Mucormycosis

Mucormycosis

Q. 1

Mucormycosis of paranasal sinus is most common in

 A

HIV

 B

Diabetes

 C

Those on immuno suppressants

 D

Post surgical

Q. 1

Mucormycosis of paranasal sinus is most common in

 A

HIV

 B

Diabetes

 C

Those on immuno suppressants

 D

Post surgical

Ans. B

Explanation:

 

MUCORMYCOSIS:

  • Caused by – rhizopus , rhizomucor , cunninghamella
  • Moulds with non septate hyphae
  • The higher prevalence of mucormycosis in India turned out to be statistically significant (p < 0.0001) in comparison with all other countries
  • Predisposing factors

            – Organ transplant recipients

            – Long term desferroxamine therapy

            – Immunosuppression due to steroids or cytotoxic drugs Hematological malignancy

            – Diabetics

            – Chronic renal failure

  • Five forms
  1. Rhinocerebral (most common site)
  2. Pulmonary mucormycosis (2′ most common)
  3. Cutaneous
  4. Gastrointestinal
  5. Disseminated

Diagnosis:

Microscopy and biopsy show organisms that appears as broad ribbon like usually non septate hyphae which branch at right angles


Q. 2

A 33 year old diabetic patient from Bihar presents with black necrotic mass filling the nasal cavity. Most likely fungal infection is

 A

Rhinosporidiosis

 B

Aspergillosis

 C

Mucormycosis

 D

Candidiasis

Q. 2

A 33 year old diabetic patient from Bihar presents with black necrotic mass filling the nasal cavity. Most likely fungal infection is

 A

Rhinosporidiosis

 B

Aspergillosis

 C

Mucormycosis

 D

Candidiasis

Ans. C

Explanation:

Q. 3

Choose the TRUE statement/s about mucormycosis:

 A

Nose is a common site

 B

Diabetics is a predisposing factor

 C

Common in India

 D

All of the above

Q. 3

Choose the TRUE statement/s about mucormycosis:

 A

Nose is a common site

 B

Diabetics is a predisposing factor

 C

Common in India

 D

All of the above

Ans. D

Explanation:

Mucormycosis

Caused by – rhizopus, rhizomucor, cunninghamella. The higher prevalence of mucormycosis in India turned out to be statistically significant (p < ? 0001. in comparison with all other countries Predisposing factors:

  • Organ transplant recipients
  • Long term desferroxamine therapy
  • Immunosuppression due to steroids or cytotoxic drugs
  • Hematological malignancy
  • Diabetis Mellitus
  • Chronic renal failure
Five forms of mucormycosis are:
  • Rhinocerebral (most common site)
  • Pulmonary mucormycosis (2nd most common)
  • Cutaneous
  • Gastrointestinal
  • Disseminated
  • Miscellaneous
Diagnosis: Biopsy with histopathologic examination is the most sensitive and specific modality for definitive diagnosis. Biopsy shows wide, thick walled, ribbon like, aseptate hyphal elements that branch at acute angles.

Q. 4

A 55 year old diabetic patient presents to the clinic with pain and proptosis of the left eye. On examination there are necrotic  areas with black eschar formation on the mucosa of palate, nasal septum and skin of left eyelids.

Assertion: This condition is most commonly caused by Mucor.

Reason: Intravenous amphotericin B is the drug of choice.

 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Q. 4

A 55 year old diabetic patient presents to the clinic with pain and proptosis of the left eye. On examination there are necrotic  areas with black eschar formation on the mucosa of palate, nasal septum and skin of left eyelids.

Assertion: This condition is most commonly caused by Mucor.

Reason: Intravenous amphotericin B is the drug of choice.

 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Ans. B

Explanation:

This patient is showing features of orbital mucormycosis most commonly caused by Mucor and Rhizopus. It is commonly seen in diabetics and immunocompromised patients. Treatment involves surgical excision of the involved tissue and use of intravenous amphotericin B.

Ref: Comprehensive Ophthalmology By A K Khurana, 4th Edition, Page 386.

 


Q. 5

Orbital mucormycosis is a complication of

 A

AIDS

 B

Steroid therapy

 C

Cushing’s disease

 D

Diabetic ketoacidosis

Q. 5

Orbital mucormycosis is a complication of

 A

AIDS

 B

Steroid therapy

 C

Cushing’s disease

 D

Diabetic ketoacidosis

Ans. D

Explanation:

Ans. is ‘d’ i.e., Diabetic ketoacidosis

Note – Orbital mucormycosis occurs secondary to paranasal sinus mucormycosis.

  • Predisposing factors for paranasal sinus mucormycosis

Diabetes mellitus                                                           – Long term deferoxamine therapy

–  Hematological malignancies                                      – Organ transplantation

.  Predisposing factors for G.I. mucormycosis

– Uremia                                                                           – Diarrheal diseases

–   Severe malnutrition


Q. 6

A diabetic patient presents with pus from eye. Colonies of isolated organisms are black with microscopic feature of non-septate hyphae and obtuse branching. Diagnosis is ‑

 A

Aspergillosis

 B

Candidiasis

 C

Mucormycosis

 D

Histoplasmosis

Q. 6

A diabetic patient presents with pus from eye. Colonies of isolated organisms are black with microscopic feature of non-septate hyphae and obtuse branching. Diagnosis is ‑

 A

Aspergillosis

 B

Candidiasis

 C

Mucormycosis

 D

Histoplasmosis

Ans. C

Explanation:

Ans. is ‘c’ i.e., Mucormycosis

  • Information in this question are :

i)       Patient is diabetic

ii)      Orbital mycosis

iii)     Non-septate hyphae with obtuse branching (seen in rhizopus and mucor).

  • All these suggest the diagnosis of mucormycosis, most common organism being rhizopus.

Q. 7

Vascular invasion is characteristic feature of-

 A

Candidiasis

 B

Mucormycosis

 C

Blastomycosis

 D

Sporotrichosis

Q. 7

Vascular invasion is characteristic feature of-

 A

Candidiasis

 B

Mucormycosis

 C

Blastomycosis

 D

Sporotrichosis

Ans. B

Explanation:

Ans. is ‘b’ i.e., Mucormycosis

.  In all form of mucormycosis, vascular invasion by hyphae is a prominant feature.

.  Ischemic or hemorrhagic necrosis is the foremost histologic finding.


Q. 8

Vascular involvement and thrombosis is seen in –

 A

Coccidioidomycosis

 B

Aspergillosis

 C

Mucormycosis

 D

b and c

Q. 8

Vascular involvement and thrombosis is seen in –

 A

Coccidioidomycosis

 B

Aspergillosis

 C

Mucormycosis

 D

b and c

Ans. D

Explanation:

Ans. is ‘b’ i.e., Aspergillosis; ‘c’ i.e., Mucormycosis


Q. 9

A 68-year-old male is a diabetic and presented with black, foul smelling discharge from the nose. Exami­nation revealed blackish discoloration of the inferior turbinate. The diagnosis is:

 A

Mucormycosis

 B

Aspergillosis

 C

Infarct of inferior turbinate 

 D

Foreign body

Q. 9

A 68-year-old male is a diabetic and presented with black, foul smelling discharge from the nose. Exami­nation revealed blackish discoloration of the inferior turbinate. The diagnosis is:

 A

Mucormycosis

 B

Aspergillosis

 C

Infarct of inferior turbinate 

 D

Foreign body

Ans. A

Explanation:

Q. 10

IDDM patient presents with septal perforation of nose with brownish black discharge, probable diagnosis is:

 A

Rhinosporidiosis

 B

Aspergillus

 C

Leprosy

 D

Mucormycosis

Q. 10

IDDM patient presents with septal perforation of nose with brownish black discharge, probable diagnosis is:

 A

Rhinosporidiosis

 B

Aspergillus

 C

Leprosy

 D

Mucormycosis

Ans. D

Explanation:

 

  • Mucormycosis is fungal infection of nose and paranasal sinuses which may prove rapidly fatal if untreated.
  • It is seen in uncontrolled diabetes or in those taking immunosuppressive drugs.
  • It presents as black necrotic mass filling the nasal cavity and eroding the septum and hard palate.
  • Treatment is by amphotericin B and surgical debridement.
  • Most common fungal infection of nose is Aspergillosis.

Q. 11

A Rapidly destructive infection of nose and paranasal sinuses in diabetics is:

 A

Histoplasmosis

 B

Sporotrichosis

 C

Mucormycosis

 D

Sarcoidosis

Q. 11

A Rapidly destructive infection of nose and paranasal sinuses in diabetics is:

 A

Histoplasmosis

 B

Sporotrichosis

 C

Mucormycosis

 D

Sarcoidosis

Ans. C

Explanation:

 

Mucormycosis

It is a fungal infection of nose and paranasal sinuses which may prove rapidly fatal

It is seen in uncontrolled diabetes or in those taking immunosuppressive drugs 


Q. 12

All are true about mucormycosis, except:

 A

Lymph invasion

 B

Angio invasion

 C

Long term deferoxanine therepy

 D

b and c

Q. 12

All are true about mucormycosis, except:

 A

Lymph invasion

 B

Angio invasion

 C

Long term deferoxanine therepy

 D

b and c

Ans. D

Explanation:

 

  • Mucormycosis is caused by Rhizopus species, Rhizomucus and Absidia species.
  • Intitially, the disease runs a subtle course with only fever and rhinorrhea. Later on, it invades the orbit and intracranial cavity with rapid loss of vision, meningitis, cavernous sinus thrombosis and multiple cranial nerve palsies.
  • It has marked predilection for vascular invasion leading to widespread thrombosis, tissue necrosis, and gangrene.
  • Characteristic nasal finding is a dark necrotic turbinate surrounded by pale mucosa blackish discharge and crusts.
  • M/C site is middle turbinate followed by middle meatus and septum.
  • Investigation of choice is MRI, while biopsy is confirmatory.

Treatment: Includes amphotericin-B, heparin, hyperbaric oxygen, and debridement.



Q. 13

Central retinal artery occlusion is known to be associated with:

 A

Panophthalmitis

 B

Diabetic retinopathy

 C

CMV retinitis

 D

Orbital mucormycosis.

Q. 13

Central retinal artery occlusion is known to be associated with:

 A

Panophthalmitis

 B

Diabetic retinopathy

 C

CMV retinitis

 D

Orbital mucormycosis.

Ans. D

Explanation:

Ans. Orbital mucormycosis.


Q. 14

Black necrotic mass seen in the nose of a elderly diabetic patient. Most probable diagnosis ‑

 A

Lupus vulgaris

 B

Aspergillosis

 C

Mucormycosis

 D

Pseudomonas infection

Q. 14

Black necrotic mass seen in the nose of a elderly diabetic patient. Most probable diagnosis ‑

 A

Lupus vulgaris

 B

Aspergillosis

 C

Mucormycosis

 D

Pseudomonas infection

Ans. C

Explanation:

Ans. is ‘c’ i.e., Mucormycosis

  • Mucormycosis is fungal infection of nose and paranasal sinuses which may prove rapidly fatal if untreated. 
  • It is seen in uncontrolled diabetics or in those taking immunosuppressive drugs.
  • From the nose and sinuses, infection can spread to orbit, cribriform plate, meninges and brain.
  • The rapid destruction associated with the disease is due to affinity of fungus to invade the arteries and cause endothelial damage and thrombus.
  • It presents as black necrotic mass filling the nasal cavity and eroding the septum and hard palate.
  • Treatment is by amphotericin B and surgical debridement.


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