Mycology: invasive aspergillosis: practice question

A Microbiology 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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Microbiology · Mycology: invasive aspergillosis

Sample item

A 45-year-old man with acute myeloid leukaemia has been neutropenic for 14 days and remains febrile despite broad-spectrum antibiotics. He has pleuritic chest pain, and CT shows a nodule surrounded by ground-glass opacity (halo sign). Serum galactomannan is positive. Which drug is the best first-line therapy?

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

The answer and the reasoning

A. Voriconazole

The halo sign and positive galactomannan in a prolonged neutropenic patient indicate invasive pulmonary aspergillosis. Voriconazole is the first-line agent, with isavuconazole as an alternative, and levels are monitored. Fluconazole has no activity against Aspergillus.

Option by option

  • A. Voriconazole (correct)

    Correct. Voriconazole is the recommended first-line therapy.

  • B. Oral nystatin

    Nystatin is not absorbed and is only a topical agent for mucosal candidiasis.

  • C. Fluconazole

    Fluconazole is inactive against Aspergillus and other moulds.

  • D. Flucytosine alone

    Flucytosine alone is not active enough against Aspergillus and is not used as monotherapy.

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.

More Microbiology questions

Questions about this Microbiology question

What is the answer to this Microbiology question?

The best answer is A, Voriconazole. The halo sign and positive galactomannan in a prolonged neutropenic patient indicate invasive pulmonary aspergillosis.

Why is "Oral nystatin" not the answer?

Nystatin is not absorbed and is only a topical agent for mucosal candidiasis.

Why is "Fluconazole" not the answer?

Fluconazole is inactive against Aspergillus and other moulds.

Why is "Flucytosine alone" not the answer?

Flucytosine alone is not active enough against Aspergillus and is not used as monotherapy.

What concept does this question test?

It tests Mycology: invasive aspergillosis in Microbiology. Voriconazole is the first-line agent, with isavuconazole as an alternative, and levels are monitored. Fluconazole has no activity against Aspergillus.

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 Mycology: invasive aspergillosis?

Make a one-line identity card for each organism: shape and stain, defining test, toxin, disease and drug. Then use the flashcards and the other Microbiology 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.