Deck 7: Fungal Diseases

Question 1

A florist presents with a subcutaneous lesion on the hand, which she thinks resulted from a jab wound she received while she was making a sphagnum moss-wire frame for a floral wreath. The nodule has ulcerated and not healed despite use of antibacterial cream, and a new nodule is forming above the original lesion. What is most likely to be an appropriate treatment for this infection?

A) Oral itraconazole or potassium iodide
B) Miconazole cream
C) Cortisone cream
D) Oral griseofulvin
E) Penicillin

Answer 1

Oral itraconazole or potassium iodide

Question 2

Although hard to find in the above mentioned nodule, what form would be present in the tissue?

A) Lots of hyphae
B) Long, branching hyphae with acute angles
C) Yeasts with broad-based buds
D) Cigar-shaped to oval yeasts
E) Yeast with multiple buds (mariner's wheel)

Answer 2

Cigar-shaped to oval yeasts

Question 3

A patient presents with paranasal swelling and bloody exudate from both his eyes and nares, and he is nearly comatose. Necrotic tissue in the nasal turbinates show nonseptate hyphae consistent with Rhizopus, Mucor, or Absidia (phylum Zygomycota, class Phycomycetes). What is the most likely compromising condition underlying this infection?

A) AIDS
B) Ketoacidotic diabetes
C) Neutropenia
D) B-cell defects
E) Chronic sinusitis

Answer 3

Ketoacidotic diabetes

Question 4

A patient presents with a circular, itchy, inflamed skin lesion that is slightly raised; it is on his left side where his dog sleeps next to him. His dog has had some localized areas of hair loss. The patient has no systemic symptoms. What would you expect to find in a KOH of skin scrapings?

A) Clusters of yeastlike cells and short curved septate hyphae
B) Hyphae with little branching but possibly with some hyphae breaking up into arthroconidia
C) Filariform larvae
D) Budding yeasts with some pseudohyphae and true hyphae
E) Large budding yeast cells with broad bases on the buds and thick cell walls

Question 5

A severely neutropenic patient presents with pneumonia. Bronchial alveolar fluid shows dichotomously branching (generally with acute angles), septate hyphae. What is the most likely causative agent?

A) Aspergillus
B) Cryptococcus
C) Candida
D) Malassezia
E) Rhizopus

Question 6

What is a mass of fungal filaments called?

A) Pseudohyphae
B) Hyphae
C) Mycelium
D) Septum
E) Yeast

Question 7

A premature infant on intravenous nutrients and high-lipid fluids has developed septicemia that cultures out on blood agar only when overlaid with sterile olive oil. What is the most likely causative agent?

A) Aspergillus
B) Candida
C) Cryptococcus
D) Malassezia
E) Sporothrix

Question 8

A filamentous fungus subunit is a

A) Coenocyte
B) Hypha
C) Mycelium
D) Septum
E) Yeast

Question 9

To treat a patient with a life-threatening fungal infection, you choose an antifungal drug that causes pore formation in the fungal membrane and actually kills the cells. Which drug would this be?

A) Amphotericin B
B) Griseofulvin
C) Ketoconazole
D) Miconazole
E) Nystatin

Question 10

A 15-year-old dirt-bike rider visiting southern California the first time has developed pneumonia. The causative organism has environmental form that consists of hyphae that break up into arthroconidia, which become airborne. What is the agent?

A) Aspergillus fumigatus
B) Blastomyces dermatitidis
C) Coccidioides immitis
D) Histoplasma capsulatum
E) Sporothrix schenckii

Question 11

Which of the following drugs inhibits ergosterol synthesis, is important in treating Candida fungemias, and is used orally to suppress relapses of cryptococcal meningitis in AIDS patients?

A) Amphotericin B
B) Fluconazole
C) Griseofulvin
D) Echinocandins
E) Nystatin

Question 12

A patient has splotchy hypopigmentation on the chest and back with only slight itchiness. What is most likely to be seen on a KOH mount of the skin scraping?

A) Yeasts, pseudohyphae, and true hyphae
B) Filaments with lots of arthroconidia
C) Clusters of round fungal cells with short, curved, septate hyphae
D) Darkly pigmented, round cells with sharp interior septations
E) Cigar-shaped yeasts

Question 13

A patient has a dry, scaly, erythematous penis. Skin scales stained with calcofluor white show fluorescent blue-white yeasts and a few pseudohyphae. What is the causative agent of this dermatophytic look-alike?

A) Candida
B) Trichosporon
C) Trichophyton
D) Malassezia
E) Microsporum

Question 14

A recent immigrant from rural Brazil presents with a swollen face and extremely poor dental hygiene, including loss of an adult tooth, which appears to be the focus of the current infection. There are two open ulcers on the outside of the swollen cheek. Small yellow "grains" are seen in one of the ulcers. Gram stain shows purple-staining fine filaments. What is the most likely disease?

A) Actinomycotic mycetoma
B) Chromomycosis
C) Eumycotic mycetoma
D) Sporotrichosis
E) Paracoccidioidomycosis

Question 15

A patient who is a recent immigrant from a tropical, remote, rural area with no medical care is now working with a group of migrant crop harvesters. He has a large, raised, colored, cauliflower-like ankle lesion. Darkly pigmented, yeastlike sclerotic bodies are seen in the tissue biopsy. Which of the following is the most likely diagnosis?

A) Actinomycotic mycetoma
B) Chromoblastomycosis
C) Eumycotic mycetoma
D) Sporotrichosis
E) Tinea nigra

Question 16

A premature baby, now 4 days old, has developed a white coating on her buccal mucosa extending onto her lips. It appears to be painful. What is the most likely causative agent?

A) Actinomyces
B) Aspergillus
C) Candida
D) Fusobacterium
E) Microsporum

Question 17

Which of the following stains allows differentiation of fungus from human tissue by staining the fungus a pink-red color?

A) Calcofluor white stain
B) Gomori methenamine-silver stain
C) Periodic acid-Schiff stain
D) Hematoxylin and eosin stain

Question 18

A normally healthy 8-year-old boy from Florida is visiting friends on a farm in Iowa during the month of July. He presents on July 28 with a fever, cough, and lower respiratory symptoms (no upper respiratory tract symptoms). He has been ill for 4 days. His chest sounds are consistent with pneumonia, so a chest radiograph is obtained. The radiograph shows small, patchy infiltrates with hilar adenopathy. His blood smear shows small, nondescript yeast forms inside monocytic cells. What is the most likely causative agent?

A) Aspergillus fumigatus
B) Blastomyces dermatitidis
C) Coccidioides immitis
D) Histoplasma capsulatum
E) Pneumocystis jiroveci

Question 19

Which of the following is a polyene antifungal agent used for many life-threatening fungal infections?

A) Amphotericin B
B) Griseofulvin
C) Itraconazole
D) Miconazole
E) Nystatin

Question 20

A logger undergoing chemotherapy for cancer has developed pneumonia and skin lesions. Biopsy of the skin lesions demonstrates the presence of large yeasts with thick cell walls and broad-based buds. What is the most likely causative agent?

A) Aspergillus fumigatus
B) Blastomyces dermatitidis
C) Coccidioides immitis
D) Histoplasma capsulatum
E) Sporothrix schenckii

Question 21

What is the scientific name for a fungal cross wall?

A) Coenocyte
B) Hypha
C) Mycelium
D) Septum
E) Yeast

Question 22

A noncompliant, human immunodeficiency virus (HIV)-positive patient has been complaining of a stiff neck and a severe headache. The headache was initially lessened by analgesics, but the analgesics are no longer effective. His current $DC4^+$ count is 180/mm3. He is not on any prophylactic drugs. What is the most likely causative agent?

A) Aspergillus
B) Cryptococcus
C) Candida
D) Malassezia
E) Sporothrix

Question 23

Which of the following features differentiates fungal cells from human cells?

A) 80S ribosomes
B) Presence of an endoplasmic reticulum
C) Ergosterol as the major membrane sterol
D) Enzymes that allow them to use carbon dioxide as their sole carbon source
E) Presence of chloroplasts