Candidiasis — MCQs
Which infection commonly spreads to newborns through caregivers?
Which drug should not be given with ketoconazole?
A 23-year-old woman presents with vulvovaginal itching, burning, and thick white discharge. Microscopy shows budding yeast with pseudohyphae. She reports recurrent episodes. What is the most appropriate management?
In an HIV-infected individual, the Gram stain of lung aspirate shows yeast-like morphology. Which of the following is the least likely diagnosis?
A 25 year old lady presented with curdy white discharge from the vagina is likely to be suffering from:-
A 35-year-old patient presents with white plaques on the tongue and inner cheeks, which can be scraped off, leaving a red base. The patient also complains of a sore throat. What is the most appropriate management for this condition?
An HIV positive patient with a CD4 count of 300/cumm presents with mucosal lesions in the mouth as shown in the figure. On microscopy, budding yeasts and pseudohyphae are seen. A most probable diagnosis is?
What is the correct term for candidiasis of the penis?
A 7-year-old boy presented with painful boggy swelling of scalp, multiple sinuses with purulent discharge, easily pluckable hairs and lymph nodes enlarged in occipital region. Which one of the following would be most helpful for diagnostic evaluation?
A 70 year old farmer, presented to you with complaints of yellowish discolouration of his finger nails for the past 6 months, he also gives history of recurrent episodes of itching in the groin for which he used to take local home made herbal remedy. On examination 3 of his toe nails also show similar change with tunneling. Which among the following is the best test for rapid confirmation of your diagnosis?
Candidiasis Indian Medical PG Practice Questions and MCQs
Question 1: Which infection commonly spreads to newborns through caregivers?
- A. Candida parapsilosis (Correct Answer)
- B. Candida albicans
- C. Candida tropicalis
- D. Candida glabrata
Explanation: ***Candida parapsilosis*** - This species is a well-known cause of **nosocomial bloodstream infections** in neonates, particularly in **premature infants** and those with central venous catheters. It is often spread via the hands of **healthcare workers**. - Its ability to form **biofilms on medical devices** (like catheters) further facilitates its transmission and makes it a significant infectious agent in neonatal intensive care units (NICUs). *Candida albicans* - While *Candida albicans* is the **most common Candida species** causing infections in humans, including superficial and invasive candidiasis in neonates, its transmission is less frequently linked to direct caregiver spread in the context of outbreaks compared to *C. parapsilosis*. - Neonatal *C. albicans* infections are often acquired **vertically from the mother** or through endogenous gut colonization. *Candida tropicalis* - *Candida tropicalis* can cause **invasive candidiasis**, especially in immunocompromised patients, but it is less frequently implicated in **outbreaks** attributed to hand-to-patient transmission by caregivers in NICUs than *C. parapsilosis*. - It is often associated with **neutropenia** and broad-spectrum antibiotic use. *Candida glabrata* - *Candida glabrata* is a significant pathogen, particularly in adults and immunocompromised individuals, known for its **fluconazole resistance**. - While it can cause bloodstream infections, it is not typically recognized as a primary cause of **caregiver-spread outbreaks** in newborns to the same extent as *C. parapsilosis*.
Question 2: Which drug should not be given with ketoconazole?
- A. Indinavir (Correct Answer)
- B. Macrolide
- C. All of the options
- D. Aminoglycoside
Explanation: ***Correct: Indinavir*** - **Indinavir** is a **protease inhibitor (antiretroviral)** that is primarily metabolized by **CYP3A4** - **Ketoconazole** is a **potent CYP3A4 inhibitor** that significantly increases indinavir plasma concentrations - Co-administration leads to **increased risk of indinavir toxicity** including nephrolithiasis, hyperbilirubinemia, and hepatotoxicity - **Dose reduction of indinavir is required** if concurrent use is necessary (typically reduce to 600 mg q8h from 800 mg q8h) *Incorrect: Macrolide* - Many **macrolides** (erythromycin, clarithromycin) are CYP3A4 substrates and can interact with ketoconazole - While caution is advised due to **QT prolongation risk**, this interaction is less severe than with indinavir - Not an absolute contraindication but requires monitoring *Incorrect: Aminoglycoside* - **Aminoglycosides** (gentamicin, amikacin, tobramycin) are **NOT metabolized by CYP450 enzymes** - They are **hydrophilic** and eliminated **unchanged by renal excretion** - **No clinically significant interaction** with ketoconazole - Can be safely co-administered without dose adjustment *Key Learning Point* - Ketoconazole inhibits CYP3A4, affecting metabolism of many drugs including **protease inhibitors, calcium channel blockers, statins, and some macrolides** - Always check for CYP3A4 substrate drugs when prescribing azole antifungals
Question 3: A 23-year-old woman presents with vulvovaginal itching, burning, and thick white discharge. Microscopy shows budding yeast with pseudohyphae. She reports recurrent episodes. What is the most appropriate management?
- A. Fluconazole 150mg orally as single dose
- B. Topical clotrimazole for 7 days
- C. Weekly fluconazole 150mg for 6 months (Correct Answer)
- D. Metronidazole 500mg orally twice daily for 7 days
Explanation: ***Weekly fluconazole 150mg for 6 months*** - The patient's history of **recurrent episodes** of vulvovaginal candidiasis, coupled with the presence of **budding yeast and pseudohyphae**, indicates a need for **prophylactic treatment**. - **Weekly fluconazole** for an extended period (e.g., 6 months) is the recommended regimen for **recurrent vulvovaginal candidiasis**, aiming to suppress future outbreaks. *Fluconazole 150mg orally as single dose* - A **single dose of fluconazole** is typically effective for **uncomplicated, sporadic vulvovaginal candidiasis**. - It is insufficient to prevent recurrence in a patient with a history of **recurrent candidiasis**. *Topical clotrimazole for 7 days* - **Topical antifungals** like clotrimazole are effective for **acute episodes of candidiasis**, particularly when symptoms are mild or localized. - Similar to a single oral dose, a 7-day course of topical treatment is generally not adequate for **preventing recurrence** in chronic cases. *Metronidazole 500mg orally twice daily for 7 days* - **Metronidazole** is an antibiotic used to treat **bacterial vaginosis** and **trichomoniasis**, which are caused by bacteria and parasites, respectively. - It has **no antifungal activity** and would be ineffective against vulvovaginal candidiasis.
Question 4: In an HIV-infected individual, the Gram stain of lung aspirate shows yeast-like morphology. Which of the following is the least likely diagnosis?
- A. Candida tropicalis
- B. Cryptococcus neoformans
- C. Aspergillus fumigatus (Correct Answer)
- D. Penicillium marneffei
Explanation: ***Aspergillus fumigatus*** - While *Aspergillus* can cause pulmonary infections in immunosuppressed individuals, it typically presents as **hyphae**, not yeast-like morphology, on Gram stain. - Identification usually requires visualization of **septate hyphae with acute-angle branching**. *Candida tropicalis* - *Candida* species are common causes of opportunistic infections in HIV patients and present as **yeast and pseudohyphae** (though true hyphae can also be seen). - *Candida tropicalis* lung infection would appear as **yeast-like forms** on Gram stain, making it a plausible diagnosis. *Cryptococcus neoformans* - *Cryptococcus neoformans* is a significant pathogen in HIV-infected individuals, causing pulmonary and disseminated disease, and is characterized by its **yeast morphology** and prominent capsule. - Staining would reveal **budding yeast cells**, often with a clear halo due to the capsule, fitting the description. *Penicillium marneffei* - *Penicillium marneffei* is a dimorphic fungus endemic in Southeast Asia that causes disseminated infection in HIV patients, and it grows as **yeast-like cells** at body temperature. - In infected tissues, it appears as **intracellular and extracellular oval yeast-like cells** with transverse septation, consistent with the description.
Question 5: A 25 year old lady presented with curdy white discharge from the vagina is likely to be suffering from:-
- A. Trichomoniasis
- B. Gonococcal vulvovaginitis
- C. Chlamydia trachomatis
- D. Candida vaginitis (Correct Answer)
Explanation: ***Candida vaginitis*** - **Candida vaginitis** is characterized by a **curdy white vaginal discharge**, often described as cottage cheese-like. - This condition is caused by an overgrowth of *Candida* species, typically *Candida albicans*, and is associated with **vaginal itching, burning**, and **dyspareunia**. *Trichomoniasis* - **Trichomoniasis** typically presents with a **frothy, greenish-yellow discharge** and a **foul odor**. - It often causes **severe itching, redness, and irritation**, which differ from the curdy discharge described. *Gonococcal vulvovaginitis* - **Gonococcal vulvovaginitis** in women can cause a **purulent or mucopurulent discharge**, often yellowish. - While it can lead to vaginal irritation, a **curdy white discharge** is not its classic presentation. *Chlamydia trachomatis* - **Chlamydia trachomatis** often causes an **asymptomatic infection**; when symptoms occur, they may include a **mucopurulent discharge**. - A **curdy white discharge** is not a typical symptom of *Chlamydia* infection.
Question 6: A 35-year-old patient presents with white plaques on the tongue and inner cheeks, which can be scraped off, leaving a red base. The patient also complains of a sore throat. What is the most appropriate management for this condition?
- A. Prescribe antifungal medication (Correct Answer)
- B. Provide vitamin supplements
- C. Administer dapsone and steroids
- D. Advise smoking cessation and screen for malignancy
Explanation: ***Prescribe antifungal medication*** - The symptoms described, **white plaques on the tongue and inner cheeks** that can be **scraped off leaving a red base**, along with a **sore throat**, are classic for **oral candidiasis** (thrush). - Oral candidiasis is a **fungal infection** caused by *Candida albicans*, and therefore, **antifungal medications** are the appropriate treatment [1]. *Provide vitamin supplements* - While nutritional deficiencies can sometimes impact oral health, they do not directly cause **oral candidiasis** or present with these specific findings. - Vitamin supplements would not address the underlying **fungal infection**. *Administer dapsone and steroids* - **Dapsone** is an antibiotic/anti-inflammatory often used for dermatological conditions like dermatitis herpetiformis, and **steroids** are anti-inflammatory but can actually predispose to fungal infections. - This combination is not indicated for the treatment of **oral candidiasis** and could potentially worsen the condition if steroids suppress the immune response. *Advise smoking cessation and screen for malignancy* - While smoking cessation is beneficial for overall health and reducing the risk of oral cancers, and malignancy screening is important for suspicious oral lesions, these actions are not the primary management for an acute presentation of **oral candidiasis**. - The lesions described are characteristic of a fungal infection, not immediately suggestive of malignancy, especially given their **removable nature**.
Question 7: An HIV positive patient with a CD4 count of 300/cumm presents with mucosal lesions in the mouth as shown in the figure. On microscopy, budding yeasts and pseudohyphae are seen. A most probable diagnosis is?
- A. Candidiasis (Correct Answer)
- B. Hairy leukoplakia
- C. Lichen planus
- D. Diphtheria
Explanation: ***Candidiasis*** - The image shows **white, creamy patches** on the tongue, which are characteristic of **oral candidiasis** (thrush). These lesions are often easily **scrapable**. - The presence of **budding yeasts and pseudohyphae** on microscopy confirms a fungal infection, and in an **HIV-positive patient with a CD4 count of 300/cumm**, Candida infection is very common due to immunosuppression. *Hairy leukoplakia* - Hairy leukoplakia presents as **white, corrugated, non-scrapable lesions**, typically on the lateral borders of the tongue. - It is caused by the **Epstein-Barr virus (EBV)** and does not show budding yeasts or pseudohyphae on microscopy. *Lichen planus* - Oral lichen planus presents with **white, lacy patterns (Wickham's striae)** on the buccal mucosa or tongue, which are usually not scrapable. - It is a **chronic inflammatory condition** and not an infectious process characterized by yeasts and pseudohyphae. *Diphtheria* - Diphtheria causes the formation of a **thick, gray pseudomembrane** in the throat and tonsils, which is firmly adherent and can cause bleeding if removed. - It is a **bacterial infection** caused by *Corynebacterium diphtheriae*, and microscopic examination would reveal characteristic gram-positive rods, not yeasts.
Question 8: What is the correct term for candidiasis of the penis?
- A. Oral thrush
- B. No candidiasis present
- C. Candidal balanitis (Correct Answer)
- D. Leukoplakia
Explanation: ***Balanitis*** - **Candidiasis of the penis** is specifically referred to as Candidal balanitis, an inflammatory condition affecting the **glans penis**. - This term accurately describes the location and cause of the infection. *Oral thrush* - **Oral thrush** is candidiasis of the mouth, characterized by **white patches** on the tongue and oral mucosa. - This term refers to a different anatomical location and is not applicable to penile infection. *No candidiasis present* - This option is incorrect because candidiasis can indeed affect the penis, leading to a recognized clinical condition. - Symptoms like **redness, itching, and discharge** would indicate the presence of candidiasis. *Leukoplakia* - **Leukoplakia** is a condition characterized by **white patches** that develop on the mucous membranes of the mouth, tongue, or sometimes the genitals. - It is a **precancerous lesion** that is not caused by Candida infection, distinguishing it from balanitis.
Question 9: A 7-year-old boy presented with painful boggy swelling of scalp, multiple sinuses with purulent discharge, easily pluckable hairs and lymph nodes enlarged in occipital region. Which one of the following would be most helpful for diagnostic evaluation?
- A. Bacterial culture
- B. Biopsy
- C. KOH mount (Correct Answer)
- D. Patch test
Explanation: ***KOH mount*** - The symptoms described (painful boggy swelling of the scalp, multiple sinuses with purulent discharge, easily pluckable hairs, and occipital lymph nodes) are highly characteristic of **kerion celsi**, a severe inflammatory form of **tinea capitis**. - A **KOH mount** is the most direct and rapid method to confirm a fungal infection by visualizing fungal elements (hyphae and spores) from removed hairs or scalp scrapings. - It is the **first-line diagnostic test** for tinea capitis, providing results within minutes and having high specificity when positive. *Bacterial culture* - While there is purulent discharge, the primary pathology in kerion is fungal, not bacterial. Bacterial culture would likely show **secondary infection** rather than the underlying cause. - Antibiotics alone would not resolve the fungal infection, making a bacterial culture less helpful for the primary diagnosis. *Biopsy* - A biopsy would be more invasive and reveal an inflammatory reaction, but it is **not the first-line diagnostic test** for suspected tinea capitis. - While it can demonstrate fungal elements, a **KOH mount** is much quicker, less invasive, and equally effective for initial diagnosis. *Patch test* - A patch test is used to identify **allergic contact dermatitis** by applying specific allergens to the skin. - It is completely irrelevant for diagnosing a fungal infection like kerion celsi, which is an infection, not an allergic reaction.
Question 10: A 70 year old farmer, presented to you with complaints of yellowish discolouration of his finger nails for the past 6 months, he also gives history of recurrent episodes of itching in the groin for which he used to take local home made herbal remedy. On examination 3 of his toe nails also show similar change with tunneling. Which among the following is the best test for rapid confirmation of your diagnosis?
- A. Tzanck smear
- B. KOH mount (Correct Answer)
- C. Woods lamp
- D. Biopsy
Explanation: ***KOH mount*** - A **KOH mount** (potassium hydroxide) dissolves keratinocytes, allowing for direct visualization of fungal elements such as **hyphae** and **spores** under a microscope. This is the **most rapid and cost-effective test** for confirming fungal infections like **onychomycosis**. - The patient's presentation with **yellowish discoloration** and **"tunneling"** of nails (suggesting onycholysis and subungual hyperkeratosis), along with a history of recurrent groin itching (potentially **tinea cruris**), strongly points to a fungal infection. *Tzanck smear* - A **Tzanck smear** is primarily used to detect multinucleated giant cells in **herpesvirus infections** (e.g., herpes simplex, varicella-zoster). - It is not useful for identifying fungal elements responsible for nail discoloration or suspected onychomycosis. *Woods lamp* - A **Woods lamp** uses ultraviolet light to detect specific fluorescent substances, particularly useful for diagnosing certain **bacterial infections** (e.g., *Corynebacterium minutissimum* in erythrasma) or some **tinea capitis** species (*Microsporum*). - Most common dermatophytes causing onychomycosis **do not fluoresce** under a Wood's lamp, making it an unreliable diagnostic tool in this scenario. *Biopsy* - A **nail biopsy** (with histology and special stains like PAS) is a highly accurate diagnostic method for onychomycosis, especially when other tests are inconclusive. - However, it is an **invasive procedure**, takes more time for results, and is generally not the **most rapid** initial test compared to a KOH mount.
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