UTI and Prostatitis

Question 1

1. The preferred treatment option for an initial UTI episode in a 22-year-old female patient with normal renal function is:

A. Trimethoprim-sulfamethoxazole
B. Cefuroxime
C. Nitrofurantoin
D. Amoxicillin
E. Ciprofloxacin

Answer 1

C

Question 2

2. Which of the following treatments options may be used in patients with uncomplicated cystitis as a single-dose therapy:

A. Ciprofloxacin
B. Amoxicillin/clavulanate
C. Gentamicin
D. Fosfomycin
E. Methenamine

Answer 2

D

Question 3

3. The preferred antibiotic regimen in a male patient with pyelonephritis and concomitant urosepsis due to Pseudomonas aeruginosa is:

A. Ertapenem
B. Amoxicillin-clavulanic acid
C. Fosfomycin
D. Piperacillin-tazobactam
E. Gentamicin

Answer 3

D

Question 4

4. The preferred regimen for patients requiring a single-dose intravenous antibiotic as supplemental therapy for treatment of pyelonephritis due to fluoroquinolone resistant E. coli is:

A. Trimethoprim-sulfamethoxazole
B. Ceftriaxone
C. Ampicillin/sulbactam
D. Ceftazidime
E. Ciprofloxacin

Answer 4

B

Question 5

5. Which of the following fluoroquinolone antibiotics should not be used for UTIs due to its limited urinary excretion?

A. Moxifloxacin
B. Ofloxacin
C. Levofloxacin
D. Ciprofloxacin
E. Norfloxacin

Answer 5

A

Question 6

6. Decreases in a patient’s glomerular filtration rate can significantly decrease urine concentrations of all of the following antibiotics except:

A. Gentamicin
B. Levofloxacin
C. Minocycline
D. Nitrofurantoin
E. Trimethoprim-sulfamethoxazole

Answer 6

B

Question 7

7. A 29-year-old woman who is 20 weeks pregnant has a routine clean-catch urine growth E. coli at a scheduled visit. The following are treatment options for this patient except:

a. Amoxicillin-clavulanate
b. Cephalexin
c. Ciprofloxacin
d. Trimethoprim/sulfamethoxazole
e. Nitrofurantoin

Answer 7

C

Question 8

8. A 26-year-old man with a fever of 39.8°C and flank pain who had a renal transplant 6 months ago and is still on high doses of immunosuppressive therapy. Blood cultures are no growth at 48 hours, but Klebsiella pneumoniae (> 200 CFU/mL [200 × 103CFU/L] ) is isolated from his clean-catch urine sample. The patient has a recent history of a long
   hospital and intensive care unit stay. His creatinine clearance is currently estimated to be 50 mL/min (0.83 mL/s), and is hepatic function is normal. Based on his medical history, which of the following is the most appropriate empiric antimicrobial therapy?

A. Cefazolin
B. Cefepime
C. Ciprofloxacin
D. Doripenem
E. No treatment is recommended at this time

Answer 8

C

Question 9

9. The urine identification and susceptibility results from the previous patient return
   Klebsiella pneumoniae that is sensitive to all of the antibiotics listed in question 8. Which of the following antibiotics is most appropriate for this patient’s complicated UTI as outpatient treatment?

A. Cefazolin
B. Cefepime
C. Ciprofloxacin
D. Doripenem
E. No treatment is recommended at this time

Answer 9

C

Question 10

10. Methenamine hippurate and methenamine mandelate are effective options for preventing recurrent UTIs due to its mechanism of action of:

A. Acidifying the urine
B. Conversion to the antimicrobial formaldehyde
C. Preventing microbial attachment
D. Increasing renal clearance of pathogens
E. Recolonization of normal flora

Answer 10

B

Question 11

11. The appropriate treatment for an asymptomatic 65-year-old man with an
    indwelling catheter, moderate renal impairment, and bacteriuria with pan-susceptible Enterobactercloacae is:

A. Trimethoprim-sulfamethoxazole
B. Ciprofloxacin
C. Ampicillin-sulbactam
D. Cefepime
E. Hold antibiotics and remove the catheter if possible

Answer 11

E

Question 12

12. A 60-year-old woman with a urinary catheter develops symptoms of a UTI that include fever, flank pain, elevated white blood count. The patient cannot have the catheter removed, but he is started on ciprofloxacin. The catheter be replaced:

A. Immediately
B. When the initial catheter is 1 week old
C. When the initial catheter is 2 weeks old
D. When the initial catheter is 4 weeks old
E. The catheter should not be replaced as this increasing the risk of
reinfection

Answer 12

C

Question 13

13. For patients requiring continuous prophylaxis due to recurrent lower tract UTIs, the recommended duration for a prophylaxis course is:

A. 2 weeks
B. 1 month
C. 3 months
D. 6 months
E. 1 year

Answer 13

D

Question 14

14. Nitrofurantoin or fosfomycin are currently recommended over ciprofloxacin as first-line empiric agents for treatment of uncomplicated cystitis because these two agents possess:

A. Limited scope of activity directed toward common uropathogens
B. Increased adherence potential
C. Greater activity against E. coli
D. Lower probability for resistance emergence in E. coli
E. No differences have been shown between fluoroquinolone, nitrofurantoin,
and fosfomycin treatment regimens

Answer 14

A

Question 15

15. A 5-year-old girl with no significant past medical history presents to the pediatrician
    due to increased urinary incontinence and general complaints of back pain. Recommend the most appropriate empiric antibiotic regimen.

A. Doxycycline
B. Ertapenem
C. Norfloxacin
D. Amoxicillin-clavulanic acid
E. Tobramycin

Answer 15

D

Question 16

1. Which of the following is the most common bacterial cause of acute cystitis in an otherwise healthy, 22-year-old woman?

A. Klebsiella pneumoniae
B. Escherichia coli
C. Staphylococcus saprophyticus
D. Proteus mirabilis

Answer 16

B

Question 17

2. H.G. is a 20-year-old college junior. She presents to her PCP with complaints of painful urination and increased urinary frequency, both of which began 2 days ago. She has no other symptoms and
   her vital signs are normal. She is otherwise healthy and not pregnant. Assuming she does not live in an area of high antimicrobial resistance, which of the following would be the best therapy for her at this time and best represents a first-line empiric treatment for acute cystitis in an otherwise healthy, nonpregnant woman?

A. Trimethoprim/sulfamethoxazole one DS tablet by mouth every 12 hours for 5 days
B. Ertapenem 1 g intravenous for 3 days
C. Nitrofurantoin 100 mg by mouth every 12 hours for 5 days
D. Ciprofloxacin 500 mg by mouth every 12 hours for 3 days

Answer 17

C

Question 18

3. For trimethoprim/sulfamethoxazole to be a viable first-line option for the empiric treatment of acute cystitis, resistance of E. coli should be less than which of the following percentages?

A. 5%
B. 10%
C. 20%
D. 25%

Answer 18

C

Question 19

4. Which of the following would a patient suffering from pyelonephritis be most likely to experience?

A. Flank pain
B. Altered mental status
C. Temperature of 37C
D. Increased appetite

Answer 19

A

Question 20

5. J.P. is a 29-year-old woman who presents to the emergency department for a self-reported fever, painful urination, and flank pain. She is diagnosed with acute pyelonephritis, but the attending
   physician does not feel as though she requires hospitalization. The physician would like to discharge home with an oral antibiotic but also wants to give an intravenous antibiotic prior to discharge.
   Which of the following would be the best option for this patient?

A. Daptomycin
B. Ertapenem
C. Piperacillin/tazobactam
D. Tobramycin (24-hour dosed)

Answer 20

D

Question 21

6. J.S. is a 25-year-old woman who is 30 weeks pregnant. At a routine appointment with her obstetrician, a clean-catch urine specimen is collected, which grows greater than 100,000 CFUs of a Gram-negative rod, with sensitivities pending. The patient is asymptomatic of a UTI. Which of the
   following is the best treatment for the patient at this time?

A. Ciprofloxacin 500 mg by mouth every 12 hours for 3 days
B. Trimethoprim/sulfamethoxazole one DS tablet by mouth every 12 hours for 3 days
C. Cefpodoxime 100 mg by mouth every 12 hours for 7 days
D. The patient does not require treatment since she is asymptomatic

Answer 21

C

Question 22

7. B.P. is an 84-year-old man who resides at a skilled nursing facility. He requires a permanent indwelling Foley catheter. His catheter is routinely changed on a monthly basis. One week after his
   last catheter change, routine quarterly labs are performed on the patient, which include a CMP, CBC, and urinalysis. The urinalysis reveals the presence of leukocyte esterase but is negative for nitrites.
   The patient has no symptoms of a UTI and is at his normal baseline mental status. Which of the following is the most appropriate course of action at this time?

A. Replace the catheter now and begin empiric antimicrobials
B. Do not replace the catheter now but begin empiric antimicrobials
C. Replace the catheter now but do not begin empiric antimicrobials
D. Do not replace the catheter and do not begin empiric antimicrobials

Answer 22

D

Question 23

8. Which of the following antimicrobials is associated with the greatest risk for collateral damage?

A. Cephalexin
B. Nitrofurantoin
C. Levofloxacin
D. Trimethoprim/sulfamethoxazole

Answer 23

C

Question 24

9. Which of the following would a patient with acute prostatitis most likely experience?

A. Fever and chills
B. Difficulty with urination
C. Perineal pain
D. Low back pain

Answer 24

A

Question 25

10. Which of the following represents the best length of therapy needed for a patient diagnosed with chronic prostatitis? A. 7 days B. 10 days C. 4 weeks D. 6 weeks

Answer 25

D

Question 26

11. N.M. is a 22-year-old, otherwise healthy woman who recently graduated from college. She presents to the outpatient pharmacy with a prescription for trimethoprim/sulfamethoxazole (Bactrim DS), one tablet PO BID for 3 days for acute cystitis. The pharmacist filling the prescription knows that E. coli resistance to trimethoprim/sulfamethoxazole in the area is approximately 28%. What is the most appropriate action for the pharmacist to do at this time? A. Call the prescribing physician for a new prescription for ciprofloxacin (Cipro) B. Call the prescribing physician to get the length of therapy extended to 7 days C. Fill the prescription as written and counsel the patient on possible adverse drug events D. Call the prescribing physician to change the antibiotic to nitrofurantoin 100 mg by mouth every 12 hours for 5 days

Answer 26

D

Question 27

12. W.N. is a 40-year-old woman who presents to her PCP with complaints of flank pain, burning upon urination, and fever 102F. She is diagnosed with acute pyelonephritis, though the physician says she does not require hospitalization. She has NKDA and has no significant PMH. Resistance in the area of E. coli to ciprofloxacin and trimethoprim/sulfamethoxazole is 7% and 15%, respectively. Which of the following is the most appropriate treatment for her at this time? A. Ciprofloxacin 500 mg BID orally for 7 days B. Trimethoprim/sulfamethoxazole 160/800 mg BID for 14 days C. Ertapenem 1 g IV daily for 3 days D. Nitrofurantoin 100 mg PO BID for 7 days

Answer 27

A

Question 28

13. Which of the following antimicrobials is contraindicated in patients with a creatinine clearance less than 30 mL/min due to decreased efficacy and increased risk of adverse effects? A. Nitrofurantoin B. Ciprofloxacin C. Amoxicillin/clavulanate D. Trimethoprim/sulfamethoxazole

Answer 28

A

Question 29

14. Y.Y. is a 66-year-old woman who presents to an urgent care facility with complaints of dysuria, frequency of urination, and urgency to urinate over the past 3 days. She also reports some left flank pain, which she rates as a 4 out 10 in severity and says it has not impacted her activities of daily living. She denies any nausea, vomiting, or diarrhea. She decided to see a physician because she started to feel feverish in the past 24 hours. Her regular physician is out of town on vacation which is why she is visiting the urgent care center today. Vitals in clinic: T: 101.2F RR: 14 breaths/min BP: 114/68 mm Hg Pulse: 72 beats/min. PMH is significant for hypertension, GERD, and diabetes mellitus type 2. She has NKDA. Local resistance patterns from the community are not known. A urine culture is obtained, which is pending, and the following are the results from her urinalysis: Reference Range Result Appearance Clear Hazy Color Clear Amber Specific gravity 1.002–1.030 1.016 Urine pH 5.0–7.0 5.2 Urine glucose None None Urine protein None None Urine bilirubin None None Urine WBC None 30 cells/hpf Leukocyte esterase None 3+ Nitrites Negative Positive Bacteria None Many Which of the following is the best recommendation for Y.Y. at this time? A. Admit to the hospital for treatment ceftriaxone 1 g IV once daily B. Trimethoprim/sulfamethoxazole 80/400 mg by mouth every 12 hours for 14 days C. Fosfomycin 3 g by mouth every 24 hours for three doses D. Ceftriaxone 1 g IV as a one-time dose, then begin ciprofloxacin 500 mg by mouth every 12 hours for 7 days

Answer 29

D

Question 30

15. J.C. is a 73-year-old man who has a PMH significant for hypertension and depression. Over the past year, he has had three different UTIs, all due to pan-sensitive Klebsiella pneumoniae. He also complains of difficulty urinating and has had low back pain for several months. He is diagnosed with chronic prostatitis. Which of the following is the best recommendation for J.C. at this time? A. Ciprofloxacin 500 mg by mouth every 12 hours for 4 weeks B. Amoxicillin/clavulanate 500 mg/125 mg by mouth every 8 hours for 12 weeks C. Levofloxacin 750 mg by mouth once daily for 8 weeks D. Trimethoprim/sulfamethoxazole one DS tablet by mouth every 12 hours for 4 weeks

Answer 30

C