Mycology: oesophageal candidiasis in HIV: 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: oesophageal candidiasis in HIV

Sample item

A man with HIV (CD4 count 45 cells per cubic mm) has painful swallowing and white plaques on the tongue and palate that scrape off. What is the most appropriate initial approach?

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

The answer and the reasoning

B. Empirical oral fluconazole

Odynophagia with oral thrush in advanced HIV is oesophageal candidiasis until proved otherwise. Empirical systemic fluconazole is the standard first step, and endoscopy is reserved for patients who do not respond.

Option by option

  • A. Upper endoscopy with biopsy before treatment

    Endoscopy is reserved for non-responders, so delaying treatment for it is unnecessary.

  • B. Empirical oral fluconazole (correct)

    Correct. A therapeutic trial of fluconazole is both diagnostic and curative in typical cases.

  • C. Oral nystatin suspension alone

    Nystatin is a topical agent for oral thrush and does not treat oesophageal disease.

  • D. Intravenous acyclovir

    Acyclovir treats herpes oesophagitis, which is less likely with thrush present.

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 Microbiology question

What is the answer to this Microbiology question?

The best answer is B, Empirical oral fluconazole. Odynophagia with oral thrush in advanced HIV is oesophageal candidiasis until proved otherwise.

Why is "Upper endoscopy with biopsy before treatment" not the answer?

Endoscopy is reserved for non-responders, so delaying treatment for it is unnecessary.

Why is "Oral nystatin suspension alone" not the answer?

Nystatin is a topical agent for oral thrush and does not treat oesophageal disease.

Why is "Intravenous acyclovir" not the answer?

Acyclovir treats herpes oesophagitis, which is less likely with thrush present.

What concept does this question test?

It tests Mycology: oesophageal candidiasis in HIV in Microbiology. Empirical systemic fluconazole is the standard first step, and endoscopy is reserved for patients who do not respond.

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 Mycology: oesophageal candidiasis in HIV?

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.