A 5-year-old with urinary symptoms has fresh urine nitrite positive and leukocyte esterase negative. Urine findings are reviewed alongside the child's age, symptoms, response to treatment and previous UTI history. What is recommended?

Give antibiotics and send urine culture

Discard the sample as contaminated

A 14-year-old with pyelonephritis is suitable for oral treatment. The treating team considers age, clinical severity, ability to take oral treatment and prior microbiology. Which cefalexin regimen is listed?

500 mg twice or three times daily

A 6-year-old with dysuria has both leukocyte esterase and nitrite positive, is well and has no previous UTI. Urine findings are reviewed alongside the child's age, symptoms, response to treatment and previous UTI history. What is the initial approach?

Assume UTI and give antibiotics

A 10-year-old has lower UTI symptoms and no fever or upper UTI features. The clinician considers symptom severity, urine culture findings, age, renal function and prior antibiotic exposure. What prescription does NICE recommend?

An immediate antibiotic prescription

No antibiotic unless symptoms last a week

A 4-year-old with suspected lower UTI has not yet provided a urine sample. The clinician considers symptom severity, urine culture findings, age, renal function and prior antibiotic exposure. Should antibiotics be started before trying to collect urine?

Obtain urine before antibiotics when possible

Only collect urine after the first dose

Do not collect urine in children

A 7-year-old has leukocyte esterase positive and nitrite negative without clear urinary symptoms. Urine findings are reviewed alongside the child's age, symptoms, response to treatment and previous UTI history. What is the next step?

Send urine for microscopy and culture; treat only with good clinical evidence

Give antibiotics without testing

Give a back-up antibiotic and omit culture, as nitrite negative results are unreliable

A 10-year-old with pyelonephritis weighs less than expected for age. The treating team considers age, clinical severity, ability to take oral treatment and prior microbiology. How should age-band doses be used?

Consider size and severity with the age band

Use age band without considering size

Use the lowest dose regardless of severity

A 5-year-old has one episode of pyelonephritis and one separate episode of cystitis. Urine findings are reviewed alongside the child's age, symptoms, response to treatment and previous UTI history. Does this meet the recurrent definition?

Yes, one upper plus one lower qualifies

No, two upper UTIs are required

No, three lower UTIs are required

PLAB 1 Urinary tract infection Questions: 10 Free Practice MCQs

Urinary tract infection appears across primary care, paediatrics, obstetrics and acute medicine. The MLA content map wants you to distinguish uncomplicated cystitis from pyelonephritis and sepsis, to choose the right sample and antibiotic, and to know when imaging or referral is needed. The exam is strict about when not to treat, especially in catheterised patients and in asymptomatic bacteriuria.

Where candidates lose marks

Treating asymptomatic bacteriuria outside pregnancy and before urological surgery.
Using a urine dipstick alone to diagnose UTI in an older patient with confusion.
Missing pyelonephritis or an obstructed infected kidney when pain and fever persist.
Forgetting to adjust the antibiotic to renal function and to local resistance data.

Guideline to follow: PLAB 1 follows NICE antimicrobial prescribing guidance for urinary tract infection, plus NICE NG111 for acute pyelonephritis and NG109 for UTI in under 16s.

Ten PLAB 1-style urinary tract infection questions with the answer and the reasoning behind it. They come from the UK.med bank, which has 150 urinary tract infection questions and many more across every topic.

Free timed mock exam

1 / 10
A 12-year-old with lower UTI is treated with nitrofurantoin using the modified release option. The clinician considers symptom severity, urine culture findings, age, renal function and prior antibiotic exposure.
How often is the listed dose taken?
Show answer
Answer: A. 100 mg twice daily
Why: For ages 12 to 15 years, the modified-release nitrofurantoin option is 100 mg twice daily for 3 days when eGFR is at least 45 ml/minute. Apply the recommendation to the child's age, symptoms and susceptibility results, and reassess if features suggest upper UTI.
- B. 100 mg once daily is not appropriate for how often is the listed dose taken?. NICE NG109 supports 100 mg twice daily instead. For ages 12 to 15 years, the modified-release nitrofurantoin option is 100 mg twice daily for 3 days when eGFR is at least 45 ml/minute. Apply the recommendation to the child's age, symptoms and susceptibility results, and reassess if features suggest upper UTI.
- C. 750 micrograms/kg once daily is not appropriate for how often is the listed dose taken?. NICE NG109 supports 100 mg twice daily instead. For ages 12 to 15 years, the modified-release nitrofurantoin option is 100 mg twice daily for 3 days when eGFR is at least 45 ml/minute. Apply the recommendation to the child's age, symptoms and susceptibility results, and reassess if features suggest upper UTI.
- D. Single dose is not appropriate for how often is the listed dose taken?. NICE NG109 supports 100 mg twice daily instead. For ages 12 to 15 years, the modified-release nitrofurantoin option is 100 mg twice daily for 3 days when eGFR is at least 45 ml/minute. Apply the recommendation to the child's age, symptoms and susceptibility results, and reassess if features suggest upper UTI.
Sources: NICE NG109 recommendation 1.4.1 table 2
2 / 10
A 5-year-old with urinary symptoms has fresh urine nitrite positive and leukocyte esterase negative. Urine findings are reviewed alongside the child's age, symptoms, response to treatment and previous UTI history.
What is recommended?
Show answer
Answer: B. Give antibiotics and send urine culture
Why: For children aged 3 years or older, nitrite positive and leukocyte esterase negative on a fresh sample calls for antibiotics and urine culture. Apply this recommendation using the child's age, symptoms, treatment response and previous UTI history; those details determine which NG224 pathway applies.
- A. NICE NG224 recommendation 1.1.20 table 2 supports "Give antibiotics and send urine culture". "Withhold treatment" does not follow the recommended approach for this presentation.
- C. NICE NG224 recommendation 1.1.20 table 2 supports "Give antibiotics and send urine culture". "Discard the sample as contaminated" does not follow the recommended approach for this presentation.
- D. NICE NG224 recommendation 1.1.20 table 2 supports "Give antibiotics and send urine culture". "Repeat using non-fresh urine" does not follow the recommended approach for this presentation.
Sources: NICE NG224 recommendation 1.1.20 table 2
3 / 10
A 14-year-old with pyelonephritis is suitable for oral treatment. The treating team considers age, clinical severity, ability to take oral treatment and prior microbiology.
Which cefalexin regimen is listed?
Show answer
Answer: B. 500 mg twice or three times daily
Why: For ages 12 to 15 years, NICE lists cefalexin 500 mg twice or three times daily for 7 to 10 days. Use age, size, severity and current culture information to apply the recommendation to the individual child.
- A. 125 mg once daily is not the recommended action for which cefalexin regimen is listed?. NICE NG111 recommends 500 mg twice or three times daily instead. For ages 12 to 15 years, NICE lists cefalexin 500 mg twice or three times daily for 7 to 10 days. Use age, size, severity and current culture information to apply the recommendation to the individual child.
- C. 250 mg once daily is not the recommended action for which cefalexin regimen is listed?. NICE NG111 recommends 500 mg twice or three times daily instead. For ages 12 to 15 years, NICE lists cefalexin 500 mg twice or three times daily for 7 to 10 days. Use age, size, severity and current culture information to apply the recommendation to the individual child.
- D. Single dose is not the recommended action for which cefalexin regimen is listed?. NICE NG111 recommends 500 mg twice or three times daily instead. For ages 12 to 15 years, NICE lists cefalexin 500 mg twice or three times daily for 7 to 10 days. Use age, size, severity and current culture information to apply the recommendation to the individual child.
Sources: NICE NG111 recommendation 1.3.3 table 3
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4 / 10
A 6-year-old with dysuria has both leukocyte esterase and nitrite positive, is well and has no previous UTI. Urine findings are reviewed alongside the child's age, symptoms, response to treatment and previous UTI history.
What is the initial approach?
Show answer
Answer: A. Assume UTI and give antibiotics
Why: When both dipstick markers are positive in a child aged 3 years or older, assume UTI and give antibiotics. Culture is additionally recommended for previous UTI or high or intermediate risk of serious illness. Apply this recommendation using the child's age, symptoms, treatment response and previous UTI history; those details determine which NG224 pathway applies.
- B. NICE NG224 recommendation 1.1.20 table 2 supports "Assume UTI and give antibiotics". "Wait for culture in every case" does not follow the recommended approach for this presentation.
- C. NICE NG224 recommendation 1.1.20 table 2 supports "Assume UTI and give antibiotics". "Image before treatment" does not follow the recommended approach for this presentation.
- D. NICE NG224 recommendation 1.1.20 table 2 supports "Assume UTI and give antibiotics". "Treat only if fever develops" does not follow the recommended approach for this presentation.
Sources: NICE NG224 recommendation 1.1.20 table 2
5 / 10
A 10-year-old has lower UTI symptoms and no fever or upper UTI features. The clinician considers symptom severity, urine culture findings, age, renal function and prior antibiotic exposure.
What prescription does NICE recommend?
Show answer
Answer: B. An immediate antibiotic prescription
Why: Offer an immediate antibiotic prescription to children and young people under 16 with lower UTI, considering previous urine cultures and antibiotic use. Apply the recommendation to the child's age, symptoms and susceptibility results, and reassess if features suggest upper UTI.
- A. No antibiotic unless symptoms last a week is not appropriate for what prescription does nice recommend?. NICE NG109 supports An immediate antibiotic prescription instead. Offer an immediate antibiotic prescription to children and young people under 16 with lower UTI, considering previous urine cultures and antibiotic use. Apply the recommendation to the child's age, symptoms and susceptibility results, and reassess if features suggest upper UTI.
- C. A back-up antibiotic only is not appropriate for what prescription does nice recommend?. NICE NG109 supports An immediate antibiotic prescription instead. Offer an immediate antibiotic prescription to children and young people under 16 with lower UTI, considering previous urine cultures and antibiotic use. Apply the recommendation to the child's age, symptoms and susceptibility results, and reassess if features suggest upper UTI.
- D. One dose of prophylaxis is not appropriate for what prescription does nice recommend?. NICE NG109 supports An immediate antibiotic prescription instead. Offer an immediate antibiotic prescription to children and young people under 16 with lower UTI, considering previous urine cultures and antibiotic use. Apply the recommendation to the child's age, symptoms and susceptibility results, and reassess if features suggest upper UTI.
Sources: NICE NG109 recommendation 1.1.11
6 / 10
A 6-year-old is treated with oral cefalexin for acute pyelonephritis. The treating team considers age, clinical severity, ability to take oral treatment and prior microbiology.
What course length is listed?
Show answer
Answer: A. 7 to 10 days
Why: NICE lists a 7 to 10 day cefalexin course for children aged 3 months and over with acute pyelonephritis. Use age, size, severity and current culture information to apply the recommendation to the individual child.
- B. 3 days is not the recommended action for what course length is listed?. NICE NG111 recommends 7 to 10 days instead. NICE lists a 7 to 10 day cefalexin course for children aged 3 months and over with acute pyelonephritis. Use age, size, severity and current culture information to apply the recommendation to the individual child.
- C. 14 days for all children is not the recommended action for what course length is listed?. NICE NG111 recommends 7 to 10 days instead. NICE lists a 7 to 10 day cefalexin course for children aged 3 months and over with acute pyelonephritis. Use age, size, severity and current culture information to apply the recommendation to the individual child.
- D. One dose is not the recommended action for what course length is listed?. NICE NG111 recommends 7 to 10 days instead. NICE lists a 7 to 10 day cefalexin course for children aged 3 months and over with acute pyelonephritis. Use age, size, severity and current culture information to apply the recommendation to the individual child.
Sources: NICE NG111 recommendation 1.3.3 table 3
7 / 10
A 4-year-old with suspected lower UTI has not yet provided a urine sample. The clinician considers symptom severity, urine culture findings, age, renal function and prior antibiotic exposure.
Should antibiotics be started before trying to collect urine?
Show answer
Answer: B. Obtain urine before antibiotics when possible
Why: Obtain a urine sample from children with lower UTI before antibiotics are taken, then dipstick test or send for culture and susceptibility in line with the under-16 UTI guideline. Apply the recommendation to the child's age, symptoms and susceptibility results, and reassess if features suggest upper UTI.
- A. Only collect urine after the first dose is not appropriate for should antibiotics be started before trying to collect urine?. NICE NG109 supports Obtain urine before antibiotics when possible instead. Obtain a urine sample from children with lower UTI before antibiotics are taken, then dipstick test or send for culture and susceptibility in line with the under-16 UTI guideline. Apply the recommendation to the child's age, symptoms and susceptibility results, and reassess if features suggest upper UTI.
- C. Do not collect urine in children is not appropriate for should antibiotics be started before trying to collect urine?. NICE NG109 supports Obtain urine before antibiotics when possible instead. Obtain a urine sample from children with lower UTI before antibiotics are taken, then dipstick test or send for culture and susceptibility in line with the under-16 UTI guideline. Apply the recommendation to the child's age, symptoms and susceptibility results, and reassess if features suggest upper UTI.
- D. Wait until symptoms resolve is not appropriate for should antibiotics be started before trying to collect urine?. NICE NG109 supports Obtain urine before antibiotics when possible instead. Obtain a urine sample from children with lower UTI before antibiotics are taken, then dipstick test or send for culture and susceptibility in line with the under-16 UTI guideline. Apply the recommendation to the child's age, symptoms and susceptibility results, and reassess if features suggest upper UTI.
Sources: NICE NG109 recommendation 1.1.9
8 / 10
A 7-year-old has leukocyte esterase positive and nitrite negative without clear urinary symptoms. Urine findings are reviewed alongside the child's age, symptoms, response to treatment and previous UTI history.
What is the next step?
Show answer
Answer: B. Send urine for microscopy and culture; treat only with good clinical evidence
Why: For children aged 3 years or older, leukocyte esterase positive and nitrite negative calls for microscopy and culture. Do not give antibiotics unless there is good clinical evidence of UTI. Apply this recommendation using the child's age, symptoms, treatment response and previous UTI history; those details determine which NG224 pathway applies.
- A. NICE NG224 recommendation 1.1.20 table 2 supports "Send urine for microscopy and culture; treat only with good clinical evidence". "Give antibiotics without testing" does not follow the recommended approach for this presentation.
- C. NICE NG224 recommendation 1.1.20 table 2 supports "Send urine for microscopy and culture; treat only with good clinical evidence". "Ignore the result" does not follow the recommended approach for this presentation.
- D. NICE NG224 recommendation 1.1.20 table 2 supports "Send urine for microscopy and culture; treat only with good clinical evidence". "Give a back-up antibiotic and omit culture" does not follow the recommended approach for this presentation.
Sources: NICE NG224 recommendation 1.1.20 table 2
9 / 10
A 10-year-old with pyelonephritis weighs less than expected for age. The treating team considers age, clinical severity, ability to take oral treatment and prior microbiology.
How should age-band doses be used?
Show answer
Answer: C. Consider size and severity with the age band
Why: NICE says age bands are based on average-sized children and should be applied with severity and the child's size relative to the average for age. Use age, size, severity and current culture information to apply the recommendation to the individual child.
- A. Use age band without considering size is not the recommended action for how should age-band doses be used?. NICE NG111 recommends Consider size and severity with the age band instead. NICE says age bands are based on average-sized children and should be applied with severity and the child's size relative to the average for age. Use age, size, severity and current culture information to apply the recommendation to the individual child.
- B. Use adult dose automatically is not the recommended action for how should age-band doses be used?. NICE NG111 recommends Consider size and severity with the age band instead. NICE says age bands are based on average-sized children and should be applied with severity and the child's size relative to the average for age. Use age, size, severity and current culture information to apply the recommendation to the individual child.
- D. Use the lowest dose regardless of severity is not the recommended action for how should age-band doses be used?. NICE NG111 recommends Consider size and severity with the age band instead. NICE says age bands are based on average-sized children and should be applied with severity and the child's size relative to the average for age. Use age, size, severity and current culture information to apply the recommendation to the individual child.
Sources: NICE NG111 recommendation 1.3.3
10 / 10
A 5-year-old has one episode of pyelonephritis and one separate episode of cystitis. Urine findings are reviewed alongside the child's age, symptoms, response to treatment and previous UTI history.
Does this meet the recurrent definition?
Show answer
Answer: B. Yes, one upper plus one lower qualifies
Why: NICE defines recurrent UTI to include one episode of upper UTI plus one or more episodes of lower UTI. Apply this recommendation using the child's age, symptoms, treatment response and previous UTI history; those details determine which NG224 pathway applies.
- A. NICE NG224 recommendation 1.3.2 box 1 supports "Yes, one upper plus one lower qualifies". "No, two upper UTIs are required" does not follow the recommended approach for this presentation.
- C. NICE NG224 recommendation 1.3.2 box 1 supports "Yes, one upper plus one lower qualifies". "No, three lower UTIs are required" does not follow the recommended approach for this presentation.
- D. NICE NG224 recommendation 1.3.2 box 1 supports "Yes, one upper plus one lower qualifies". "Only if both were E. coli" does not follow the recommended approach for this presentation.
Sources: NICE NG224 recommendation 1.3.2 box 1

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PLAB 1 Urinary tract infection Questions: 10 Free Practice MCQs

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