A 40 yrs. man presents with clinical acute pyelonephritis, on intravenous antibiotics for 4 days, CT shows a renal abscess. What is next in the treatment?
carry on the full antibiotic course, and then repeat CT
incision and drainage of the renal abscess with/without nephrectomy
the abscess size dictates management
perc. drainage of the renal abscess
Correct Answer :
C. the abscess size dictates management
the abscess size dictates management. Abscesses of 3 cm or less can be managed with antibiotics alone.
Related Questions
What is false regarding malakoplakia?
is an uncommon granulomatous disease that affect the skin and/or urinary bladder
it might be due to a disturbed function of B lymphocytes
characterized by the presence of basophilic inclusion structure (Michaelis-Gutmann body)
it might be due to a defective phagolysosomal activity of monocytes or macrophages
Histologically, the pathognomonic finding of Fournier gangrene include:
necrosis of the superficial and deep fascial planes
fibrinoid thrombosis of the nutrient arterioles
polymorphonuclear cell infiltration
all of the above
What is true regarding genitourinary TB?
commonly, TB enters the urinary tract via intravesical instillation of attenuated live BCG to treat bladder cancer
CT urography may show infundibular stricture with or without hydrocalicosis
renal ultrasonography reveals calyceal erosions moth-eaten calyx
TB of the vas appears, clinically, as a thin hard strictured tube
What kind of cystitis does NOT progress to malignancy?
foreign-body cystitis due to vesical calculi
Von Brunn`s nests of cystitis cystica and cystitis glandularis
schistosomiasis cystitis
inverted papilloma of the bladder
In which segmented voided bladder (VB) specimen, the diagnosis of chronic prostatitis is confirmed?
VB1 and VB3
prostatic secretions and the VB3
prostatic secretions and the VB2
prostatic secretions and the VB1
What is the most virulent factor for bacterial adherence?
P blood group
fimbria
pili
hemolysin
What is false regarding biopsy-taking from interstitial cystitis bladder?
no pathognomonic histology for interstitial cystitis
basically, biopsies are performed to exclude carcinomas and other varieties of cystitis
diagnostic biopsies include the presence of discrete micro-ulcers and increased numbers of mast cells in the detrusor muscle or submucosa
none of the above
What could cause unresolved bacteriuria?
drug resistance
non-compliance
the presence of persistent pathology
all of the above
What are the commonest organisms causing acute epididymitis in males younger than 35 yrs.?
N. gonorrhea and C. trachomatis
E. coli and Pseudomonas species
Mycoplasma genitalium and Ureaplasma species
Trichomonas vaginalis and Gardnerella vaginalis
What is false concerning UTI in long-term care facilities?
in catheterized individuals, entry of bacteria into the bladder is facilitated by the bacterial glycocalyx biofilm
infection cannot be reliably distinguished from bacteriuria by lab tests
co-trimoxazole is the preferred antibiotic for empiric therapy
symptomatic UTI may be a diagnosis of exclusion
What is the commonest intra-scrotal pathology in AIDS patients?
beaded vas deferens
testicular micrilithiasis
testicular atrophy
epididymal granuloma
What virus(s) could cause orchitis?
Coxsackie B
Epstein-Barr
varicella
all of the above
Under which surgical wound classification, does diagnostic cystoscopy under sterile technique fit?
dirty - infected
contaminated
clean - contaminated
clean
What is false concerning esinophilic cystitis?
probably due to antibody/antigen reaction
has no diagnostic findings on cystoscopy
has no specific medical therapy
on histology, Von Brunn`s nests appear invaginating the urothelium into the lamina propria
What is false concerning corpora amylacea of the prostate?
are premalignant, and found in 1-6% of prostate biopsies
are small hyaline masses of unknown significance found in the prostate gland
they are degenerate cells or thickened secretions in the prostate ducts
might appear as prostate calcifications on X-ray KUB
What condition does NOT present as an acute loin pain with fever and marked flank tenderness?
ascending UTI causing acute lobar nephronia
acute pyelonephritis in a transplanted kidney
infected renal subcapsular hematoma
perinephric abscess causing septicemia
What are the sequelae of recurrent uncomplicated UTI in young women?
minimal
chronic persistent infections
chronic relapsing infections
bouts of chronic pyelonephritis
HIV infection increases the incidence of the following cancers, EXCEPT:
Kaposi sarcoma,
Hodgkin lymphoma
non-Hodgkin lymphoma
cervical cancer
What is the mortality rate of emphysematous pyelonephritis?
43%
53%
63%
73%
What is NOT a complication of mumps orchitis?
infertility
hypogonadotropic hypogonadism
non seminomatous germ cell tumor
chronic orchalgia
What type of scrotal ulcers is painless, punched out, with yellowish grey floor?
tuberculous ulcer
malignant ulcer
gummatous ulcers
traumatic ulcer
What is false concerning antiretroviral medications?
multiple antiretroviral drugs can be combined into a single pill
might cause radiolucent renal stones
can lead to a significant rise in the serum level of PDE5 inhibitors, if taken simultaneously
have the advantage of structured treatment interruptions (drug holidays)
What is false regarding the etiology and treatment of orchialgia syndrome?
small indirect inguinal hernia may irritate the genital branch of genitofemoral nerve causing orchialgia
might respond to a selective nerve block
the recommended treatment is orchiectomy with implantation of a testicular prosthesis
psychotherapy and stress management might alleviate the pain
Using low-dose prophylactic or suppressive antimicrobials might be an option in treating the following type of prostatitis:
acute bacterial prostatitis presenting with abscess formation
recurrent or refractory chronic bacterial prostatitis
asymptomatic prostatitis with pyuria resistant to common antimicrobials
curiously, chronic inflammatory prostatitis could respond to low-dose suppressive antibiotic
What is true concerning HIV infection?
HIV is a retrovirus that infects B-cells and dendritic cells
circumcised men are at lower risk for HIV infection
HPV infection increases the risk for cancers in HIV patients by 6.3 times
plasma HIV RNA load is a predictor of disease remission
A 48 yrs. woman presents with recurrent cystitis. Cystoscopy showed a raised bladder lesion. Biopsies from the lesion reveals Von Hansemann histiocytes, and Michaelis-Gutmann bodies. What is the treatment?
sulfonamide for several months
TUR of the bladder lesion followed by proper staging
radical cystectomy and urinary diversion
intravesical installation of mitomycin without irradiation
What is true concerning the definition of UTI in women, based on culture results from a suprapubic aspirate of urine?
any amount of uropathogen grown in culture indicates UTI
for cystitis, more than 1000 CFU/mL indicates UTI
for pyelonephritis, more than 10,000 CFU/mL indicates UTI
for asymptomatic bacteriuria, more than 100,000 CFU/mL indicates UTI
What antimicrobial agent treats UTI and does NOT alter the gut flora?
trimethoprim- sulfamethoxazole
fluoroquinolones
aminoglycosides
nitrofurantoins
What is the percentage of occurrence of Staphylococcus saprophyticus in symptomatic lower UTIs in young sexually active females?
5%
10%
15%
20%
What is (are) the cause(s) of recurrent community acquired UTI in women?
uncontrolled DM
sexual activity with multiple partners
high vaginal receptivity to bacterial adherence
all of the above