Fungal and Parasitic Infections USMLE Step 1 Practice Question
A 56-year-old man with type 2 diabetes mellitus presents to the emergency department with a 3-day history of severe facial pain, right-sided nasal congestion, and fever. On examination, he has significant edema of the right cheek and palate with black, necrotic tissue on the hard palate. Temperature is 39.4°C, blood pressure 148/92, heart rate 112, respiratory rate 22. CT of the paranasal sinuses shows opacification of the maxillary and ethmoid sinuses with erosion of the alveolar bone. A biopsy of the palatal tissue reveals broad, non-septate hyphae with acute-angle branching patterns. Which of the following is the most appropriate initial management?
Answer choices
- AInitiate high-dose IV fluconazole and optimize glycemic control
- BPerform immediate surgical debridement combined with IV amphotericin BCorrect answer
- CStart broad-spectrum antibiotics and arrange outpatient imaging follow-up
- DBegin oral posaconazole monotherapy with endoscopic sinus evaluation
- EApply topical antifungal agents and control blood glucose with insulin
- FAdminister IV caspofungin with delayed surgical consultation
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