1. Which one of the sets of 3 symptoms and signs below are used in the NHS as the 3 key diagnostic symptoms/signs for a UTI? 

a. Cloudy urine, visible haematuria and dysuria
FALSE. The 3 key signs/symptoms are cloudy urine, dysuria and new nocturia
b. Visible haematuria, dysuria and suprapubic pain/tenderness
FALSE. The 3 key signs/symptoms are cloudy urine, dysuria and new nocturia
c. Cloudy urine, dysuria and new nocturia
CORRECT
d. Dysuria, new nocturia and visible haematuria
FALSE. The 3 key signs/symptoms are cloudy urine, dysuria and new nocturia

2. Which ONE of the following is TRUE about simple urinary tract infection (cystitis) in women?

a. Women with cystitis should be advised to drink copious amounts of fluids
FALSE. Current advice is to remain well hydrated (but not to deliberately increase consumption)
b. Potassium citrate solution can help cure mild cystitis
FALSE. Potassium citrate may reduce symptoms by alkalinising urine but does not treat infection
c. Women with symptoms of UTI and loin pain should be referred to their GP
TRUE. Loin pain may be due to kidney infection which if suspected warrants urgent referral
d. ‘Lower’ or simple UTI is frequently associated with a temperature above 38.5°C
FALSE. A temperature above 38.5°C (as with loin pain) suggests kidney infection rather than lower or simple UTI and urgent referral is indicated 

3. Which ONE of the patients below does NOT need same day referral?

a. A pregnant woman
FALSE. Pregnancy is an indication for same day referral
b. A woman who has had 2 UTIs in the last 12 months
CORRECT. Only women who have had 2 episodes in the last 6 months or 3 episodes in the last 12 months need to be referred, and the referral would not need to be same day
c. A 61-year-old woman who is feeling drowsy and confused
FALSE. Confusion/altered mental state/very drowsy is an indication for same day referral
d. A woman who reports that her urine looked reddish in colour
FALSE. Visible haematuria is an indication for same day referral

4. In relation to self-care advice for an uncomplicated UTI, which one of the following is FALSE?

a. Offer paracetamol (or ibuprofen if preferred and suitable) for up to 2 days
TRUE
b. Reducing intake of alcohol and coffee may help as these make the urine more alkaline, exacerbating dysuria
FALSE. Reducing intake of alcohol and coffee may help but because these seem to act as direct bladder irritants in some people
c. Cranberry products will not help
TRUE. NICE advises that there is no evidence to support use of cranberry products for symptom relief in acute UTI
d. Drinking additional fluids is thought to help by resulting in more frequent and complete bladder emptying
TRUE

5. Which of the following statements is TRUE in relation to recurrent urinary tract infections (UTIs)

a. Between 1 in 6 and 1 in 5 women with UTI will have a recurrent infection within 3 to 6 months
FALSE. Approximately 25-35% of women with UTI will have a recurrent infection within 3 to 6 months
b. NICE advises against recommendation of cranberry products for prevention of UTI on the basis that there is no evidence
FALSE. NICE advises against use to treat symptoms but states that there is some evidence for use in preventing UTI
c. Between 1 in 4 and 1 in 3 women with UTI will have a recurrent infection within 3 to 6 months
TRUE. Approximately 25-35% of women with UTI will have a recurrent infection within 3 to 6 months
d. NICE advises against recommendation of D-mannose products for prevention of UTI on the basis that there is no evidence
FALSE. NICE advises against use to treat symptoms but states that there is some evidence for use in preventing UTI

6. Which ONE of the following is FALSE concerning timescales in uncomplicated UTI?

a. Symptoms should start to improve within 48 hours
TRUE
b. Treatment with an antibiotic reduces the duration of UTI by 3 days
FALSE. Using an antibiotic to which the infection is sensitive may shorten the episode by only 1.6 days (from 4.9 to 3.3 days)
c. Acute, uncomplicated UTI usually resolves in a few days with or without antibiotic treatment
TRUE 
d. If there is no improvement within 48 hours the patient should be referred to the general practice
TRUE 

7. Which one of the following is FALSE regarding urine testing in uncomplicated UTI in Pharmacy First in England?

a. Dipstick urine testing should be done in the pharmacy for all women presenting with suspected UTI who have none or 1 of the 3 key diagnostic symptoms/signs
FALSE. If required, dipstick testing is done by the GP or nurse
b. Sending urine for culture is routine for pregnant women and postmenopausal women
FALSE. The TARGET flowchart for women under 65 years of age with suspected UTI states “send urine for culture if risk of antibiotic resistance or pregnant”
c. Dipstick urine testing is not required for women who have 2 or 3 of the key diagnostic signs/symptoms
TRUE
d. Sending urine for culture is routine where there is a risk of antibiotic resistance
TRUE. The TARGET flowchart for women under 65 years with suspected UTI states “send urine for culture if risk of antibiotic resistance or pregnant”

8. Some drugs may cause urinary tract symptoms. Which one of the following has NOT been reported to do so? 

a. Nifedipine
INCORRECT
b. Omeprazole
CORRECT 
c. Morphine
INCORRECT
d. Cyclophosphamide
INCORRECT