Chemotherapy: echinocandins: 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 · Chemotherapy: echinocandins

Sample item

A man with HIV and CD4 count of 40 has headache and neck stiffness, and India ink staining of cerebrospinal fluid shows encapsulated yeasts. A colleague proposes caspofungin. Why is it inappropriate?

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

The answer and the reasoning

B. Cryptococcus is intrinsically resistant to echinocandins

Echinocandins inhibit beta-1,3-glucan synthase and are fungicidal against Candida, but Cryptococcus is intrinsically resistant and they penetrate cerebrospinal fluid poorly. Induction therapy for cryptococcal meningitis is amphotericin B with flucytosine, followed by fluconazole. Caspofungin is a good choice for invasive candidiasis.

Option by option

  • A. Cryptococcus lacks a cell wall

    Cryptococcus has a cell wall, and a polysaccharide capsule outside it.

  • B. Cryptococcus is intrinsically resistant to echinocandins (correct)

    Correct. There is no useful activity against Cryptococcus.

  • C. Caspofungin is highly nephrotoxic

    Nephrotoxicity is a feature of amphotericin B, not caspofungin.

  • D. Echinocandins are fungistatic against yeasts

    Echinocandins are fungicidal against Candida and fungistatic against Aspergillus.

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.

More Pharmacology questions

Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is B, Cryptococcus is intrinsically resistant to echinocandins. Echinocandins inhibit beta-1,3-glucan synthase and are fungicidal against Candida, but Cryptococcus is intrinsically resistant and they penetrate cerebrospinal fluid poorly.

Why is "Cryptococcus lacks a cell wall" not the answer?

Cryptococcus has a cell wall, and a polysaccharide capsule outside it.

Why is "Caspofungin is highly nephrotoxic" not the answer?

Nephrotoxicity is a feature of amphotericin B, not caspofungin.

Why is "Echinocandins are fungistatic against yeasts" not the answer?

Echinocandins are fungicidal against Candida and fungistatic against Aspergillus.

What concept does this question test?

It tests Chemotherapy: echinocandins in Pharmacology. Induction therapy for cryptococcal meningitis is amphotericin B with flucytosine, followed by fluconazole. Caspofungin is a good choice for invasive candidiasis.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Chemotherapy: echinocandins?

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.