Urinary tract infections: Clinical

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Urinary tract infections: Clinical

USMLE® Step 2 questions

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USMLE® Step 2 style questions USMLE

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A 35-year-old man comes to clinic because of hematuria for the past week. He says red streaks of blood appear during the last 2 seconds of urination. Past medical history is noncontributory. He does not take any medications and denies alcohol, tobacco, or illicit drug use. His spouse mentions that he went on a trip to North Africa 8 months ago and since then he has had diarrhea about 3 days per week. His temperature is 37.2° C (99° F), pulse is 77/min, respirations are 16/min, and blood pressure is 130/70 mm Hg. A bladder biopsy shows pink, polygonal cells with hyperchromatic nuclei having intermediate filament. Which of the following mechanisms of treatment would have most likely prevented this exacerbation of his condition?


Urinary tract infections or UTIs are infections that affect part of the urinary tract.

They’re usually caused by bacteria found in fecal flora, which normally colonizes the urethral meatus.

However, when those bacteria make their way up the urethra and into the bladder, they can cause lower UTIs, like cystitis, which is the inflammation of the bladder, or upper UTIs, like acute pyelonephritis, which is the inflammation of the renal pelvis and kidneys.

Both cystitis and acute pyelonephritis can be uncomplicated or complicated.

By complicated, we mean that the individual has an associated structural or functional condition of the genitourinary tract or an underlying disease which increases the risk of a severe infection.

So a complicated UTI is one that happens in a male, a pregnant female, and individuals with indwelling urinary catheters.

Additionally, it’s considered a complicated UTI when it happens in individuals with poorly controlled diabetes mellitus, immunocompromised individuals, those with urologic conditions- like urethral strictures, and those that have had urologic procedures.

So let’s start with uncomplicated cystitis.

The most common pathogens are Enterobacteriaceae which include Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis.

Another pathogen is Staphylococcus saprophyticus.

Uncomplicated cystitis usually appears in women, because they have a shorter urethra than men, making the urethral meatus closer to the anal orifice.



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