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Cervical cancer screening — MCCQE Part 1 MCQ

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ModeratePreventive MedicineCervical cancer screeningMCCQE Part 1

An 82-year-old long-term-care resident has a urine culture growing Escherichia coli after staff sent a sample because the urine looked cloudy. She has no dysuria, urgency, suprapubic or flank pain, fever, new delirium or hemodynamic instability, and her examination is unchanged. What is the best management?

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Correct answer: E — Do not prescribe antibiotics; monitor and assess noninfectious contributors

This stable resident has asymptomatic bacteriuria, not a clinical urinary tract infection. Cloudy urine and a positive culture without localizing urinary symptoms or compatible systemic illness do not justify antibiotics. Choosing Wisely Canada recommends asking why the specimen was sent, reassessing for minimum clinical criteria and looking for other explanations while monitoring. Treating colonization exposes the patient to adverse drug effects, Clostridioides difficile infection and antimicrobial resistance without clinical benefit. Catheterization and serial cultures add harm, and urgent transfer is unnecessary in a stable resident. New hemodynamic instability or a convincing symptomatic syndrome would require prompt reassessment and treatment.

Reference: Choosing Wisely Canada—Using Antibiotics Wisely in Long-Term Care: https://choosingwiselycanada.org/long-term-care/antibiotics/