Fungal sinusitis: practice question

A ENT question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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ENT · Fungal sinusitis

Sample item

A man with diabetic ketoacidosis develops facial pain, a black necrotic eschar on the palate and nasal turbinates, and rapid orbital involvement. Which is the most important combination of treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Amphotericin B with urgent surgical debridement and correction of the metabolic state

This is invasive rhinocerebral mucormycosis, an angio-invasive infection of Mucorales that thrives in acidosis. Management is rapid correction of acidosis and hyperglycaemia, liposomal amphotericin B and aggressive surgical debridement of necrotic tissue.

Option by option

  • A. Amphotericin B with urgent surgical debridement and correction of the metabolic state (correct)

    Correct. Mucor needs prompt antifungal therapy and removal of the necrotic tissue.

  • B. Systemic corticosteroids with oral antihistamines

    Steroids worsen the immune and metabolic state and would worsen the infection.

  • C. Broad-spectrum antibiotics with nasal saline irrigation

    Antibiotics do not treat a fungal infection.

  • D. Oral fluconazole alone

    Fluconazole is inactive against Mucorales.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this ENT question

What is the answer to this ENT question?

The best answer is A, Amphotericin B with urgent surgical debridement and correction of the metabolic state. This is invasive rhinocerebral mucormycosis, an angio-invasive infection of Mucorales that thrives in acidosis.

Why is "Systemic corticosteroids with oral antihistamines" not the answer?

Steroids worsen the immune and metabolic state and would worsen the infection.

Why is "Broad-spectrum antibiotics with nasal saline irrigation" not the answer?

Antibiotics do not treat a fungal infection.

Why is "Oral fluconazole alone" not the answer?

Fluconazole is inactive against Mucorales.

What concept does this question test?

It tests Fungal sinusitis in ENT. Management is rapid correction of acidosis and hyperglycaemia, liposomal amphotericin B and aggressive surgical debridement of necrotic tissue.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Fungal sinusitis?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.