Infections: bacterial, viral, fungal, parasitic: cutaneous cryptococcosis in HIV: 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: cutaneous cryptococcosis in HIV

Sample item

A man with HIV and a CD4 count of 40 cells per cubic millimetre has several umbilicated skin-coloured papules on the face that resemble molluscum contagiosum. He also reports a two-week headache. What is the best next step?

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

The answer and the reasoning

A. Serum cryptococcal antigen and lumbar puncture

In advanced HIV, molluscum-like papules can be a skin marker of disseminated cryptococcosis. Headache raises concern for meningitis, so serum cryptococcal antigen and a lumbar puncture with CSF antigen are the right next steps before any local therapy.

Option by option

  • A. Serum cryptococcal antigen and lumbar puncture (correct)

    Correct. Cryptococcal antigen testing and lumbar puncture look for disseminated disease and meningitis.

  • B. Topical imiquimod to the lesions

    Imiquimod treats the skin lesions of true molluscum but leaves the systemic fungal infection undetected.

  • C. Tzanck smear and oral acyclovir

    A Tzanck smear and acyclovir target herpesvirus, which does not explain umbilicated papules with a headache here.

  • D. Cryotherapy of all lesions

    Cryotherapy removes lesions without addressing a possible disseminated infection.

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 Dermatology questions

Questions about this Dermatology question

What is the answer to this Dermatology question?

The best answer is A, Serum cryptococcal antigen and lumbar puncture. In advanced HIV, molluscum-like papules can be a skin marker of disseminated cryptococcosis.

Why is "Topical imiquimod to the lesions" not the answer?

Imiquimod treats the skin lesions of true molluscum but leaves the systemic fungal infection undetected.

Why is "Tzanck smear and oral acyclovir" not the answer?

A Tzanck smear and acyclovir target herpesvirus, which does not explain umbilicated papules with a headache here.

Why is "Cryotherapy of all lesions" not the answer?

Cryotherapy removes lesions without addressing a possible disseminated infection.

What concept does this question test?

It tests Infections: bacterial, viral, fungal, parasitic: cutaneous cryptococcosis in HIV in Dermatology. Headache raises concern for meningitis, so serum cryptococcal antigen and a lumbar puncture with CSF antigen are the right next steps before any local therapy.

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: cutaneous cryptococcosis in HIV?

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.