Infectious diseases: rhino-orbital mucormycosis: practice question

A General Medicine 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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General Medicine · Infectious diseases: rhino-orbital mucormycosis

Sample item

A 52-year-old man with poorly controlled diabetes, recently treated for ketoacidosis, has facial pain, unilateral periorbital swelling and proptosis. A black necrotic eschar is seen on the nasal turbinate. What is the most appropriate treatment?

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

The answer and the reasoning

C. Liposomal amphotericin B with urgent surgical debridement and glycaemic control

Rhino-orbital mucormycosis is an angioinvasive fungal infection that thrives in acidosis and hyperglycaemia, producing tissue necrosis and rapid orbital and cerebral spread. Treatment needs early diagnosis, correction of the metabolic state, aggressive surgical debridement and intravenous liposomal amphotericin B. Voriconazole, fluconazole and echinocandins lack reliable activity against Mucorales.

Option by option

  • A. Oral voriconazole alone

    Voriconazole has no reliable activity against Mucorales and may even select for them.

  • B. Intravenous fluconazole

    Fluconazole is inactive against Mucorales.

  • C. Liposomal amphotericin B with urgent surgical debridement and glycaemic control (correct)

    Amphotericin B is the active antifungal and must be combined with debridement and glycaemic control.

  • D. Intravenous caspofungin alone

    Echinocandins are not active against Mucorales and monotherapy is inadequate.

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 General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Liposomal amphotericin B with urgent surgical debridement and glycaemic control. Rhino-orbital mucormycosis is an angioinvasive fungal infection that thrives in acidosis and hyperglycaemia, producing tissue necrosis and rapid orbital and cerebral spread.

Why is "Oral voriconazole alone" not the answer?

Voriconazole has no reliable activity against Mucorales and may even select for them.

Why is "Intravenous fluconazole" not the answer?

Fluconazole is inactive against Mucorales.

Why is "Intravenous caspofungin alone" not the answer?

Echinocandins are not active against Mucorales and monotherapy is inadequate.

What concept does this question test?

It tests Infectious diseases: rhino-orbital mucormycosis in General Medicine. Treatment needs early diagnosis, correction of the metabolic state, aggressive surgical debridement and intravenous liposomal amphotericin B. Voriconazole, fluconazole and echinocandins lack reliable activity against Mucorales.

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 Infectious diseases: rhino-orbital mucormycosis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine 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.