New: our faculty are still reviewing these cards. Spotted an error? Use “Report an issue” on the card in the app, or contact us.

UTI, prostatitis & incontinence flashcards

11 high-yield MRCP Part 1 cards from the Intellect Medicos Nephrology course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.

Study these 11 cards Save progress — free account

1. What is the first-line antibiotic treatment for lower UTI in a non-pregnant woman (NICE), and for how long?

   Show answer

   Nitrofurantoin (if eGFR ≥45) or trimethoprim (if low resistance risk) for 3 days.

   Why? Second choice (no improvement after 48 h or first choice unsuitable): nitrofurantoin if not used first, pivmecillinam or fosfomycin.

2. How long should a man with a lower UTI be treated with trimethoprim or nitrofurantoin?

   Show answer

   7 days (and send a urine culture before starting).

   Why? UTIs in men are treated as complicated. If he has systemic features and a tender prostate, think acute prostatitis.

3. What is the first-line antibiotic for symptomatic lower UTI in pregnancy, and which drug should be avoided in the first trimester?

   Show answer

   Nitrofurantoin for 7 days (avoid near term); avoid trimethoprim in the first trimester.

   Why? Trimethoprim is a folate antagonist (neural tube risk). Nitrofurantoin near term can cause neonatal haemolysis. Alternatives are amoxicillin (if sensitive) or cefalexin.

4. In which group should asymptomatic bacteriuria be treated?

   Show answer

   Pregnant women (also before urological procedures).

   Why? In pregnancy it raises the risk of pyelonephritis and preterm birth. Treat for 7 days and repeat culture. In catheterised and elderly patients it should not be treated.

5. Below what eGFR should nitrofurantoin generally be avoided?

   Show answer

   eGFR below 45 mL/min/1.73 m².

   Why? It becomes less effective (inadequate urinary levels) and more toxic. It can be used with caution at 30–44 for a short course for resistant organisms.

6. A patient whose urinary catheter has been in for more than 7 days develops a symptomatic UTI. What should be done with the catheter, and where should the urine sample come from?

   Show answer

   Remove it (or change it if still needed) as soon as possible without delaying antibiotics; take the urine sample from the new catheter (or a midstream sample if it is removed) before antibiotics.

   Why? Biofilm on the old catheter harbours bacteria that antibiotics cannot clear. Asymptomatic bacteriuria in catheterised patients is not treated.

7. What is the first-choice oral antibiotic for acute pyelonephritis in a non-pregnant adult (NICE)?

   Show answer

   Cefalexin for 7–10 days (co-amoxiclav or trimethoprim only if culture shows susceptibility; ciprofloxacin only if other first choices are unsuitable).

   Why? Nitrofurantoin is not used because it does not reach adequate kidney tissue levels. If severely unwell use IV options such as cefuroxime, ceftriaxone or gentamicin.

8. What is the first-choice antibiotic and duration for acute bacterial prostatitis (NICE)?

   Show answer

   Ciprofloxacin or ofloxacin for 14 days, then review (trimethoprim if a fluoroquinolone is unsuitable).

   Why? Fluoroquinolones penetrate prostatic tissue well. MHRA (2024) restricts fluoroquinolones to cases where other recommended antibiotics are inappropriate because of disabling tendon, nerve and psychiatric adverse effects.

9. What is the first-line drug treatment for overactive bladder (urge incontinence) after bladder training, and which drug should be avoided in frail older people?

   Show answer

   An antimuscarinic (anticholinergic) with the lowest acquisition cost, e.g. solifenacin or tolterodine; do not offer immediate-release oxybutynin to frail older women.

   Why? Bladder training for at least 6 weeks comes first. Oxybutynin crosses the blood–brain barrier and worsens cognition; consider total anticholinergic burden.

10. What is the mechanism of mirabegron for overactive bladder, and its key caution?

    Show answer

    Beta-3 adrenoceptor agonist (relaxes the detrusor); avoid in severe uncontrolled hypertension and monitor BP.

    Why? It is used when antimuscarinics are unsuitable, ineffective or not tolerated, and has no anticholinergic burden. Vibegron (NICE TA999, 2024) is another beta-3 agonist.

11. What is the first-line treatment for stress urinary incontinence in women?

    Show answer

    Supervised pelvic floor muscle training for at least 3 months.

    Why? Surgery is considered if this fails; duloxetine is a second-line option for women who do not want or are unsuitable for surgery.