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NEPHRO > UTI > Flashcards

UTI Flashcards

1
Q
  1. Which of the following patients with asymptomatic bacteriuria (ASB) should be treated with antibiotics?
    A. A healthy 40-year-old woman with incidental bacteriuria
    B. A 25-year-old pregnant woman with ≥10^5 CFU/mL in a urine culture
    C. A 30-year-old man with no urinary symptoms but positive urine culture
    D. A postmenopausal woman with recurrent UTIs but no current symptoms
A

B. A 25-year-old pregnant woman with ≥10^5 CFU/mL in a urine culture

Treatment of ASB is indicated in pregnant women due to the risk of complications such as pyelonephritis and preterm delivery. Other groups, like individuals undergoing urologic surgery, may also require treatment.

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2
Q

hat is the most common causative organism of acute uncomplicated cystitis in the United States?
A. Staphylococcus saprophyticus
B. Escherichia coli
C. Klebsiella pneumoniae
D. Pseudomonas aeruginosa

A

B. Escherichia coli

E. coli accounts for 75–90% of isolates in acute uncomplicated cystitis.

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3
Q

A 55-year-old man presents with dysuria, pelvic pain, and fever. Examination reveals an enlarged, tender prostate. What is the most likely diagnosis?
A. Acute bacterial prostatitis
B. Chronic bacterial prostatitis
C. Complicated UTI
D. Pyelonephritis

A

A. Acute bacterial prostatitis

Acute bacterial prostatitis presents with dysuria, pelvic or perineal pain, and systemic symptoms like fever. Prostate tenderness on exam supports this diagnosis.

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4
Q

Which of the following is an independent risk factor for recurrent UTIs in postmenopausal women?
A. Frequent sexual intercourse
B. Use of diaphragms with spermicide
C. Urinary incontinence
D. Lack of circumcision

A

C. Urinary incontinence

In postmenopausal women, risk factors for recurrent UTI include anatomic issues like cystoceles, urinary incontinence, and residual urine.

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5
Q

A 30-year-old woman presents with fever, flank pain, nausea, and vomiting. Urinalysis shows pyuria and bacteriuria. What is the first-line therapy for acute uncomplicated pyelonephritis?
A. Nitrofurantoin for 5 days
B. Ciprofloxacin for 7 days
C. Fosfomycin single dose
D. Amoxicillin for 10 days

A

B. Ciprofloxacin for 7 days

Fluoroquinolones like ciprofloxacin are first-line therapy for acute uncomplicated pyelonephritis. Nitrofurantoin and fosfomycin are not effective for upper urinary tract infections.

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6
Q

What is the recommended treatment duration for catheter-associated UTI (CAUTI)?
A. 3–5 days
B. 5–7 days
C. 7–14 days
D. 14–21 days

A

C. 7–14 days

A 7- to 14-day course of antibiotics is recommended for CAUTI, guided by culture results and clinical response.

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7
Q

Which of the following is a distinguishing feature of pyelonephritis compared to cystitis?
A. Dysuria and urinary frequency
B. Suprapubic discomfort
C. High-grade fever and flank pain
D. Positive nitrite test on urinalysis

A

C. High-grade fever and flank pain

High-grade fever and flank pain are hallmark features of pyelonephritis, distinguishing it from the localized symptoms of cystitis.

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8
Q

Which of the following groups should routinely receive treatment for asymptomatic bacteriuria?
A. All elderly patients
B. Non-pregnant women with diabetes
C. Pregnant women
D. Immunocompetent men without symptoms

A

C. Pregnant women

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9
Q

Which of the following best describes the primary route by which bacteria establish infection in most UTIs?
A. Hematogenous spread
B. Ascension from the urethra to the bladder
C. Contamination during sexual activity
D. Lymphatic spread

A

B. Ascension from the urethra to the bladder

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10
Q

Which of the following therapies is the first-line treatment for symptomatic Candida infections of the urinary tract?
A. Fluconazole
B. Amphotericin B
C. TMP-SMX
D. Nitrofurantoin

A

A. Fluconazole

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11
Q

A 24-year-old woman presents with flank pain, high fever, and vomiting. Urine culture grows E. coli resistant to fluoroquinolones and TMP-SMX. Which of the following is the most appropriate initial therapy?
A. Oral nitrofurantoin
B. IV ceftriaxone
C. Oral fosfomycin
D. IV ciprofloxacin

A

B. IV ceftriaxone

For pyelonephritis with known resistance to fluoroquinolones and TMP-SMX, IV ceftriaxone is appropriate for initial therapy until culture and susceptibility results guide definitive treatment. Nitrofurantoin and fosfomycin are not appropriate for pyelonephritis due to poor tissue penetration.

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12
Q

A 58-year-old woman with diabetes presents with fever, flank pain, and imaging showing gas formation within the renal parenchyma. Which of the following is the most appropriate next step?
A. Begin broad-spectrum antibiotics and observe closely
B. Perform emergent percutaneous drainage
C. Initiate IV antifungals
D. Schedule elective nephrectomy

A

B. Perform emergent percutaneous drainage

Emphysematous pyelonephritis is a life-threatening condition requiring urgent intervention. Percutaneous drainage is the initial step, and nephrectomy may follow if the condition does not improve or is refractory to treatment.

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13
Q

A 50-year-old man presents with a 6-month history of recurrent dysuria and pelvic discomfort. Urine cultures during symptomatic episodes consistently grow E. coli. Which of the following is the most appropriate treatment?
A. 7-day course of ciprofloxacin
B. 2-week course of TMP-SMX
C. 4- to 6-week course of ciprofloxacin
D. Long-term nitrofurantoin prophylaxis

A

C. 4- to 6-week course of ciprofloxacin

Chronic bacterial prostatitis requires prolonged therapy to eradicate infection within the prostate. Ciprofloxacin is an effective agent due to its high penetration into prostatic tissue.

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14
Q

A 72-year-old woman with an indwelling urinary catheter develops fever and leukocytosis. Urine culture reveals Klebsiella pneumoniae with >10
3
3
CFU/mL. Which of the following is the most appropriate next step?
A. Remove the catheter without replacing it and initiate antibiotics
B. Replace the catheter and initiate antibiotics
C. Treat with antibiotics without changing the catheter
D. Perform routine catheter flushing

A

B. Replace the catheter and initiate antibiotics

Changing the catheter is essential in managing catheter-associated UTI (CAUTI) to remove the biofilm-associated organisms that may act as a nidus for infection.

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15
Q

A 63-year-old woman presents with chronic flank pain, fever, and imaging findings of a staghorn calculus with non-functioning renal tissue. What is the definitive treatment for this condition?
A. Percutaneous nephrostomy
B. IV antibiotics and observation
C. Nephrectomy
D. Extracorporeal shock wave lithotripsy

A

C. Nephrectomy

Xanthogranulomatous pyelonephritis involves chronic infection and destruction of renal tissue, often necessitating nephrectomy as definitive treatment.

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16
Q

A 68-year-old woman in the intensive care unit has an indwelling urinary catheter. A urine culture grows Candida glabrata, but she has no urinary symptoms. What is the most appropriate next step?
A. Start oral fluconazole for 7 days
B. Remove the urinary catheter and reassess
C. Start parenteral amphotericin B
D. Treat with oral flucytosine

A

B. Remove the urinary catheter and reassess

Removal of the catheter often resolves candiduria in asymptomatic cases. Antifungal therapy is not indicated for asymptomatic candiduria unless the patient is at high risk for disseminated disease.

17
Q

Which of the following patients with candiduria would benefit from antifungal therapy?
A. A 50-year-old man with asymptomatic candiduria and diabetes mellitus
B. A 60-year-old woman with symptomatic cystitis due to Candida albicans
C. A 45-year-old man with asymptomatic candiduria undergoing broad-spectrum antibiotic therapy
D. A 70-year-old woman with candiduria after catheter removal and no symptoms

A

B. A 60-year-old woman with symptomatic cystitis due to Candida albicans

Therapy is recommended for patients with symptomatic cystitis or pyelonephritis caused by Candida, as well as for high-risk patients (e.g., those undergoing urologic manipulation or neutropenic individuals).

18
Q

A 30-year-old neutropenic man undergoing treatment for leukemia is found to have asymptomatic candiduria. A urine culture grows Candida albicans. What is the best initial treatment?
A. Start oral fluconazole for 7–14 days
B. Observe and repeat the urine culture
C. Initiate parenteral amphotericin B
D. Remove the urinary catheter

A

A. Start oral fluconazole for 7–14 days

Rationale: High-risk patients (e.g., neutropenic individuals) require treatment even if they are asymptomatic, as they are at increased risk for disseminated disease.

19
Q

A urine culture grows Candida krusei in a clinically unstable patient. Which of the following is the most appropriate treatment?
A. Oral fluconazole for 7–14 days
B. Parenteral amphotericin B
C. Oral flucytosine
D. Continue observation

A

B. Parenteral amphotericin B

Candida krusei is intrinsically resistant to fluconazole, and amphotericin B is a preferred option for treating serious urinary Candida infections caused by fluconazole-resistant species.

20
Q

A 65-year-old man with an indwelling urinary catheter develops fever and dysuria. Urine culture grows Escherichia coli at 10³ CFU/mL. Which of the following is true?
A. This does not meet the threshold for CAUTI.
B. This is consistent with asymptomatic bacteriuria.
C. This meets the definition of CAUTI.
D. Antibiotics are not required unless symptoms persist.

A

C. This meets the definition of CAUTI.

CAUTI is defined by bacteriuria (≥10³ CFU/mL) and the presence of symptoms in a catheterized patient.

21
Q

A 45-year-old woman undergoes routine screening. Urine culture grows Escherichia coli at 10⁵ CFU/mL. She denies dysuria, fever, or any urinary symptoms. Which of the following best describes her condition?
A. Cystitis
B. Pyelonephritis
C. Asymptomatic bacteriuria (ASB)
D. Catheter-associated urinary tract infection (CAUTI)

A

C. Asymptomatic bacteriuria (ASB)

ASB is defined by the presence of bacteriuria (≥10⁵ CFU/mL) without any urinary symptoms.

NEPHRO (9 decks)

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