Welcome, PharmD students, to this MCQ quiz on Uncomplicated Urinary Tract Infections (UTIs)! Uncomplicated UTIs, primarily acute cystitis, are common infections, especially in women, and pharmacists frequently encounter patients seeking advice or treatment. A strong understanding of the typical pathogens, clinical presentation, diagnostic considerations, appropriate antimicrobial selection based on current guidelines, and patient counseling is essential for effective management and antimicrobial stewardship. This quiz will test your knowledge on these key aspects of uncomplicated UTIs. Let’s begin!
1. An uncomplicated urinary tract infection (UTI) most commonly refers to acute cystitis occurring in:
- a) Men with benign prostatic hyperplasia.
- b) Healthy, non-pregnant, premenopausal adult women with no structural or functional urinary tract abnormalities.
- c) Patients with indwelling urinary catheters.
- d) Individuals with neurogenic bladder.
Answer: b) Healthy, non-pregnant, premenopausal adult women with no structural or functional urinary tract abnormalities.
2. The most common causative pathogen for uncomplicated UTIs is:
- a) Staphylococcus aureus
- b) Pseudomonas aeruginosa
- c) Escherichia coli
- d) Enterococcus faecalis
Answer: c) Escherichia coli
3. Which of the following are classic symptoms of uncomplicated acute cystitis?
- a) High fever, chills, and severe flank pain.
- b) Dysuria (painful urination), urinary urgency, and increased urinary frequency.
- c) Nausea, vomiting, and diarrhea.
- d) Vaginal discharge and itching.
Answer: b) Dysuria (painful urination), urinary urgency, and increased urinary frequency.
4. A positive nitrite test on a urine dipstick is suggestive of a UTI because:
- a) It detects the presence of white blood cells.
- b) Many common Gram-negative uropathogens (like E. coli) convert urinary nitrates to nitrites.
- c) It measures urine pH.
- d) It indicates the presence of ketones.
Answer: b) Many common Gram-negative uropathogens (like E. coli) convert urinary nitrates to nitrites.
5. Leukocyte esterase on a urine dipstick is an indicator of:
- a) Bacteriuria (bacteria in the urine)
- b) Pyuria (white blood cells in the urine), suggesting inflammation.
- c) Hematuria (blood in the urine)
- d) Proteinuria (protein in the urine)
Answer: b) Pyuria (white blood cells in the urine), suggesting inflammation.
6. Which of the following is generally considered a first-line antimicrobial agent for the empiric treatment of uncomplicated acute cystitis in many regions, assuming low local resistance?
- a) Ciprofloxacin
- b) Nitrofurantoin monohydrate/macrocrystals
- c) Amoxicillin
- d) Gentamicin
Answer: b) Nitrofurantoin monohydrate/macrocrystals
7. Trimethoprim/sulfamethoxazole (TMP/SMX) is a recommended first-line option for uncomplicated UTI if local resistance rates to E. coli are known to be:
- a) >50%
- b) >30%
- c) ≤20%
- d) Not a consideration
Answer: c) ≤20%
8. Fosfomycin trometamol is an appropriate first-line option for uncomplicated cystitis, typically administered as:
- a) A 7-day course.
- b) A single oral dose.
- c) An intravenous infusion.
- d) A 3-day course.
Answer: b) A single oral dose.
9. What is the typical duration of therapy for nitrofurantoin monohydrate/macrocrystals when used to treat uncomplicated acute cystitis in women?
- a) Single dose
- b) 3 days
- c) 5 days
- d) 7-10 days
Answer: c) 5 days (Sometimes 5-7 days, but 5 is common).
10. Fluoroquinolones (e.g., ciprofloxacin, levofloxacin) are generally NOT recommended as first-line therapy for uncomplicated cystitis due to:
- a) Their narrow spectrum of activity.
- b) Concerns about their “collateral damage” (e.g., promoting resistance, risk of serious adverse effects like tendon rupture, C. difficile infection).
- c) Their poor urine concentrations.
- d) Their ineffectiveness against E. coli.
Answer: b) Concerns about their “collateral damage” (e.g., promoting resistance, risk of serious adverse effects like tendon rupture, C. difficile infection).
11. Which of the following symptoms, if present, would typically classify a UTI as complicated or suggest pyelonephritis, thus making it unsuitable for standard uncomplicated UTI self-care/empiric treatment?
- a) Mild suprapubic discomfort.
- b) Urinary frequency.
- c) Fever, chills, and flank pain.
- d) Dysuria.
Answer: c) Fever, chills, and flank pain.
12. Nitrofurantoin’s mechanism of action involves:
- a) Inhibition of bacterial cell wall synthesis.
- b) Inhibition of bacterial DNA gyrase.
- c) Being reduced by bacterial flavoproteins to reactive intermediates that damage bacterial DNA, ribosomes, and other macromolecules.
- d) Inhibition of folic acid synthesis.
Answer: c) Being reduced by bacterial flavoproteins to reactive intermediates that damage bacterial DNA, ribosomes, and other macromolecules.
13. A common counseling point for patients taking nitrofurantoin is to:
- a) Take it on an empty stomach to maximize absorption.
- b) Take it with food to enhance absorption and reduce GI upset.
- c) Expect their urine to turn bright red.
- d) Avoid all dairy products.
Answer: b) Take it with food to enhance absorption and reduce GI upset.
14. Nitrofurantoin should generally be avoided in patients with significantly impaired renal function, typically if CrCl is:
- a) >90 mL/min
- b) >60 mL/min
- c) <30 mL/min (or per specific product labeling, as efficacy depends on adequate urine concentration and risk of toxicity increases)
- d) It is safe at any level of renal function.
Answer: c) <30 mL/min (or per specific product labeling, as efficacy depends on adequate urine concentration and risk of toxicity increases)
15. Fosfomycin exerts its bactericidal effect by inhibiting:
- a) Bacterial protein synthesis.
- b) An early step in bacterial cell wall synthesis by inactivating the enzyme MurA (enolpyruvyl transferase).
- c) DNA gyrase.
- d) Dihydropteroate synthase.
Answer: b) An early step in bacterial cell wall synthesis by inactivating the enzyme MurA (enolpyruvyl transferase).
16. Which non-pharmacological measure can be recommended to help prevent recurrent uncomplicated UTIs in some women?
- a) Decreasing fluid intake.
- b) Voiding immediately after sexual intercourse and maintaining adequate hydration.
- c) Using spermicidal contraceptives.
- d) Regular douching.
Answer: b) Voiding immediately after sexual intercourse and maintaining adequate hydration.
17. Asymptomatic bacteriuria (ASB) is the presence of bacteria in the urine without UTI symptoms. In which of the following patient populations is screening and treatment for ASB generally recommended?
- a) Healthy, non-pregnant premenopausal women.
- b) Elderly institutionalized patients.
- c) Pregnant women.
- d) Patients with indwelling catheters for less than 2 weeks.
Answer: c) Pregnant women.
18. The typical duration of therapy with trimethoprim/sulfamethoxazole for uncomplicated acute cystitis is:
- a) Single dose
- b) 3 days
- c) 7 days
- d) 10-14 days
Answer: b) 3 days
19. A patient with a known sulfa allergy should generally avoid which first-line agent for uncomplicated UTI?
- a) Nitrofurantoin
- b) Fosfomycin
- c) Trimethoprim/sulfamethoxazole
- d) Amoxicillin/clavulanate
Answer: c) Trimethoprim/sulfamethoxazole
20. Which of the following patient populations is NOT considered to have an uncomplicated UTI if they present with cystitis symptoms?
- a) A healthy 25-year-old non-pregnant female.
- b) A 60-year-old male.
- c) A 30-year-old pregnant female.
- d) Both b and c.
Answer: d) Both b and c. (Males with UTI and UTIs in pregnancy are generally considered complicated).
21. When is a urine culture and susceptibility testing typically recommended for a patient with suspected uncomplicated cystitis?
- a) Always, for every patient.
- b) If symptoms persist or recur after initial empiric therapy, or if there are risk factors for resistant organisms.
- c) Never, empiric therapy is always sufficient.
- d) Only if the patient has a fever.
Answer: b) If symptoms persist or recur after initial empiric therapy, or if there are risk factors for resistant organisms.
22. Beta-lactam antibiotics (e.g., amoxicillin/clavulanate, cefpodoxime, cefdinir) can be used as alternative agents for uncomplicated UTI, but they are generally considered:
- a) More effective than first-line agents.
- b) Less effective than first-line agents like nitrofurantoin or TMP/SMX for uncomplicated cystitis and may have higher rates of collateral damage.
- c) To have no risk of resistance.
- d) To require a single-dose regimen.
Answer: b) Less effective than first-line agents like nitrofurantoin or TMP/SMX for uncomplicated cystitis and may have higher rates of collateral damage.
23. A potential adverse effect of nitrofurantoin, especially with long-term use or in patients with renal impairment, is:
- a) Tendon rupture
- b) Pulmonary toxicity (acute or chronic)
- c) Severe photosensitivity
- d) Red man syndrome
Answer: b) Pulmonary toxicity (acute or chronic)
24. What is the primary reason cranberry products (juice or supplements) are sometimes used for UTI prevention (though evidence is mixed)?
- a) They directly kill bacteria in the urine.
- b) They are thought to contain proanthocyanidins that may prevent E. coli from adhering to urothelial cells.
- c) They alkalinize the urine.
- d) They act as potent diuretics.
Answer: b) They are thought to contain proanthocyanidins that may prevent E. coli from adhering to urothelial cells.
25. A key piece of counseling for any patient receiving antibiotics for a UTI is to:
- a) Stop taking the medication as soon as symptoms improve.
- b) Complete the full prescribed course of therapy, even if symptoms resolve earlier.
- c) Share the medication with family members who have similar symptoms.
- d) Take the antibiotic with large amounts of dairy products.
Answer: b) Complete the full prescribed course of therapy, even if symptoms resolve earlier.
26. Which of the following is a significant risk factor for developing an uncomplicated UTI in women?
- a) High fluid intake.
- b) Frequent voiding.
- c) Sexual activity and use of spermicides.
- d) Use of cranberry supplements.
Answer: c) Sexual activity and use of spermicides.
27. If a patient with uncomplicated cystitis does not experience symptom improvement within _______ of starting appropriate antibiotic therapy, they should be re-evaluated.
- a) 1 hour
- b) 12 hours
- c) 48-72 hours
- d) 1 week
Answer: c) 48-72 hours
28. Phenazopyridine is an OTC urinary analgesic used for symptomatic relief of dysuria. Patients should be counseled that it:
- a) Will treat the underlying infection.
- b) May turn their urine reddish-orange and should be used for a short duration only (e.g., 1-2 days).
- c) Is a potent antibiotic.
- d) Should be taken for at least 7 days.
Answer: b) May turn their urine reddish-orange and should be used for a short duration only (e.g., 1-2 days).
29. Recurrent uncomplicated UTIs in women are often defined as:
- a) One UTI per year.
- b) Two or more infections in 6 months, or three or more infections in 1 year.
- c) Any UTI that requires hospitalization.
- d) A UTI that lasts longer than 3 days.
Answer: b) Two or more infections in 6 months, or three or more infections in 1 year.
30. For a patient with an uncomplicated UTI, which factor is LEAST likely to be considered when selecting an empiric antibiotic?
- a) Local E. coli susceptibility patterns.
- b) Patient allergies.
- c) The color of the antibiotic tablet.
- d) Potential drug interactions.
Answer: c) The color of the antibiotic tablet.
31. The term “cystitis” specifically refers to inflammation of the:
- a) Kidneys
- b) Urethra
- c) Bladder
- d) Prostate
Answer: c) Bladder
32. Which laboratory finding from a urinalysis strongly suggests the presence of bacteria?
- a) Presence of ketones.
- b) Positive nitrites.
- c) Presence of red blood cells only.
- d) Low specific gravity.
Answer: b) Positive nitrites.
33. A major principle of treating uncomplicated UTIs is to choose an antimicrobial that:
- a) Has the broadest spectrum possible.
- b) Achieves adequate concentrations in the urine and is active against common uropathogens.
- c) Requires intravenous administration only.
- d) Is known to cause significant nephrotoxicity.
Answer: b) Achieves adequate concentrations in the urine and is active against common uropathogens.
34. What is the significance of flank pain in a patient with UTI symptoms?
- a) It is a common symptom of uncomplicated cystitis.
- b) It may indicate involvement of the upper urinary tract (kidneys), suggesting pyelonephritis.
- c) It usually means the UTI is caused by a virus.
- d) It is an indication for immediate surgical intervention.
Answer: b) It may indicate involvement of the upper urinary tract (kidneys), suggesting pyelonephritis.
35. In the pathogenesis of UTIs, bacteria most commonly ascend from the _______ to the bladder.
- a) Bloodstream
- b) Kidneys
- c) Urethra (often from periurethral colonization by fecal flora)
- d) Lymphatic system
Answer: c) Urethra (often from periurethral colonization by fecal flora)
36. If a patient being treated for an uncomplicated UTI develops a rash and itching after starting TMP/SMX, the pharmacist should suspect:
- a) A normal side effect that will resolve.
- b) An allergic reaction, and advise the patient to contact their prescriber.
- c) That the dose is too low.
- d) That the infection is getting worse.
Answer: b) An allergic reaction, and advise the patient to contact their prescriber.
37. Prolonged or unnecessary use of antibiotics for UTIs can contribute to:
- a) Improved bladder health.
- b) Development of antimicrobial resistance and disruption of normal vaginal/gut flora.
- c) Prevention of all future UTIs.
- d) Reduced healthcare costs.
Answer: b) Development of antimicrobial resistance and disruption of normal vaginal/gut flora.
38. Which of these is NOT a common symptom directly related to uncomplicated lower UTI (cystitis)?
- a) Dysuria
- b) Urinary urgency
- c) Suprapubic pain
- d) Joint pain
Answer: d) Joint pain
39. The efficacy of nitrofurantoin is dependent on it reaching adequate concentrations in the:
- a) Systemic circulation.
- b) Cerebrospinal fluid.
- c) Urine.
- d) Bile.
Answer: c) Urine.
40. For women with recurrent uncomplicated UTIs, which is a potential non-antibiotic prophylactic strategy (though evidence and recommendations vary)?
- a) Daily high-dose aspirin.
- b) Use of certain probiotic strains (e.g., Lactobacillus spp.) or D-mannose.
- c) Regular use of systemic corticosteroids.
- d) Drinking large amounts of caffeinated beverages.
Answer: b) Use of certain probiotic strains (e.g., Lactobacillus spp.) or D-mannose.
41. A urine culture report showing >100,000 CFU/mL of E. coli that is “Susceptible” to nitrofurantoin means:
- a) Nitrofurantoin should not be used.
- b) The infection is too severe for nitrofurantoin.
- c) Nitrofurantoin is likely to be an effective treatment option for this infection.
- d) The patient is allergic to nitrofurantoin.
Answer: c) Nitrofurantoin is likely to be an effective treatment option for this infection.
42. When counseling a patient on fosfomycin for an uncomplicated UTI, it’s important to explain that:
- a) It requires a 7-day course of therapy.
- b) It is a single-dose therapy, and the powder should be mixed with water before ingestion.
- c) It needs to be taken with a fatty meal for absorption.
- d) It commonly causes severe kidney damage.
Answer: b) It is a single-dose therapy, and the powder should be mixed with water before ingestion.
43. A key component of “Introduction to Infectious Diseases” relevant to UTIs is understanding that most are caused by:
- a) Viruses
- b) Fungi
- c) Bacteria ascending from the patient’s own fecal flora.
- d) Parasites
Answer: c) Bacteria ascending from the patient’s own fecal flora.
44. Which question is important to ask when assessing a female patient for UTI symptoms to rule out other conditions?
- a) “What is your favorite color?”
- b) “Are you experiencing any vaginal discharge or itching?” (To help differentiate from vaginitis).
- c) “Do you own a pet?”
- d) “What is your occupation?”
Answer: b) “Are you experiencing any vaginal discharge or itching?” (To help differentiate from vaginitis).
45. The primary therapeutic goal in treating uncomplicated acute cystitis is to:
- a) Prevent kidney transplantation.
- b) Eradicate the infecting pathogen from the urine and resolve symptoms.
- c) Only provide symptomatic relief without addressing the infection.
- d) Ensure the patient develops resistance to future infections.
Answer: b) Eradicate the infecting pathogen from the urine and resolve symptoms.
46. A patient who is currently breastfeeding and develops an uncomplicated UTI needs an antibiotic. The pharmacist should help select an agent that is:
- a) Known to be highly concentrated in breast milk and toxic to infants.
- b) Considered relatively safe during lactation, with low transfer into breast milk or known safety in infants.
- c) Always the broadest spectrum available.
- d) Available only as an IV formulation.
Answer: b) Considered relatively safe during lactation, with low transfer into breast milk or known safety in infants.
47. Which of the following is a risk factor for antimicrobial resistance in UTIs?
- a) No prior antibiotic use.
- b) Recent antibiotic use (e.g., within the last 3-6 months).
- c) High fluid intake.
- d) Regular use of cranberry supplements.
Answer: b) Recent antibiotic use (e.g., within the last 3-6 months).
48. A principle of UTI management is that if pyelonephritis is suspected (fever, flank pain), the treatment approach will differ from uncomplicated cystitis by typically requiring:
- a) A shorter course of antibiotics.
- b) Oral therapy only with fosfomycin.
- c) Potentially initial IV therapy and a longer course of antibiotics that achieve good tissue penetration in the kidneys.
- d) No antibiotics, only supportive care.
Answer: c) Potentially initial IV therapy and a longer course of antibiotics that achieve good tissue penetration in the kidneys.
49. The “interaction of bacteria with the immune system” (from PHA5782 Module 2.1.1) in the context of UTIs involves:
- a) Bacteria producing antibodies against the host.
- b) Host defenses like flushing action of urine, bladder epithelial cells, and local immune responses attempting to clear the bacteria.
- c) Viruses attacking the bacteria in the bladder.
- d) The bacteria becoming part of the normal flora immediately.
Answer: b) Host defenses like flushing action of urine, bladder epithelial cells, and local immune responses attempting to clear the bacteria.
50. Patient education provided by a pharmacist for uncomplicated UTI management should include information on the prescribed antibiotic, adherence, potential side effects, and:
- a) How to perform a urine culture at home.
- b) When to expect symptom improvement and when to seek follow-up care if symptoms persist or worsen.
- c) The exact genetic sequence of the infecting E. coli.
- d) How to prescribe antibiotics for family members.
Answer: b) When to expect symptom improvement and when to seek follow-up care if symptoms persist or worsen.