UTI ASSIGNMENT

AY 2019-2020

Objectives: Given paper cases, the student should be able to:

1. Identify the signs and symptoms of kidney and urinary tract disease.
2. Identify the UTI syndrome in each case presented.
3. Apply clinical practice guidelines in the management of patients with UTI.
4. Select the appropriate diagnostic tools to support the diagnosis of UTI.
5. Recommend a cost-effective treatment for patients with UTI.

Instructions:
1. Process each case and answer the guide questions individually. Answers should fit in
1 A4 size paper. Cite your references for each answer.
2. Exchange your paper with a classmate from the same block. Check your classmate’s
answers.
3. If you do not agree with your classmate’s answers, discuss the answers together.
Prepare a consensus answer for each answer that you answered differently. Cite
your references for the consensus answer.
4. Submit as a pdf file labelled with your names and Block. (Cruz and dela
Cruz_UTI_Block A)

Case 1. A 25 year old female consults for dysuria and urinary frequency. She claims that
this is her 3rd episode in the past 8 months. On further history, she had no gross hematuria,
obstructive symptoms, flank pains, fever or chills. Labs done 2 months ago grew E. coli for
which she took cefuroxime based on culture. Serum creatinine was normal. Imaging then did
not show any urolithiases. Your complete physical examination was normal and
unremarkable. You even referred her to the GYN service to evaluate urogenital anatomy and
estrogenization of vaginal tissues and to check for prolapse.

1. What is your diagnosis? What is the basis for diagnosis?

2. What further diagnostic examinations would you recommend?
3. How would you manage this episode?
4. What preventive measures can be done to avoid future recurrences of UTI?
5. The patient asks you, “Pwede bang uminom ng cranberry juice?” Write a narrative of
your answer to this question.

Case 2. A 59 year old male consults you with a urine culture showing > 100,00 cfu of E. coli.
On history taking, he had no symptoms but on routine annual physical examination, he had
microscopic hematuria without pyuria, leukocyte esterase or nitrites. KUB ultrasound showed
a mass in the urinary bladder. He has been scheduled for cystoscopy in 5 days. Physical
examination is normal.

1. What is your diagnosis? What is the basis for diagnosis?

2. Does he need treatment? Explain your answer.
3. If you decide to treat him with antibiotics, how long would you make him take
medications?

Case 3. K.J. a 20 year old female, single, consulted due to burning sensation whenever she
voids, associated with an abrupt urge to void every hour. She denies history of any vaginal
discharge or pruritus. Her last menstrual period was 3 weeks ago.

1. What is your diagnosis? What is the basis for diagnosis?

2. Explain the pathogenesis of UTI in this patient.
 3. What is the recommended test to confirm your diagnosis prior to starting antimicrobial
treatment?
4. Based on clinical practice guidelines, what antibiotics can you prescribe? Include
duration of treatment.

Case 4. A 43 year old female, single consulted due to fever, vomiting and right flank pain of
1 day duration. She had a history of painful urination and hypogastric pain when voiding 5
days ago. PE: (+) CVA tenderness on the right

1. What is your diagnosis? What is the basis for diagnosis?

2. Explain the pathogenesis of UTI in this patient.
3. What single test would support your diagnosis?
4. What is the recommended first line empiric antibiotic treatment for this patient?
Include duration of treatment.
5. Would you recommend hospital confinement? Explain your answer.

Case 5. DM, a 75 year old male, consults for weak stream, frequent urination at night with
feeling of urinary retention. There is hypogastric fullness and tenderness on physical
examination. He is afebrile. DRE shows a large doughy prostate. Urinalysis shows (+) nitrites,
(+) leukocyte esterase, (-) albumin, (-) glucose, 15-20 wbc/hpf and (++) bacteriuria.

1. Does DM have UTI? Explain your answer.

2. What diagnostic test would you recommend?
3. How would you manage him?

DM is treated with Tamsulosin and Finasteride and his symptoms improve. Two years later,
you see him at the ER complaining of inability to void. His bladder is distended and urinary
catheter is inserted with relief of symptoms. He is sent home on an indwelling Foley catheter.
He returns to you a month later with urine CS results showing 50,000 cfu of E. coli. He is
asymptomatic.

4. Does DM now have UTI? What does he have?

5. How would you manage the bacteriuria?