Complicated urinary tract infections (cUTIs) represent a more serious clinical challenge than simple cystitis, often occurring in patients with underlying structural or functional abnormalities of the urinary tract and involving a broader spectrum of pathogens. As detailed in the Patient Care 4 curriculum, managing cUTIs requires careful antibiotic selection, consideration of local resistance patterns, and often a longer duration of therapy. This quiz will test your knowledge on the risk factors, microbiology, and evidence-based pharmacologic management of complicated UTIs, including catheter-associated infections and UTIs in males.
1. Which of the following patient scenarios would classify a urinary tract infection as “complicated”?
- a. A healthy 24-year-old female with dysuria.
- b. A 45-year-old male with fever and flank pain.
- c. A patient with an indwelling urinary catheter.
- d. Both b and c.
Answer: d. Both b and c.
2. A UTI in any male patient is generally considered:
- a. Uncomplicated
- b. Complicated
- c. Self-limiting and requires no treatment.
- d. A viral infection.
Answer: b. Complicated
3. Compared to uncomplicated cystitis, the microbiology of complicated UTIs is more likely to include:
- a. Only E. coli.
- b. A broader range of organisms, including Pseudomonas and Enterococcus.
- c. Only Gram-positive organisms.
- d. Viruses.
Answer: b. A broader range of organisms, including Pseudomonas and Enterococcus.
4. What is the most important initial step in managing a catheter-associated UTI (CAUTI)?
- a. Starting a broad-spectrum IV antibiotic.
- b. Obtaining a urine culture.
- c. Prompt removal or exchange of the urinary catheter, if possible.
- d. Administering an analgesic.
Answer: c. Prompt removal or exchange of the urinary catheter, if possible.
5. Which of the following is an appropriate oral antibiotic choice for an outpatient with a cUTI, assuming local quinolone resistance is low?
- a. Nitrofurantoin
- b. Fosfomycin
- c. Ciprofloxacin or Levofloxacin
- d. Amoxicillin
Answer: c. Ciprofloxacin or Levofloxacin
6. The “Management of UTIs, Part 2: Complicated UTI, UTI in Males, Prostatitis” 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. A patient is hospitalized with a severe complicated UTI and is at risk for a multidrug-resistant Pseudomonas aeruginosa. Which of the following IV antibiotics would provide appropriate empiric coverage?
- a. Ceftriaxone
- b. Ertapenem
- c. Piperacillin-tazobactam or Cefepime
- d. Doxycycline
Answer: c. Piperacillin-tazobactam or Cefepime
8. What is the typical duration of therapy for a complicated UTI?
- a. A single dose.
- b. 3 days.
- c. 7-14 days.
- d. 21-28 days.
Answer: c. 7-14 days.
9. The presence of asymptomatic bacteriuria in a patient with an indwelling catheter should:
- a. Always be treated with a 7-day course of antibiotics.
- b. Be treated only if the patient is elderly.
- c. Generally not be treated with antibiotics.
- d. Be treated with a single dose of fosfomycin.
Answer: c. Generally not be treated with antibiotics.
10. A urine culture and sensitivity test is essential in the management of complicated UTIs in order to:
- a. Fulfill a billing requirement.
- b. Guide the de-escalation or tailoring of antibiotic therapy.
- c. Diagnose the presence of a UTI.
- d. Determine the patient’s renal function.
Answer: b. Guide the de-escalation or tailoring of antibiotic therapy.
11. The management of pyelonephritis is a topic within the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
12. Which two classes of antibiotics have excellent penetration into prostatic tissue, making them good choices for treating prostatitis and UTIs in males?
- a. Penicillins and cephalosporins
- b. Macrolides and tetracyclines
- c. Nitrofurantoin and fosfomycin
- d. Fluoroquinolones and trimethoprim-sulfamethoxazole
Answer: d. Fluoroquinolones and trimethoprim-sulfamethoxazole
13. A patient with a complicated UTI caused by an ESBL-producing E. coli would most likely require treatment with which class of antibiotics?
- a. A fluoroquinolone
- b. A third-generation cephalosporin
- c. A carbapenem
- d. A macrolide
Answer: c. A carbapenem
14. The term “urosepsis” indicates:
- a. A complicated UTI.
- b. Sepsis that has originated from a urinary source.
- c. Asymptomatic bacteriuria.
- d. An infection of the prostate.
Answer: b. Sepsis that has originated from a urinary source.
15. A key role for the pharmacist in managing complicated UTIs is:
- a. Inserting the urinary catheter.
- b. Performing the urine culture.
- c. Ensuring appropriate antimicrobial selection and dosing based on patient factors and culture data.
- d. Obtaining a renal ultrasound.
Answer: c. Ensuring appropriate antimicrobial selection and dosing based on patient factors and culture data.
16. “Infectious Diseases of the Kidney” is a module within the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
17. A patient hospitalized for a complicated UTI is improving on IV ceftriaxone. The urine culture returns showing E. coli susceptible to TMP/SMX. What is an appropriate “step-down” therapy?
- a. Continue IV ceftriaxone for 14 days.
- b. Switch to oral ciprofloxacin.
- c. Switch to oral trimethoprim-sulfamethoxazole.
- d. Switch to oral nitrofurantoin.
Answer: c. Switch to oral trimethoprim-sulfamethoxazole.
18. A patient has a complicated UTI with bacteremia. The duration of therapy should be:
- a. The same as for an uncomplicated UTI.
- b. Generally longer, often 10-14 days.
- c. Only 3 days.
- d. Guided by the resolution of fever only.
Answer: b. Generally longer, often 10-14 days.
19. Why is a UTI in a pregnant patient always considered complicated?
- a. Due to the risk of adverse outcomes for both the mother (e.g., pyelonephritis) and the fetus (e.g., preterm birth).
- b. Because pregnant patients are always immunocompromised.
- c. Because only IV antibiotics can be used.
- d. It is not considered complicated.
Answer: a. Due to the risk of adverse outcomes for both the mother (e.g., pyelonephritis) and the fetus (e.g., preterm birth).
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. Which antibiotic would be a poor choice for a cUTI suspected to be caused by Enterococcus faecalis?
- a. Ampicillin
- b. Vancomycin
- c. Ceftriaxone
- d. Linezolid
Answer: c. Ceftriaxone
22. “Source control” in the management of a complicated UTI could involve:
- a. Removing an obstructing kidney stone.
- b. Draining a renal abscess.
- c. Replacing a chronic indwelling catheter.
- d. All of the above.
Answer: d. All of the above.
23. The microbiology of common UTI pathogens like E. coli is covered in the Patient Care 2 curriculum.
- a. True
- b. False
Answer: a. True
24. The renal system module in Patient Care 4 covers the management of UTIs.
- a. True
- b. False
Answer: a. True
25. A patient with a complicated UTI requires dose adjustment of their antibiotic. What is the most likely reason?
- a. The patient has underlying chronic kidney disease.
- b. The infection itself caused acute kidney injury.
- c. The antibiotic being used is nephrotoxic.
- d. All of the above are possible reasons.
Answer: d. All of the above are possible reasons.
26. Which of the following is NOT a risk factor for a complicated UTI?
- a. Male gender
- b. Recent urologic instrumentation
- c. A history of one episode of uncomplicated cystitis as a young woman.
- d. Anatomic abnormality of the urinary tract.
Answer: c. A history of one episode of uncomplicated cystitis as a young woman.
27. The main goal of treating a complicated UTI is to:
- a. Prevent progression to pyelonephritis, urosepsis, and renal damage.
- b. Only relieve the symptom of dysuria.
- c. Use the broadest spectrum antibiotic for the longest possible time.
- d. Avoid hospitalization at all costs.
Answer: a. Prevent progression to pyelonephritis, urosepsis, and renal damage.
28. 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
29. A patient is being treated for a cUTI with IV piperacillin-tazobactam. This drug provides coverage for:
- a. Only Gram-positive organisms.
- b. Only anaerobic organisms.
- c. A broad spectrum of organisms including Pseudomonas aeruginosa.
- d. Only E. coli.
Answer: c. A broad spectrum of organisms including Pseudomonas aeruginosa.
30. The management of UTIs is covered in the renal system module.
- a. True
- b. False
Answer: a. True
31. A pharmacist must ensure that the chosen antibiotic for a UTI in a pregnant patient is:
- a. A fluoroquinolone.
- b. A tetracycline.
- c. Safe for use in pregnancy (e.g., a beta-lactam).
- d. An aminoglycoside.
Answer: c. Safe for use in pregnancy (e.g., a beta-lactam).
32. What is a key reason for obtaining a urine culture in a male patient with a UTI?
- a. To confirm the diagnosis and guide the longer course of therapy required.
- b. It is not necessary.
- c. To rule out a sexually transmitted infection.
- d. To check for prostate cancer.
Answer: a. To confirm the diagnosis and guide the longer course of therapy required.
33. De-escalating antibiotic therapy based on culture results is an example of:
- a. A medication error.
- b. Poor clinical practice.
- c. Good antimicrobial stewardship.
- d. Therapeutic failure.
Answer: c. Good antimicrobial stewardship.
34. The presence of fever and chills with urinary symptoms strongly suggests:
- a. The infection is limited to the bladder.
- b. The infection has ascended to the kidneys (pyelonephritis).
- c. The infection is viral.
- d. The patient is dehydrated.
Answer: b. The infection has ascended to the kidneys (pyelonephritis).
35. A patient with a cUTI who is hemodynamically unstable should be:
- a. Managed as an outpatient.
- b. Admitted to the hospital for IV antibiotics and supportive care.
- c. Given a single dose of fosfomycin.
- d. Told to increase their fluid intake.
Answer: b. Admitted to the hospital for IV antibiotics and supportive care.
36. The duration of therapy for acute bacterial prostatitis is typically:
- a. 3-5 days
- b. 7 days
- c. 10-14 days
- d. 2-4 weeks
Answer: d. 2-4 weeks
37. Which of the following is NOT a goal of therapy for a complicated UTI?
- a. Eradication of the invading pathogen.
- b. Resolution of clinical signs and symptoms.
- c. Prevention of recurrence.
- d. Prophylactic treatment of all household contacts.
Answer: d. Prophylactic treatment of all household contacts.
38. The lecture “Management of UTIs, Part 2” covers complicated UTIs.
- a. True
- b. False
Answer: a. True
39. A pharmacist’s role includes counseling a patient on the importance of completing the full course of antibiotics for a cUTI, even if symptoms improve.
- a. True
- b. False
Answer: a. True
40. An active learning session covering infectious diseases of the kidney 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 first-line treatment for a hospitalized patient with a cUTI and no risk factors for resistant organisms is often:
- a. IV Vancomycin
- b. IV Daptomycin
- c. IV Ceftriaxone
- d. Oral Amoxicillin
Answer: c. IV Ceftriaxone
42. Which of the following is a risk factor for having a UTI caused by a drug-resistant pathogen?
- a. A recent hospitalization.
- b. Use of antibiotics in the past 90 days.
- c. An indwelling urinary catheter.
- d. All of the above.
Answer: d. All of the above.
43. A patient with a complicated UTI should have their antibiotic regimen reassessed after how long, once culture results are available?
- a. 1 week
- b. 48-72 hours
- c. 24 hours
- d. It does not need to be reassessed.
Answer: b. 48-72 hours
44. What is the most important component of managing a UTI caused by a kidney stone obstruction?
- a. A 14-day course of antibiotics.
- b. A procedure to remove the obstructing stone.
- c. A diuretic.
- d. An analgesic.
Answer: b. A procedure to remove the obstructing stone.
45. A pharmacist should always verify a patient’s ____ before recommending a dose for an antibiotic used to treat a complicated UTI.
- a. Allergies
- b. Renal function
- c. Concurrent medications
- d. All of the above
Answer: d. All of the above
46. A patient is treated for a CAUTI. After the catheter is removed and the antibiotic course is complete, what is recommended?
- a. Lifelong prophylactic antibiotics.
- b. A follow-up urine culture to ensure eradication.
- c. No routine follow-up culture is needed if the patient is asymptomatic.
- d. Insertion of a new catheter immediately.
Answer: c. No routine follow-up culture is needed if the patient is asymptomatic.
47. A “defend a therapeutic plan” exercise for a UTI is an objective in the Professional Skills Lab 3.
- a. True
- b. False
Answer: a. True
48. An active learning session on complicated 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
49. The overall management of a severe complicated UTI requires:
- a. A single oral antibiotic.
- b. A multifaceted approach including source control, appropriate IV antibiotics, and supportive care.
- c. Only non-pharmacologic interventions.
- d. A watch-and-wait approach.
Answer: b. A multifaceted approach including source control, appropriate IV antibiotics, and supportive care.
50. The ultimate goal of understanding the management of complicated UTIs is to:
- a. Select appropriate, evidence-based antimicrobial therapy to prevent serious complications like urosepsis and renal damage.
- b. Memorize all possible antibiotic regimens.
- c. Ensure every patient with a UTI receives a fluoroquinolone.
- d. Pass the final exam.
Answer: a. Select appropriate, evidence-based antimicrobial therapy to prevent serious complications like urosepsis and renal damage.