Barkley Renal/Genitourinary Practice ACTUAL
EXAM ALL QUESTIONS AND ANSWERS
ALREADY GRADED A+. 100% VERIFIED
SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
Section 1: Urinary Tract Infections & Pyelonephritis (Questions 1-20)
Question 1
A 40-year-old female with stage 3 chronic kidney disease secondary to hypertension presents
complaining of dysuria and frequency for 3 days. She denies fever or hematuria. Exam is
unremarkable except for suprapubic tenderness. UA reveals cloudy urine with positive
leukocyte esterase, nitrites, and protein. Cultures are pending. What is the correct medication
therapy?
A. Oral trimethoprim-sulfamethoxazole
B. IM ceftriaxone
C. IV gentamicin
D. IV vancomycin
Correct Answer: A
Rationale: This patient has an uncomplicated UTI. Oral TMP-SMX is appropriate first-line
therapy for cystitis. IV antibiotics are not indicated without signs of systemic infection, and
gentamicin would be nephrotoxic in a patient with CKD .
Question 2
A 34-year-old male arrives at clinic with acute onset 30 minutes ago of severe colicky flank pain
on the left that comes in waves. He reports nausea and emesis x 3. On exam, he appears
anxious and ill. Temp 99, HR 100. Abdomen is soft, nontender, with normal bowel sounds.
Urinalysis is pink in color with a large number of red blood cells. Which of the following is true?
,A. An MRI should be ordered
B. CPK should be ordered
C. Renal ultrasound is indicated
D. The patient should receive ceftriaxone and doxycycline
Correct Answer: C
Rationale: The presentation is consistent with nephrolithiasis and renal colic. Most kidney
stones are made of calcium oxalate. Pain varies depending on the location and size of the stone.
Stones in the renal pelvis or upper urethra cause flank pain; stones lower in the urethra radiate
to the testicle or labia. Renal ultrasound is indicated for initial evaluation .
Question 3
What accounts for 80-90% of UTIs in pregnant women?
A. Staphylococcus saprophyticus
B. Escherichia coli
C. Klebsiella pneumoniae
D. Proteus mirabilis
Correct Answer: B
Rationale: Escherichia coli accounts for 80-90% of UTIs in pregnant women. Asymptomatic
bacteriuria in pregnancy requires treatment to prevent pyelonephritis and preterm birth .
Question 4
Which of the following groups should asymptomatic bacteriuria be treated in?
A. Patients with diabetes mellitus
B. Patients with spinal cord injuries
C. Patients with indwelling catheters
D. Pregnant women
Correct Answer: D
Rationale: Pregnant women are at increased risk of asymptomatic bacteriuria becoming acute
cystitis and/or acute pyelonephritis, with significant maternal and obstetric risks. The Infectious
Disease Society of America does not recommend treatment for the other listed groups .
,Question 5
Which of the following is NOT considered a risk factor for urinary tract infection?
A. Intrauterine device
B. Pregnancy
C. Diabetes mellitus
D. New sexual partner
Correct Answer: A
Rationale: IUD is not a risk factor for UTI. Risk factors for UTI include: pregnancy, diabetes,
diaphragm use, and a new sexual partner .
Question 6
A 68-year-old woman with a history of sickle cell disease presents with suspected UTI. She has
no history of this condition. Which of the following is true regarding her risk?
A. Sickle cell disease increases risk of UTI due to renal medullary ischemia
B. Sickle cell disease does not affect UTI risk
C. Patients with sickle cell disease are at lower risk for UTI
D. Sickle cell disease only affects pediatric patients
Correct Answer: A
Rationale: Sickle cell disease can lead to renal medullary ischemia and infarction, increasing
susceptibility to UTIs. These patients may also have baseline hematuria complicating diagnosis .
Question 7
A 65-year-old female presents with UTI symptoms. Which of the following is a contraindication
to nitrofurantoin?
A. CrCl <30 mL/min
B. Diabetes
C. Hypertension
D. Atrial fibrillation
Correct Answer: A
Rationale: Nitrofurantoin is contraindicated in patients with CrCl <30 mL/min due to inadequate
urinary concentrations. It is also contraindicated in patients with known G6PD deficiency.
, Question 8
What is the most appropriate treatment for a pregnant woman with asymptomatic bacteriuria?
A. No treatment needed
B. Nitrofurantoin 100 mg daily for 5 days
C. Amoxicillin 500 mg TID for 7 days
D. Doxycycline 100 mg BID for 7 days
Correct Answer: B
Rationale: Asymptomatic bacteriuria in pregnancy requires treatment to prevent pyelonephritis
and preterm birth. Nitrofurantoin is a common first-line agent; however, it should be avoided
near term due to risk of neonatal hemolysis.
Question 9
A 72-year-old female with a urinary catheter develops fever and leukocytosis. Urine culture
grows Pseudomonas aeruginosa. What is the appropriate antibiotic?
A. Ciprofloxacin (if susceptible)
B. Cefepime
C. Meropenem
D. All of the above may be appropriate
Correct Answer: D
Rationale: Pseudomonas aeruginosa requires specific coverage. Antibiotics with activity include
ciprofloxacin (if susceptible), cefepime, ceftazidime, piperacillin-tazobactam, and carbapenems.
Choice depends on susceptibility results.
Question 10
Which of the following is a risk factor for acute pyelonephritis?
A. Urinary obstruction
B. Pregnancy
C. Vesicoureteral reflux
D. All of the above
Correct Answer: D
Rationale: All of these conditions increase the risk of acute pyelonephritis. Urinary obstruction
allows bacterial growth, pregnancy causes urinary stasis, and vesicoureteral reflux allows
bacteria to reach the kidneys.
EXAM ALL QUESTIONS AND ANSWERS
ALREADY GRADED A+. 100% VERIFIED
SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
Section 1: Urinary Tract Infections & Pyelonephritis (Questions 1-20)
Question 1
A 40-year-old female with stage 3 chronic kidney disease secondary to hypertension presents
complaining of dysuria and frequency for 3 days. She denies fever or hematuria. Exam is
unremarkable except for suprapubic tenderness. UA reveals cloudy urine with positive
leukocyte esterase, nitrites, and protein. Cultures are pending. What is the correct medication
therapy?
A. Oral trimethoprim-sulfamethoxazole
B. IM ceftriaxone
C. IV gentamicin
D. IV vancomycin
Correct Answer: A
Rationale: This patient has an uncomplicated UTI. Oral TMP-SMX is appropriate first-line
therapy for cystitis. IV antibiotics are not indicated without signs of systemic infection, and
gentamicin would be nephrotoxic in a patient with CKD .
Question 2
A 34-year-old male arrives at clinic with acute onset 30 minutes ago of severe colicky flank pain
on the left that comes in waves. He reports nausea and emesis x 3. On exam, he appears
anxious and ill. Temp 99, HR 100. Abdomen is soft, nontender, with normal bowel sounds.
Urinalysis is pink in color with a large number of red blood cells. Which of the following is true?
,A. An MRI should be ordered
B. CPK should be ordered
C. Renal ultrasound is indicated
D. The patient should receive ceftriaxone and doxycycline
Correct Answer: C
Rationale: The presentation is consistent with nephrolithiasis and renal colic. Most kidney
stones are made of calcium oxalate. Pain varies depending on the location and size of the stone.
Stones in the renal pelvis or upper urethra cause flank pain; stones lower in the urethra radiate
to the testicle or labia. Renal ultrasound is indicated for initial evaluation .
Question 3
What accounts for 80-90% of UTIs in pregnant women?
A. Staphylococcus saprophyticus
B. Escherichia coli
C. Klebsiella pneumoniae
D. Proteus mirabilis
Correct Answer: B
Rationale: Escherichia coli accounts for 80-90% of UTIs in pregnant women. Asymptomatic
bacteriuria in pregnancy requires treatment to prevent pyelonephritis and preterm birth .
Question 4
Which of the following groups should asymptomatic bacteriuria be treated in?
A. Patients with diabetes mellitus
B. Patients with spinal cord injuries
C. Patients with indwelling catheters
D. Pregnant women
Correct Answer: D
Rationale: Pregnant women are at increased risk of asymptomatic bacteriuria becoming acute
cystitis and/or acute pyelonephritis, with significant maternal and obstetric risks. The Infectious
Disease Society of America does not recommend treatment for the other listed groups .
,Question 5
Which of the following is NOT considered a risk factor for urinary tract infection?
A. Intrauterine device
B. Pregnancy
C. Diabetes mellitus
D. New sexual partner
Correct Answer: A
Rationale: IUD is not a risk factor for UTI. Risk factors for UTI include: pregnancy, diabetes,
diaphragm use, and a new sexual partner .
Question 6
A 68-year-old woman with a history of sickle cell disease presents with suspected UTI. She has
no history of this condition. Which of the following is true regarding her risk?
A. Sickle cell disease increases risk of UTI due to renal medullary ischemia
B. Sickle cell disease does not affect UTI risk
C. Patients with sickle cell disease are at lower risk for UTI
D. Sickle cell disease only affects pediatric patients
Correct Answer: A
Rationale: Sickle cell disease can lead to renal medullary ischemia and infarction, increasing
susceptibility to UTIs. These patients may also have baseline hematuria complicating diagnosis .
Question 7
A 65-year-old female presents with UTI symptoms. Which of the following is a contraindication
to nitrofurantoin?
A. CrCl <30 mL/min
B. Diabetes
C. Hypertension
D. Atrial fibrillation
Correct Answer: A
Rationale: Nitrofurantoin is contraindicated in patients with CrCl <30 mL/min due to inadequate
urinary concentrations. It is also contraindicated in patients with known G6PD deficiency.
, Question 8
What is the most appropriate treatment for a pregnant woman with asymptomatic bacteriuria?
A. No treatment needed
B. Nitrofurantoin 100 mg daily for 5 days
C. Amoxicillin 500 mg TID for 7 days
D. Doxycycline 100 mg BID for 7 days
Correct Answer: B
Rationale: Asymptomatic bacteriuria in pregnancy requires treatment to prevent pyelonephritis
and preterm birth. Nitrofurantoin is a common first-line agent; however, it should be avoided
near term due to risk of neonatal hemolysis.
Question 9
A 72-year-old female with a urinary catheter develops fever and leukocytosis. Urine culture
grows Pseudomonas aeruginosa. What is the appropriate antibiotic?
A. Ciprofloxacin (if susceptible)
B. Cefepime
C. Meropenem
D. All of the above may be appropriate
Correct Answer: D
Rationale: Pseudomonas aeruginosa requires specific coverage. Antibiotics with activity include
ciprofloxacin (if susceptible), cefepime, ceftazidime, piperacillin-tazobactam, and carbapenems.
Choice depends on susceptibility results.
Question 10
Which of the following is a risk factor for acute pyelonephritis?
A. Urinary obstruction
B. Pregnancy
C. Vesicoureteral reflux
D. All of the above
Correct Answer: D
Rationale: All of these conditions increase the risk of acute pyelonephritis. Urinary obstruction
allows bacterial growth, pregnancy causes urinary stasis, and vesicoureteral reflux allows
bacteria to reach the kidneys.
