Fungal and Parasitic Infections USMLE Step 1 Practice Question
A 45-year-old woman with poorly controlled diabetes (HbA1c 11.2%) presents with severe frontal headache, proptosis, and black necrotic tissue involving the nasal turbinate and palate. Vital signs show BP 148/92, HR 102, RR 18, Temp 38.5°C, SpO2 98% on room air. MRI demonstrates invasion into the paranasal sinuses and frontal lobe. Blood glucose is 385 mg/dL. She denies recent nasal trauma. Which of the following is the most appropriate initial intervention?
Answer choices
- AOral fluconazole monotherapy
- BIV ceftriaxone and vancomycin
- CUrgent surgical debridement combined with IV amphotericin BCorrect answer
- DObservation with repeat imaging in one week
- ETopical miconazole applied directly to lesions
- FIV liposomal amphotericin B with delayed surgical intervention pending culture results
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