Pyelonephritis, an infection of the kidney parenchyma and renal pelvis, is a serious medical condition requiring more aggressive management than a simple bladder infection. Selecting the correct antibiotic is crucial, as the chosen agent must achieve adequate concentrations in the renal tissue to be effective. As detailed in the Patient Care 4 curriculum’s module on “Infectious Diseases of the Kidney,” a pharmacist’s expertise is vital for guiding appropriate, evidence-based therapy. This quiz will test your knowledge on the diagnosis, risk stratification, and pharmacologic management of pyelonephritis in both outpatient and inpatient settings.
1. Pyelonephritis is best described as an infection of the:
- a. Bladder and urethra
- b. Prostate gland
- c. Kidney parenchyma and renal pelvis
- d. Peritoneal cavity
Answer: c. Kidney parenchyma and renal pelvis
2. Which of the following constellations of symptoms is most characteristic of acute pyelonephritis?
- a. Dysuria and urinary frequency only.
- b. Fever, chills, flank pain, and costovertebral angle (CVA) tenderness.
- c. Abdominal bloating and alternating constipation/diarrhea.
- d. Hematuria without any other symptoms.
Answer: b. Fever, chills, flank pain, and costovertebral angle (CVA) tenderness.
3. What is the most common pathogen responsible for community-acquired pyelonephritis?
- a. Enterococcus faecalis
- b. Staphylococcus aureus
- c. Escherichia coli
- d. Klebsiella pneumoniae
Answer: c. Escherichia coli
4. Why is nitrofurantoin NOT an appropriate choice for treating pyelonephritis?
- a. It has a high rate of resistance against E. coli.
- b. It achieves high urinary concentrations but poor renal tissue concentrations.
- c. It can only be administered intravenously.
- d. It has too many drug interactions.
Answer: b. It achieves high urinary concentrations but poor renal tissue concentrations.
5. According to IDSA guidelines, an oral fluoroquinolone (e.g., ciprofloxacin) can be considered for empiric outpatient treatment of pyelonephritis ONLY if:
- a. The patient has a sulfa allergy.
- b. The local resistance rate of E. coli to fluoroquinolones is less than 10%.
- c. The patient is pregnant.
- d. The patient is over 65 years old.
Answer: b. The local resistance rate of E. coli to fluoroquinolones is less than 10%.
6. The “Management of… Pyelonephritis” 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. If local fluoroquinolone resistance is high, what is the recommended strategy for initiating outpatient treatment for pyelonephritis?
- a. A 3-day course of oral fosfomycin.
- b. An initial single IV dose of a long-acting agent like ceftriaxone, followed by an appropriate oral antibiotic.
- c. A 14-day course of oral nitrofurantoin.
- d. A watchful waiting approach without antibiotics.
Answer: b. An initial single IV dose of a long-acting agent like ceftriaxone, followed by an appropriate oral antibiotic.
8. Which of the following would be an indication for hospitalizing a patient with pyelonephritis?
- a. Mild flank pain but able to tolerate oral intake.
- b. A temperature of 99.5°F.
- c. Signs of sepsis (e.g., hypotension, tachycardia) or inability to tolerate oral medications.
- d. A positive urine culture.
Answer: c. Signs of sepsis (e.g., hypotension, tachycardia) or inability to tolerate oral medications.
9. The presence of which of the following in a urinalysis is most specific for an upper urinary tract infection?
- a. Leukocyte esterase
- b. Nitrites
- c. White blood cell (WBC) casts
- d. Red blood cells
Answer: c. White blood cell (WBC) casts
10. What is the typical duration of therapy with an oral fluoroquinolone for uncomplicated pyelonephritis?
- a. 3 days
- b. 5-7 days
- c. 10-14 days
- d. 21 days
Answer: b. 5-7 days
11. The management of UTIs is a specific topic within the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
12. A patient hospitalized with severe pyelonephritis might be started on which empiric IV antibiotic regimen?
- a. IV Vancomycin
- b. IV Doxycycline
- c. IV Piperacillin-tazobactam
- d. IV Metronidazole
Answer: c. IV Piperacillin-tazobactam
13. What is the role of a urine culture and sensitivity test in the management of pyelonephritis?
- a. It is not necessary if the patient feels better.
- b. It identifies the causative pathogen and guides de-escalation to a narrower-spectrum antibiotic.
- c. It determines the patient’s renal function.
- d. It is only used to diagnose cystitis.
Answer: b. It identifies the causative pathogen and guides de-escalation to a narrower-spectrum antibiotic.
14. A patient is being discharged after being treated for pyelonephritis with IV ceftriaxone. An appropriate oral “step-down” therapy, based on culture results showing a susceptible organism, would be:
- a. Oral vancomycin
- b. Oral linezolid
- c. Oral cephalexin or cefpodoxime
- d. Oral rifaximin
Answer: c. Oral cephalexin or cefpodoxime
15. The term “urosepsis” refers to:
- a. A simple bladder infection.
- b. Sepsis originating from a urinary tract source.
- c. The presence of crystals in the urine.
- d. An infection of the prostate.
Answer: b. Sepsis originating from a urinary tract source.
16. “Infectious Diseases of the Kidney” is a module within the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
17. Why is a follow-up urine culture generally not needed for a patient who has clinically improved after treatment for pyelonephritis?
- a. Because the infection always recurs.
- b. Because clinical resolution is a reliable indicator of microbiological cure.
- c. Because the tests are too expensive.
- d. It is always required for every patient.
Answer: b. Because clinical resolution is a reliable indicator of microbiological cure.
18. A patient with pyelonephritis due to a highly resistant Pseudomonas aeruginosa may require treatment with:
- a. Oral ciprofloxacin
- b. IV ceftriaxone
- c. An IV carbapenem like meropenem
- d. Oral nitrofurantoin
Answer: c. An IV carbapenem like meropenem
19. A key role for the pharmacist in managing pyelonephritis is:
- a. Performing a renal ultrasound.
- b. Ensuring the chosen antibiotic regimen is appropriate based on severity, local resistance data, and patient-specific factors.
- c. Placing a urinary catheter.
- d. Obtaining the urine sample.
Answer: b. Ensuring the chosen antibiotic regimen is appropriate based on severity, local resistance data, and patient-specific factors.
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 pregnant patient should be:
- a. Left untreated unless symptomatic.
- b. Treated as a complicated infection, and pyelonephritis often requires hospitalization.
- c. Treated with a tetracycline.
- d. Managed with cranberry juice alone.
Answer: b. Treated as a complicated infection, and pyelonephritis often requires hospitalization.
22. Which of the following oral beta-lactams is generally NOT recommended for pyelonephritis due to poor bioavailability and lower efficacy?
- a. Cefpodoxime
- b. Cefixime
- c. Amoxicillin or cephalexin
- d. Levofloxacin
Answer: c. Amoxicillin or cephalexin
23. The pathophysiology of most kidney infections involves:
- a. Bacteria traveling from the bloodstream to the kidney.
- b. Bacteria ascending from the bladder up the ureters to the kidneys.
- c. A direct injury to the kidney.
- d. A viral pathogen.
Answer: b. Bacteria ascending from the bladder up the ureters to the kidneys.
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 history of an ESBL-producing E. coli UTI is admitted with pyelonephritis. Which class of antibiotics is often the treatment of choice?
- a. Fluoroquinolones
- b. Cephalosporins
- c. Carbapenems
- d. Macrolides
Answer: c. Carbapenems
26. The duration of therapy for pyelonephritis treated with an oral beta-lactam is typically:
- a. 3 days
- b. 5 days
- c. 7 days
- d. 10-14 days
Answer: d. 10-14 days
27. A patient being treated for pyelonephritis should be counseled on the importance of:
- a. Limiting their fluid intake.
- b. Completing the full course of antibiotics, even if they feel better.
- c. Taking an anti-diarrheal medication.
- d. Taking their antibiotic with milk.
Answer: b. Completing the full course of antibiotics, even if they feel better.
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. What is a renal abscess?
- a. A kidney stone
- b. A localized collection of pus within the kidney, a serious complication of pyelonephritis.
- c. A benign kidney cyst.
- d. A type of kidney cancer.
Answer: b. A localized collection of pus within the kidney, a serious complication of pyelonephritis.
30. The management of a renal abscess requires antibiotics and what other intervention?
- a. A high-fiber diet.
- b. Drainage of the abscess.
- c. A diuretic.
- d. A blood transfusion.
Answer: b. Drainage of the abscess.
31. Costovertebral angle (CVA) tenderness is elicited by:
- a. Pressing deeply on the abdomen.
- b. Percussing (tapping) on the back over the kidney area.
- c. Asking the patient to cough.
- d. Performing a straight leg raise.
Answer: b. Percussing (tapping) on the back over the kidney area.
32. The microbiology of common UTI pathogens is covered in the Patient Care 2 curriculum.
- a. True
- b. False
Answer: a. True
33. Empiric therapy for pyelonephritis should be based on:
- a. The cheapest available antibiotic.
- b. The patient’s preference.
- c. Local antimicrobial susceptibility data (antibiograms).
- d. The color of the patient’s urine.
Answer: c. Local antimicrobial susceptibility data (antibiograms).
34. A patient with pyelonephritis fails to improve after 72 hours of appropriate IV antibiotic therapy. What is the next step?
- a. Continue the same antibiotic for another 72 hours.
- b. Obtain imaging (e.g., CT scan) to look for a complication like an abscess or obstruction.
- c. Stop all antibiotics.
- d. Switch to an oral antibiotic.
Answer: b. Obtain imaging (e.g., CT scan) to look for a complication like an abscess or obstruction.
35. Which of the following is NOT a goal of pyelonephritis treatment?
- a. Eradication of the infecting organism.
- b. Prevention of complications like sepsis and renal scarring.
- c. Resolution of symptoms.
- d. A 14-day course of nitrofurantoin.
Answer: d. A 14-day course of nitrofurantoin.
36. A pharmacist must always adjust the dose of antibiotics used for pyelonephritis based on the patient’s:
- a. Age
- b. Weight
- c. Renal function
- d. All of the above are important considerations.
Answer: d. All of the above are important considerations.
37. Staphylococcus saprophyticus is a cause of UTIs, including pyelonephritis, most commonly seen in:
- a. Elderly men
- b. Hospitalized patients
- c. Young, sexually active women
- d. Patients with catheters
Answer: c. Young, sexually active women
38. The lecture “Management of UTIs, Part 1” covers pyelonephritis.
- a. True
- b. False
Answer: a. True
39. A patient is being treated with an aminoglycoside for complicated pyelonephritis. The pharmacist should monitor:
- a. Drug levels (peaks and troughs).
- b. Serum creatinine.
- c. Signs of ototoxicity.
- d. All of the above.
Answer: d. All of the above.
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 most important host defense mechanism against developing a UTI and pyelonephritis is:
- a. A high urine pH.
- b. The complete and regular voiding of the bladder.
- c. The presence of glucose in the urine.
- d. A short urethra.
Answer: b. The complete and regular voiding of the bladder.
42. A key component of managing pyelonephritis is ensuring the patient is:
- a. Adequately hydrated, either orally or intravenously.
- b. On strict bed rest.
- c. Consuming a low-protein diet.
- d. Avoiding all fluids.
Answer: a. Adequately hydrated, either orally or intravenously.
43. A patient with pyelonephritis reports an allergy to penicillin causing a mild rash. Which of the following would likely be safe to use?
- a. Ampicillin
- b. Piperacillin-tazobactam
- c. A third-generation cephalosporin like ceftriaxone.
- d. Amoxicillin-clavulanate
Answer: c. A third-generation cephalosporin like ceftriaxone.
44. What is a key reason to treat pyelonephritis aggressively?
- a. To prevent the long-term complication of renal scarring and chronic kidney disease.
- b. It is not a serious infection.
- c. To ensure the patient can be discharged in 24 hours.
- d. To prevent the development of a cough.
Answer: a. To prevent the long-term complication of renal scarring and chronic kidney disease.
45. A pharmacist’s role includes counseling patients on non-pharmacologic measures for UTI prevention, such as:
- a. Proper hygiene (wiping front to back).
- b. Adequate fluid intake.
- c. Post-coital voiding.
- d. All of the above.
Answer: d. All of the above.
46. If a patient is treated empirically with a fluoroquinolone for pyelonephritis and the culture returns showing the E. coli is resistant, the pharmacist should:
- a. Recommend continuing the fluoroquinolone.
- b. Recommend stopping all antibiotics.
- c. Recommend switching to a new antibiotic based on the sensitivity report.
- d. Recommend doubling the dose of the fluoroquinolone.
Answer: c. Recommend switching to a new antibiotic based on the sensitivity report.
47. A UTI is defined as the presence of pathogens in the urinary tract accompanied by:
- a. A normal urinalysis.
- b. Symptoms of infection.
- c. A normal body temperature.
- d. A negative urine culture.
Answer: b. Symptoms of infection.
48. 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
49. The overall management of pyelonephritis is guided by:
- a. The patient’s preference for an antibiotic.
- b. The severity of the illness and local resistance patterns.
- c. The cost of the medication.
- d. The time of day the patient presents.
Answer: b. The severity of the illness and local resistance patterns.
50. The ultimate goal of understanding the management of pyelonephritis is to:
- a. Ensure patients receive timely, effective, and safe antimicrobial therapy to prevent serious complications.
- b. Memorize a list of all possible causative organisms.
- c. Be able to perform a urinalysis.
- d. Pass the final exam for Patient Care 4.
Answer: a. Ensure patients receive timely, effective, and safe antimicrobial therapy to prevent serious complications.