UTIs Flashcards
Jane, a 23-year-old female, presents to her GP with 3 days white and milky vaginal discharge and itchiness/irritation around the genital area. She reveals that she had unprotected sex 2 weeks ago. While examining the cervix and vaginal with the speculum, a swab of the discharge is collected. Laboratory analysis of the high vaginal swab detects the presence of clue cells under the microscope. Which antibiotic should be used to treat Jane’s presentation?
Ceftriaxone Doxycycline Azithromycin Metronidazole Nystatin
Metronidazole
Jim is a 57 year old male presenting acutely to ED with a fever, dysuria, pyuria and pelvic pain. He also has difficulty initiating urination and notices dribbling throughout the day. On digital rectal examination his prostate is tender and is found to be inflamed.Jim is diagnosed with acute prostatitis and is prescribed ciprofloxacin for 14 days as empiric antibiotic. Jim asks what the side effects of this antibiotic are.Which of the following is NOT a potentially serious side effect of ciprofloxacin?
Peripheral neuropathy Tendinitis Ototoxicity Hypoglycaemia Seizures
Ototoxicity
Which is false with regards to Urinary tract infections
Select one:
The most common organisims that cause uncomplicated UTI are UPEC, S. saprophyticus, K.pneumoniae.
Urinary tract infections are the most common hospital acquired infection. The risk for acquiring such an infection can be reduced by removal of urinary catheters
Candida spp is the cause of more uncomplicated Urinary tract infections than complicated Urinary tract infections
Risk factors for Urinary tract infections include , being female, elderly, indwelling catheters, suppression, antibiotic exposure.
Candida spp is the cause of more uncomplicated Urinary tract infections than complicated Urinary tract infections
A 27 year old woman comes to your practice complaining of urinary urgency, increased frequency, and burning when urinating. Her symptoms began 48h ago and she has no fever or costovertebral angle tenderness. She has not experienced anything like this before. Which of the following bacteria are the least likely cause of her symptoms? (Choose the most correct answer)
Select one:
Uropathogenic Escherichia coli
Pseudomonas aeruginosa
Staphylococcus saprophyticus
Klebsiella pneumoniae
Pseudomonas aeruginosa
Eden a 21 year old female presents to her family GP that shes been with for the previous 15 years since moving to wellington when she was 6. She describes a symptoms of dysuria and recalls that shes needing to pee more often and more urgently than usual and this has been going on for about 4-5 days.Eden has recently been swabbed for sexually transmitted infections 2 weeks ago in a routine sexual health check along with her smear and these have both come back negative. on questioning she also confirms that she hasn’t been experiencing any abnormal vaginal discharge or back pain.Eden also has an IUD for contraceptive and menstrual control.Eden has a temp of 37.5 and is otherwise healthy and doesn’t have any known allergies.As her GP what would be the next most appropriate action(s) to take?
Select one:
Take STI swabs and give advice on safe sex and keeping up fluids and to come back if it doesnt go away in 3 days
Empirically treat her with Nitrofurantoin
Empirically treat her with Amoxicillin
Empirically treat her with gentamicin
Gain a midstream urine and send away for culture
Empirically treat her with Nitrofurantoin
A previously healthy 75 year old man presents with a 3 day history of fever, perineal pain, pain at the tip of the penis, frequency, urgency and dysuria. On digital rectal exam the prostate was tender and palpable but soft, with no hard nodules or irregularities. PSA was 40ng/ml-Creatinine clearance was 75ml/min
What is the most appropriate antibiotic to use?
Select one:
Nitrofurantoin
Gentamycin
Trimethoprim
Clindamycin
Co-Trimoxazole
Co-Trimoxazole
A 70 year old woman presents to ED with confusion, flank pain and vomiting. On examination, her heart rate is 94bpm, respiratory rate is 20 and temperature is 38.4. What is the best choice of antibiotics?
Select one:
Gentamicin
Trimethoprim
Cefuroxime
Nitrofurantoin
Cefuroxime
Mrs EC is a 67 year old woman who presents to ED with a 24 hour history of flank pain, fevers and vomiting. She also complains painful urination and seeing blood in her urine.You give her a dose of gentamicin, admit her and start a course of amoxicillin clavulanate, and then leave for your long weekend off.On Tuesday when you review her, she has not clinically improved.Her urine culture has come back showing EBSL-producing E.coli The antibiotics listed below are the ones available on the ward for you to chart. Which one will be most appropriate for Mrs EC, assuming she is otherwise healthy with no other medical conditions?
Meropenem Cefuroxime Amoxicillin clavulanate Ceftriaxone
Meropenem
Mrs J is a 35 year old woman with a 3 day history of painful urination, urgency, and dysuria. In the last 3 hours, she has also experienced fevers, postural hypotension and flank pain. She presents to ED. Without a urine culture, what antibiotic(s) would be best to empirically treat Mrs J?
Select one:
IV Cefuroxime + Oral Co-trimoxazole for switch on day 2
Oral Nitrofuratoin or Oral Trimethoprim
No antibiotics required - this will resolve spontaneously after 2-5 days
IV Co-trimoxazole + Oral Erythromicin for switch on day 3
Piperacillin+Tazobactam IM injection + 10 days of Oral Amoxycillin clavulanate
IV Cefuroxime + Oral Co-trimoxazole for switch on day 2
72 year old Moira is recovering from a partial colectomy in the hospital ward. She presents 2 days post op with fevers, hypotension and confusion.O/E T 38.3, HR=102, O2 Sats 95%.Urine dipstick shows WBC ++, protein +, and nitrates ++Moira has had a catheter in since before the surgery.Culture of catheter urine grows enterococcus fecalis.What is the best management of this?
Select one:
Remove the catheter, start Moira on a course of cephalosporin antibiotics.
Just remove the catheter. Give no antibiotics. Enterococcus is not that virulent and resistant to almost all cephalosporins so no need to give antibiotics.
Remove the catheter, start Moira on a course of Nitrofurantoin/Trimethoprim
Take the urine sample/culture again. It has been contaminated
Start Moira on a course of cephalosporin antibiotics but no point taking the catheter out - the infection is already past lower urinary tract.
Just remove the catheter. Give no antibiotics. Enterococcus is not that virulent and resistant to almost all cephalosporins so no need to give antibiotics.
19 year old Leo Valdez presents to your clinic, suffering from a 2 day history of dysuria. He also noticed penile discharge that was milky white. Leo is currently sexually active and states that he previously had unprotected sex 2 weeks ago.You are highly suspicious of a possible STI and so collect a first pass urine sample from Leo. A PCR test was utilised to identify the infective organism and confirm the diagnosis.Based on this, which antibiotic would you prescribe to Leo?
Select one:
Nystatin
Azithromycin
Acyclovir
Ceftriaxone
Metronidazole
Azithromycin
Mrs Anderson is 8 weeks pregnant and has visited your GP practice to discuss a few cranberry based supplements that she has picked up, on the recommendation of her girlfriends. As you check through her notes, you identify that she has had a number of urinary tract infections over the past 3 years. So you make your mind up that you will ask her to take a urine dipstick test while she is here. The test shows that her urine was positive for Nitrites and leukocytes. She has not experienced any symptoms at all concerning her urinary tract, explaining to you that she has had it plenty of times before and would know if she had one. How do you go about managing this issue ? (note that repeat test will show same result)
Select one:
Antibiotic Treatment will be required - Trimethoprim
Suggest that she make her way to ED as this could be harmful to the fetus
No treatment required as there is no evidence that suggests antibiotics will reduce her chance of developing symptoms
Antibiotic treatment required - Nitrofurantoin
Tell her to avoid using the supplements as they will increase her chances of developing a urinary tract infection
Antibiotic treatment required - Nitrofurantoin
Miss Herbert, a 27 year old presented to her GP following two days of dysuria and frequency. She had recently been to hospital for surgery during which time she had a urinary catheter. She reported no discharge, no abnormal vaginal bleeding, no fever, no back pain. She was started on empiric treatment for a UTI. After finishing the course, she found that she still had her symptoms and was feeling no better. The GP then decided to send a urine culture which grew Pseudomonas aeruginosa. Which of the following would be the best treatment to use for Miss Herbert?
Select one:
Nitrofurantoin
Ciprofloxacin
Trimethoprim
Cefuroxime
Clotrimazole
Ciprofloxacin
Jennifer, a 24 year old woman visits you, her GP, with symptoms of cystitis.She is a non-smoker and drinks alcohol on the weekends.Her past medical history includes appendicectomy aged 12, depression, Crohn’s disease and PCOS.You decide to give her trimethoprim for her UTI. As she leaves you remember to ask her what medications she’s taking. She says she taking fluoxetine, methotrexate , pentaza and metformin.You thank your lucky stars you remembered to ask her.What drug interaction will you now avoid?
Select one:
- Trimethoprim is a bacterial dihydrofolate reductase inhibitor. Combining it with methotrexate can have devastating side effects such as bone marrow suppression and pancytopaenia. These can be lethal. As a precaution, you decide to lower her dose of methotrexate until she has finished her course of trimethoprim.
- Fluoxetine can cause symptoms of pseudo-UTI, whereby the urethra is inflamed but not infected. This is due to metabolites of fluoxetine being excreted into the kidneys. You know that Jennifer therefore doesn’t need trimethoprim. You instead send her home with information and reassurance.
- Pentaza increases the absorption of trimethoprim, which causes devastating side effects such as bone marrow suppression and pancytopaenia. As Jennifer already has an infection, further compromising her immune system could lead to fatal consequences. Best to take her off the pentaza until she has finished her course of antibiotics
- Trimethoprim is a bacterial dihydrofolate reductase inhibitor. Combining it with with methotrexate can have devastating side effects such as bone marrow suppression and pancytopaenia. These can be lethal. You decide to change the trimethoprim to nitrofurantoin.
Trimethoprim is a bacterial dihydrofolate reductase inhibitor. Combining it with with methotrexate can have devastating side effects such as bone marrow suppression and pancytopaenia. These can be lethal. You decide to change the trimethoprim to nitrofurantoin.
Which of the following statement about uncomplicated cystitis is false:
Select one:
Urine culture is needed in women with symptoms but no vaginal discharge
Laboratory diagnosis is based on microscopic urinalysis, which indicates microscopic pyuria, bacteriuria, and occasionally hematuria
Adults with uncomplicated cystitis can be treated with nitrofurantoin or trimethoprim
Children with uncomplicated cystitis can be treated with cefaclor or augmentin
Urine culture is needed in women with symptoms but no vaginal discharge
