Infections

The bacterial organisms most likely to be responsible for the

formation of struvite
stones are Proteus mirabilis and:
A. Corynebacterium diphtheriae.
B. Escherichia coli.
C. Serratia marcescens.
D. Staphylococcus aureus.
E. Streptococcus pneu moniae.

ANSWER=D

Proteus species are most commonly associated with struvite stones.

However, more than 90% of 5. aureus organisms produce urease,
and are, therefore, associated with struvite stones. The remainder of
the bacteria listed are not associated with urease production.

CAMPBELL-WALSH UROLOGY, ed 11. Philadelphia, Elsevier,

2015, vol2, chap 51, pp 1194-1195

A 33-year-old woman has dysuria and fever. Urinalysis is leukocyte

esterase positive and nitrite negative. There are 10 RBC and 30
WBCIhpf on microscopy. Urine culture will likely grow:
A. Escherichia coli.
B. Pseudomonas aeruginosa.
C. Serratia marcescens.
D. Klebsiella oxytoca.
E. Proteus mirabilis.

ANSWER=B
Bacteria may convert urinary nitrates into nitrites and this may be
used as evidence of UTI.

Gram-negative bacteria commonly do this, while Gram-positive

species generally do not.

One very important gram-negative exception is Pseudomonas, which

does not contain the enzymatic machinery to make this conversion.

Thus, a negative nitrite by urinary dipstick in this patient with

symptoms and other urinalysis findings suggestive of UTI should
likely be treated presumptively pending culture, and Pseudomonas is
one of the very important, aggressive pathogens that must be
considered in this circumstance.

A 64-year-old man has dysuria, frequency, and hematuria following

removal of a urethral catheter after radical prostatectomy. He is
allergic to penicillin. A urine culture at the time of catheter removal
grew Enterococcus faecalis. The best treatment is:
A. cephalexin.
B. gentamicin.
C. ciprofloxacin.
D. clindamycin.
E. nitrofurantoin

Corrct answer E

Effective against enterococci Not effective

ES penicillin- piptaz FQ
Amox Clinda
NFT AG
fosfomycin cephalosporins
A one-month-old girl with a history of glucose-6-phosphate
dehydrogenase
deficiency has a febrile UTI. Urine culture grows Enterococcus and
she is treated with
amoxicillin. VCUG shows bilateral grade 4 VUR. The most
appropriate prophylactic
antibiotic is:
A. amoxicillin.
B. amoxicillin/clavulanate K (Augmentin@).-
C. trimethoprim/suIfamethoxazole.
D. nitrofurantoin.
E. cephalexin

A. amoxicillin.
B. amoxicillin/clavulanate K (Augmentin@).- wide spectrum not
for prophylaxis
C. trimethoprim/suIfamethoxazole.- - avoid in 1st month of life
D. nitrofurantoin.- hemolysis in G6PD- avoid in 1st month of life
E. cephalexin

Treatment of asymptomatic bacteriuria is most indicated in

patients who are

Option A elderly
Option B catheterized
Option C pregnant
Option D confused

Correct Option C
. Bacteriuria without pyuria is indicative of

Option A infection
Option B colonization
Option C tuberculosis
Option D contamination

Correct Option B

The ideal class of drugs for empirical treatment of

uncomplicated UTIs is
Option A aminopenicillins
Option B aminoglycosides
Option C fluoroquinolones
Option D cephalosporins

Correct Option C

The most reliable urine specimen is obtained by

Option A uretheralcatherization
Option B catheter aspiration
Option C midstream voiding
Option D suprapubic aspiration

Correct Option D
A patient with acute pyelonephritis, persistent fever and flank
pain for 24
hours warrants
Option A observation
Option B CT
Option C change in antimicrobial therapy
Option D ultrasonography
Correct Option A

The most common bacterial cause of xanthogranulomatous

pyelonephritis is
Option A Escherichia coli
Option B Pseudomonas
Option C Klebsiella
Option D Proteus mirabilis
Correct Option D

. Factors that influence sexual transmission of HIV include all of

the following EXCEPT

Option A sexually transmitted infections

Option B antiretroviral therapy
Option C circumcision status
Option D anti-inflammatory therapy

Correct Option D

Most patients with presumed indinavir containing urinary

calculi require
Option A extracorporeal shockwave lithotripsy
Option B ureteroscopy
Option C noncontrast CT for diagnosis
Option D hydration, analgesics, and temporary cessation of
indinavir
Correct Option D

The late stage of lichen sclerosus involving the glans penis is

termed

Option A keratinizing balanoposthitis

Option B pseudoepitheliomatous, keratotic and
micaceousbalanitis
Option C bowenoidpapulosis
Option D balanitisxeroticaobliterans

Correct Option D

Which of the following cutaneous conditions has been associated

with an
increased risk of squamous cell carcinoma ?
Option A lichen sclerosus et atrophicus
Option B Lichen planus
Option C Psoriasis
Option D Bullous pemphigoid
Correct Option A

15. Which of the following statements regarding tuberculosis is

correct ?
Option A Renal tuberculosis is usually the result of activation of
prior blood borne metastatic
renal infection
Option B Epididymitis is a rare presenting symptom of
genitourinary tuberculosis
Option C Transmission of genitourinary tuberculosis from male
to female is common
Option D Renal tuberculosis is most common in children
younger than 5 years of age
Correct Option A
16. Radiographic findings may be similar to those of
tuberculosis in which
genitourinary fungal infection ?
Option A candidiasis
Option B hydatid disease
Option C schistosomiasis
Option D coccidiodomycosis
Correct Option D

15. Which of the following cutaneous conditions has been

associated with an
increased risk of squamous cell carcinoma ?
Option A lichen sclerosus et atrophicus
Option B Lichen planus
Option C Psoriasis
Option D Bullous pemphigoid
Correct Option A

16 . Which fungus is the most common cause of systemic fungal

infections in
severly immunocompromised patients ?
Option A aspergillus
Option B cryptococcusneoformans
Option C blastomyces
Option D histoplasma
Correct Option A
A.31-year-old woman has acute cystitis. The most appropriate
treatment is three days of:
A. fosfomycin.
B. nitrofurantoin.
C. ampicillin.
D. ciprofloxacin.
E. trimethoprimlsulfamethoxazole

Duration of Therapy.

Three-day therapy is the preferred regimen

for uncomplicated cystitis in women

3-day therapy is more effective than single-dose therapy.

Three-day therapy with

TMP-SMX,
TMP,
amoxicillin, or
cloxacillin

Because 7-day therapy often causes more adverse effects, it is

recommended only

for women with symptoms of 1 week or more,

men, and individuals with possible complicating factors.

Other options include nitrofurantoin, perhaps as 7-day therapy, and

fosfomycin singledose therapy; each of these requires further study.

β-Lactams as a group are less effective in treatment of cystitis than

TMP, TMP-SMX, and the fluoroquinolones.
Seven-day therapy is the preferred regimen in uncomplicated
cystitis in men.
Uncomplicated cystitis women – TMP SMX/ 3 days
amoxicillin,
Uncomplicated cystitis women – nitrofurantoin 7 days
Uncomplicated cystitis women- fosfomycin Single dose
Uncomplicated cystitis men- any drug 7 days
β-Lactams as a group are less effective in treatment of
cystitis than TMP, and FQ..

90% of women are asymptomatic within 72

hours after initiating antimicrobial therapy
young women who are asymptomatic after therapy follow-up visit or
culture is not
required in
older women A follow-up visit,
those with potential risk factors urinalysis, and
men urine culture
recommended
UTIs in most men should be considered
complicated until proven otherwise.
patient does not respond to therapy, appropriate
microbiologic
urologic
evaluations

narrow spectrum of organisms with highly predictable

profiles of antimicrobial susceptibility
Young women m/c organism UC E. coli-70-90%
Young women 2nd m/c organism UC S. saprophyticus
men m/c organism UC E. coli and other
Enterobacteriaceae
Symptomatic patients, the presence of 102 cfu/mL or indicates infection
more
women with recent onset of s/s s/o acute uncomplicated No need of c/s
cystitis with positive for pyuria, bacteriuria, or
hematuria, or a combination
symptoms and urine examination findings leave the Obtain c/s
diagnosis of cystitis in doubt.
patients with recent antimicrobial therapy or UTI

Uncomplicated Cystitis

By definition, acute cystitis is a superficial infection of the bladder

mucosa, so fever, chills, and other signs of dissemination are not
present.

Antimicrobial Selection.

NFT TMP-SMX amoxicillin/clav Fosfomycin

ulanate trometamol
more expensive effective and and the high cost minimal
inexpensive agent resistance
and propensity
for collateral
damage
less active against
aerobic gram-negative
rods other than E.
coli.

prescribed for 5 days (3 g in a single

and may cause dose)
gastrointestinal upset
Not a/w plasmid- Recommended in high in vitro
mediated resistance so areas where resistance to
is choice for patients E.coli resistance ampicillin and
with recent exposure is <20% sulfonamide
to other antibiotics
TMP is as inferior
 efficacious as efficacy
TMP-SMX and is compared with
a/w fewer side standard short-
effects, because course
of the absence of regimens
the sulfa
component

Fluoroquinolones

are equally effective

They have a high propensity for collateral damage (i.e., ecological
adverse effects, such as drug resistance) and should be reserved for
important infections other than acute cystitis and thus should be
considered alternative antimicrobials for acute cystitis

drugs are less effective than multiple-day regimens in this regard

(Fihn et al, 1988), which probably explains why there are more
early recurrent infections after single-dose therapy with these drugs.
Nitrofurantoin and β-lactam drugs are generally not effective in
eliminating E. coli from the vagina.