An 18-year-old coed came to the infirmary at the University of Florida complaining of nausea and left flank pain. An 18-year-old coed came to the infirmary at the University of Florida complaining of nausea and left flank pain.
Question 1 - Single Best Answer
What is the most likely site of her primary problem?
A) uterus - she is pregnant
B) intestinal tract (food poisoning or GI infection)
C) muscle strain
D) kidney
E) bladder
Question 2 - Single Best Answer
What is another name for infection of the kidney?
A) cystitis
B) pyelonephritis
C) dysuria
D) colitis
E) blepharitis
She has been having fevers and chills off and on for about five days. The chills and fever started at about the time that she noted increased urinary frequency with some burning and pain when she urinated. She took some amoxicillin that had been given to her four months ago. That infection had been successfully treated by the amoxicillin, but it didn't seem to be having an effect on this infection. Today she is somewhat worried because she has noted some blood in her urine.
Question 3 - Single Best Answer
What is cystitis?
A) ear infection
B) eyelid infection
C) stomach infection
D) bladder infection
E) introital infection
Question 4 - Single Best Answer
What host defense operates to provide the primary protection in the bladder?
A) cell-mediated immunity
B) constant flushing and desquamation
C) very low pH (below 2)
D) phagocytosis
E) an abundant normal flora that protects against pathogenic bacteria
Question 5 - Single Best Answer
What test(s) would you order to diagnose the patient's problem?
A) Gram stain of urinary sediment
B) urine culture
C) Gram stain of urethral swab
D) blood pressure
E) both A and B
Question 6 - Single Best Answer
Which list below best represents the infectious agents likely to colonize the urinary tract in this young woman?
A) E. coli, S. aureus, Neisseria gonorrhoeae, Proteus
B) Staphylococcus saprophyticus, Neisseria gonorrhoea, Treponema pallidum
C) S. saprophyticus, E. coli, Proteus, Pseudomonas
D) Gardnerella vaginalis, Neisseria gonorrhoea, T. pallidum
E) Peptostreptococcus, Bacteroides, Clostridia
Question 7 - Single Best Answer
What is the most likely source of agents that cause disease in the urinary tracts of young women?
A) the blood (haematogenous route)
B) the skin
C) the intestine via the ascending route
D) the intestine via direct extension into the bladder
E) from their sexual partners
Question 8 - Single Best Answer
What are the reasons that women, in general, suffer more urinary tract infections than men?
A) they are more sexually active
B) they have larger bladders
C) they have a shorter urethra
D) they have a larger variety of intestinal flora
E) they urinate less frequently
You examine the patient and ask her for a urine sample. You note a temperature of 39, and your physical examination shows left costovertebral angle tenderness. You note that the urine sample of your patient is cloudy and frankly foul smelling. The Gram stain of the sediment showed more than 50 white blood cells per high-power field, and many Gram negative rods. Several red blood cells were also seen.
Question 9 - Single Best Answer
a Of your previous list of possible infective agents, which does this information eliminate?
A) S. saprophyticus
B) E. coli
C) Proteus
D) Pseudomonas
E) all of the above, because the white cells mean that the infection has been eliminated
Question 10 - Single Best Answer
How many white blood cells per high power field would be considered normal?
A) less than 5
B) 5-10
C) 20
D) 50
E) 100
Question 11 - Single Best Answer
If there had been bacteria, but no white cells ( i.e., <5) in the urine, could you conclude that she had a bacterial infection?
A) yes
B) no
The urine culture indicated that there were >100,000 colony forming units/ml of a Gram-, lactose+ rod.
Question 12 - Single Best Answer
How is it easily determined that a Gram- bacterium can ferment lactose?
A) pink colonies on MacConkey's agar
B) any growth on Thayer-Martin media
C) colorless colonies on EMB agar
D) blue colonies on MacConkey's agar
E) complete haemolysis on blood agar
The laboratory reports that the organism in the urine culture is an amoxicillin resistant, chloramphenicol resistant, gentamicin resistant E. coli. You conclude that the patient has pyelonephritis due to a resistant strain of E. coli.
Question 13 - Single Best Answer
What led to the conclusion that she had pyelonephritis and not cystitis?
A) the number of bacteria
B) the number of white cells
C) the kind of bacteria
D) her dysuria
E) her fever
Question 14 - Single Best Answer
Most strains of E. coli are sensitive to amoxicillin. What resulted in the amoxicillin resistance of her E. coli?
A) the amoxicillin taken for her previous infection caused it to mutate
B) a plasmid was transferred to this E. coli from the organism causing her previous infection.
C) the amoxicillin taken for her previous infection selected a resistant variant of E. coli from her normal flora
Question 15 - Single Best Answer
Why are urinary tract infections more common in diabetics than in normal individuals?
A) they have damaged urethras due to cross reacting antibodies
B) they void less frequently as they drink less fluids
C) they have a high incidence of stones in their urinary tracts
D) their urine has a higher concentration of glucose and is a better bacteriological medium
E) their urine has a lower concentration of urea due to higher concentrations of urease and is a better bacteriological medium
Question 16 - Single Best Answer
What is the single most common reason for the increase in UTI's in older men?
A) defective bladder contraction
B) shortening of the urethra
C) defective bladder-ureteral valves
D) periurethral colonization
E) obstruction of the urethra
Question 17 - Single Best Answer
How can you tell the difference between urethritis and cystitis in a young female?
A) only urethritis is accompanied by inflammatory cells
B) only cystitis is accompanied by inflammatory cells
C) the symptoms are different
D) there are more bacteria in the urine in cystitis
E) there are more bacteria in the urine in urethritis
The young woman was hospitalized and given intravenous trimethoprim- sulfamethoxazole. Her fever and symptoms resolved in three days and she was released.
Question 18 - Single Best Answer
In young women with recurrent UTI's, what is the most effective prophylactic measure that can be taken to prevent recurrences?
A) use a condom during sexual intercourse
B) drink lots of blueberry and cranberry juice
C) void after sexual intercourse
D) take an antibiotic after sexual intercourse
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