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Pyelonephritis – Acute (PG)
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1. What is acute pyelonephritis?
*
Infection of the kidney
Obstruction of the ureter
Inflammation of the bladder
Infection of the urethra
2. Which urinary finding supports a diagnosis of pyelonephritis?
*
Leukocytes and nitrites
Glucose and ketones
Protein and bilirubin
Casts and crystals
3. Which investigation is first-line for suspected pyelonephritis in primary care?
*
Cystoscopy
Urine culture
CT abdomen
Renal ultrasound
4. What sign on examination may indicate pyelonephritis?
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Peripheral cyanosis
Jaundice
Costovertebral angle tenderness
Positive Trendelenburg test
5. Which test is NOT routinely indicated for uncomplicated pyelonephritis?
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Urinalysis
FBC and CRP
CT abdomen
Urine culture
6. Which organism most commonly causes acute pyelonephritis?
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Escherichia coli
Proteus mirabilis
Enterococcus faecalis
Klebsiella pneumoniae
7. Which symptom warrants immediate hospital referral in pyelonephritis?
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Mild headache
Vomiting and dehydration
Constipation
Dyspepsia
8. When should hospital admission be considered for pyelonephritis?
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If no fever
If BP is above 140/90
Always for elderly patients
If systemic features or unable to tolerate oral intake
9. Which of the following is an appropriate empirical antibiotic for pyelonephritis?
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Amoxicillin
Co-amoxiclav
Erythromycin
Nitrofurantoin
10. What is the purpose of imaging in pyelonephritis?
*
Detect renal cancer
Evaluate urethral strictures
Assess complications like obstruction or abscess
Confirm diagnosis in all cases
11. Which follow-up is appropriate after treatment of uncomplicated pyelonephritis?
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Weekly ultrasound
Routine repeat culture
Referral to nephrology
Only if symptoms persist
12. What is a typical symptom of acute pyelonephritis?
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Flank pain and fever
Pelvic heaviness
Bilateral leg oedema
Painful ejaculation
13. Which symptom would differentiate cystitis from pyelonephritis?
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Frequency
Dysuria
Urgency
Fever and flank pain
14. Which route of antibiotic administration is preferred for severe pyelonephritis?
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Rectal
Intramuscular
Oral
Intravenous
15. What should be advised to reduce recurrence of pyelonephritis?
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Antifungal prophylaxis
Strict bed rest
High-protein diet
Hydration and proper perineal hygiene
16. What is the most appropriate fluid management for a patient with pyelonephritis?
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Intravenous potassium
Encourage oral hydration
Administer diuretics
Restrict fluids
17. Which condition is a possible complication of untreated pyelonephritis?
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Bladder stone
Hydrocele
Renal abscess
Interstitial cystitis
18. Which patient group is more at risk for pyelonephritis?
*
Healthy men under 20
Teenage boys
Pregnant women
Elderly women with dentures
19. Which of the following would suggest severe pyelonephritis?
*
Hypotension and rigors
Mild dysuria
Night-time frequency
Mild flank tenderness
20. How long is the typical duration of antibiotic therapy for pyelonephritis?
*
3 weeks
7–10 days
1 month
3 days