Geographic distribution of dimorphic fungi — MCQs

A 29-year-old woman comes to the military physician because of a 2-day history of fever, joint pain, dry cough, chest pain, and a painful red rash on her lower legs. Two weeks ago, she returned from military training in Southern California. She appears ill. Her temperature is 39°C (102.1°F). Physical examination shows diffuse inspiratory crackles over all lung fields and multiple tender erythematous nodules over the anterior aspect of both legs. A biopsy specimen of this patient's lungs is most likely to show which of the following?

A 41-year-old woman presents to urgent care with complaints of a new rash. On review of systems, she endorses ankle pain bilaterally. Otherwise, she has no additional localized complaints. Physical examination reveals numerous red subcutaneous nodules overlying her shins, bilaterally. Complete blood count shows leukocytes 7,300, Hct 42.0%, Hgb 14.0 g/dL, mean corpuscular volume (MCV) 88 fL, and platelets 209. Chest radiography demonstrates bilateral hilar adenopathy with clear lungs. Which of the following is the most likely diagnosis?

A 27-year-old female presents to her primary care physician because she is concerned about lighter colored patches on her skin. She recently went sunbathing and noticed that these areas also did not tan. Her doctor explains that she has a fungal infection of the skin that damages melanocytes by producing acids. She is prescribed selenium sulfide and told to follow-up in one month. Which of the following describes the appearance of the most likely infectious organism under microscopy?

A 16-year-old boy presents to his pediatrician because he has noticed white plaques forming on his tongue over the last 5 days. He recently returned from a boy scout trip where he traveled across the country and hiked through the woods. His past medical history is significant for asthma for which he uses an inhaler as needed. He says that during the trip he felt short of breath several times and had to use the inhaler. He also says that several of his friends appeared to get sick on the same trip and were coughing a lot. He has not experienced any other symptoms since returning from the trip. On presentation, he is found to have white plaques on the tongue that can be scraped off. Which of the following is a characteristic of the most likely cause of this patient's disease?

A 44-year-old man comes to the physician because of a 3-week history of productive cough, fever, and lethargy. He also has several skin lesions over his body. His symptoms began 3 weeks after he returned from a camping trip in Kentucky. Three years ago, he underwent kidney transplantation for polycystic kidney disease. Current medications include sirolimus and prednisone. His temperature is 38°C (100.4°F). Diffuse crackles are heard over the lung fields. There are 4 white, verrucous skin patches over his chest and upper limbs. A photomicrograph of a skin biopsy specimen from one of the lesions is shown. Which of the following is the most likely diagnosis?

An investigator is studying growth patterns of various fungal pathogens. Incubation of an isolated fungus at 25°C shows branching hyphae with rosettes of conidia under light microscopy. After incubation at 37°C, microscopic examination of the same organism instead shows smooth, white colonies with rounded, elongated cells. Infection with the investigated pathogen is most likely to cause which of the following conditions?

A young woman from the Ohio River Valley in the United States currently on corticosteroid therapy for ulcerative colitis presented to a clinic complaining of fever, sweat, headache, nonproductive cough, malaise, and general weakness. A chest radiograph revealed patchy pneumonia in the lower lung fields, together with enlarged mediastinal and hilar lymph nodes. Skin changes suggestive of erythema nodosum (i.e. an acute erythematous eruption) were noted. Because the patient was from a region endemic for fungal infections associated with her symptoms and the patient was in close contact with a person presenting similar symptoms, the attending physician suspected that systemic fungal infection might be responsible for this woman’s illness. Which of the following laboratory tests can the physician use to ensure early detection of the disease, and also effectively monitor the treatment response?

A 40-year-old farmer from Ohio seeks evaluation at a clinic with complaints of a chronic cough, fevers, and anorexia of several months duration. On examination, he has generalized lymphadenopathy with hepatosplenomegaly. A chest radiograph reveals local infiltrates and patchy opacities involving all lung fields. Fine needle aspiration of an enlarged lymph node shows the presence of intracellular yeast. A fungal culture shows the presence of smooth, thin-walled microconidia and tuberculate macroconidia. Which of the following is the most likely diagnosis?

A 47-year-old woman comes to the physician because of a 3-day history of fever, fatigue, loss of appetite, cough, and chest pain. Physical examination shows diffuse inspiratory crackles over the left lung field. An x-ray of the chest shows hilar lymphadenopathy and well-defined nodules with central calcifications. Urine studies show the presence of a polysaccharide antigen. A biopsy specimen of the lung shows cells with basophilic, crescent-shaped nuclei and pericellular halos located within macrophages. This patient's history is most likely to show which of the following?

A 52-year-old man comes to the physician because of a 4-day history of a productive cough, shortness of breath, and low-grade fever. He works as a farmer in southern Arizona. Physical examination shows multiple skin lesions with a dark blue center, pale intermediate zone, and red peripheral rim on the upper and lower extremities. There are diffuse crackles on the left side of the chest. An x-ray of the chest shows left basilar consolidation and left hilar lymphadenopathy. A photomicrograph of tissue obtained from a biopsy of the lung is shown. Which of the following is the most likely causal pathogen?