 1 dose or tinidazole 2 g PO × 1 dose for men who have sex with women in high-prevalence areas.
What laboratory features are associated with a perinephric abscess?
Leukocytosis, elevated serum creatinine, and pyuria.
Which microorganisms are common causes of acute orchitis and epididymitis?
E. coli and Pseudomonas.
What bacteria causes genitourinary tuberculosis (GU TB)?
Mycobacterium tuberculosis complex (MTBC).
What is the most common site of GU TB infection?
The kidneys.
What factors affect the ability to provide an adequate midstream clean-catch sample?
Increased body mass index, vaginal atrophy, poor manual dexterity, inability to bear weight, intravaginal pessary, and nonsterile collection receptacle.
What is the preferred treatment for the initial episode of nongonococcal urethritis (NGU)?
Azithromycin 1 g PO × 1 dose or doxycycline 100 mg PO bid × 7 days.
What is the first-line procedure for most renal abscesses larger than 5 cm?
Drainage remains the first-line procedure of choice.
What is the incidence of cross-reactivity in patients allergic to penicillin or cephalosporins when using Aztreonam?
1% incidence of cross-reactivity.
What characterizes a perinephric abscess?
It extends beyond the renal capsule but is contained by Gerota’s fascia.
What are the major risks associated with Aminoglycosides?
Ototoxicity, nephrotoxicity, and neuromuscular blockade with high levels.
What are the symptoms of acute orchitis and epididymitis?
Pain, swelling, and inflammation of the testicle and epididymis.
How is Trichomonas vaginalis diagnosed?
Using NAATs or wet mounts of cultures.
What diagnostic tests should be performed for patients with suspected orchitis?
Urine culture and STI testing, if indicated.
What appearance may ureteral strictures take in GU TB?
A 'beaded corkscrew' appearance.
What procedure may be necessary to differentiate an abscess from a tumor?
Image-guided needle aspiration.
What should be done if there are recurrent or persistent symptoms of NGU?
Repeat the treatment regimen for the initial episode of NGU.
What should be corrected in patients with complicated UTIs?
Any underlying urinary tract abnormalities.
What is a pathognomonic finding of Emphysematous Cystitis?
Gas noted within the bladder wall on CT imaging.
Who is typically affected by Emphysematous Cystitis?
Older women with poorly controlled diabetes.
Which HPV types are associated with most cervical and other cancers?
High-risk types, predominantly 16, 18, 31, 33, and 35.
What imaging technique can help distinguish testicular torsion from orchitis?
Scrotal ultrasound (US).
What are some risk factors for developing Fournier gangrene?
Alcoholism, diabetes, recent urogenital or colorectal instrumentation or trauma, and preexisting peripheral vascular disease.
How can TB infect the genitourinary tract?
Through ascending infection or hematogenous seeding.
What are essential management steps for patients with EP?
Fluid resuscitation, glucose and electrolyte management, and broad-spectrum antimicrobial therapy.
What is the most common organism found in urine cultures for Emphysematous Pyelonephritis?
E. coli.
What should be considered when using pivmecillinam?
Use with caution in patients with penicillin hypersensitivity.
When is nephrectomy advised in cases of EP?
When patients do not respond to conservative management or if there is extensive and diffuse gas with renal destruction.
What imaging technique is valuable for demonstrating a primary abscess?
CT (Computed Tomography) is valuable for this purpose.
Which pathogens do Aminoglycosides target?
Staphylococcus (urine) and most gram-negative pathogens, including P. aeruginosa.
What may be necessary if the kidney is nonfunctioning or severely infected?
Nephrectomy may be necessary.
What significant finding was noted in the excretory urogram of the 18-year-old girl?
Focal, coarse scarring in the right kidney.
What is the significance of pyuria in diagnosing a UTI?
Pyuria is defined as >5 white blood cells (WBCs)/high-power field (HPF) and moderate pyuria (>50 WBCs/HPF) in conjunction with urinary symptoms may indicate a UTI.
At what age does the CDC recommend routine vaccination against HPV?
At 11 or 12 years of age.
What are typical constitutional symptoms of TB?
Fever, weight loss, night sweats, and malaise.
In which patients should Aminoglycosides be avoided?
Pregnant patients and those with severely impaired renal function, diabetes, or hepatic failure.
What caution should be taken when using Aminoglycosides with other drugs?
Use with caution in patients taking other potentially ototoxic and nephrotoxic drugs.
Which pathogens are treated by Third-generation cephalosporins (ceftriaxone)?
Streptococcus, Staphylococcus (not MRSA), and most gram-negative pathogens excluding P. aeruginosa.
What does the presence of leukocyte esterase in urine indicate?
It indicates pyuria but not specifically bacteria.
What percentage of cervical cancer cases are attributed to HPV types 16 and 18?
Approximately 70%.
What specific symptoms may indicate GU TB?
Dysuria, storage symptoms, hematuria, and flank pain.
What complications can arise from untreated GU TB?
Renal failure and infertility.
What symptoms may patients with a perinephric abscess present with?
An abdominal or flank mass can be felt in approximately half of the cases.
What viruses are responsible for anogenital warts?
Human papillomaviruses (HPVs), specifically types 6 and 11.
Why is imaging not required in most cases of UTI?
Because most cases can be diagnosed based on urine analysis, but some scenarios may warrant imaging to identify underlying abnormalities.
What is the recommended treatment for small perinephric abscesses in clinically stable patients?
They may be treated with antibiotics alone.
How is the diagnosis of anogenital warts typically made?
By clinical examination.
What happens to the renal parenchyma in progressive GU TB?
Granulomas form and can lead to caseating cavities and abscesses.
