MCQ on Systemic Mycoses (Medical Mycology), Aspergillosis, Histoplasmosis

Multiple Choice Question  on Systemic Mycoses 

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1) All of the following are the characteristics of systemic mycoses/deep mycosis, EXCEPT?
a) Most of the dimorphic fungi cause the infection
b) Pathogenesis mostly occurs due to the inhalation of spores
c) Opportunistic fungal infections are the only example of deep mycosis
d) Aspergillosis and Mucormycoses are the systemic mycoses

2) Which of the following systemic mycoses is often associated with skin and bone lesions and is more common in male patients?
a) Blastomycosis
b) Coccidioidomycosis
c) Cryptococcosis
d) Histoplasmosis

3) Coccidioidomycosis has the lesions the same as that of the lesion caused by which of the following bacterial infection?
a) Sporotrichosis
b) Brucellosis
c) Syphilis
d) Small pox

4) Which of the following statement is true for the microscopic characteristics of Coccidioides spp taken from sputum or tissue sample?

a) Identification of budding yeast with its pseudohyphae
b) The detection of spherules with endospores in sputum or tissue
c) The saprophytic phase is observed as septate mycelium with pyriform conidia
d) Tuberculate microconidia are observed in culture

5) What is the other name for coccidioidomycosis?
a) Yellow fever
b) San Joaquin Valley fever
c) Rocky mountain fever
d) Relapsing fever

6) A farmer residing in the Midwest of America developed flu-like symptoms with fever, headache, muscle pain, and cough for a week. Swabs specimens and the sputum sample were taken, radiography examination was also performed which showed diffused bilateral pneumonia. After a week of culture, white mold colonies were observed with large and small conidia. 
Name the possible pathogen responsible for this type of infection?
a) Coccidioidomycosis
b) Sporotrichosis
c) Histoplasmosis
d) Blastomycosis

7) What is the most common zoonotic source for the transfer of the above disease(question 6) to humans?
a) Birds
b) Cats
c) Cows
d) Pigs

8) What is the primary route of infection for most systemic mycoses?
a) Direct contact with infected individuals
b) Ingestion of contaminated food
c) Inhalation of fungal spores
d) Skin contact with contaminated soil

9) All of the following statements are true about Histoplasmosis duboisii, EXCEPT?
a) Mostly affects the skin and bone
b) This type of infection is confined to African regions
c) The usual entry of pathogen is through the skin abrasions
d) Acquired by inhalation of the fungal spores 

10) Which of the following animal is most susceptible to Blastomycoses?
a) Dogs
b) Pigs
c) Hens
d) Pigeons

11) Which fungal pathogen, when cultured from a sputum specimen, exhibits mold growth characterized by the presence of tuberculate macroconidia and oval microconidia in the laboratory culture media?
a) Blastomyces dermatitidis
b) Coccidioides immitis
c) Histoplasma capsulatum
d) Paracoccidioides brasiliensis

12) Which of the following pathogen causes the fungal infection known as South American Blastomycosis?
a) Histoplasma duboisii
b) Blastomyces dermatitidis
c) Paracoccidioides brasiliensis 
d) Coccidioides immitis

13) Which of the following fungi is a common opportunistic pathogen that can cause meningitis in HIV infected patients?
a) Rickettsia spp
b) Mucor spp
c) Candida spp
d) Cryptococcus spp
e) Penicillium spp

14) Which of the following pathogen is found in soil with high nitrogen content?
a) Histoplasma capsulatum
b) Blastomyces dermatitidis
c) Aspergillus niger
d) Coccidioides immitis

15) Which type of fungal spores is produced by Coccidioides immitis?
a) Macroconidia
b) Arthroconidia
c) Chlamydospores
d) Sporangia

16) Which of the following is Not the common specimen taken for the diagnosis of Cryptococcus spp?
a) Urine
b) Sputum
c) Skin tissues
d) Cerebrospinal fluid
e) Blood

17) All of the following fungi are important part of the medical mycology that causes systemic infection, Except?
a) Aspergillus spp
b) Candida spp
c) Mucor spp
d) Penicillium spp 
e) Rhizopus spp

18) In 1992, a large number of individuals in the western USA experienced symptoms resembling the flu or pneumonia. It was determined that fungal spores, found in soil and air, were responsible for the outbreak. The infection was coined 'valley fever.' What could be the potential fungal pathogen causing this infection?
a) Aspergillus niger
b) Blastomyces dermatitidis
c) Coccidioides immitis
d) Paracoccidioides brasiliensis

19) The combination of Christensen's urea agar is useful in the isolation and identification of which of the following fungi?
a) Cryptococcus spp
b) Histoplasma spp and Blastomyces spp
c) Malassezia furfur
d) Penicillium spp and Candida spp

20) Which of the following fungal infection is most common in dogs?
a) Coccidioidomycosis
b) Blastomycosis
c) Histoplasmosis
d) Sporotrichosis

21) Which of the following fungi cause systemic fungal infections that are dimorphic fungi? 
Select all the correct answers:
a) Blastomyces spp
b) Coccidioides spp
c) Histoplasma spp
d) Cryptococcus spp

22) Zygomycosis/ Mucormycosis is a systemic mycosis most often seen in which of the following patients?
a) Arthritis patient
b) Diabetic patient
c) High blood pressure patient
d) Migraine patient

23) The following systemic infection fungi typically affects the respiratory system, but rare disseminated form may be seen in immunocompromised individuals and patients may experience second-line prophylaxis that includes hepatosplenomegaly and thyroid, ocular, ear, or skin lesions.
Name the pathogen?
a) Actinomyces israelii
b) Candida spp
c) Microsporum spp
d) Pneumocystis jirovecii

24) Which of the following is correct statement regarding histopathology?
a) Isolation and detection of fungi from sputum or other respiratory secretions.
b) Isolation and detection of fungi in cerebrospinal fluid
c) Examination of stained tissue sections under a microscope for the identification fungal elements in the tissues
d) Examination and identification of the characteristics of fungal infections by using X-rays, CT scans, or MRI 

25) Which of the following antimicrobial agent is commonly added for the proper isolation of fungi in blood culture media?
a) Chloramphenicol
b) Ethyl alcohol
c) Phenols
d) Sodium chloride

26. A 52 year old male residing in Delhi, India visits the hospital with a history of persistent fever, cough, and shortness of breath for the past two months. 
Two months ago, the man developed a low-grade fever, which was initially attributed to a viral infection. He was prescribed antibiotics for the persistence of fever and cough, but his symptoms did not improve. He now experiences significant fatigue, cough with yellowish sputum, and occasional night sweats. He has also noticed a gradual weight loss of approximately 5 kg over the past one month, and appears chronically ill, cachectic, and fatigued.
Physical examination is done by the clinician, temperature is 101.2°F (38.4°C), and oxygen saturation is 92% on room air.
Respiratory examination reveals decreased breath sounds in the lower lung. Chest X-ray shows bilateral diffuse infiltrates and multiple nodular opacities, Hemoglobin is 10.2 g/dL (mild anemia). Sputum sample is taken, shows no growth on culture media for bacteria. HIV test is negative.
BAL fluid analysis reveals a significant increase in lymphocytes and elevated levels of beta-D-glucan.
Fungal cultures of BAL fluid are positive, small, white to beige, and waxy colonies appear on agar. 
Chest CT Scan shows bilateral pulmonary infiltrates with multiple nodular lesions and mediastinal lymphadenopathy.
Based on the clinical presentation and laboratory findings, the man is diagnosed with which of the following systemic mycoses?
a) Candidiasis
b) Disseminated histoplasmosis
c) Giardiasis
d) Toxoplasmosis

27. Which antifungal medication is often the treatment of choice for severe systemic mycoses?
a) Amphotericin B
b) Acyclovir
c) Ciprofloxacin
d) Penicillin

28. Which of the following systemic mycoses is primarily associated with exposure to contaminated water sources?
a) Blastomycosis
b) Coccidioidomycosis
c) Histoplasmosis
d) Paracoccidioidomycosis

Answers with Explanation:
1-c)  Opportunistic fungal infections are the only example of deep mycosis. Systemic or deep fungal infections can affect various organs and tissues throughout the body, these infections can be acquired by both healthy and immunocompromised individuals but opportunistic fungal infection is seen only seen in immunocompromised individuals.

2-b) Blastomycosis

3-c) Syphilis, the infection is caused by bacteria Treponema pallidum.

4-b) The detection of spherules with endospores in sputum or tissue

5-b) San Joaquin Valley fever, the fungus was first identified in San Joaquin Valley, California and is commonly found in some parts of USA and Mexico.

6-c) Histoplasmosis, it is often acquired by inhaling fungal spores present in soil contaminated with bird or droppings, the fungus primarily affects the lungs but can spread to other organs.

7-a) Birds, Histoplasma spp can live in soil contaminated with bird and bat droppings.

8-a) Inhalation of fungal spores, Systemic mycoses is acquired by inhaling fungal spores present in air or soil.

9-c) The usual entry of pathogen is through the skin abrasions
10-a) Dogs
11-c) Histoplasma capsulatum, it typically exhibits mold growth with distinctive features such as tuberculate macroconidia and oval microconidia.

12-c) Paracoccidioides brasiliensis, is a dimorphic fungi that causes Paracoccidioidomycosis and occurs due to the inhalation of the fungal spores, the disease is prevalent in South America mainly in males.

13-d) Cryptococcus spp, it commonly affects individuals with weakened immune systems, such as those with HIV/AIDS. The fungus can cause lung infections and may spread to the central nervous system, leading to meningitis.

14-a) Histoplasma capsulatum 
15-b) Arthroconidia
16-c) Skin tissues

17- b) Candida spp, it causes cutaneous infections also known as dermatomycoses or superficial mycoses.

18- c) C. immitis
19- a) Cryptococcus spp
20- b) Blastomycosis
21- aBlastomyces spp, b) Coccidioides spp, and c) Histoplasma spp
22- b) Diabetic patient

23- d) Pneumocystis jirovecii, causes a serious respiratory infection known as Pneumocystis pneumonia (PCP). It primarily affects immunocompromised individuals, particularly those with HIV/AIDS but the infection can spread to other organs and can be life threatening if left untreated.
a) Actinomyces israelii is a gram positive bacteria.  b) Candida spp and c) Microsporum spp are fungi that cause superficial mycoses or dermatomycoses.

24- c) Examination of stained tissue sections under a microscope for the identification fungal elements in the tissues.

25- a) Chloramphenicol, it inhibits the growth of bacteria but not the fungi.
b) Ethyl alcohol and c) Phenols are extensively used as antimicrobial agents for disinfection and to inhibit the growth of microorganisms in the lab.

26- b) Disseminated histoplasmosis
27- a) Amphotericin B
28- d) Paracoccidioidomycosis. It is often associated with exposure to contaminated water sources and is caused by Paracoccidioides brasiliensis.


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