Mycology: cryptococcal antigen screening: practice question

A Microbiology 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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Microbiology · Mycology: cryptococcal antigen screening

Sample item

A man with newly diagnosed HIV has a CD4 count of 40 per cubic millimetre and no neurological symptoms. A lateral flow serum cryptococcal antigen test is positive. What is the best next step?

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

The answer and the reasoning

B. Lumbar puncture to exclude meningitis

Antigenaemia in advanced HIV can precede meningitis, so lumbar puncture is done to decide between pre-emptive therapy and treatment of meningitis. Antiretroviral therapy is delayed in cryptococcal meningitis to limit IRIS.

Option by option

  • A. Give an inhaled steroid

    Inhaled steroid has no role.

  • B. Lumbar puncture to exclude meningitis (correct)

    Correct. A positive serum antigen needs CSF evaluation for meningitis.

  • C. Start empiric antitubercular drugs

    Antitubercular therapy does not address cryptococcal antigenaemia.

  • D. Stop screening and observe

    Observing risks progression to meningitis.

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 Microbiology question

What is the answer to this Microbiology question?

The best answer is B, Lumbar puncture to exclude meningitis. Antigenaemia in advanced HIV can precede meningitis, so lumbar puncture is done to decide between pre-emptive therapy and treatment of meningitis.

Why is "Give an inhaled steroid" not the answer?

Inhaled steroid has no role.

Why is "Start empiric antitubercular drugs" not the answer?

Antitubercular therapy does not address cryptococcal antigenaemia.

Why is "Stop screening and observe" not the answer?

Observing risks progression to meningitis.

What concept does this question test?

It tests Mycology: cryptococcal antigen screening in Microbiology. Antiretroviral therapy is delayed in cryptococcal meningitis to limit IRIS.

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 Mycology: cryptococcal antigen screening?

Make a one-line identity card for each organism: shape and stain, defining test, toxin, disease and drug. Then use the flashcards and the other Microbiology 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.