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Self-Assessment Questions

Infectious Diseases

Endemic Mycosis: Review Questions

Varsha Moudgal, MD

Dr. Moudgal is an assistant professor, Wayne State University, Detroit, MI.

Choose the single best answer for each question.

Questions 1 and 2 refer to the following case.

A 52-year-old chicken farmer from rural Ohio with a history of AIDS is admitted to the hospital in July with a high-grade fever, malaise, chills, and dry cough. About 10 days prior to presentation, he cleaned out his chicken coops. Upon examination, he is found to have hepatosplenomegaly and a 1-cm ulcer on his hard palate. Chest radiography reveals evidence of patchy pneumonitis with hilar node enlargement.

1. What is this patient’s most likely diagnosis?

  1. Bacterial pneumonia
  2. Candida pneumonia
  3. Histoplasmosis
  4. Influenza
  5. Malaria
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2. Which of the following tests will confirm this patient’s diagnosis the fastest?

  1. Blood culture
  2. Computed tomography of the chest
  3. Peripheral smear
  4. Sputum culture
  5. Urine test
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3. A 39-year-old construction worker from Mississippi presents to his primary care physician with a productive cough, weight loss, and low-grade fever. The physician also notices a 2 × 3-cm ulcer on the patient’s left cheek, which appears to be slightly raised and has a bed of reddish friable granulation tissue. The patient states that he first noticed the ulcer about 10 days ago and does not recall any trauma to the area. The patient should be treated with which of the following medications?

  1. Cephalexin
  2. Ciprofloxacin
  3. Fluconazole
  4. Ketoconazole
  5. Linezolid
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  4. A 28-year-old woman presents to her primary care physician 2 weeks after a trip to Arizona with chief complaints of fever, bilateral knee and ankle pain (not associated with swelling), and tender, red subcutaneous nodules over her shins. Urinalysis is normal. Chest radiography is normal. A complete blood count reveals an elevated erythrocyte sedimentation rate and eosinophilia. What is this patient’s most likely diagnosis?
  1. Aspergillosis
  2. Blastomycosis
  3. Candidiasis
  4. Coccidioidomycosis
  5. Histoplasmosis
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5. All of the following statements are correct EXCEPT

  1. Blastomycosis often involves skin, bones, joints, and genitourinary tract
  2. Histoplasma capsulatum and Blastomyces dermatitidis exist as mycelial forms at room temperature and yeast forms at body temperature
  3. Histoplasmosis may result in mediastinal fibrosis
  4. Patients with early coccidioidal infections should be treated aggressively to prevent disseminated disease
  5. Pregnant women are at high risk for developing disseminated coccidioidomycosis
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