While lower urinary tract infections are common, infectious diseases of the kidney, such as pyelonephritis, represent a more serious systemic illness requiring prompt and appropriate antimicrobial therapy. Pharmacists must be skilled at differentiating upper from lower UTIs based on clinical presentation and selecting evidence-based treatments that achieve adequate tissue concentrations. As detailed in the Patient Care 4 curriculum’s dedicated module on “Infectious Diseases of the Kidney,” this is a core competency for practice. This quiz will test your knowledge on the pathophysiology, diagnosis, and pharmacologic management of these important renal infections.
1. Which of the following symptoms is most indicative of an upper urinary tract infection (pyelonephritis) as opposed to an uncomplicated lower UTI (cystitis)?
- a. Dysuria
- b. Urinary frequency
- c. Fever and flank pain
- d. Suprapubic discomfort
Answer: c. Fever and flank pain
2. What is the most common causative pathogen for both uncomplicated cystitis and pyelonephritis?
- a. Enterococcus faecalis
- b. Staphylococcus saprophyticus
- c. Klebsiella pneumoniae
- d. Escherichia coli
Answer: d. Escherichia coli
3. A patient is diagnosed with mild-to-moderate outpatient pyelonephritis. Local quinolone resistance is >10%. Which of the following is an appropriate initial treatment strategy?
- a. A single dose of IV ceftriaxone followed by an oral cephalosporin.
- b. A 3-day course of oral nitrofurantoin.
- c. A 7-day course of oral ciprofloxacin.
- d. A single dose of fosfomycin.
Answer: a. A single dose of IV ceftriaxone followed by an oral cephalosporin.
4. Why is nitrofurantoin NOT an appropriate agent for treating pyelonephritis?
- a. It has a high rate of resistance.
- b. It does not achieve adequate concentrations in the renal tissue.
- c. It has too many side effects.
- d. It only covers Gram-positive organisms.
Answer: b. It does not achieve adequate concentrations in the renal tissue.
5. A “complicated” urinary tract infection is defined by the presence of which of the following factors?
- a. The infection occurs in a male patient.
- b. The patient has an indwelling urinary catheter.
- c. The patient has a structural abnormality of the urinary tract.
- d. All of the above.
Answer: d. All of the above.
6. The “Management of UTIs, Part 1: Uncomplicated UTI, Pyelonephritis, Catheter-associated UTI” is a specific lecture in which course?
- a. PHA5784C Patient Care 4
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5878C Patient Care 3
Answer: a. PHA5784C Patient Care 4
7. What is the typical duration of antibiotic therapy for outpatient management of pyelonephritis?
- a. 3 days
- b. 5-7 days for fluoroquinolones, or 7-14 days for other agents.
- c. 14-21 days
- d. A single dose.
Answer: b. 5-7 days for fluoroquinolones, or 7-14 days for other agents.
8. An infection of the prostate gland is known as:
- a. Cystitis
- b. Pyelonephritis
- c. Prostatitis
- d. Urethritis
Answer: c. Prostatitis
9. The presence of white blood cell (WBC) casts in the urine sediment is highly suggestive of:
- a. A lower UTI (cystitis).
- b. Inflammation or infection within the kidney parenchyma (pyelonephritis).
- c. Dehydration.
- d. A normal urinalysis.
Answer: b. Inflammation or infection within the kidney parenchyma (pyelonephritis).
10. What is the most important first step in managing a catheter-associated UTI (CAUTI)?
- a. Starting a broad-spectrum antibiotic immediately.
- b. Obtaining a urine culture.
- c. Replacing or removing the urinary catheter, if possible.
- d. Administering an anti-motility agent.
Answer: c. Replacing or removing the urinary catheter, if possible.
11. The management of complicated UTIs and prostatitis is a topic within the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
12. Which of the following is NOT a first-line agent for uncomplicated cystitis?
- a. Nitrofurantoin
- b. Trimethoprim/sulfamethoxazole (if local resistance is low)
- c. Fosfomycin
- d. Moxifloxacin
Answer: d. Moxifloxacin
13. A patient with severe pyelonephritis requiring hospitalization might be treated empirically with:
- a. Oral amoxicillin
- b. IV piperacillin-tazobactam
- c. Oral nitrofurantoin
- d. A single dose of fosfomycin
Answer: b. IV piperacillin-tazobactam
14. What is asymptomatic bacteriuria?
- a. A urinary tract infection with severe symptoms.
- b. The presence of bacteria in the urine without any signs or symptoms of infection.
- c. An infection caused by a virus.
- d. A urinary tract infection that is resistant to antibiotics.
Answer: b. The presence of bacteria in the urine without any signs or symptoms of infection.
15. In which of the following patient populations is it recommended to screen for and treat asymptomatic bacteriuria?
- a. Elderly patients in long-term care facilities.
- b. Patients with indwelling urinary catheters.
- c. Pregnant patients.
- d. Non-pregnant, premenopausal women.
Answer: c. Pregnant patients.
16. The “Infectious Diseases of the Kidney” is a module within the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
17. The primary route by which bacteria cause a UTI and pyelonephritis is:
- a. The hematogenous (bloodstream) route.
- b. The ascending route from the urethra.
- c. The lymphatic route.
- d. Direct inoculation during surgery.
Answer: b. The ascending route from the urethra.
18. Which pathogen can produce urease, leading to alkaline urine and the formation of struvite kidney stones?
- a. E. coli
- b. Proteus mirabilis
- c. Enterococcus faecalis
- d. Staphylococcus saprophyticus
Answer: b. Proteus mirabilis
19. A key counseling point for a patient taking nitrofurantoin is that it may:
- a. Cause photosensitivity.
- b. Turn the urine a brown or dark yellow color.
- c. Interact with dairy products.
- d. Be taken as a single dose.
Answer: b. Turn the urine a brown or dark yellow color.
20. An active learning session on infectious diseases of the kidney is part of the Patient Care 4 course.
- a. True
- b. False
Answer: a. True
21. A UTI in a male patient is always considered:
- a. Uncomplicated
- b. Complicated
- c. A sexually transmitted infection
- d. A viral infection
Answer: b. Complicated
22. Why are fluoroquinolones no longer recommended as first-line agents for uncomplicated cystitis?
- a. They are not effective against E. coli.
- b. Due to increasing resistance rates and the potential for significant “collateral damage” and adverse effects.
- c. They are too expensive.
- d. They are only available in an IV formulation.
Answer: b. Due to increasing resistance rates and the potential for significant “collateral damage” and adverse effects.
23. The pharmacist’s role in managing infectious diseases of the kidney includes:
- a. Recommending appropriate, guideline-based antibiotic therapy.
- b. Adjusting doses for renal dysfunction.
- c. Counseling on preventative non-pharmacologic measures.
- d. All of the above.
Answer: d. All of the above.
24. The renal system module in Patient Care 4 covers UTIs.
- a. True
- b. False
Answer: a. True
25. A patient with a history of recurrent UTIs should be counseled on which preventative measure?
- a. Decreasing fluid intake.
- b. Post-coital voiding and adequate hydration.
- c. Daily use of a topical antiseptic.
- d. Taking a prophylactic antibiotic every day without consulting a doctor.
Answer: b. Post-coital voiding and adequate hydration.
26. The term “urosepsis” refers to:
- a. A simple bladder infection.
- b. Sepsis that is caused by a urinary tract source.
- c. The presence of crystals in the urine.
- d. An infection of the urethra.
Answer: b. Sepsis that is caused by a urinary tract source.
27. An active learning session on UTIs is part of which course?
- a. PHA5784C Patient Care 4
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5784C Patient Care 4
28. A patient is treated for pyelonephritis with IV ceftriaxone in the hospital. Their symptoms have improved. What is an appropriate oral “step-down” therapy?
- a. Oral vancomycin
- b. Oral doxycycline
- c. Oral cephalexin or cefpodoxime
- d. Oral metronidazole
Answer: c. Oral cephalexin or cefpodoxime
29. The presence of nitrites on a urinalysis dipstick is suggestive of:
- a. The presence of Gram-negative bacteria like E. coli.
- b. Dehydration.
- c. Kidney stones.
- d. Glomerular damage.
Answer: a. The presence of Gram-negative bacteria like E. coli.
30. The management of UTIs is covered in the renal system module.
- a. True
- b. False
Answer: a. True
31. Fosfomycin is an appropriate first-line agent for uncomplicated cystitis that is unique because it is administered as:
- a. A 7-day course.
- b. A twice-daily tablet.
- c. A single oral dose.
- d. An IV infusion.
Answer: c. A single oral dose.
32. A patient with acute prostatitis often requires a longer duration of antibiotic therapy (e.g., 2-4 weeks) because:
- a. The prostate gland is difficult for antibiotics to penetrate.
- b. The causative organisms are more resistant.
- c. The symptoms take longer to resolve.
- d. This is not true; therapy is only 3 days.
Answer: a. The prostate gland is difficult for antibiotics to penetrate.
33. The microbiology of common UTI pathogens like E. coli is covered in the Patient Care 2 curriculum.
- a. True
- b. False
Answer: a. True
34. A patient with pyelonephritis who is vomiting and unable to tolerate oral medications should be:
- a. Sent home with an oral antibiotic.
- b. Admitted to the hospital for IV fluids and IV antibiotics.
- c. Told to take an OTC antiemetic.
- d. Given a prescription for fosfomycin.
Answer: b. Admitted to the hospital for IV fluids and IV antibiotics.
35. A key difference between cystitis and pyelonephritis is that pyelonephritis is an infection of the:
- a. Bladder
- b. Urethra
- c. Kidney parenchyma and renal pelvis
- d. Prostate
Answer: c. Kidney parenchyma and renal pelvis
36. Trimethoprim/sulfamethoxazole should be used with caution in patients with:
- a. Hypertension
- b. A sulfa allergy
- c. Diabetes
- d. Asthma
Answer: b. A sulfa allergy
37. Which of the following is NOT a risk factor for developing a UTI?
- a. Female anatomy
- b. Sexual activity
- c. High fluid intake
- d. Use of a diaphragm or spermicide
Answer: c. High fluid intake
38. The lecture “Management of UTIs, Part 2” covers complicated UTI and prostatitis.
- a. True
- b. False
Answer: a. True
39. For an elderly patient with asymptomatic bacteriuria, antibiotic treatment generally leads to:
- a. Improved mortality and morbidity.
- b. Increased risk of adverse drug events and antibiotic resistance without clinical benefit.
- c. Prevention of future symptomatic UTIs.
- d. A shorter hospital stay.
Answer: b. Increased risk of adverse drug events and antibiotic resistance without clinical benefit.
40. An active learning session covering UTIs is part of which course module?
- a. Module 9: Infectious Diseases of the Kidney
- b. Module 1: PUD and GERD
- c. Module 4: Gastrointestinal Infections
- d. Module 5: Nutrition & Weight Management
Answer: a. Module 9: Infectious Diseases of the Kidney
41. The primary goal of treating pyelonephritis is to:
- a. Prevent progression to urosepsis and preserve kidney function.
- b. Only relieve the symptom of dysuria.
- c. Sterilize the urine within 24 hours.
- d. Prevent the development of kidney stones.
Answer: a. Prevent progression to urosepsis and preserve kidney function.
42. Which of the following is a non-pharmacologic recommendation for preventing recurrent UTIs?
- a. Cranberry products have strong evidence for prevention.
- b. Post-coital voiding.
- c. Decreasing water intake.
- d. Using bubble baths daily.
Answer: b. Post-coital voiding.
43. A pharmacist’s role in managing a patient with pyelonephritis includes:
- a. Ensuring the chosen antibiotic has adequate renal tissue penetration.
- b. Monitoring for signs of clinical improvement or worsening.
- c. Recommending a transition from IV to PO therapy when appropriate.
- d. All of the above.
Answer: d. All of the above.
44. If a patient with an indwelling catheter has bacteria in their urine but no symptoms, this is called:
- a. Catheter-associated UTI (CAUTI)
- b. Catheter-associated asymptomatic bacteriuria (CA-ASB)
- c. Pyelonephritis
- d. Urosepsis
Answer: b. Catheter-associated asymptomatic bacteriuria (CA-ASB)
45. Which of the following is the most appropriate treatment for CA-ASB?
- a. A 7-day course of ciprofloxacin.
- b. IV ceftriaxone.
- c. No antibiotic treatment is recommended.
- d. A single dose of fosfomycin.
Answer: c. No antibiotic treatment is recommended.
46. A patient is being treated for a complicated UTI caused by a resistant Pseudomonas aeruginosa. Which agent might be required?
- a. Nitrofurantoin
- b. Amoxicillin
- c. An anti-pseudomonal carbapenem like meropenem.
- d. Trimethoprim/sulfamethoxazole
Answer: c. An anti-pseudomonal carbapenem like meropenem.
47. A “urine culture and sensitivity” provides what critical information for managing a UTI?
- a. The patient’s renal function.
- b. The identity of the causative bacteria and which antibiotics it is susceptible to.
- c. The presence of casts and crystals.
- d. The urine pH and specific gravity.
Answer: b. The identity of the causative bacteria and which antibiotics it is susceptible to.
48. An active learning session on infectious diseases of the kidney is part of which course?
- a. PHA5784C Patient Care 4
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5784C Patient Care 4
49. The overall management of a severe kidney infection like pyelonephritis requires:
- a. A single oral antibiotic.
- b. A careful selection of an appropriate antibiotic, adequate duration of therapy, and supportive care.
- c. Only non-pharmacologic interventions.
- d. A watch-and-wait approach.
Answer: b. A careful selection of an appropriate antibiotic, adequate duration of therapy, and supportive care.
50. The ultimate goal of understanding the management of kidney infections is to:
- a. Be able to recommend the correct antibiotic to prevent complications and ensure patient safety.
- b. Memorize all the antibiotic doses.
- c. Pass the infectious disease section of the exam.
- d. Know how to place a urinary catheter.
Answer: a. Be able to recommend the correct antibiotic to prevent complications and ensure patient safety.