Neurology: cryptococcal meningitis in HIV: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Neurology: cryptococcal meningitis in HIV

Sample item

A 35-year-old man with HIV (CD4 count 40 per mm3) has a 2-week headache and fever. CT head is normal, lumbar puncture opening pressure is 42 cm of CSF, and India ink and cryptococcal antigen are positive. Which management is most appropriate?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Amphotericin B with flucytosine, with therapeutic lumbar puncture to lower pressure

Cryptococcal meningitis requires induction with amphotericin B plus flucytosine for 2 weeks, then fluconazole consolidation. Raised pressure is managed with repeated therapeutic lumbar punctures. Antiretroviral therapy is deferred for about 4 to 6 weeks to lower the risk of immune reconstitution syndrome.

Option by option

  • A. Amphotericin B with flucytosine, with therapeutic lumbar puncture to lower pressure (correct)

    Correct. This is the standard induction regimen with pressure control.

  • B. Fluconazole alone with immediate antiretroviral therapy

    Fluconazole alone is inadequate for induction and early ART increases mortality from immune reconstitution.

  • C. Acetazolamide to control intracranial pressure with fluconazole

    Acetazolamide does not reduce cryptococcal pressure and causes acidosis; serial lumbar puncture is the proven method.

  • D. Amphotericin B alone with dexamethasone for raised pressure

    Dexamethasone increased adverse events and disability in trials of cryptococcal meningitis and is not recommended.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Amphotericin B with flucytosine, with therapeutic lumbar puncture to lower pressure. Cryptococcal meningitis requires induction with amphotericin B plus flucytosine for 2 weeks, then fluconazole consolidation.

Why is "Fluconazole alone with immediate antiretroviral therapy" not the answer?

Fluconazole alone is inadequate for induction and early ART increases mortality from immune reconstitution.

Why is "Acetazolamide to control intracranial pressure with fluconazole" not the answer?

Acetazolamide does not reduce cryptococcal pressure and causes acidosis; serial lumbar puncture is the proven method.

Why is "Amphotericin B alone with dexamethasone for raised pressure" not the answer?

Dexamethasone increased adverse events and disability in trials of cryptococcal meningitis and is not recommended.

What concept does this question test?

It tests Neurology: cryptococcal meningitis in HIV in General Medicine. Raised pressure is managed with repeated therapeutic lumbar punctures. Antiretroviral therapy is deferred for about 4 to 6 weeks to lower the risk of immune reconstitution syndrome.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neurology: cryptococcal meningitis in HIV?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.