Fungal and Parasitic Infections USMLE Step 1 Practice Question
A 42-year-old woman from Arizona presents with a 3-month history of progressive cough, hemoptysis, and night sweats. She denies dyspnea at rest but reports fatigue. Vital signs: BP 128/82 mmHg, HR 96/min, RR 20/min, Temperature 37.8°C, SpO2 94% on room air. Chest X-ray shows a left upper lobe cavitary infiltrate with surrounding consolidation. Sputum acid-fast bacilli smears are negative on three separate occasions. Serum testing demonstrates elevated coccidioidal IgM and IgG antibodies. Sputum culture grows Coccidioides immitis. The patient has no immunocompromise and normal renal function. Which of the following is the most appropriate treatment?
Answer choices
- AAmphotericin B lipid complex intravenously
- BItraconazole orally for 6-12 monthsCorrect answer
- CIsoniazid, rifampin, pyrazinamide, and ethambutol
- DTerbinafine orally
- ESupportive care alone with serial imaging follow-up
- FVoriconazole intravenously followed by oral step-down
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