Prostatitis is a common yet often misunderstood urological condition that encompasses a spectrum of disorders, from acute bacterial infection to chronic pelvic pain. Effective management, a key topic within the Patient Care 4 curriculum on infectious diseases, requires careful diagnosis and a tailored therapeutic approach. Pharmacists play a crucial role in ensuring appropriate antibiotic selection and duration, which is critical for eradicating infection and preventing chronic complications. This quiz will test your knowledge on the classification, microbiology, and evidence-based management of prostatitis.
1. A 60-year-old male presents with high fever, chills, perineal pain, and significant dysuria. On physical exam, his prostate is extremely tender. This presentation is most consistent with which NIH category of prostatitis?
- a. Category I: Acute Bacterial Prostatitis
- b. Category II: Chronic Bacterial Prostatitis
- c. Category III: Chronic Prostatitis/Chronic Pelvic Pain Syndrome
- d. Category IV: Asymptomatic Inflammatory Prostatitis
Answer: a. Category I: Acute Bacterial Prostatitis
2. What is the most common causative pathogen in acute and chronic bacterial prostatitis?
- a. Staphylococcus aureus
- b. Enterococcus faecalis
- c. Escherichia coli
- d. Chlamydia trachomatis
Answer: c. Escherichia coli
3. Which two classes of antibiotics are generally preferred for treating bacterial prostatitis due to their excellent penetration into prostatic tissue?
- a. Penicillins and cephalosporins
- b. Macrolides and tetracyclines
- c. Fluoroquinolones and trimethoprim-sulfamethoxazole
- d. Nitrofurantoin and fosfomycin
Answer: c. Fluoroquinolones and trimethoprim-sulfamethoxazole
4. A patient is being treated for acute bacterial prostatitis. What is the recommended minimum duration of antibiotic therapy?
- a. 3-5 days
- b. 7-10 days
- c. 2-4 weeks
- d. A single dose
Answer: c. 2-4 weeks
5. Which of the following best describes Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)?
- a. A well-defined bacterial infection with a rapid onset.
- b. An asymptomatic condition found incidentally.
- c. Pelvic pain for at least 3 months with no definitive evidence of a bacterial infection.
- d. An acute infection requiring hospitalization.
Answer: c. Pelvic pain for at least 3 months with no definitive evidence of a bacterial infection.
6. The “Management of… 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. Why is a long duration of antibiotic therapy necessary for bacterial prostatitis?
- a. Because the causative bacteria are always highly resistant.
- b. To prevent side effects.
- c. Because of the difficulty for many antibiotics to penetrate prostatic tissue and eradicate the infection.
- d. To ensure patient adherence.
Answer: c. Because of the difficulty for many antibiotics to penetrate prostatic tissue and eradicate the infection.
8. In the management of Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS), which class of medication may be used to relieve symptoms of bladder outlet obstruction and improve urinary flow?
- a. Alpha-blockers (e.g., tamsulosin)
- b. Diuretics
- c. Antihistamines
- d. Opioid analgesics
Answer: a. Alpha-blockers (e.g., tamsulosin)
9. A vigorous digital rectal exam (prostatic massage) should be avoided in patients suspected of having which condition due to the risk of inducing bacteremia?
- a. Benign Prostatic Hyperplasia (BPH)
- b. Asymptomatic Inflammatory Prostatitis
- c. Chronic Bacterial Prostatitis
- d. Acute Bacterial Prostatitis
Answer: d. Acute Bacterial Prostatitis
10. Which of the following is NOT a typical symptom of Acute Bacterial Prostatitis?
- a. High fever and chills
- b. Perineal and low back pain
- c. Urinary frequency and urgency
- d. Asymptomatic bacteriuria
Answer: d. Asymptomatic bacteriuria
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 with Chronic Bacterial Prostatitis is being treated with oral ciprofloxacin. What is the recommended duration of therapy?
- a. 7-10 days
- b. 14 days
- c. At least 4-6 weeks
- d. 3 days
Answer: c. At least 4-6 weeks
13. Which of the following agents is NOT appropriate for treating bacterial prostatitis?
- a. Levofloxacin
- b. Trimethoprim-sulfamethoxazole
- c. Nitrofurantoin
- d. Ciprofloxacin
Answer: c. Nitrofurantoin
14. A key role for the pharmacist in managing prostatitis is:
- a. Performing a digital rectal exam.
- b. Counseling on the importance of completing the long course of antibiotics.
- c. Obtaining a urine culture.
- d. Prescribing the antibiotics.
Answer: b. Counseling on the importance of completing the long course of antibiotics.
15. A UTI in a male is considered complicated and may involve infection of the:
- a. Bladder only
- b. Urethra only
- c. Prostate
- d. Kidneys only
Answer: c. Prostate
16. “Infectious Diseases of the Kidney” is a module within the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
17. The microbiology of common prostatitis pathogens like E. coli is covered in the Patient Care 2 curriculum.
- a. True
- b. False
Answer: a. True
18. For a patient hospitalized with severe Acute Bacterial Prostatitis, initial therapy might involve:
- a. Oral amoxicillin
- b. A single dose of fosfomycin
- c. An IV fluoroquinolone or an IV combination like ampicillin plus gentamicin.
- d. Watchful waiting.
Answer: c. An IV fluoroquinolone or an IV combination like ampicillin plus gentamicin.
19. A patient is treated for Chronic Bacterial Prostatitis with a 6-week course of levofloxacin. A key counseling point is to monitor for:
- a. A metallic taste.
- b. Brown discoloration of the urine.
- c. Tendon pain or rupture.
- d. Constipation.
Answer: c. Tendon pain or rupture.
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. The most common form of prostatitis is:
- a. Category I: Acute Bacterial Prostatitis
- b. Category II: Chronic Bacterial Prostatitis
- c. Category III: Chronic Prostatitis/Chronic Pelvic Pain Syndrome
- d. Category IV: Asymptomatic Inflammatory Prostatitis
Answer: c. Category III: Chronic Prostatitis/Chronic Pelvic Pain Syndrome
22. A patient with CP/CPPS may be given a trial of antibiotics because:
- a. It is proven to cure the condition.
- b. A low-grade, difficult-to-culture infection cannot be definitively ruled out.
- c. Antibiotics have anti-inflammatory properties.
- d. Both b and c are possible reasons.
Answer: d. Both b and c are possible reasons.
23. Why do beta-lactam antibiotics have poor penetration into non-inflamed prostatic tissue?
- a. They are too large.
- b. They are generally more lipid-soluble.
- c. They are generally more water-soluble and have unfavorable ionization characteristics at prostatic fluid pH.
- d. They are rapidly metabolized by the prostate.
Answer: c. They are generally more water-soluble and have unfavorable ionization characteristics at prostatic fluid pH.
24. The renal system module in Patient Care 4 covers the management of UTIs in males.
- a. True
- b. False
Answer: a. True
25. A patient with symptoms of prostatitis should be evaluated by a physician to differentiate it from other conditions such as:
- a. Benign Prostatic Hyperplasia (BPH)
- b. Bladder cancer
- c. A simple UTI
- d. All of the above
Answer: d. All of the above
26. Which of the following is NOT a risk factor for prostatitis?
- a. Recent urological instrumentation
- b. An indwelling catheter
- c. Dehydration
- d. A high-fiber diet
Answer: d. A high-fiber diet
27. An active learning session on prostatitis 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. The treatment of Acute Bacterial Prostatitis is considered successful when:
- a. The patient’s fever resolves.
- b. The urine is sterilized.
- c. The patient completes the full 2-4 week course of antibiotics and symptoms resolve.
- d. The PSA level returns to normal.
Answer: c. The patient completes the full 2-4 week course of antibiotics and symptoms resolve.
29. For a patient with a documented quinolone-resistant E. coli causing chronic bacterial prostatitis, a potential option might be:
- a. A lower dose of a quinolone.
- b. Long-term trimethoprim-sulfamethoxazole if susceptible.
- c. Nitrofurantoin.
- d. A 3-day course of amoxicillin.
Answer: b. Long-term trimethoprim-sulfamethoxazole if susceptible.
30. The management of UTIs, including prostatitis, is covered in the renal system module.
- a. True
- b. False
Answer: a. True
31. In CP/CPPS, what is the role of 5-alpha reductase inhibitors like finasteride?
- a. They are first-line therapy for pain.
- b. They may be used in some patients with an enlarged prostate to help reduce symptoms.
- c. They are potent anti-inflammatory agents.
- d. They have no role in this condition.
Answer: b. They may be used in some patients with an enlarged prostate to help reduce symptoms.
32. The primary symptom that defines Category III Prostatitis is:
- a. Fever
- b. Positive urine culture
- c. Chronic pelvic pain
- d. Lack of symptoms
Answer: c. Chronic pelvic pain
33. The “defend a therapeutic plan” for a UTI is an objective in the Professional Skills Lab 3.
- a. True
- b. False
Answer: a. True
34. A patient diagnosed with Asymptomatic Inflammatory Prostatitis (Category IV) requires:
- a. A 4-week course of ciprofloxacin.
- b. A 6-week course of trimethoprim-sulfamethoxazole.
- c. An alpha-blocker.
- d. No treatment.
Answer: d. No treatment.
35. A key difference between acute and chronic bacterial prostatitis is:
- a. The causative organisms.
- b. The duration of therapy required.
- c. The severity of systemic symptoms (fever/chills are common in acute but not chronic).
- d. Both b and c.
Answer: d. Both b and c.
36. The pharmacist’s role in managing prostatitis involves all of the following EXCEPT:
- a. Recommending an appropriate antibiotic based on likely pathogens and penetration.
- b. Counseling on adherence for a long duration of therapy.
- c. Performing a prostatic massage to obtain a fluid sample.
- d. Screening for potential drug interactions.
Answer: c. Performing a prostatic massage to obtain a fluid sample.
37. Which of the following is an appropriate non-pharmacologic recommendation for a patient with prostatitis?
- a. Increased caffeine intake.
- b. Sitz baths for perineal pain relief.
- c. Complete bed rest.
- d. A low-fluid diet.
Answer: b. Sitz baths for perineal pain relief.
38. The lecture “Management of UTIs, Part 2” covers prostatitis.
- a. True
- b. False
Answer: a. True
39. A patient is treated for ABP with IV antibiotics and improves. An appropriate oral follow-up therapy would be:
- a. A 7-day course of levofloxacin.
- b. A 2-4 week course of levofloxacin.
- c. A 3-day course of nitrofurantoin.
- d. A single dose of fosfomycin.
Answer: b. A 2-4 week course of levofloxacin.
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. Why might a patient with CP/CPPS be referred to physical therapy?
- a. To learn how to administer their own injections.
- b. For pelvic floor muscle relaxation techniques.
- c. To build upper body strength.
- d. For cardiovascular exercise.
Answer: b. For pelvic floor muscle relaxation techniques.
42. The most important factor for an antibiotic to be effective for bacterial prostatitis is its:
- a. Cost.
- b. Ability to penetrate into prostatic tissue.
- c. Color.
- d. Brand name.
Answer: b. Ability to penetrate into prostatic tissue.
43. A patient with acute urinary retention due to ABP may require:
- a. A diuretic.
- b. An anticholinergic medication.
- c. Placement of a suprapubic catheter.
- d. Vigorous prostatic massage.
Answer: c. Placement of a suprapubic catheter.
44. A follow-up urine culture after treatment for Chronic Bacterial Prostatitis is recommended to:
- a. Ensure microbiological cure.
- b. Check for resistance.
- c. Fulfill an insurance requirement.
- d. It is not recommended.
Answer: a. Ensure microbiological cure.
45. Which of the following is NOT a symptom of prostatitis?
- a. Painful ejaculation
- b. Perineal pain
- c. Dysuria
- d. Normal urinary flow
Answer: d. Normal urinary flow
46. A UTI in a male is often considered prostatitis until proven otherwise.
- a. True
- b. False
Answer: a. True
47. The management of prostatitis can be challenging due to:
- a. The difficulty in diagnosing the specific type.
- b. The need for long courses of antibiotics.
- c. The psychosocial impact of chronic pain in CP/CPPS.
- d. All of the above.
Answer: d. All of the above.
48. An active learning session on prostatitis 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 CP/CPPS is often:
- a. A single course of a single medication.
- b. Focused on a quick cure.
- c. Multimodal, involving pharmacologic and non-pharmacologic approaches to manage symptoms.
- d. Always surgical.
Answer: c. Multimodal, involving pharmacologic and non-pharmacologic approaches to manage symptoms.
50. The ultimate goal of learning about the management of prostatitis is to:
- a. Be able to recommend safe and effective, evidence-based therapy to resolve infections and improve quality of life.
- b. Memorize the NIH classification system.
- c. Pass the final exam.
- d. Know how to counsel on every single fluoroquinolone side effect.
Answer: a. Be able to recommend safe and effective, evidence-based therapy to resolve infections and improve quality of life.