Candiduria, the presence of Candida species in the urine, is a common finding in hospitalized patients, especially those with indwelling urinary catheters. The pharmacist’s role in managing this condition is crucial for promoting antimicrobial stewardship, primarily by differentiating asymptomatic colonization from a true infection requiring treatment. As detailed in the curriculum through courses like Patient Care 2, understanding the pharmacology of antifungals and the principles of infectious disease management is essential. This quiz will test your knowledge on the risk factors, diagnosis, and evidence-based management of candiduria.
1. Candiduria is defined as:
- a. A bacterial urinary tract infection.
- b. The presence of Candida species in the urine.
- c. An infection of the kidney parenchyma.
- d. The presence of white blood cell casts in the urine.
Answer: b. The presence of Candida species in the urine.
2. What is the single most common risk factor for developing candiduria?
- a. A high-sugar diet
- b. The presence of an indwelling urinary catheter.
- c. Old age
- d. Hypertension
Answer: b. The presence of an indwelling urinary catheter.
3. A patient with an indwelling catheter has a urine culture positive for Candida albicans but has no fever, dysuria, or other signs of infection. This condition is best described as:
- a. Urosepsis
- b. Fungal pyelonephritis
- c. Symptomatic candiduria
- d. Asymptomatic candiduria
Answer: d. Asymptomatic candiduria
4. What is the most appropriate first step in managing asymptomatic candiduria in a catheterized patient?
- a. Start oral fluconazole immediately.
- b. Start IV amphotericin B.
- c. Remove or exchange the urinary catheter.
- d. Obtain a blood culture.
Answer: c. Remove or exchange the urinary catheter.
5. In which of the following patient populations should asymptomatic candiduria generally be treated with antifungal therapy?
- a. Elderly patients in long-term care facilities.
- b. Patients with spinal cord injuries.
- c. Neutropenic patients and low-birth-weight infants.
- d. All patients with a positive urine culture.
Answer: c. Neutropenic patients and low-birth-weight infants.
6. The “Management of Fungal Infections” is a specific learning module in which course?
- a. PHA5782C Patient Care 2
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5784C Patient Care 4
Answer: a. PHA5782C Patient Care 2
7. What is the drug of choice for treating a symptomatic UTI caused by a fluconazole-susceptible Candida albicans?
- a. Amphotericin B
- b. Micafungin
- c. Oral fluconazole
- d. Terbinafine
Answer: c. Oral fluconazole
8. Why is fluconazole a preferred agent for fungal UTIs?
- a. It is the only antifungal with activity against Candida.
- b. It achieves high concentrations in the urine and is available orally.
- c. It has no drug interactions.
- d. It has a very narrow spectrum of activity.
Answer: b. It achieves high concentrations in the urine and is available orally.
9. A patient’s urine culture grows Candida glabrata. This is clinically significant because this species:
- a. Is never a true pathogen.
- b. Is always susceptible to fluconazole.
- c. Often exhibits resistance to fluconazole.
- d. Is not a type of yeast.
Answer: c. Often exhibits resistance to fluconazole.
10. Which of the following antifungal agents would be appropriate for treating a symptomatic UTI caused by fluconazole-resistant C. glabrata?
- a. Ketoconazole
- b. Nystatin cream
- c. Amphotericin B deoxycholate or flucytosine
- d. Itraconazole
Answer: c. Amphotericin B deoxycholate or flucytosine
11. The pharmacology of antifungals is a topic within the Patient Care 2 curriculum.
- a. True
- b. False
Answer: a. True
12. The mechanism of action of fluconazole involves the inhibition of:
- a. Fungal cell wall synthesis.
- b. Fungal DNA gyrase.
- c. Fungal 14-alpha-demethylase, an enzyme needed for ergosterol synthesis.
- d. Fungal protein synthesis.
Answer: c. Fungal 14-alpha-demethylase, an enzyme needed for ergosterol synthesis.
13. Amphotericin B’s mechanism of action involves:
- a. Inhibiting ergosterol synthesis.
- b. Binding directly to ergosterol in the fungal cell membrane, creating pores.
- c. Inhibiting fungal DNA synthesis.
- d. Activating the host immune system.
Answer: b. Binding directly to ergosterol in the fungal cell membrane, creating pores.
14. A major dose-limiting toxicity of amphotericin B deoxycholate is:
- a. Hepatotoxicity
- b. Cardiotoxicity
- c. Nephrotoxicity
- d. Myelosuppression
Answer: c. Nephrotoxicity
15. What is the primary role of the pharmacist in cases of candiduria?
- a. To ensure every positive culture is treated with an antifungal.
- b. To promote antimicrobial stewardship by discouraging the treatment of asymptomatic candiduria.
- c. To recommend the most expensive antifungal agent.
- d. To place the urinary catheter.
Answer: b. To promote antimicrobial stewardship by discouraging the treatment of asymptomatic candiduria.
16. The “Medicinal Chemistry of Antifungals” is a module within the Patient Care 2 course.
- a. True
- b. False
Answer: a. True
17. A patient develops a fungal ball (bezoar) in their bladder. This complication often requires:
- a. A long course of oral fluconazole only.
- b. Surgical removal in addition to antifungal therapy.
- c. A topical antifungal cream.
- d. No treatment, as it will dissolve on its own.
Answer: b. Surgical removal in addition to antifungal therapy.
18. The typical duration of therapy for symptomatic candiduria (fungal cystitis) is:
- a. A single dose
- b. 3 days
- c. 7-14 days
- d. 28 days
Answer: c. 7-14 days
19. Which of the following is NOT a significant risk factor for developing candiduria?
- a. Diabetes mellitus
- b. Recent antibiotic therapy
- c. Young age
- d. Immunosuppression
Answer: c. Young age
20. An active learning session covering fungal infections is part of the Patient Care 2 course.
- a. True
- b. False
Answer: a. True
21. Flucytosine is converted to what active compound inside fungal cells?
- a. Fluorouracil (5-FU)
- b. Fluconazole
- c. Fluoride
- d. Folic acid
Answer: a. Fluorouracil (5-FU)
22. Why is flucytosine rarely used as monotherapy?
- a. Due to its high cost.
- b. Due to its poor oral absorption.
- c. Due to the rapid development of resistance.
- d. Due to its lack of activity against Candida.
Answer: c. Due to the rapid development of resistance.
23. The most common Candida species isolated from urine is:
- a. C. krusei
- b. C. parapsilosis
- c. C. glabrata
- d. C. albicans
Answer: d. C. albicans
24. The management of UTIs, including fungal causes, is discussed in the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
25. A patient has a symptomatic UTI caused by Candida krusei. This species is intrinsically resistant to which antifungal?
- a. Amphotericin B
- b. Flucytosine
- c. Fluconazole
- d. Micafungin
Answer: c. Fluconazole
26. A bladder irrigation with amphotericin B is:
- a. The standard of care for all fungal UTIs.
- b. A highly effective therapy with strong evidence.
- c. No longer routinely recommended by IDSA guidelines.
- d. The only option for fluconazole-resistant organisms.
Answer: c. No longer routinely recommended by IDSA guidelines.
27. The pharmacist’s role in stewardship includes questioning the need for a urinary catheter in the first place.
- a. True
- b. False
Answer: a. True
28. A patient is being treated for a symptomatic UTI with oral fluconazole. The pharmacist should screen for drug interactions because fluconazole is a potent inhibitor of:
- a. CYP1A2
- b. CYP2D6
- c. CYP2C9 and CYP3A4
- d. UGT1A1
Answer: c. CYP2C9 and CYP3A4
29. What is the most important factor in diagnosing a true UTI versus colonization in a catheterized patient?
- a. The quantity of yeast in the urine culture.
- b. The presence of clinical signs and symptoms of infection.
- c. The color of the urine.
- d. The duration of catheterization.
Answer: b. The presence of clinical signs and symptoms of infection.
30. The “Introduction to Fungal Infections” is a lecture within the Patient Care 2 curriculum.
- a. True
- b. False
Answer: a. True
31. Which of the following is a potential side effect of flucytosine therapy?
- a. Nephrotoxicity
- b. Bone marrow suppression
- c. QTc prolongation
- d. Hypertension
Answer: b. Bone marrow suppression
32. A patient with candiduria who also has Candida in their blood (candidemia) requires:
- a. Treatment with oral fluconazole only.
- b. No treatment, as it is likely a contaminant.
- c. Aggressive systemic antifungal therapy as it indicates a disseminated infection.
- d. A 3-day course of antibiotics.
Answer: c. Aggressive systemic antifungal therapy as it indicates a disseminated infection.
33. What is the main advantage of using a lipid formulation of amphotericin B over the conventional deoxycholate formulation?
- a. It is significantly less expensive.
- b. It has a broader spectrum of activity.
- c. It has a significantly lower risk of nephrotoxicity.
- d. It can be administered orally.
Answer: c. It has a significantly lower risk of nephrotoxicity.
34. The term “colonization” means:
- a. The organism is actively causing infection and tissue damage.
- b. The organism is present in or on the body but is not causing signs or symptoms of disease.
- c. The patient is immune to the organism.
- d. The organism is resistant to all antibiotics.
Answer: b. The organism is present in or on the body but is not causing signs or symptoms of disease.
35. A pharmacist’s role includes counseling on the proper technique for catheter care to prevent infections.
- a. True
- b. False
Answer: a. True
36. A patient is treated for a symptomatic C. albicans UTI with fluconazole. How long should treatment typically continue?
- a. 1 day
- b. 3 days
- c. 7-14 days
- d. 28 days
Answer: c. 7-14 days
37. Which of the following is NOT a risk factor for candiduria?
- a. Female gender
- b. Diabetes
- c. Immunosuppression
- d. Recent antibiotic use
Answer: a. Female gender
38. The active learning session on fungal infections is part of which course?
- a. PHA5782C Patient Care 2
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5784C Patient Care 4
Answer: a. PHA5782C Patient Care 2
39. Why are echinocandins (e.g., micafungin, caspofungin) not preferred for treating fungal UTIs?
- a. They do not have activity against Candida.
- b. They have poor penetration into the urine.
- c. They are only available as topical creams.
- d. They have a high risk of nephrotoxicity.
Answer: b. They have poor penetration into the urine.
40. An active learning session covering fungal infections is part of which course module?
- a. Module 5: Introduction to Fungal Infections & Antifungals
- b. Module 1: PUD and GERD
- c. Module 4: Gastrointestinal Infections
- d. Module 7: Renal System
Answer: a. Module 5: Introduction to Fungal Infections & Antifungals
41. The most important preventative measure for candiduria is:
- a. Prophylactic fluconazole
- b. Judicious use of urinary catheters.
- c. A low-sugar diet.
- d. Daily use of probiotics.
Answer: b. Judicious use of urinary catheters.
42. A patient with a fungal UTI should also be assessed for:
- a. Disseminated infection (candidemia).
- b. The presence of a fungal ball.
- c. An underlying cause like an obstruction or uncontrolled diabetes.
- d. All of the above.
Answer: d. All of the above.
43. A pharmacist reviewing a patient’s culture report should be able to:
- a. Identify the specific Candida species.
- b. Recognize potential resistance patterns (e.g., C. glabrata and fluconazole).
- c. Recommend appropriate therapy based on the findings.
- d. All of the above.
Answer: d. All of the above.
44. The presence of pyuria (WBCs in urine) is highly specific for a urinary tract infection.
- a. True
- b. False
Answer: b. False
45. What is the pharmacist’s best course of action when they see a new order for fluconazole for an asymptomatic patient with a catheter and a positive urine culture for Candida?
- a. Dispense the medication immediately.
- b. Contact the prescriber to discuss whether treatment is necessary, citing guidelines against treating CA-ASB.
- c. Substitute the fluconazole for amphotericin B.
- d. Counsel the patient on the side effects of fluconazole.
Answer: b. Contact the prescriber to discuss whether treatment is necessary, citing guidelines against treating CA-ASB.
46. Which of the following is a key goal of antifungal stewardship?
- a. To use antifungals for all patients with catheters.
- b. To ensure the appropriate use of antifungal agents to improve outcomes and reduce resistance.
- c. To use the broadest spectrum agent for the longest possible duration.
- d. To only use IV formulations of antifungals.
Answer: b. To ensure the appropriate use of antifungal agents to improve outcomes and reduce resistance.
47. The pharmacology of antifungals is covered in the Patient Care 2 curriculum.
- a. True
- b. False
Answer: a. True
48. An active learning session on fungal infections is part of which course?
- a. PHA5782C Patient Care 2
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5784C Patient Care 4
Answer: a. PHA5782C Patient Care 2
49. The overall management of candiduria is primarily focused on:
- a. Treating every positive culture.
- b. Identifying and managing the underlying cause or risk factor (e.g., the catheter).
- c. A 14-day course of amphotericin B for everyone.
- d. Preventing candidemia at all costs.
Answer: b. Identifying and managing the underlying cause or risk factor (e.g., the catheter).
50. The ultimate goal of learning about candiduria is to:
- a. Be able to recommend the correct antifungal dose to prevent medication errors and promote stewardship.
- b. Memorize all the species of Candida.
- c. Pass the infectious disease exam.
- d. Become an expert in infectious disease.
Answer: a. Be able to recommend the correct antifungal dose to prevent medication errors and promote stewardship.