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Asymptomatic bacteriuria — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CareAsymptomatic bacteriuriaUSMLE Step 3

A 76-year-old woman in assisted living has a positive urine culture obtained during evaluation for chronic urinary frequency. She has no dysuria, fever, flank pain, suprapubic pain, delirium, or hemodynamic instability. Urinalysis shows pyuria. Which of the following is the most appropriate at this time?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Do not prescribe antibiotics

Asymptomatic bacteriuria should not be treated in older nonpregnant adults; pyuria does not establish symptomatic infection.

Reference: IDSA asymptomatic bacteriuria guideline: https://www.idsociety.org/