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 young asthmatic from a hot, humid region has chronic bilateral nasal polyps. CT of the sinuses shows expansion of the sinuses with hyperdense central opacities, and a polyp specimen shows thick, tenacious, peanut-butter-like mucus with sheets of eosinophils and fungal hyphae without tissue invasion. Which is the correct diagnosis and the most suitable management?

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

The answer and the reasoning

D. Allergic fungal rhinosinusitis, treated by surgical clearance of the mucin followed by oral and topical steroids

Allergic fungal rhinosinusitis is a type I hypersensitivity response to fungal antigens in atopic, immunocompetent patients, and gives eosinophilic mucin and polyps. The treatment is endoscopic surgical clearance of the allergic mucin, followed by corticosteroids to reduce recurrence.

Option by option

  • A. Fungal ball, treated by oral itraconazole alone

    A fungal ball is usually a unilateral single sinus lesion in an older patient and is cured by removal.

  • B. Granulomatosis with polyangiitis, treated by cyclophosphamide

    Granulomatosis shows vasculitis with necrotising granulomas and crusting, not eosinophilic mucin.

  • C. Invasive fungal sinusitis, treated by amphotericin B alone

    Invasive disease requires hyphae in the tissue and an immunocompromised host, and this host is atopic.

  • D. Allergic fungal rhinosinusitis, treated by surgical clearance of the mucin followed by oral and topical steroids (correct)

    Correct. Non-invasive hyphae with eosinophilic mucin define the condition, and surgery plus steroids is the mainstay.

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 D, Allergic fungal rhinosinusitis, treated by surgical clearance of the mucin followed by oral and topical steroids. Allergic fungal rhinosinusitis is a type I hypersensitivity response to fungal antigens in atopic, immunocompetent patients, and gives eosinophilic mucin and polyps.

Why is "Fungal ball, treated by oral itraconazole alone" not the answer?

A fungal ball is usually a unilateral single sinus lesion in an older patient and is cured by removal.

Why is "Granulomatosis with polyangiitis, treated by cyclophosphamide" not the answer?

Granulomatosis shows vasculitis with necrotising granulomas and crusting, not eosinophilic mucin.

Why is "Invasive fungal sinusitis, treated by amphotericin B alone" not the answer?

Invasive disease requires hyphae in the tissue and an immunocompromised host, and this host is atopic.

What concept does this question test?

It tests Fungal sinusitis in ENT. The treatment is endoscopic surgical clearance of the allergic mucin, followed by corticosteroids to reduce recurrence.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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.