Systemic Mycoses with Cutaneous Manifestations — MCQs
Which of the following is NOT a fungal infection?
A farmer presents you with a cauliflower-shaped mass on foot, which developed after a minor injury. Microscopy shows copper penny bodies. What is the most likely diagnosis?
All of the following drugs cause renal failure except?
An organism produces cutaneous disease (malignant pustule or eschar) at the site of inoculation in handlers of animal skins. Most likely organism is:
A 40-year-old gardener presents with several subcutaneous nodules on his right hand, where he had cut himself on rose thorns, and physical examination reveals several erythematous fluctuant lesions. Which organism is most likely responsible for his condition?
Match the following: A) Caplan syndrome- 1) Found first in coal worker B) Asbestosis- 2) Upper lobe predominance C) Mesothelioma- 3) Involves lower lobe D) Sarcoidosis- 4) Pleural effusion is seen
A lady from West Rajasthan presented with an ulcer surrounded by erythema on the right leg. Microscopy of the biopsy from the edge of the ulcer showed organisms with dark staining nuclei and kinetoplast. What is the most likely causative agent? (Refer to the provided image)
Induration of seminal vesicle is seen most often in
A baby from a second degree consanguineous marriage presents with diarrhoea and redness in the perianal diaper area. What is the most likely diagnosis?
Saddle nose deformity is seen in?
Systemic Mycoses with Cutaneous Manifestations Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is NOT a fungal infection?
- A. Black Piedra
- B. White Piedra
- C. Tinea nigra Palmaris
- D. Mycoses fungoides (Correct Answer)
Explanation: ***Mycoses fungoides*** - This is a type of **cutaneous T-cell lymphoma**, which is a **malignancy of lymphocytes**, not a fungal infection [1]. - It presents with skin lesions that can mimic various dermatological conditions but is characterized by abnormal T-cells infiltrating the skin [1], [2]. *Black Piedra* - This is a superficial fungal infection of the **hair shaft** caused by **Piedraia hortae**, forming hard, black nodules. - It is an example of a **dermatomycosis**. *White Piedra* - This is a fungal infection of the **hair shaft** caused by **Trichosporon species**, leading to soft, white to light brown nodules. - Like black piedra, it is also a **dermatomycosis**. *Tinea nigra Palmaris* - This is a superficial fungal infection of the **stratum corneum** of the skin, primarily on the palms and soles, caused by **Hortaea werneckii**. - It presents as irregular, darkly pigmented (brown to black) macules and is a true **mycosis**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 613-614. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 564-565.
Question 2: A farmer presents you with a cauliflower-shaped mass on foot, which developed after a minor injury. Microscopy shows copper penny bodies. What is the most likely diagnosis?
- A. Sporotrichosis
- B. Blastomycosis
- C. Chromoblastomycosis (Correct Answer)
- D. Phaeohyphomycosis
Explanation: **Chromoblastomycosis** - The characteristic "cauliflower-shaped" lesion on the foot following a minor injury, especially in a farmer (indicating outdoor exposure), is highly suggestive of chromoblastomycosis. - The presence of **copper penny bodies** (also known as **sclerotic** or **muriform cells**) on microscopy is **pathognomonic** for chromoblastomycosis. *Blastomycosis* - Blastomycosis typically presents with **granulomatous lesions** that can ulcerate but are rarely described as cauliflower-shaped. - Microscopic examination would reveal **broad-based budding yeast cells**, not copper penny bodies. *Sporotrichosis* - Sporotrichosis usually presents as **subcutaneous nodules** that can ulcerate and spread lymphatically, forming a chain of lesions. - Microscopy shows **cigar-shaped budding yeasts** within macrophages or neutrophils, which are distinct from copper penny bodies. *Phaeohyphomycosis* - Phaeohyphomycosis encompasses a broad group of infections by dematiaceous fungi that produce **dark-walled hyphae** or yeast-like cells in tissue. - While it can cause subcutaneous nodules or cysts, the presence of distinct copper penny bodies points away from phaeohyphomycosis as the primary diagnosis.
Question 3: All of the following drugs cause renal failure except?
- A. Cefoperazone (Correct Answer)
- B. Amphotericin B
- C. Gentamicin
- D. Cephaloridine
Explanation: ***Cefoperazone*** - **Cefoperazone** is a third-generation cephalosporin that is primarily eliminated by the liver and does not typically cause **nephrotoxicity**. - While all cephalosporins can potentially cause hypersensitivity reactions or interstitial nephritis in rare cases, cefoperazone is not known for direct renal tubular damage. *Amphotericin B* - **Amphotericin B** is a potent antifungal agent that frequently causes dose-dependent **nephrotoxicity** due to direct damage to renal tubular cells. - It can lead to acute kidney injury, electrolyte imbalances (e.g., **hypokalemia**, **hypomagnesemia**), and renal tubular acidosis. *Gentamicin* - **Gentamicin** is an aminoglycoside antibiotic known for its significant **nephrotoxic** potential, particularly with prolonged use or high doses. - It accumulates in renal cortical cells, leading to **proximal tubular necrosis** and acute tubular necrosis. *Cephaloridine* - **Cephaloridine** is a first-generation cephalosporin that was historically removed from the market due to its significant and dose-dependent **nephrotoxicity**. - It caused direct damage to the **renal tubules**, leading to acute kidney injury.
Question 4: An organism produces cutaneous disease (malignant pustule or eschar) at the site of inoculation in handlers of animal skins. Most likely organism is:
- A. Neisseria meningitidis
- B. Bacillus anthracis (Correct Answer)
- C. Pseudomonas aeruginosa
- D. Cryptococcus neoformans
Explanation: ***Bacillus anthracis*** - This description is classic for **cutaneous anthrax**, characterized by a **malignant pustule** or **eschar** that develops at the site of inoculation. - The context of handling **animal skins** (e.g., wool-sorter's disease) is a key epidemiological clue for _Bacillus anthracis_ infection. *Neisseria meningitidis* - Primarily causes **meningitis** and **meningococcemia**, involving a petechial or purpuric rash, not a single eschar or malignant pustule. - There is no direct association with handling animal skins. *Pseudomonas aeruginosa* - This bacterium is often associated with **opportunistic infections** in immunocompromised individuals, burn patients, or those with indwelling medical devices. - While it can cause skin lesions (e.g., **ecthyma gangrenosum**), these are distinct from the anthrax eschar and are not linked to animal skin exposure. *Cryptococcus neoformans* - A **fungus** that primarily causes **cryptococcal meningitis** or pulmonary infections, especially in immunocompromised individuals. - Skin manifestations, when they occur, are typically papules, nodules, or ulcers, not the classic **cutaneous anthrax eschar**.
Question 5: A 40-year-old gardener presents with several subcutaneous nodules on his right hand, where he had cut himself on rose thorns, and physical examination reveals several erythematous fluctuant lesions. Which organism is most likely responsible for his condition?
- A. Aspergillus
- B. Malassezia
- C. Sporothrix (Correct Answer)
- D. Histoplasma
Explanation: ***Sporothrix*** - The gardener's history of a cut from rose thorns and the development of **subcutaneous nodules** are classic presentations of **sporotrichosis** (rose gardener's disease), caused by *Sporothrix schenckii*. - *Sporothrix schenckii* is a **dimorphic fungus** found in soil and on plant matter, causing localized cutaneous or subcutaneous lesions that typically follow **lymphatic spread** (lymphocutaneous pattern). *Aspergillus* - *Aspergillus* species typically cause **invasive pulmonary infections** (aspergillosis) in immunocompromised individuals or allergic bronchopulmonary aspergillosis. - While it can cause cutaneous infections, these are rare and usually occur in severely immunocompromised patients, without the classic "rose thorn" association. *Malassezia* - *Malassezia* species are yeasts that are normal skin flora and are primarily associated with **pityriasis versicolor**, **seborrheic dermatitis**, and **folliculitis**. - They do not typically cause deep subcutaneous nodules or are associated with puncture wounds from plants. *Histoplasma* - *Histoplasma capsulatum* is a **dimorphic fungus** that primarily causes **pulmonary infections** through inhalation of spores from soil contaminated with bird or bat droppings. - While it can rarely cause cutaneous lesions (especially in disseminated disease in immunocompromised patients), it is not associated with traumatic inoculation from plant material or the lymphocutaneous pattern seen here.
Question 6: Match the following: A) Caplan syndrome- 1) Found first in coal worker B) Asbestosis- 2) Upper lobe predominance C) Mesothelioma- 3) Involves lower lobe D) Sarcoidosis- 4) Pleural effusion is seen
- A. A-3, B-4, C-2, D-1
- B. A-1, B-4, C-3, D-2 (Correct Answer)
- C. A-4, B-2, C-3, D-1
- D. A-2, B-4, C-3, D-1
Explanation: **A-1, B-4, C-3, D-2** - **Caplan syndrome** was first described in **coal workers** with **rheumatoid arthritis** and progressive massive fibrosis. - **Asbestosis** is often associated with **pleural effusion**, which can be benign or malignant. - **Mesothelioma** typically involves the **lower lobes** of the lungs, specifically the pleura, and is strongly linked to asbestos exposure. - **Sarcoidosis** is characterized by **non-caseating granulomas**, which have a predilection for the **upper lobes** of the lungs. *A-3, B-4, C-2, D-1* - This option incorrectly states that Caplan syndrome involves the lower lobe; **Caplan syndrome** is defined by the presence of large nodules in the lungs of coal workers with rheumatoid arthritis, and their specific lobar distribution is not a defining characteristic. - This option incorrectly states that Mesothelioma has an upper lobe predominance; **Mesothelioma** is a pleural malignancy and typically involves the **lower lobes**, extending along the pleura. *A-4, B-2, C-3, D-1* - This option incorrectly associates Caplan syndrome with pleural effusion; **Caplan syndrome** manifests as rheumatoid nodules in the lungs, not primarily pleural effusion. - This option incorrectly states that Asbestosis has an upper lobe predominance; **Asbestosis** predominantly affects the **lower lobes** of the lungs, causing interstitial fibrosis. *A-2, B-4, C-3, D-1* - This option incorrectly states that Caplan syndrome has an upper lobe predominance; the defining feature of **Caplan syndrome** is the combination of rheumatoid arthritis and pneumoconiosis, not specific lobar involvement. - This option correctly identifies pleural effusion with asbestosis and lower lobe involvement with mesothelioma, but **Caplan syndrome** is not characterized by upper lobe predominance.
Question 7: A lady from West Rajasthan presented with an ulcer surrounded by erythema on the right leg. Microscopy of the biopsy from the edge of the ulcer showed organisms with dark staining nuclei and kinetoplast. What is the most likely causative agent? (Refer to the provided image)
- A. Leishmania tropica (Correct Answer)
- B. Babesia microti
- C. Trypanosoma brucei
- D. Histoplasma capsulatum
Explanation: ***Leishmania tropica*** - The presence of an ulcer with surrounding erythema in **West Rajasthan**, along with microscopy showing organisms with a **nucleus and kinetoplast**, is highly characteristic of **cutaneous leishmaniasis** caused by *Leishmania tropica*. - The organisms seen are **amastigotes** within macrophages in skin lesions, which are identified by their distinct **nucleus and kinetoplast** on microscopy. - West Rajasthan is an **endemic area** for cutaneous leishmaniasis. *Babesia microti* - *Babesia microti* causes **babesiosis**, a tick-borne illness affecting red blood cells, leading to **hemolytic anemia** and malaria-like symptoms. - It does not typically cause **skin ulcers** and its characteristic form in smears is a **ring form or tetrad ("Maltese cross")** within red blood cells, not organisms with kinetoplasts in macrophages. *Trypanosoma brucei* - *Trypanosoma brucei* causes **African trypanosomiasis (sleeping sickness)**, presenting with fever, headaches, joint pain, and neurological symptoms, possibly a **chancre** at the inoculation site. - While it has a **kinetoplast**, it exists as a flagellated **trypomastigote** in the blood and CSF, not as an **amastigote** in macrophages within a skin ulcer. - Additionally, this is **geographically incorrect** for West Rajasthan. *Histoplasma capsulatum* - *Histoplasma capsulatum* is a **fungus** that causes **histoplasmosis**, primarily affecting the respiratory system, especially in immunocompromised individuals. - It does **not possess a kinetoplast** and while it can cause disseminated disease with skin lesions, the microscopic appearance would be **yeast forms** within macrophages, not organisms with kinetoplasts.
Question 8: Induration of seminal vesicle is seen most often in
- A. Lymphogranuloma venereum
- B. Syphilis
- C. Gonorrhea
- D. Tuberculosis (Correct Answer)
Explanation: ***Tuberculosis*** - **Tuberculosis** of the male genital tract often affects the seminal vesicles, leading to extensive tissue damage and **induration** due to granuloma formation and fibrosis. - This involvement can be part of disseminated tuberculosis or primary genitourinary tuberculosis, presenting with symptoms like **hematuria**, **epididymo-orchitis**, and painful ejaculation. *Lymphogranuloma venereum* - Characterized by **lymphadenopathy**, **genital ulcers**, and **proctitis**, but does not typically cause induration of the seminal vesicles. - Primarily affects **lymphatic tissues** in the inguinal and pelvic regions. *Syphilis* - Manifests with **chancres**, **rashes**, and later neurological or cardiovascular complications, but direct involvement and induration of seminal vesicles are not typical features. - While it can affect various organs, induration of the seminal vesicles is not a classic presentation. *Gonorrhea* - Causes **urethritis**, **epididymitis**, and sometimes prostatitis, but significant **induration** of the seminal vesicles is uncommon. - It primarily involves mucous membranes and often leads to purulent discharge.
Question 9: A baby from a second degree consanguineous marriage presents with diarrhoea and redness in the perianal diaper area. What is the most likely diagnosis?
- A. Fungal infection (Correct Answer)
- B. Shigella infection
- C. Salmonella infection
- D. Lactose intolerance
Explanation: ***Fungal infection (Candida diaper dermatitis)*** - **Diarrhea with perianal diaper rash** is the classic presentation of **Candida (fungal) diaper dermatitis**, the most common cause of diaper rash in infants with diarrhea. - **Diarrhea increases skin moisture and alters pH**, creating optimal conditions for **Candida albicans overgrowth**. - **Perianal involvement with bright erythema** is characteristic of Candida, often with **satellite lesions** and involvement of skin folds. - This is a **clinical diagnosis** based on distribution pattern and association with diarrhea; consanguinity is not directly relevant to this common condition. *Lactose intolerance* - **Congenital lactase deficiency** is extremely rare (< 50 cases worldwide) and unlikely to be the primary diagnosis. - While **secondary lactose intolerance** can occur with gastroenteritis causing diarrhea, it doesn't explain the **specific perianal rash pattern** described. - The perianal redness in lactose malabsorption would be **irritant contact dermatitis** from acidic stools, which would secondarily get infected with **Candida** - making fungal infection the more complete diagnosis. *Shigella infection* - Typically presents with **bloody diarrhea (dysentery)**, high fever, abdominal cramps, and tenesmus. - Would not specifically cause the **perianal diaper rash pattern** characteristic of Candida. - Consanguinity doesn't predispose to this bacterial infection. *Salmonella infection* - Usually presents with **fever, vomiting, and systemic symptoms** along with diarrhea. - May cause bloody or non-bloody diarrhea but doesn't explain the **characteristic perianal redness pattern**. - Not associated with consanguinity as it's an acquired infectious disease.
Question 10: Saddle nose deformity is seen in?
- A. Primary Syphilis
- B. Secondary Syphilis
- C. Tertiary Syphilis (Correct Answer)
- D. Lupus Vulgaris
Explanation: ***Tertiary Syphilis*** - **Saddle nose deformity** is a characteristic late manifestation of **tertiary syphilis** due to destructive lesions (gummas) affecting the nasal cartilage and bone [1], [2]. - It results from the **collapse of the nasal bridge**, leading to a flattened appearance [2]. *Primary Syphilis* - Characterized by a **chancre**, a painless ulcer, usually at the site of infection [1]. - This stage does not involve destructive lesions of the nose. *Secondary Syphilis* - Presents with a **widespread rash**, lymphadenopathy, and mucous patches [1]. - While systemic, it typically does not cause structural damage like saddle nose deformity. *Lupus Vulgaris* - This is a **cutaneous form of tuberculosis**, characterized by chronic, destructive skin lesions. - While it can cause facial disfigurement, saddle nose deformity is not a typical feature of lupus vulgaris.
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