Deck 34: Urinary System

Question 1

Bacteria that are able to cause urinary tract infections often possess

A) a capsule.
B) fimbriae.
C) endotoxin.
D) antibiotic resistance.

Answer 1

fimbriae.

Question 2

Which of the following factors leads to urinary tract infections in hospitalized patients?

A) Shorter urethra in females
B) Kidney stones
C) Catheterization
D) Underlying medical conditions

Answer 2

Catheterization

Question 3

The least common route of acquiring pyelonephritis is

A) via the urethra.
B) catheterization.
C) via the ureters.
D) via the blood.

Answer 3

via the blood.

Question 4

In addition to culture, pyelonephritis may be diagnosed by the presence of _________________ in the urine.

A) red blood cells
B) white blood cells
C) protein
D) white blood cell casts

Question 5

A 77-year-old male is experiencing urinary frequency and an increased need to void at night. His physician suspects a urinary tract infection and has the patient submit urine for culture. If the urine culture demonstrates bacterial growth, how will the microbiology laboratory define a urinary tract infection for this individual?

A) A single clean catch voided urine with >10⁵ organisms/mL of one bacterial species
B) Two consecutive clean catch voided urines with >100,000 CFU/mL of one bacterial species
C) A single catheterized urine with >10³ CFU/mL of one bacterial species
D) A pooled 24 clean catch voided urine with >100,000 CFU/mL of one bacterial species

Question 6

Which of the following individuals meets the definition for acute urethral syndrome?

A) 86-year-old male with >10² organisms/mL in a catheterized urine
B) 30-year-old pregnant female, experiencing burning on urination, with at least >100 CFU/mL in a clean catch, voided urine
C) 44-year-old female, experiencing urinary frequency, with >100,000 organisms/mL in two consecutive clean catch, voided urines
D) 27-year-old kidney transplant patient with >10⁵ CFU/mL in a clean catch, voided urine

Question 7

A voided urine collected in a physician's office is delivered to the Microbiology department on Monday at 9:00 a.m. The collection date and time is recorded as Friday 4:20 p.m. You call the physician's office to verify. Her nurse verifies the collection date and time as correct. She explains the specimen was missed by the courier on Friday but she refrigerated it until the next scheduled pickup on Monday morning. You will

A) process the specimen as received.
B) add a phenylethyl alcohol agar in addition to the routine media.
C) request a recollect.
D) centrifuge the specimen and process it.

Question 8

An 89-year-old female is experiencing signs and symptoms of a urinary tract infection. She had submitted a previous voided urine specimen but it was heavily contaminated with normal urethral flora. Which of the following procedures would be the least invasive but provide a clean urine specimen?

A) Cystoscopy
B) In and out catheterization
C) Indwelling catheter
D) Suprapubic aspiration

Question 9

A urine specimen collected via a urostomy is received in the clinical laboratory. The specimen should be processed using

A) sheep blood agar.
B) MacConkey agar.
C) phenylethyl alcohol agar.
D) a and b.
E) all of the above.

Question 10

Which of following urine collection procedures provides a specimen that is acceptable for anaerobic culture?

A) Suprapubic aspiration
B) In and out catheterization
C) Cystoscopy
D) Urostomy bag

Question 11

Catheterized urine from a 49-year-old female was submitted for Gram stain and culture. The image provided demonstrates the Gram stain of one drop of the urine at 1000X magnification.
Source: CDC and Dr. Normal Jacobs
Determine the expected bacterial colony count based on these results.

A) >10² CFU/mL but <10⁵ CFU/mL
B) >1000 organisms/mL but < 100,000 organisms/mL
C) >10⁵ CFU/mL
D) 10,000 - 50,000 organisms/mL

Question 12

A positive urine catalase test indicates the potential presence of

A) white blood cells.
B) red blood cells.
C) bacteria.
D) all of the above.
E) a and b.

Question 13

The nitrate reductase test for preculture screening of urines has low sensitivity if

A) the organism does not reduce nitrate.
B) there are fewer than 10⁵ organisms/mL.
C) the specimen is collected by suprapubic aspiration.
D) all of the above.
E) a and b.

Question 14

A clean voided urine from a 27-year-old female was collected at 9:00 am and processed for a routine urinalysis. The specimen demonstrated a positive leukocyte esterase, marked protein, positive nitrite, and 2+ blood. Upon finishing the morning run of urinalysis specimens, the technologist left the specimens at the bench and returned to the chemistry department. Seeing the urinalysis results, the physician calls at 12:00 pm to add a urine
Culture to the patient's orders. At 1:00 pm the urine specimen is sent to Microbiology for processing and should be

A) plated to sheep blood and MacConkey agars using a calibrated loop.
B) plated to sheep blood, MacConkey, and phenylethyl alcohol agars using a calibrated loop.
C) rejected and the physician called for a recollect.
D) Gram stained first and, if positive, then plated.

Question 15

Given the following urine culture sheep blood agar plate, and knowing the colony count is 10,000? 50,000 CFU/mL, which of the following calibrated loops was used to inoculate it?

A) 0.1 mL
B) 0.01 mL
C) 0.001 mL
D) 0.0001mL

Question 16

A catheterized urine was processed and the resulting culture sheep blood and MacConkey agar plates are provided. How do you account for the difference in the colony counts between the two agar plates?

A) The urine loop used to inoculate the blood agar was inserted into the urine at a 90° angle.
B) The urine sat at room temperature prior to processing, allowing the organisms to multiply.
C) The urine loop was not redipped into the urine prior to inoculation of the MacConkey agar.
D) Two different sizes of calibrated loops were used for inoculation.

Question 17

A clean catch, voided urine was collected in the physician's office from a 72-year-old female complaining of burning on urination. The urine was processed in the Microbiology department using a 0.001 mL calibrated loop. The culture grew:
23 colonies of viridans Streptococcus
14 colonies of Staphylococcus not S. aureus
11 colonies of Lactobacillus spp.
These results suggest

A) previous antibiotic therapy.
B) possible urinary tract infection.
C) colonization.
D) normal urethral flora.

Question 18

The catheterized urine from a pregnant 28-year-old female at 26 weeks gestation grows 110 colonies of beta-hemolytic, gray colonies that prove to be catalase negative, PYR negative, and hippurate hydrolysis positive. There is no growth on the MacConkey agar. A 0.001 mL calibrated loop was used to inoculate both agars. This organism should be reported as

A) >1000 CFU/mL of Streptococcus agalactiae.
B) >100,00 CFU/mL of Streptococcus pyogenes.
C) >100,000 CFU/mL of Streptococcus agalactiae.
D) >10,000 CFU/mL of Streptococcus pyogenes.

Question 19

Thirty colonies of a white creamy isolate were noted at 24 hours on the sheep blood agar of a catheterized urine culture from a 53-year-old male hospitalized for a ruptured appendix. The MacConkey agar showed no growth. The agars were inoculated using a 0.01 mL calibrated loop.
On further testing, the white colony produced the results observed in the image provided.
Source: CDC/Dr. Godon Roberstad
This organism should be reported as

A) 300 colonies/mL of yeast not Candida albicans.
B) 300 colonies/mL of Candida glabrata.
C) 3000 colonies/mL of Candida glabrata.
D) 3000 colonies/mL of Candida albicans.

Question 20

Less than 10,000 colonies/mL of a dark lactose fermenter, a non-lactose fermenter, and a late lactose fermenter were isolated from the culture of a foley catheter tip. How will you proceed with this culture?

A) report the organisms in terms of gram reaction and morphology only.
B) reject the culture due to an unacceptable specimen.
C) identify all organisms to species.
D) Do not identify the organisms but hold for seven days.