Respiratory medicine: Pneumocystis pneumonia adjunct steroid: 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 · Respiratory medicine: Pneumocystis pneumonia adjunct steroid

Sample item

A 38-year-old man with HIV, a CD4 count of 60 per microlitre and 3 weeks of dry cough and exertional dyspnoea has a room air PaO2 of 58 mmHg. LDH is raised and the radiograph shows bilateral perihilar ground-glass opacities. Co-trimoxazole is started. Which additional drug reduces mortality?

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

The answer and the reasoning

D. Prednisolone

Adjunctive corticosteroids reduce respiratory failure and death in Pneumocystis pneumonia when room air PaO2 is below 70 mmHg, and are started with or soon after the antimicrobial. Steroids dampen the inflammation that follows organism death.

Option by option

  • A. Ganciclovir

    Ganciclovir treats cytomegalovirus and does not act on Pneumocystis.

  • B. Amphotericin B

    Amphotericin B has no role in first-line therapy of Pneumocystis pneumonia.

  • C. Fluconazole

    Fluconazole treats Candida and Cryptococcus and is not used for Pneumocystis.

  • D. Prednisolone (correct)

    Correct. Adjunctive steroids reduce mortality in moderate to severe Pneumocystis pneumonia.

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 D, Prednisolone. Adjunctive corticosteroids reduce respiratory failure and death in Pneumocystis pneumonia when room air PaO2 is below 70 mmHg, and are started with or soon after the antimicrobial.

Why is "Ganciclovir" not the answer?

Ganciclovir treats cytomegalovirus and does not act on Pneumocystis.

Why is "Amphotericin B" not the answer?

Amphotericin B has no role in first-line therapy of Pneumocystis pneumonia.

Why is "Fluconazole" not the answer?

Fluconazole treats Candida and Cryptococcus and is not used for Pneumocystis.

What concept does this question test?

It tests Respiratory medicine: Pneumocystis pneumonia adjunct steroid in General Medicine. Steroids dampen the inflammation that follows organism death.

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 Respiratory medicine: Pneumocystis pneumonia adjunct steroid?

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.