Urinary tract infections MCQs With Answer

Introduction: Urinary tract infections (UTIs) are common and clinically significant for B. Pharm students studying pharmacology, therapeutics, and clinical pharmacy. This concise, keyword-rich overview covers UTI pathophysiology, common pathogens (E. coli, Klebsiella, Proteus), diagnostic tests (urinalysis, culture, dipstick), antimicrobial selection (nitrofurantoin, TMP-SMX, fosfomycin, fluoroquinolones), resistance mechanisms (ESBLs), dosing adjustments in renal impairment, catheter-associated infections, and antimicrobial stewardship. Understanding microbiology, PK/PD, drug safety in pregnancy, and prevention strategies helps future pharmacists optimize treatment and reduce recurrence. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which pathogen is the most common cause of community-acquired uncomplicated urinary tract infections?

• Staphylococcus aureus
• Escherichia coli
• Klebsiella pneumoniae
• Enterococcus faecalis

Correct Answer: Escherichia coli

Q2. A positive nitrite test on a urine dipstick most specifically suggests which of the following?

• Presence of leukocyte esterase
• Presence of nitrate-reducing bacteria
• Proteinuria due to glomerular disease
• Crystalluria

Correct Answer: Presence of nitrate-reducing bacteria

Q3. Which urinary tract infection presentation is characterized by flank pain, fever, and systemic symptoms?

• Asymptomatic bacteriuria
• Acute cystitis
• Acute pyelonephritis
• Urethritis

Correct Answer: Acute pyelonephritis

Q4. Which antibiotic is commonly recommended as first-line oral therapy for uncomplicated cystitis in many guidelines?

• Nitrofurantoin
• Ampicillin
• Ceftriaxone
• Vancomycin

Correct Answer: Nitrofurantoin

Q5. Fosfomycin’s single-dose regimen for uncomplicated cystitis works primarily by inhibiting which bacterial process?

• Protein synthesis at the 30S ribosomal subunit
• Peptidoglycan cell wall synthesis via MurA inhibition
• DNA gyrase activity
• Folate synthesis by inhibiting dihydropteroate synthase

Correct Answer: Peptidoglycan cell wall synthesis via MurA inhibition

Q6. Which antibiotic is contraindicated in pregnancy for treatment of uncomplicated UTI due to teratogenic risk?

• Amoxicillin
• Trimethoprim-sulfamethoxazole in first trimester
• Nitrofurantoin in second trimester
• Cefuroxime

Correct Answer: Trimethoprim-sulfamethoxazole in first trimester

Q7. In catheter-associated urinary tract infection (CA-UTI) management, which step is most important in addition to appropriate antibiotics?

• Immediate bladder irrigation in all patients
• Replacement or removal of the urinary catheter
• Empiric antifungal therapy
• Routine daily culture monitoring

Correct Answer: Replacement or removal of the urinary catheter

Q8. Which drug’s urinary concentration is high and makes it effective for lower UTIs but not for pyelonephritis?

• Levofloxacin
• Nitrofurantoin
• Ciprofloxacin
• Amikacin

Correct Answer: Nitrofurantoin

Q9. Asymptomatic bacteriuria should be treated in which of the following patient groups?

• Healthy nonpregnant adults
• Pregnant women
• Patients with short-term catheterization only
• All elderly patients regardless of symptoms

Correct Answer: Pregnant women

Q10. Extended-spectrum beta-lactamases (ESBLs) confer resistance by which mechanism?

• Altering drug target ribosomal binding sites
• Enzymatic hydrolysis of beta-lactam antibiotics
• Increased efflux pump expression of fluoroquinolones
• Decreased permeability to aminoglycosides only

Correct Answer: Enzymatic hydrolysis of beta-lactam antibiotics

Q11. Which laboratory test quantifies bacteriuria and helps diagnose UTI when interpreted with clinical context?

• Urine culture with colony count (CFU/mL)
• Serum creatinine
• Blood culture only
• Urine protein electrophoresis

Correct Answer: Urine culture with colony count (CFU/mL)

Q12. In pharmacodynamics, which antibiotic class exhibits concentration-dependent killing useful in severe pyelonephritis?

• Beta-lactams
• Aminoglycosides
• Beta-lactamase inhibitors
• Tetracyclines

Correct Answer: Aminoglycosides

Q13. Which of the following is a common oral option for uncomplicated UTI where local resistance to TMP-SMX is high?

• Fosfomycin trometamol single dose
• Intravenous cefazolin only
• Oral vancomycin
• Oral amphotericin B

Correct Answer: Fosfomycin trometamol single dose

Q14. Which clinical feature distinguishes complicated UTI from uncomplicated UTI?

• Urinary frequency only
• Presence of structural or functional urinary tract abnormality
• Dysuria without systemic signs
• Asymptomatic bacteriuria

Correct Answer: Presence of structural or functional urinary tract abnormality

Q15. Which antimicrobial requires dose adjustment in renal impairment to avoid toxicity when used for UTI?

• Nitrofurantoin even in severe renal impairment
• Fosfomycin without any adjustment
• Trimethoprim-sulfamethoxazole
• Ceftriaxone which is exclusively hepatic

Correct Answer: Trimethoprim-sulfamethoxazole

Q16. A positive leukocyte esterase on dipstick indicates which of the following?

• Bacterial nitrate reduction
• Presence of white blood cells in urine
• High glucose in urine
• Hematuria

Correct Answer: Presence of white blood cells in urine

Q17. Which antibiotic is often avoided for lower UTI in patients with significant renal impairment because it concentrates poorly in the bladder?

• Fosfomycin
• Nitrofurantoin
• Trimethoprim-sulfamethoxazole
• Amoxicillin

Correct Answer: Nitrofurantoin

Q18. Which symptom is most characteristic of acute cystitis?

• Severe costovertebral angle tenderness and fever
• Burning micturition and urinary frequency
• Asymptomatic microscopic bacteriuria
• Painful scrotal swelling

Correct Answer: Burning micturition and urinary frequency

Q19. Which antibiotic mechanism is most relevant to trimethoprim’s activity against UTI pathogens?

• Inhibition of DNA gyrase
• Inhibition of dihydrofolate reductase
• Disruption of 50S ribosomal subunit
• Blocking cell wall cross-linking via PBPs

Correct Answer: Inhibition of dihydrofolate reductase

Q20. For suspected severe pyelonephritis with sepsis, the empiric inpatient therapy should prioritize what?

• Oral nitrofurantoin
• Rapid initiation of broad-spectrum IV antibiotics covering gram-negatives
• Wait for culture results before starting any antibiotics
• Topical antiseptics for urinary meatus

Correct Answer: Rapid initiation of broad-spectrum IV antibiotics covering gram-negatives

Q21. Which imaging modality is preferred to evaluate complicated UTI or suspected obstruction?

• Plain abdominal X-ray
• Renal ultrasound
• Electrocardiogram
• Chest radiograph

Correct Answer: Renal ultrasound

Q22. Which bacteria is most associated with struvite stone formation and recurrent UTI?

• Enterococcus faecalis
• Proteus mirabilis
• Streptococcus pneumoniae
• Staphylococcus epidermidis

Correct Answer: Proteus mirabilis

Q23. The minimum inhibitory concentration (MIC) is best defined as:

• The highest antibiotic concentration that permits bacterial growth
• The lowest antibiotic concentration that prevents visible bacterial growth in vitro
• The concentration at which bacteria are killed instantly
• The serum drug concentration in the patient after dosing

Correct Answer: The lowest antibiotic concentration that prevents visible bacterial growth in vitro

Q24. Which strategy is recommended to prevent recurrent UTIs in sexually active young women?

• Postcoital antimicrobial prophylaxis
• Daily systemic corticosteroids
• Chronic broad-spectrum IV antibiotics
• Routine bladder instillations with antiseptics

Correct Answer: Postcoital antimicrobial prophylaxis

Q25. Which urinary biomarker increases in bacterial infection and can help assess severity?

• Urinary albumin
• Procalcitonin (serum, not urinary) often correlates with severe infection
• Urinary bilirubin
• Fasting blood glucose

Correct Answer: Procalcitonin (serum, not urinary) often correlates with severe infection

Q26. Which oral antibiotic achieves high urinary concentrations and is effective against many Enterobacteriaceae but has growing resistance concerns?

• Fluoroquinolones (e.g., ciprofloxacin)
• Linezolid
• Rifampin
• Daptomycin

Correct Answer: Fluoroquinolones (e.g., ciprofloxacin)

Q27. In bacterial prostatitis associated with UTI, which antibiotic property is important for adequate treatment?

• Poor tissue penetration but high urinary excretion
• Ability to achieve therapeutic prostatic tissue concentrations
• Only topical activity at the urinary meatus
• Strictly bacteriostatic activity with no tissue penetration

Correct Answer: Ability to achieve therapeutic prostatic tissue concentrations

Q28. Which mechanism contributes to biofilm-associated antibiotic tolerance in catheter-associated UTIs?

• Enhanced antibiotic uptake into cells
• Physical barrier and altered metabolic state of bacteria in biofilm
• Increased susceptibility to host immune clearance
• Immediate lysis of bacteria on antibiotic exposure

Correct Answer: Physical barrier and altered metabolic state of bacteria in biofilm

Q29. Which antibiotic combination adds a beta-lactamase inhibitor to piperacillin to extend its spectrum for complicated UTIs?

• Piperacillin-tazobactam
• Piperacillin-vancomycin
• Piperacillin-amikacin
• Piperacillin alone without inhibitor

Correct Answer: Piperacillin-tazobactam

Q30. Which of the following is a risk factor for recurrent urinary tract infections?

• Short-term antibiotic course with confirmed eradication
• Frequent sexual activity and spermicide use
• Daily cranberry consumption
• Postmenopausal estrogen therapy

Correct Answer: Frequent sexual activity and spermicide use

Q31. Which lab finding on microscopy indicates bacterial infection in urine?

• Numerous epithelial cells only
• Pyuria (white blood cells in urine)
• High urinary calcium crystals only
• Presence of squamous cells from skin contamination

Correct Answer: Pyuria (white blood cells in urine)

Q32. Which oral agent is typically avoided in children for UTI treatment due to potential effects on cartilage?

• Nitrofurantoin
• Trimethoprim-sulfamethoxazole
• Fluoroquinolones
• Amoxicillin-clavulanate

Correct Answer: Fluoroquinolones

Q33. Which factor most strongly indicates the need for urine culture rather than empiric symptomatic treatment?

• First episode of mild dysuria in young healthy woman
• Recurrent or complicated symptoms, treatment failure, or severe illness
• Asymptomatic bacteriuria in nonpregnant adult
• Single episode of nocturia without dysuria

Correct Answer: Recurrent or complicated symptoms, treatment failure, or severe illness

Q34. Which antimicrobial class is primarily time-dependent in killing and benefits from prolonged infusion or frequent dosing?

• Aminoglycosides
• Beta-lactams
• Fluoroquinolones
• Metronidazole

Correct Answer: Beta-lactams

Q35. Which condition warrants immediate urine culture and blood cultures with parenteral antibiotics rather than oral therapy?

• Uncomplicated cystitis in a young woman
• Severe sepsis or hemodynamic instability with suspected UTI
• Mild dysuria without fever
• Asymptomatic bacteriuria in a healthy patient

Correct Answer: Severe sepsis or hemodynamic instability with suspected UTI

Q36. Which of these is an adverse effect commonly associated with nitrofurantoin?

• Ototoxicity leading to hearing loss
• Pulmonary fibrosis with long-term use
• Red man syndrome
• Cholestatic jaundice universally

Correct Answer: Pulmonary fibrosis with long-term use

Q37. Which of the following best defines bacteriologic cure in UTI management studies?

• Reduction of symptoms regardless of culture
• Sterile urine culture at follow-up after treatment
• Normalization of blood glucose levels
• Only negative dipstick tests

Correct Answer: Sterile urine culture at follow-up after treatment

Q38. Which oral antibiotic is considered safe and effective for treating uncomplicated UTI in many pregnant patients (with appropriate sensitivity)?

• Trimethoprim-sulfamethoxazole throughout pregnancy
• Amoxicillin or cephalexin where susceptibilities allow
• Tetracyclines
• Fluoroquinolones during first trimester

Correct Answer: Amoxicillin or cephalexin where susceptibilities allow

Q39. Which resistance mechanism reduces efficacy of fluoroquinolones against Enterobacteriaceae?

• Mutations in DNA gyrase or topoisomerase genes
• Increased intracellular folate synthesis
• Production of beta-lactamases only
• Altered peptidoglycan cross-linking

Correct Answer: Mutations in DNA gyrase or topoisomerase genes

Q40. For complicated UTI requiring inpatient IV therapy, which agent offers strong gram-negative coverage including many resistant strains when combined appropriately?

• Aminoglycosides in combination with a beta-lactam
• Oral nitrofurantoin alone
• Topical antiseptics
• Therapeutic phlebotomy

Correct Answer: Aminoglycosides in combination with a beta-lactam

Q41. Which preventative measure can reduce UTI risk in postmenopausal women?

• High-dose systemic antibiotics indefinitely
• Topical vaginal estrogen therapy
• Avoiding all hydration
• Frequent catheterization

Correct Answer: Topical vaginal estrogen therapy

Q42. Which lab test is most sensitive for detecting hematuria associated with UTI or other urinary pathology?

• Urine dipstick for blood
• Serum hemoglobin only
• Chest X-ray
• Blood urea nitrogen exclusively

Correct Answer: Urine dipstick for blood

Q43. Which antibiotic’s efficacy for UTI correlates with time above MIC rather than peak concentration?

• Aminoglycosides
• Beta-lactams such as ceftriaxone
• Fluoroquinolones
• Metronidazole

Correct Answer: Beta-lactams such as ceftriaxone

Q44. Which organism is a common cause of UTI in hospitalized patients and is notable for intrinsic resistance to many antibiotics?

• Pseudomonas aeruginosa
• Streptococcus pyogenes
• Moraxella catarrhalis
• Treponema pallidum

Correct Answer: Pseudomonas aeruginosa

Q45. Which urinary symptom cluster would most likely indicate lower rather than upper urinary tract infection?

• High fever, rigors, and flank pain
• Urgency, frequency, suprapubic discomfort
• Confusion without urinary symptoms in elderly only
• Severe hypotension and multi-organ failure

Correct Answer: Urgency, frequency, suprapubic discomfort

Q46. Which antibiotic is frequently used as a single-dose treatment for uncomplicated cystitis due to its convenience and urinary activity?

• Fosfomycin trometamol
• Oral vancomycin single dose
• Acyclovir single dose
• Oral amphotericin B single dose

Correct Answer: Fosfomycin trometamol

Q47. Which stewardship principle is important when selecting therapy for UTI?

• Use the broadest-spectrum antibiotic available for all patients
• Tailor therapy based on culture and susceptibility results when possible
• Prescribe antibiotics indefinitely to prevent recurrence
• Always combine three antibiotics empirically

Correct Answer: Tailor therapy based on culture and susceptibility results when possible

Q48. Which change in urine culture results suggests contamination rather than true infection?

• Growth of a single uropathogen at >100,000 CFU/mL in a clean-catch specimen
• Mixed growth of multiple organisms at low colony counts
• Sterile culture with persistent symptoms
• Pure growth of E. coli at high counts

Correct Answer: Mixed growth of multiple organisms at low colony counts

Q49. Which class of antibiotics is often recommended for complicated UTI when ESBL-producing organisms are suspected and carbapenem-sparing options are needed?

• Oral first-generation cephalosporins only
• Beta-lactam/beta-lactamase inhibitor combinations with activity against ESBL producers in some cases
• Topical mupirocin
• Antifungal azoles

Correct Answer: Beta-lactam/beta-lactamase inhibitor combinations with activity against ESBL producers in some cases

Q50. Which patient counseling point is most appropriate when dispensing nitrofurantoin for uncomplicated UTI?

• It should be taken on an empty stomach only and indefinitely
• It may cause urine discoloration and should be avoided if creatinine clearance is severely reduced
• It treats pyelonephritis effectively as IV therapy
• It has no adverse effects and requires no monitoring

Correct Answer: It may cause urine discoloration and should be avoided if creatinine clearance is severely reduced

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