Infections: bacterial, viral, fungal, parasitic: cervicofacial actinomycosis: practice question

A Dermatology 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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Dermatology · Infections: bacterial, viral, fungal, parasitic: cervicofacial actinomycosis

Sample item

A man has a hard, woody swelling at the angle of the jaw for several weeks, with multiple sinuses discharging pus that contains yellow granules. Gram stain of a crushed granule shows branching filaments that are not acid-fast. Which treatment is most appropriate?

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

The answer and the reasoning

C. Prolonged high-dose penicillin

Actinomyces israelii causes chronic suppurative infection with sulfur granules and sinuses, often at the jaw. The filaments are non-acid-fast, which separates it from Nocardia. Prolonged penicillin, often with surgical drainage, is the treatment of choice.

Option by option

  • A. Metronidazole alone

    Actinomyces is intrinsically resistant to metronidazole despite being an anaerobe.

  • B. Co-trimoxazole alone

    Co-trimoxazole is the usual drug for Nocardia, which is partly acid-fast.

  • C. Prolonged high-dose penicillin (correct)

    Correct. Actinomyces responds to long courses of penicillin, with drainage of collections.

  • D. Itraconazole for six months

    Itraconazole treats fungal mycetoma and sporotrichosis, but this is a filamentous bacterium.

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 Dermatology question

What is the answer to this Dermatology question?

The best answer is C, Prolonged high-dose penicillin. Actinomyces israelii causes chronic suppurative infection with sulfur granules and sinuses, often at the jaw.

Why is "Metronidazole alone" not the answer?

Actinomyces is intrinsically resistant to metronidazole despite being an anaerobe.

Why is "Co-trimoxazole alone" not the answer?

Co-trimoxazole is the usual drug for Nocardia, which is partly acid-fast.

Why is "Itraconazole for six months" not the answer?

Itraconazole treats fungal mycetoma and sporotrichosis, but this is a filamentous bacterium.

What concept does this question test?

It tests Infections: bacterial, viral, fungal, parasitic: cervicofacial actinomycosis in Dermatology. The filaments are non-acid-fast, which separates it from Nocardia. Prolonged penicillin, often with surgical drainage, is the treatment of choice.

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 Infections: bacterial, viral, fungal, parasitic: cervicofacial actinomycosis?

Learn each condition by its primary lesion, site and signature sign. Then use the flashcards and the other Dermatology 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.