Antifungals: invasive aspergillosis: practice question

A Pharmacology 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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Pharmacology · Antifungals: invasive aspergillosis

Sample item

A 35-year-old man with acute leukaemia and prolonged neutropenia has persistent fever on broad-spectrum antibiotics. CT chest shows a nodule with a halo sign and serum galactomannan is positive. Which drug is the first-line treatment?

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

The answer and the reasoning

A. Voriconazole

The halo sign and a positive galactomannan in a neutropenic patient indicate invasive aspergillosis. Voriconazole is the first-line drug and improves survival compared with conventional amphotericin B. Fluconazole has no useful activity against Aspergillus, and echinocandins are used for salvage or combination.

Option by option

  • A. Voriconazole (correct)

    Correct. Voriconazole is recommended as primary therapy of invasive aspergillosis.

  • B. Oral nystatin

    Nystatin is not absorbed and treats only superficial candidiasis.

  • C. Fluconazole

    Fluconazole is inactive against Aspergillus species.

  • D. Caspofungin

    Echinocandins are inferior as monotherapy and are reserved for salvage therapy.

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 Pharmacology question

What is the answer to this Pharmacology question?

The best answer is A, Voriconazole. The halo sign and a positive galactomannan in a neutropenic patient indicate invasive aspergillosis.

Why is "Oral nystatin" not the answer?

Nystatin is not absorbed and treats only superficial candidiasis.

Why is "Fluconazole" not the answer?

Fluconazole is inactive against Aspergillus species.

Why is "Caspofungin" not the answer?

Echinocandins are inferior as monotherapy and are reserved for salvage therapy.

What concept does this question test?

It tests Antifungals: invasive aspergillosis in Pharmacology. Voriconazole is the first-line drug and improves survival compared with conventional amphotericin B. Fluconazole has no useful activity against Aspergillus, and echinocandins are used for salvage or combination.

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 Antifungals: invasive aspergillosis?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology 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.