ACNP Board Review Questions &
Answers
UTIs Causes (4) Correct Ans-1. Lower UTIs: Cystitis, Urethritis/Dysuria Frequency
Syndrome
2. Upper UTIs: Pyelonephritis, Renal Abscess, etc
3. **E. coli is the most common causative organism in women
4. Organisms of the proteus species are most common in men.
Signs/Symptoms fo Lower UTIs Correct Ans-1. **Dysuria is the key symptom
2. Frequency
3. Nocturia
4. Urgency
5. Hematuria- occurs in 40-60% of patients
Lower UTI Labs/Diagnostics (3) Correct Ans-1. Urinalysis- usually shows pyuria (>10
WBCs)
2. Presence of nitrate by dipstick is very specific but not sensitive test for bacteriuria
3. Esterase detection by dipstick is very sensitive but not specific
Management of Lower UTIs (4) Correct Ans-1.3 day therapy maximizes benefits and
minimizes drawbacks of treatment (ie fewer side effects, more effective that single dose, and less
costly than 7 day course)
,2. Commonly used agents: Trimethoprim-sulfamethoxazole [TMP/SMX (Bactrim)],
Ciprofloxacin, and amoxicillin/clavulanate (Augmentin)
3. Other considerations: Amoxicillin (Amoxil), levofloxacin, Nitrofurantoin (Macrobid),
Trimethoprim (Primsol), Fosfomycin (Monurol)
4. During pregnancy: Amoxicillin (Amoxil), Nitrofurantoin, Cephalexin (Keflex) for 7-10 days
of therapy
Symptoms/Physical Findings of Upper UTIs (4) Correct Ans-1. Flank, low back, or
abdominal pain may be present
2. Fever and chills often present and usually indicate upper UTI**
3. Nausea/Vomiting
4. Mental status changes in the elderly
Upper UTI Labs/Diagnostics (2) Correct Ans-1. WBC casts seen on urinalysis
2. ESR elevated with pyelonephritis
Management of Upper UTIs (3) Correct Ans-1. 14 day course vs 6 week course
2. Commonly used agents: Bactrim, Cipro, other Quinolone, amoxicillin/clavulanate
(Augmentin), Aminoglycosides (Gentamicin, Tobramycin, etc)
3. Patients with suspected pyelonephritis who have nausea and vomiting and those with more
severe illness should be hospitalized
, Renal Insufficiency Causes (5) Correct Ans-Decrease in renal function resulting in a decrease
in the GFR and a reduction in the clearance of solutes; naturally, GFR decreases naturally with
aging
1. Hypertensive nephrosclerosis
2. Glomerulonephritis
3. Diabetic nephropathy
4. Interstitial nephritis
5. Polycystic kidney disease
Renal Insufficiency Symptoms/General Concepts (3) Correct Ans-1. Patients are often
asymptomatic until the late stages of disease
2. There is a direct relationship between nephron loss and renal function
3. Systemic changes not evident until overall renal function is 20-25% of normal
Renal Insufficiency Types (2) Correct Ans-1. Acute: Sudden impairment
- BUN is increased out of proportion to serum creatinine
- **Due to obstruction, acute tubular necrosis, or contrast media
- Reversible with proper therapy
2. Chronic: Progressive impairment over months to years (chronic renal failure)
- Steady increase in BUN and serum creatinine (10:1 ratio)
- Intrinsic kidney damage which is irreversible but progression can be slowed
Answers
UTIs Causes (4) Correct Ans-1. Lower UTIs: Cystitis, Urethritis/Dysuria Frequency
Syndrome
2. Upper UTIs: Pyelonephritis, Renal Abscess, etc
3. **E. coli is the most common causative organism in women
4. Organisms of the proteus species are most common in men.
Signs/Symptoms fo Lower UTIs Correct Ans-1. **Dysuria is the key symptom
2. Frequency
3. Nocturia
4. Urgency
5. Hematuria- occurs in 40-60% of patients
Lower UTI Labs/Diagnostics (3) Correct Ans-1. Urinalysis- usually shows pyuria (>10
WBCs)
2. Presence of nitrate by dipstick is very specific but not sensitive test for bacteriuria
3. Esterase detection by dipstick is very sensitive but not specific
Management of Lower UTIs (4) Correct Ans-1.3 day therapy maximizes benefits and
minimizes drawbacks of treatment (ie fewer side effects, more effective that single dose, and less
costly than 7 day course)
,2. Commonly used agents: Trimethoprim-sulfamethoxazole [TMP/SMX (Bactrim)],
Ciprofloxacin, and amoxicillin/clavulanate (Augmentin)
3. Other considerations: Amoxicillin (Amoxil), levofloxacin, Nitrofurantoin (Macrobid),
Trimethoprim (Primsol), Fosfomycin (Monurol)
4. During pregnancy: Amoxicillin (Amoxil), Nitrofurantoin, Cephalexin (Keflex) for 7-10 days
of therapy
Symptoms/Physical Findings of Upper UTIs (4) Correct Ans-1. Flank, low back, or
abdominal pain may be present
2. Fever and chills often present and usually indicate upper UTI**
3. Nausea/Vomiting
4. Mental status changes in the elderly
Upper UTI Labs/Diagnostics (2) Correct Ans-1. WBC casts seen on urinalysis
2. ESR elevated with pyelonephritis
Management of Upper UTIs (3) Correct Ans-1. 14 day course vs 6 week course
2. Commonly used agents: Bactrim, Cipro, other Quinolone, amoxicillin/clavulanate
(Augmentin), Aminoglycosides (Gentamicin, Tobramycin, etc)
3. Patients with suspected pyelonephritis who have nausea and vomiting and those with more
severe illness should be hospitalized
, Renal Insufficiency Causes (5) Correct Ans-Decrease in renal function resulting in a decrease
in the GFR and a reduction in the clearance of solutes; naturally, GFR decreases naturally with
aging
1. Hypertensive nephrosclerosis
2. Glomerulonephritis
3. Diabetic nephropathy
4. Interstitial nephritis
5. Polycystic kidney disease
Renal Insufficiency Symptoms/General Concepts (3) Correct Ans-1. Patients are often
asymptomatic until the late stages of disease
2. There is a direct relationship between nephron loss and renal function
3. Systemic changes not evident until overall renal function is 20-25% of normal
Renal Insufficiency Types (2) Correct Ans-1. Acute: Sudden impairment
- BUN is increased out of proportion to serum creatinine
- **Due to obstruction, acute tubular necrosis, or contrast media
- Reversible with proper therapy
2. Chronic: Progressive impairment over months to years (chronic renal failure)
- Steady increase in BUN and serum creatinine (10:1 ratio)
- Intrinsic kidney damage which is irreversible but progression can be slowed
