Mycology MCQs

1
This organism grew on Sabouraud Dextrose agar without any antimicrobials. The
patient presented with onychomycosis of both great toenails. The nails were dark and
dystrophic, and thick scale was apparent on both feet. Identify the fungus.
1

Trichophyton rubrum
2

Microsporum distortum
3

Scytalidium dimidiatum
4

Coccidioides immitis
5

Trichophyton violaceum
Q/Q(M)-474523 Report a Problem
This organism grew on Sabouraud Dextrose agar without any antimicrobials. The
patient presented with onychomycosis of both great toenails. The nails were dark and
dystrophic, and thick scale was apparent on both feet. Identify the fungus.
3

This organism is inhibited by cycloheximide in artificial media. Clinically it appears
identical to a dermatophyte infection.
A biopsy shows broad-based budding thick walled yeast cells, 10-15 um with a
double contoured appearance.
1

This yeast has a yeast phase at room temperature
2

Does not grow at 37 C
3

Usually produces a severe characteristic pulmonary disease
4

May be found in dogs
5

Is transmitted by mosquitoes
A biopsy shows broad-based budding thick walled yeast cells, 10-15 um with a
double contoured appearance.
4

May be found in dogs
This biopsy describes Blastomyces dermatitidis which generally can be found in
decaying vegetation but can be carried by dogs.
Septate hyphae with 90 branching and thick walled barrel shaped arthroconidia
alternating with empty cells best describes the microscopic morphology of:
1

Histoplasma capsulatum
2

Sporothrix schenckii
3

Microsporum gypseum
4

Trichophyton tonsurans
5

2

Septate hyphae with 90 branching and thick walled barrel shaped arthroconidia
alternating with empty cells best describes the microscopic morphology of:
5

This is the only organism in this list that fits this description.
A patient with scaly feet has a positive KOH. Fungal culture reveals smooth, club-
shaped macroconidia attached to hyphae in groups. No microconidida are seen. The
organism is:
1

Microsporum canis
2

Epidermophyton floccosum
3

Trichophyton rubrum
4

Microsporum gypseum
5

A patient with scaly feet has a positive KOH. Fungal culture reveals smooth, club-
shaped macroconidia attached to hyphae in groups. No microconidida are seen. The
organism is:
2

The wet mount Epidermophyton floccosum shows smooth, thin-walled macroconidia
without microconidia. The appearance is occasionally referred to as snow shoes.
Epidermophyton floccosum is incapable of hair invasion, and therefore, does not
cause tinea capitis.
Which of the following organisms will cause infections of skin, nails and endothrix
hair?
1

2

Microsporum audouinii
3

Trichophyton schoenlinii
4

Microsporum canis
5

Trichophyton mentagrophytes
Which of the following organisms will cause infections of skin, nails and endothrix
hair?
3

Trichophyton schoenlinii
E. floccosum does not infect hair; M. audouinii and M. canis cause fluorescent
ectothrix T. capitis, T. mentagrophytes ectothrix T. capitis.
An organism producing an apricot colored colony and reflexive branching with few
conidia was cultured from a patient from Africa. Which of the following is/are true?
1. This mostly likely is T. verrucosum 2. This most likely is T. soudanense 3. This
3

most likely is T. violaceum 4. This organism causes endothrix tinea capitis 5. This
organism is zoophilic
1

1,5
2

2,4
3

2,4,5
4

3, 4
5

3, 4, 5
An organism producing an apricot colored colony and reflexive branching with few
conidia was cultured from a patient from Africa. Which of the following is/are true?
1. This mostly likely is T. verrucosum 2. This most likely is T. soudanense 3. This
most likely is T. violaceum 4. This organism causes endothrix tinea capitis 5. This
organism is zoophilic
2

2,4
T. soudanense produces an apricot colored colony with reflexive branching. It is an
anthropophilic organism causing an endothrix tinea capitis. T. verrucosum produces a
white colony and requires thiamine and inositol for sporulation, T. violaceum
produces a purple colony and has a partial requirement for thiamine
The most common cause of tinea capitis in the United States today is:
1

Trichophyton schoenleinii
2

T. tonsurans
3

T. mentagrophytes
4

5

M. canis
The most common cause of tinea capitis in the United States today is:
2

T. tonsurans
M. audouinii was previously the primary cause of T. capitis in the US.
The most sensitive microscopic test for fungal infection is:
1

Potassium Hydroxide
2

Potassium Hydroxide with DMSO
3

Chlorazol Black E
4

Calcofluor white
5

Swartz Lamkins stain
The most sensitive microscopic test for fungal infection is:
4

4

Calcofluor white
Calcofluor white is the most sensitive microscopic test for fungal infection. It is a
glucan specific immunofluorescent stain. The remaining options are useful in direct
microscopic examination, but not the most sensitive.
Which two characteristics combined form a significant risk for acquiring
sporotrichosis? 1. Animal handler 2. Male gender 3. Alcoholism 4. Filipino or African
decent 5. Genetic predisposition
1

1, 2
2

1, 3
3

3, 4
4

4, 5
5

3, 4
Which two characteristics combined form a significant risk for acquiring
sporotrichosis? 1. Animal handler 2. Male gender 3. Alcoholism 4. Filipino or African
decent 5. Genetic predisposition
2

1, 3
A variety of domestic animals can carry Sporotrichosis. Alcoholism increases the risk
for this cutaneous infection.
Which of the following statements regarding dermatophyte infection FALSE?
1

Trichophyton schoenleinii is a common cause of favus
2

Microsporum canis is associated with ectothrix tinea capitis
3

Trichophyton violaceum is normally associated with endothrix tinea capitis
4

Microsporum audouinii displays yellow fluorescence with Woods lamp
examination
5

Trichophyton rubrum is always an ectothrix infection
Which of the following statements regarding dermatophyte infection FALSE?
5

Trichophyton rubrum is always an ectothrix infection
Organisms that cause an ectothrix pattern of tinea capitis include M. canis, M.
audouinii, M. ferruginosum, M. distortium, M. gypseum and occasionally T. rubrum.
T. tonsurans, T. violaceum, T. soudanense, T. gourvilli, T. yaoundei, and occasionally
T. rubrum cause an endothrix pattern. T. schoenleinii causes favus in which hyphae
and air spaces are seen in the hair shaft. A bluish-white fluorescence pattern is seen
with Woods lamp. Clinically, patients have thick, yellow, cup-shaped crusts
(scutula); scarring and secondary infection may result. M. canis, M. audouinii, M.
ferruginosum, M. distortium display a yellow fluorescence on Woods lamp
examination.
5

The major endemic area for Histoplasmosis
1

Africa
2

Central America
3

Southwest United States
4

South America
5

Eastern United States
The major endemic area for Histoplasmosis
5

Eastern United States
The endemic area for Histoplasmosis includes: the Ohio, Mississippi and Missouri
River Valleys Syracuse NY area and the Caribbean. This organism prefers soil with a
high nitrogen content such as that enriched with bird and bat guano.
Which of the following is TRUE regarding coccidiomycosis?
1

First line treatment in pregnancy is itraconazole
2

Droplet transmission is the most common method of acquisition of disease
3

Southeast Asians are at a higher risk of disseminated disease
4

Erythema nodosum is associated with a poor prognosis
5

Approximately 75% of those contracting the disease will be symptomatic
Which of the following is TRUE regarding coccidiomycosis?
3

Southeast Asians are at a higher risk of disseminated disease
Southeast Asians and African Americans are at a higher risk for disseminated cocci,
as are pregnant women and the immunocompromised. Approximately 60% of those
contracting coccidiomycosis are asymptomatic, and the disease is infectious not
contagious. The most common method of disease acquisition is inhalation from the
soil during natural events (dust storms etc). Erythema nodosum is associated with a
good prognosis and the first-line treatment during pregnancy is amphotericin B.
(JAAD 2006 CME)
Which of the following organisms is most likely to cause a sporotrichoid nodule on
the arm:
1

Nocardia brasiliensis
2

Phialophora verrucosa
3

Rhinospiridium seeberii
4

Fusarium
5

Fonsecaea pedrosoi
6

Which of the following organisms is most likely to cause a sporotrichoid nodule on
the arm:
1

Nocardia brasiliensis is a common cause of actinomycotic mycetoma and the
ulcerative, draining lesions can be misdiagnosed as sporotrichosis.
Culturing T. rubrum from a white opacity on the fingernail plate should prompt
testing for what?
1

Diabetes mellitus
2

Hypothyroidism
3

Hyperthyroidism
4

HIV
5

Cirrhosis
Culturing T. rubrum from a white opacity on the fingernail plate should prompt
testing for what?
4

HIV
White superficial onychomycosis of the fingernails is a marker for immunosuppresion
and should prompt testing for HIV. Generally, T. mentag is the most common cause
of white superfical onychomycosis. However, in immunosuppressed patients, T.
rubrum is the more common dermatophyte.
Which of the following statements regarding mycelium is NOT true?
1

A mass of hyphae is mycelium
2

Mycelium has reproductive capability
3

Hyphae forming corkscrew-like turns are spiral hyphae
4

Pectinate bodies are hyphae resembling a comb
5

Racket forms are club-shaped cells
Which of the following statements regarding mycelium is NOT true?
2

Mycelium has reproductive capability
Mycelium does not have reproductive capabilities. The remaining statements are
correct.

A pet store owner comes into your office with pruritic scaly plaques on his arms. A
fungal culture demonstrates a yellow colony with spindle-shaped macroconidia which
grows on polished rice grains. The organism is:
1

Microsporum canis
2

7

3

Trichophyton rubrum
4

Microsporum gypseum
5


A pet store owner comes into your office with pruritic scaly plaques on his arms. A
fungal culture demonstrates a yellow colony with spindle-shaped macroconidia which
grows on polished rice grains. The organism is:
1

Microsporum canis
Microsporum canis os a zoophilic dermatophyte, which causes ectothrix invasion
when infecting the hair. Colonies of M. canis are flat, spreading, white to cream-
colored with a dense cottony surface, The reverse of the plate is a canary yellow. Wet
mount of the fungus shows spindle-shaped macroconidia with 5-15 cells and often
have a terminal knob.

A neutropenic patient has erythematous nodules for several days. A biopsy shows
branching septate hyaline hyphae. Which of the following conditions should be
included in the differential? 1. Coccidioidomycosis 2. Fusariosis 3. Aspergillosis 4.
Zygomycosis 5. Phaeohyphomycosis
1

1
2

1, 2
3

2, 3
4

3, 4
5

2, 3, 5

A neutropenic patient has erythematous nodules for several days. A biopsy shows
branching septate hyaline hyphae. Which of the following conditions should be
included in the differential? 1. Coccidioidomycosis 2. Fusariosis 3. Aspergillosis 4.
Zygomycosis 5. Phaeohyphomycosis
3

2, 3
Aspergillus and Fusarium produce similar appearing morphology in biopsy.
Coccidioidomycosis produces spherules, very few if any septations are seen in
Zygomycosis, dark hyphae, yeast cells are seen in Phaeohyphomycosis.

A 34-year-old male patient presents with a verrucous lesion of the nasal mucosa; the
biopsy showed spherules ranging in size from 200 to 325 um. The mature endospores
have a rough appearance. The diagnosis is:
1

Coccidioidomycosis
2

Protothecosis
8

3

Rhinosporidiosis
4

Pseudallescheriosis
5

Cryptococcosis

A 34-year-old male patient presents with a verrucous lesion of the nasal mucosa; the
biopsy showed spherules ranging in size from 200 to 325 um. The mature endospores
have a rough appearance. The diagnosis is:
3

Rhinosporidiosis
The large size of the spherule and the rough endospores describe this organism along
with the clinical symptoms. The other organisms that produce spherules are
Prototheca (8-20 um) and Coccidioides immitis (10-80 um)
A patient returns from a vacation in Brazil with keloidal-like nodules on the face and
arms. The patient denies any sick contacts or exposures and reports only lying on the
beach and swimming with dolphins. She likely has:
1

Actinomycosis
2

Lobomycosis
3

Chromoblastomycosis
4

Mucormycosis
5

Sporotrichosis

A patient returns from a vacation in Brazil with keloidal-like nodules on the face and
arms. The patient denies any sick contacts or exposures and reports only lying on the
beach and swimming with dolphins. She likely has:
2

Lobomycosis
Lobomycosis, also called Keloidal blastomycosis, is caused by Loboa loboi. Lesions
characteristically appear keloidal with or without fistulas. A common location for the
infection is on the ears and has been associated with dolphins. Histologically, double
contoured refractile spherules with budding may be seen.
Which of the following statements regarding superficial mycotic infections is TRUE?
1

Malassezia species do not fluoresce under a Woods lamp
2

Phaeoannellomyces wernecki causes tinea nigra
3

Trichophyton beigelii causes white piedra
4

Trichosporon hortae causes black piedra
5

Micrococcus sedentarius causes tinea nigra
9


Which of the following statements regarding superficial mycotic infections is TRUE?
2

Phaeoannellomyces wernecki causes tinea nigra
Malassezia species fluoresce pale yellow with Woods lamp examination.
Trichosporon beigelii (not trichophyton) causes white piedra, an infection that causes
tan to white, soft non-adherent concretions on head and pubic hairs. Piedraia hortae
causes black piedra, which forms dark concretions that are adherent to scalp, beard,
and pubic hairs. Micrococcus sedentarius is a bacterium that is responsible for pitted
keratolysis, which is characterized by crateriform pitting that primarily affects the
pressure-bearing aspects of the plantar surface of the feet and, occasionally, the palms
of the hands. Tinea nigra (superficial phaeohyphomycosis) presents with
asymptomatic brown to black, macular, non-scaly macules and patches on the palms
or soles. Phaeoannellomyces werneckii is causative.

The most reliable method for distinguishing between Trichophyton rubrum and T.
mentagrophytes is:
1

Morphology of microconidia
2

Morphology of macroconidia
3

Pigmentation studies
4

Hair perforation test
5

Colony morphology

The most reliable method for distinguishing between Trichophyton rubrum and T.
mentagrophytes is:
4

Hair perforation test
The diagnostic morphology of the Trichophytons overlap and may be difficult to
differentiate. T. mentagrophytes produces a positive hair perforation test (wedges in
the test hair).

A young girl presented with a scaly annular facial rash and alopecia of her lower
eyelashes. Which of the following statements is/are true? 1. A KOH prep and fungal
culture might confirm the diagnosis. 2. The etiologic agent might be Microsporum
canis. 3. The family puppy might be infected. 4. Griseofulvin would be the drug of
choice. 5. A topical azole cream would be the drug of choice.
1

1,2,4
2

1,2,3,4
3

1,3,4
4

1,2,5
10

5

1,2,3,5

A young girl presented with a scaly annular facial rash and alopecia of her lower
eyelashes. Which of the following statements is/are true? 1. A KOH prep and fungal
culture might confirm the diagnosis. 2. The etiologic agent might be Microsporum
canis. 3. The family puppy might be infected. 4. Griseofulvin would be the drug of
choice. 5. A topical azole cream would be the drug of choice.
2

1,2,3,4
KOH and culture are the best and most reliable lab tests to diagnose a fungal
infection. M. canis is frequently found in kittens and puppies and is a common cause
of tinea faciei in children. An oral antifungal should be prescribed when a fungal
infection involves hair.
This organism does not produce microconidia. The macroconidia are club shaped, and
smooth walled, they grow singly or in clusters.
1

Trichophyton rubrum
2

3

Microsporum gypseum
4

Microsporum canis
5


This organism does not produce microconidia. The macroconidia are club shaped, and
smooth walled, they grow singly or in clusters.
2

This is the only organism in this list that fits this description.
Which of the following organisms causes favus?
1

2

3

Microsporum canis
4

Trichophyton rubrum
5

Microsporum distortum

Which of the following organisms causes favus?
1

11

Favus is a chronic dermatophyte infection defined by the presence of yellowish crusts
in the hair follicles called scutula. Prolonged infections lead to cicatricial alopecias of
the scalp and glabrous skin. The infection is most commonly caused by Trichophyton
schoenleinii.
Growth of which of the following is not inhibited on Mycosel media?
1

Cryptococcus neoformans
2

Yeast forms of Histoplasma
3

Yeast forms of Blastomyces
4

Microsporum gypseum
5

Scytalidium species
Growth of which of the following is not inhibited on Mycosel media?
4

Microsporum gypseum
Cycloheximide in Mycosel or Mycobiotic media (SDA with cycloheximide and
chloramphenicol) inhibits rapidly growing nonpathogenic molds and some pathogens
(Cryptococcus neoformans, some Candida species, Prototheca, Scytalidium species,
yeast forms of Histoplasma and Blastomyces).

This organism is the most common cause of eumycotic mycetoma in the US:
1

Madurella mycetomatis
2

Nocardia asteriodes
3

Scedosporium apiospermum
4

5

Wangiella dermatitis

This organism is the most common cause of eumycotic mycetoma in the US:
3

Although fairly uncommon, S. apiospermum is the most frequently recovered
organism causing eumycotic mycetoma in the US. This name represents the asexual
stage of the organism which grows as a filamentous mould, the sexual state,
Pseudallescheria boydii, grows as a cleistothecia (round sac containing ascospores).
A horticulturist of sphagnum moss topiaries comes in with a nodular eruption with
lymphangitic spread and treatment with oral potassium iodide is initiated. What is the
most well recognized side effect of this treatment.
1

Gastrointestinal distress
12

2

Shortness of breath
3

Flushing
4

Angioedema
5

Pruritus
A horticulturist of sphagnum moss topiaries comes in with a nodular eruption with
lymphangitic spread and treatment with oral potassium iodide is initiated. What is the
most well recognized side effect of this treatment.
1

Gastrointestinal distress
This patient has sporotrichosis. Sporotrichosis is mainly an occupational disease of
farmers, gardeners, and horticulturists. Persons who handle thorny plants, sphagnum
moss, or baled hay are at increased risk. Outbreaks have occurred in nursery workers
who handled sphagnum moss, rose gardeners, children playing on baled hay, and
greenhouse workers who handled bayberry thorns contaminated by the fungus.
Classic treatment is with oral potassium iodide for 3-4 weeks. The most recognised
side effect of treatment is gastrointestinal distress. Thyroid function tests should be
performed during treatment as supppression can occur.
This organism produces an endothrix tinea capitis:
1

2

Microsporum gypseum
3

Microsporum nanum
4

Trichophyton verrucosum
5

Trichophyton soudanense
This organism produces an endothrix tinea capitis:
5

Only T. soudanense in this group of choices produces an endothrix type of tinea
capitis. Trichophyton mentagrophytes, Microsporum nanum and Trichophyton
verrucosum produce nonfluorescent ectothrix tinea capitis. Microsporum gypseum
may produce a fluorescent or nonfluorescent ectothrix tinea capitis.
A blood culture from a neutropenic patient with onychomycosis grew which of the
following organism:
1

Scopulariopsis sp
2

Aspergillus sp
3

Fusarium sp
4

Acremonium sp
5

T. rubrum
13

A blood culture from a neutropenic patient with onychomycosis grew which of the
following organism:
3

Fusarium sp
Fusarium is one of the few moulds, which yield positive blood cultures, neutropenia is
one of the risk factors for Fusariosis.
Which of the following causes "black dot ringworm"?
1

M. canis
2

T. violaceum
3

T. verrucosum
4

M. gypseum
5

M. auddouinii
Which of the following causes "black dot ringworm"?
2

T. violaceum
"Black dot ringworm" is endothrix tinea capitis. Black dots are remnants of brittle hair
broken at the surface of the scalp (cuticle intact). On KOH prep, spores are seen
within the hair shaft. Causes are T. rubrum, T. gourvilli, T. yaounde, T. tonsurans, T.
schoeleinii, T. soudanense, and T. violaceum ("Ringo Gave Yoko Two Squeaky
Violins."). T. verrucosum causes nonfluorescent ectothrix tinea capitis. M canis,
gypseum, and auddouinii also cause ectothrix tinea capitis.
Cutaneous lesions of Cryptococcosis may be 1. Nodular 2. Papular 3. Granulomatous-
ulcerative 4. Herpetiform 5. Cellulitis-like:
1

2, 3, 4
2

3, 4, 5
3

2, 3, 4
4

1, 3, 4, 5
5

All of these answers are correct
Cutaneous lesions of Cryptococcosis may be 1. Nodular 2. Papular 3. Granulomatous-
ulcerative 4. Herpetiform 5. Cellulitis-like:
5

Polymorphous lesions have been reported in Cryptococcosis
Sabouraud Dextrose Agar (SDA) Emmons Modification contains which of the
following?
1

Peptones
2

Phenol red
14

3

Chloramphenicol
4

Gentamicin
5

Cycloheximide
Sabouraud Dextrose Agar (SDA) Emmons Modification contains which of the
following?
1

Peptones
SDA Emmons Modification is the gold standard medium. It is nutritionally poor,
containing dextrose, peptones, water, and agar, and encourages sporulation. Phenol
red, gentamicin, and cycloheximide are found in dermatophyte test media (DTM).
Chloramphenicol and cycloheximide are found in Mycosel/Mycobiotic.
Mycelia can form structures with a comb-lke appearance called:
1

Racket forms
2

Favic chandeliers
3

Pectinate bodies
4

Spiral hyphae
5

Nodular bodies
Mycelia can form structures with a comb-lke appearance called:
3

Pectinate bodies
Racket forms (club-shaped cells), favic chandeliers (terminal hyphal branches having
an antler-like appearance), pectinate bodies (hyphae resembling a comb), spiral
hyphae (hyphae forming corkscrew-like turns), and nodular bodies (knot-like
structure of hyphae) are among the types of mycelia.
Nondermatophytes growing on Dermatophyte Test Media cause the media to turn
what color?
1

Amber
2

Red
3

Yellow
4

Black
5

Green
Nondermatophytes growing on Dermatophyte Test Media cause the media to turn
what color?
3

Yellow
Dermatophytes utilize protein as a carbon source producing alkaline by-products
causing Dermatophyte Test Media to turn from amber to red. Nondermatophytes
15

cause the media to turn yellow due to acid by-products.
Which of the following is not true regarding fungal culture media containing
cycloheximide?
1

Cycloheximide is not found in Sabouraud Dextrose Agar (SDA) Emmons
Modification
2

Cycloheximide is found in Mycosel
3

Cycloheximide is found in Dermatophyte Test Media
4

Cycloheximide is found in Mycobiotic
5

Cycloheximide inhibits bacterial flora
Which of the following is not true regarding fungal culture media containing
cycloheximide?
5

Cycloheximide inhibits bacterial flora
Sabouraud Dextrose Agar (SDA) Emmons Modification does not contain
cycloheximide. Mycosel/Mycobiotic (SDA with cycloheximide and chloramphenicol)
and Dermatophyte Test Media contain cycloheximide. Cycloheximide inhibits rapidly
growing nonpathogenic molds and some pathogens (Cryptococcus neoformans, some
Candida species, Prototheca, Scytalidium species, yeast forms of Histoplasma and
Blastomyces). Chloramphenicol inhibits bacterial flora.
Which of the following statments regarding pseudohyphae is incorrect?
1

Pseudohyphae are seen in yeasts
2

Are constricted at septations
3

Branching occurs at septations
4

The terminal cell is smaller than the others
5

Are not septated
Which of the following statments regarding pseudohyphae is incorrect?
5

Are not septated
Pseudohyphae are seen in yeast and resemble true hyphae except that they are
constricted at septations, branching occurs at septations, and the terminal cell is
smaller than the others. They are septated.
Trichophyton tonsurans sporulates via thick-walled round cells resistant to the
environment known as:
1

Arthroconidia
2

Blastoconidia
3

Chlamydoconidia
4

Sporangia
16

5

Mycelia
Trichophyton tonsurans sporulates via thick-walled round cells resistant to the
environment known as:
3

Chlamydoconidia
Chlamydoconidia are thick-walled round cells, resistant to the environment.
Arthroconidia are formed by fragmentation of hyphae, and may appear as thick or
thin-walled rectangular cells. Blastoconidia are formed by budding. Sporangia are
spores that are produced in a sac.
Which of the following is true regarding culture of the organisms that cause Pityriasis
versicolor?
1

Difficult to grow, requires olive oil overlay
2

Grow easily on Mycosel media
3

Cannot be cultured
4

Grow easily on Dermatophyte Test Media
5

Grow easily on Sabouraud Dextrose Agar
Which of the following is true regarding culture of the organisms that cause Pityriasis
versicolor?
1

Difficult to grow, requires olive oil overlay
Pityriasis versicolor (Tinea versicolor) is caused by Malassezia furfur, M. globosa
(most common cause), M. pachydermatis, M. dermatis, M. obtuse, M. restrica, M.
sympodialis, and M. sloofiae. The organisms that cause Pityriasis versicolor are
difficult to grow. The culture requires olive oil overlay.
Medlar bodies are diagnostic of infection with which organism?
1

Blastomycosis
2

Chromomycosis
3

Coccidiomycosis
4

Histoplasmosis
5

Sporotrichosis
Medlar bodies are diagnostic of infection with which organism?
2

Chromomycosis
Chromoblastomycosis, or chromomycosis, is a cutaneous mycosis caused by
dematiaceous, or pigmented, fungi. Several fungal species are associated with this
infection including Phialophora verrucosa, Fonsecaea pedrosoi, F compactum,
Exophiala (Fonsecaea, Wangiella) dermatitidis and Cladosporium carrionii. Infection
is typically trauma-induced and involves the lower extremities. Lesions appear as
17

verrucous papules, nodules and plaques, with occasional elephantiasis resulting from
lymphatic blockage. Histopathologic findings include pseudoepitheliomatous
epidermal hyperplasia and a dermal infiltrate composed of epithelioid histiocytes,
multinucleated giant cells, and small clusters of inflammatory cells including plasma
cells, neutrophils, eosinophils and lymphocytes. The characteristic histopathologic
feature is the presence of dark brown, thick-walled, ovoid spheres in clusters or chains
referred to as "copper pennies" or Medlar bodies. They are visible without the use of
special stains.
A mass of hyphae is known as a:
1

Sporangia
2

Conidia
3

Mycelium
4

Chlamydoconidia
5

Pseudohyphae
A mass of hyphae is known as a:
3

Mycelium
A mass of hyphae (vegetative tube-like structures) is known as a mycelium.
Sporangia, Conidia, and Chlamydoconidia are structures formed through different
types of asexual reproduction. Pseudohyphae are seen in yeast.
All of the following parameters are used to distinguish dermatophytes except:
1

Nutritional requirements
2

Colony morphology
3

Sucrose hydrolysis
4

Hair fluorescence
5

Growth temperature
All of the following parameters are used to distinguish dermatophytes except:
3

Sucrose hydrolysis
Sucrose hydrolysis is not a useful parameter to distinguish dermatophytes from one
another. Growth temperature, colony morphology, hair fluorescence and nutritional
requirements can be used to identify dermatophytes.
A slimy, mucoid colony growing on Sabouraud's agar at 37 degrees Celsius is
observed to produce urease. The organism is:
1

Candida albicans
2

3

Candida glabrata
18

4

Candida tropicalis
5

Aspergilus flavus
A slimy, mucoid colony growing on Sabouraud's agar at 37 degrees Celsius is
observed to produce urease. The organism is:
2

Cryptococcus neoformans is an encapsulated yeast with a worldwide distribution.
Cryptococcosis is usually acquired by inhalation and subsequent dissemination to
various organs including the meninges and the skin can occur. Immunosuppressed
patients are particularly susceptible to infection. In approximately ten percent of
disseminated cases, cutaneous lesions may develop. These present as acneiform
papules or pustules and may progress to infiltrated plaques, nodules, or ulcers. Less
commonly, cutaneous lesions can represent primary cutaneous cryptococcosis via
direct inoculation of organisms into the skin. Diagnosis is made by direct microscopy
and India ink stains can aid visualization. The organisms are large, encapsulated
budding yeasts. In histopathologic sections, capsules stain with alcian blue and
mucicarmine stains. In culture, C. neoformans is distinguished by production of
urease as well as the ability to pigment on Guizotia seed medium. Colonies are
described as slimy and mucoid. Serologic antigen-detection assays are also available.
Treatment of disseminated cryptococcosis includes amphotericin combined with
flucytosine.
This organism causes a resistant tinea pedis indistinguishable from dermatophytosis:
1

Aspergillus flavus
2

3

Curvularia sp.
4

Scopulariopsis
5

Fonsecaea sp
This organism causes a resistant tinea pedis indistinguishable from dermatophytosis:
2

This fungus is very difficult to treat due to its resistance to most antifungals. It is
sensitive to cylcoheximide so it should be cultured on media free of this antifungal.
Which of the following statements regarding candidal infection is FALSE?
1

Candida species displays true hyphae on potassium hydroxide examination
2

Predisposing factors for candidal infection include diabetes mellitus,
hyperhidrosis and broad spectrum antibiotics
3

Candida albicans is the number one cause of mucocutaneous infections
4

Candidal infections typically do not spare the scrotum
5

Candida species may be associated with granuloma gluteale infantum
19

Which of the following statements regarding candidal infection is FALSE?
1

Candida species displays true hyphae on potassium hydroxide examination
Candida species are part of the resident flora but they are also the most common cause
of opportunistic mycotic infection. Cutaneous clinical manifestations include thrush,
perleche, paronychia, onychomycosis, intertrigo, and folliculitis. Candida albicans is
the most common organism; however, C. dubliniensis is often implicated in mucosal
disease in AIDS patients. C. parapsilosis causes chronic paronychia and C. glabrata is
fluconazole resistant. Infection is most common in the extreme of age, and the
mucosal disease is prevalent in HIV patients. Factors predisposing patients to
infection include impaired mucocutaneous barrier function, immunodeficiencies,
broad spectrum antibiotic use, malignancies, heat, humidity, friction, diabetes, and
indwelling catheters. Groin infections often involve the scrotum unlike tinea cruris
caused by dermatophytes. On KOH examination, budding yeast and pseudohyphae
(not true hyphae) are diagnostic. Predisposing factors for granuloma gluteale infantum
include occlusion, topical corticosteroids, and possibly Candida diaper dermatitis.
What organism produces round thick walled spiny macroconidia and pear shaped
microconidia?
1

Sporothrix schenckii
2

Blastomyces dermatitidis
3

Paracoccidioides brasiliensis
4

5

What organism produces round thick walled spiny macroconidia and pear shaped
microconidia?
5

At room temperature Histoplasma capsulatum produces round thick walled spiny
macroconidia and pear shaped microconidia.
All of the following are common causes of chromoblastomycosis EXCEPT:
1

Cladosporium carrionii
2

Rhinocladiella aquaspera
3

4

Pseudallescheria boydii
5

Fonsecaea pedrosi
All of the following are common causes of chromoblastomycosis EXCEPT:
4

Chromoblastomycosis is a chronic fungal infection of the skin and the subcutaneous
20

tissue caused by traumatic inoculation of a specific group of dematiaceous
(pigmented) fungi. Fonsecaea pedrosoi is the most common causative organism, but
Fonecaea compacta, Rhinocladiella aquaspersa, Phialophora verrucosa, Exophilia
jeanselmei and Cladosporium carrionii are pathogenic as well. It is found most
commonly in agricultural workers in the tropics and subtropics, and it is notoriously
resistant to therapy. It presents as verrucous papules and plaques that may coalesce.
Histopathological findings include brown, thick-walled cells known described as
copper pennies. Early in its course, limited disease may respond to surgical
excision, electrodessication or cryosurgery. More extensive lesions may require
systemic antifungal agents including itraconazole or terbinafine, which are the
treatments of choice.
All of the following statements about paracoccidioidomycosis are true EXCEPT?
1

It is most common in male agricultural workers
2

It has a characteristic mariners wheel appearance on histopathology
3

Disease is almost always confined to the skin
4

It is endemic to Brazil
5

It may cause mucocutaneous lesions
All of the following statements about paracoccidioidomycosis are true EXCEPT?
3

Disease is almost always confined to the skin
Paracoccidioidomycosis is caused by Paracoccidioidomycosis brasiliensis, and is
endemic to Central and South America, especially Brazil, Argentina, Venezuela,
Ecuador and Columbia. Male agricultural workers are at greatest risk. Infection is
most commonly caused by direct inoculation which leads to pulmonary disease. Lung
disease may be followed by dissemination to mucocutaneous surfaces, gastrointestinal
tract, spleen, adrenal glands, and lymph nodes. Cutaneous lesions are verrucous
and/or ulcerative, and usually found on the face and in the nasal and oral mucosa.
Primary mucocutaneous disease exists as well and is caused by direct inoculation.
Biopsy specimens display multiple narrow-based budding yeast cells, described as a
mariners wheel. The treatment of choice is itraconazole.
A 45 year-old agricultural worker from Brazil presented with ulcers of the buccal
mucosa and tongue. Cervical lymph nodes were tender and enlarged. The biopsy
would most likely reveal:
1

Yeast cells in chains and a large thick walled round central yeast cell
surrounded by several thinly attached budding smaller yeast cells
2

Yeast cells with large capsules
3

Small budding yeast cells
4

Yeast cells with pseudohyphae
5

Copper pennies
21

A 45 year-old agricultural worker from Brazil presented with ulcers of the buccal
mucosa and tongue. Cervical lymph nodes were tender and enlarged. The biopsy
would most likely reveal:
1

Yeast cells in chains and a large thick walled round central yeast cell
surrounded by several thinly attached budding smaller yeast cells
Yeast cells in chains and a large thick walled round central yeast cell surrounded by
several thinly attached budding smaller yeast cells p.18. This biopsy is describing
Paracoccidioides brasiliensis, an organism endemic in Brazil. Its yeast form seen in
tissue produces a Mariners wheel-like configuration. Generally this organism is
inhaled and disseminates causing mucocutaneous lesions with lymphadenopathy.
Choose the correct statement regarding Coccidioidomycosis:
1

The most common form of primary inoculation is cutaneous
2

Dissemination may involve the bones, joints, viscera, brain and skin
3

Causative organism, C. immitits, is a thick-walled spherule with a
polysaccharide capsule demonstrated with Alcain blue
4

Erythema nodosum is a poor prognotic sign
5

Outbreaks occur in the Mississippi and Ohio River Valley
Choose the correct statement regarding Coccidioidomycosis:
2

Dissemination may involve the bones, joints, viscera, brain and skin
Coccidioidomycosis: Primary inoculation is pulmonary. Erythema nodosum is a
favorable prognostic sighn. Dissemination from the localized pulomary lesions may
occur in less than 1% of infections. Target ogans of dissemination include the bones,
joints, viscera, brain, meinnges, and skin. The causative organisms is Coccidioides
immitis, is a nonbudding, thick-walled spherule, with a polysaccharide capsule
demonstrated with Gridley or Gomori methanamine silver stain. It is endemic in
northern Mexico, Venezuela, and in southwest US, especially California
Which one of the following agents accounts for the depigmentation seen in pityriasis
versicolor?
1

Thymidine kinase
2

Ketoconazole
3

Acetone
4

Dicarbocyclic acid
5

Postinflammatory effect
Which one of the following agents accounts for the depigmentation seen in pityriasis
versicolor?
4

Dicarbocyclic acid
Pityriasis versicolor is primarily caused by the yeast M. furfur. M. furfur is a
dimorphic, lipophilic organism that can produce metabolites such as azaleic acid (a
22

dicarboxylic acid) that can inhibit tyrosinase and injure melanocytes.
All of the following statements regarding superficial mycotic infections are true
EXCEPT:
1

Trichosporon species can cause systemic disease in immunocompromised
patients
2

Malassezia furfur is the most common cause of tinea versicolor
3

Trichosporon beigelii causes white piedra
4

Malassezia species may be associated with neonatal cephalic pustulosis
5

Piedraia hortae causes black piedra
All of the following statements regarding superficial mycotic infections are true
EXCEPT:
2

Malassezia furfur is the most common cause of tinea versicolor
Trichosporon asahii can cause disseminated disease in immunocompromised patients,
especially those with neutropenia. Patients develop nodular and then necrotic lesions
and require systemic antifungal agents. Malassezia globosa is the most common cause
of tinea versicolor, not M. furfur. M. pachydermatis, M. dermatis, M. obtuse, M.
restrica, M. sympodialis and M. slooffiae are all thought to be medically important as
well. M.sympodialis is part of the skins normal flora. Trichosporon beigelii and
Piedraia hortae are the etiological agents of white and black piedra respectively.
Several Malassezia species have been implicated in neonatal cephalic pustulosis
(neonatal acne).
The most common eumycotic organism in the US produces which color grains in its
microcolony?
1

White
2

Black
3

Red
4

Yellow
5

Green
The most common eumycotic organism in the US produces which color grains in its
microcolony?
1

White
The most common cause of fungal (eumycotic) eumycetoma in the US is
Pseudallescheria boydii. This and Acremonium produce white colonies. Black
colonies are caused by Exophilia, Madurella, and Curvalaria. Red colonies are created
by Actinomadura pelletieri. Yellow colonies are made by Streptomyces and Nocardia,
both causes of bacterial mycetoma.
Trichosporon ovoides is a cause of:
23

1

Black piedra
2

White piedra
3

Tinea nigra palmaris
4

Ectothrix tinea capitis
5

Endothrix tinea capitis
Trichosporon ovoides is a cause of:
2

White piedra
White piedra is cause by Trichosporon beigelii, or Trichosporon ovoides and T. inkin
(new nomenclature). It presents with tan to white soft, nonadherent small concretions
~1mm, seen on the scalp, beard, moustache, and pubic areas. The hairs may fluoresce.
A landscape worker complained of several tender nodules on the right dorsal hand
and forearm. The biopsy of the lesion showed asteroid bodies but no organisms. The
likely diagnosis is:
1

Nocardiosis
2

Blastomycosis
3

Sporotrichosis
4

Candidiasis
5

Coccidioidomycosis
A landscape worker complained of several tender nodules on the right dorsal hand
and forearm. The biopsy of the lesion showed asteroid bodies but no organisms. The
likely diagnosis is:
3

Sporotrichosis
Sporothrix schenckii produces tiny yeast cells 4-6 um difficult to demonstrate on
biopsy unless there is an overwhelming infection. Asteroid bodies are seen on H & E
and PAS as radiating fingers of eosinophilic material.
This organism is often considered a contaminant but has been reported to cause
onychomycosis:
1

Sepedonium
2

Curvularia
3

Scopulariopsis
4

Penicillium
5

Phialophora
This organism is often considered a contaminant but has been reported to cause
onychomycosis:
24

3

Scopulariopsis
Causes white superficial onychomycosis.
This dermatophyte has a growth requirement for inositol and thiamine
1

Trichophyton equinum
2

3

Trichophyton concentricum
4

5

This dermatophyte has a growth requirement for inositol and thiamine
5

Trichophyton verrucosum is a zoophilic fungus that requires thiamine and sometimes
inositol for growth. T. violaceum and tonsurans only have a partial requirement for
thiamine. Trichophyton equinum requires niacin. (Horses are nice).
A solitary chancre-like lesion appeared on the arm of a florist who has a pet dog. No
organisms were seen on biopsy, however Sporothrix schenckii was cultured from the
tissue. This infection is known as fixed cutaneous sporotrichosis. It remains fixed
because:
1

There is a resistance due to a prior exposure
2

There is a decreased resistance due to AIDS
3

The infection was acquired from the dog rather than from a plant
4

The infection occurred in the absence of tissue injury
5

This species of Sporothrix has limited infectivity
A solitary chancre-like lesion appeared on the arm of a florist who has a pet dog. No
organisms were seen on biopsy, however Sporothrix schenckii was cultured from the
tissue. This infection is known as fixed cutaneous sporotrichosis. It remains fixed
because:
1

There is a resistance due to a prior exposure
There is a resistance due to a prior exposure.
Which actinomycotic organism has red grains?
1

Streptomyces somaliensis
2

Nocardia asteroides
3

Actinomadura madurae
4

Actinomadura pelletieri
25

5

Which actinomycotic organism has red grains?
4

Actinomadura pelletieri
Mycetoma is a granulomatous infection of dermal and subcutaneous tissues usually
occurring on the foot. Draining sinuses containing grains characterize such infections.
Three types of mycetoma exist: eumycotic (true fungal), actinomycotic (filamentous
organisms) and botryomycotic (bacterial infections). Madurella and Leptosphaeria
species produce black grains. Pseudallescheria and Acremonium species, along with
dermatophytes, make white grains. Nocardia brasiliensis and N. asteroides produce
white grains, while Nocardia caviae and Actinomyces israelii tend to have yellow-
white grains. Actinomadura madurae produce pink or white grains and Actinomadura
pelleteri make red grains. Streptomyces somaliensis produce brown or yellow grains.
Which structure is found in a biopsy of Candida tropicalis, it is branching and
pinching in at the points of septations:
1

Septate hyphae
2

Arthroconidia
3

Mosaic fungus
4

Pseudohyphae
5

Pectinate bodies
Which structure is found in a biopsy of Candida tropicalis, it is branching and
pinching in at the points of septations:
4

Pseudohyphae
Pseudohyphae are products of yeast, which produce elongated yeast cells that do not
pinch off, branching and pinching in at the points of septations.
Which of the following stains is NOT used to stain fungal elements?
1

Mucicarmine
2

Periodic Acid Schiff
3

Fontana-Masson
4

Von Kossa
5

Gormori methenamine silver
Which of the following stains is NOT used to stain fungal elements?
4

Von Kossa
Mucicarmine stain is used to stain adenocarcinoma in addition to infectious organisms
including Cryptococcus and Rhinosporidium. The Cryptococcus capsule stains red.
Periodic Acid Schiff (PAS) is useful in identifying fungi, parasites, glycogen and the
26

basement membrane. The wall of the organism stains red. Fontana-Masson stains
melanin black and therefore helps identify dematiaceous (melanin-producing) fungi.
Gormori methenamine silver stains fungi, parasites, Donovan bodies and
Rhinoscleroma black. Von Kossa stain is used to identify calcium by staining it black.
This dermatophyte is not an anthropophilic organism:
1

Trichophyton rubrum
2

3

Microsporum gypseum
4

5

This dermatophyte is not an anthropophilic organism:
3

Microsporum gypseum
M. gypseum is a geophilic organism, all others listed are anthropophilic.
A 30 year-old male living in the Chicago suburbs complained of a slowly growing
verrucous plaque with sharp borders on his left wrist. A biopsy revealed yeast cells
10-14 um. Mucicarmine was negative. A fluffy white colony grew at room
temperature having small round conidia on thin conidiophores. The diagnosis is:
1

Blastomycosis
2

Cryptococcosis
3

Candidiasis
4

South American Blastomycosis
5

Histoplasmosis
A 30 year-old male living in the Chicago suburbs complained of a slowly growing
verrucous plaque with sharp borders on his left wrist. A biopsy revealed yeast cells
10-14 um. Mucicarmine was negative. A fluffy white colony grew at room
temperature having small round conidia on thin conidiophores. The diagnosis is:
1

Blastomycosis
The biopsy describes Blastomyces dermatitidis, the negative mucicarmine rules out
Cryptococcus. Chicago is an endemic area for Blastomyces. The colony morphology
also describes Blastomyces.
The diagnosis is phaeohyphomycosis, what is the organism 1. Alternaria sp. 2.
Bipolaris sp. 3. Fusarium sp. 4. Exophiala sp.
1

1,2,3
2

2,3,4
3

1,2,4
27

4

1,3,4
5

The diagnosis is phaeohyphomycosis, what is the organism 1. Alternaria sp. 2.
Bipolaris sp. 3. Fusarium sp. 4. Exophiala sp.
3

1,2,4
All these organisms are dematiaceous, Fusarium is a hyalohyphomycete.
The outstanding characteristics of Aspergillus species on biopsy include:
1

Blastoconidia
2

Hyaline, septate dichotomously branching hyphae
3

Copper pennies
4

Ribbon-like filaments that may be twisted and distorted branching at right
angles
5

Stain with Fontana-Mason stain
The outstanding characteristics of Aspergillus species on biopsy include:
2

Hyaline, septate dichotomously branching hyphae
Aspergillus is seen as wide (3 um) septate dichotomously branching (45 angles)
hyphae.
A patient with white nodules on the hair shaft has a KOH which shows hyphae and
arthroconidia. The etiology is:
1

Corynebacterium minutissimum
2

Exophiala wernickii
3

Piedraia hortae
4

Trichosporon beigelii
5

Corynebacterium tenuis
A patient with white nodules on the hair shaft has a KOH which shows hyphae and
arthroconidia. The etiology is:
4

White piedra is an infection of the hair shaft caused by Trichosporon beigelii. Unlike
black piedra which is firmly adherent to the shaft, white piedra presents as light
brown nodules composed of hyphae and arthroconidia, which move easily along the
hair shaft. The most common sites of infection occur on the mustache, beard and
pubic area.
Q/Q(M)-477143 Report a ProblemOf the following Candida species, which is
likely to cause disseminated Candidiasis with cutaneous lesions?
28

1

Candida albicans
2

C. parapsilosis
3

C. tropicalis
4

C. krusei
5

C. neoformans
Of the following Candida species, which is likely to cause disseminated Candidiasis
with cutaneous lesions?
3

C. tropicalis
C. albicans is responsible for approximately 50% of all Candidemia, but C. tropicalis
is seen with increasing frequency among patients with dissemination and cutaneous
manifestations.
A 6 year-old Hispanic girl came into the clinic with a history of alopecia and scaly
scalp for 3 weeks. The Wood's lamp examination was negative and her cervical
lymph nodes were not enlarged. It was noted that the hairs were broken off at the
surface of the scalp. The most likely organism to be isolated would be:
1

M. audouinii
2

M. canis
3

M. gypseum
4

T. tonsurans
5

T. rubrum
A 6 year-old Hispanic girl came into the clinic with a history of alopecia and scaly
scalp for 3 weeks. The Wood's lamp examination was negative and her cervical
lymph nodes were not enlarged. It was noted that the hairs were broken off at the
surface of the scalp. The most likely organism to be isolated would be:
4

T. tonsurans
T. tonsurans causes the endothrix infection "Black Dot Ringworm". All other choices
cause Grey Patch Ringworm.
Which of the following statements about dimorphic fungi is INCORRECT?
1

Are in the mould form in the environment
2

Are in yeast/spherule form in tissue
3

Are in mould form at 25 degrees C
4

Are in yeast/spherule form at 37 degrees C
5

Are in mould form in tissue
Which of the following statements about dimorphic fungi is INCORRECT?
29

5

Are in mould form in tissue
Yeasts and moulds are not mutually exclusive. Dimorphism can occur - a dimorphic
fungus will be in a mould form in the environment at 25 degrees and in a
yeast/spherule form at 37 degrees C.
Although this organism is not a fungus, it stains with PAS and GMS and produces
spherules in tissue. This organism can be identified as:
1

Rhinosporidium seeberi
2

3

Penicillium marneffei
4

Prototheca wickerhami
5

Leishmania mexicana
Although this organism is not a fungus, it stains with PAS and GMS and produces
spherules in tissue. This organism can be identified as:
4

Prototheca wickerhami
This achloic algae produces spherules or sporangia 8-20um in tissue. The mature form
is called a morula.
Which of the following DOES NOT typically cause white superficial onychomycosis?
1

Aspergillus species
2

Fusarium species
3

4

Scopulariopsis species
5

Trichophyton rubrum
Which of the following DOES NOT typically cause white superficial onychomycosis?
5

Trichophyton rubrum
In white superficial onychomycosis, the organism only invades the superficial nail
plate, and it clinically appears as chalky white patches on the nails. The most common
organism is T. mentagrophytes, but Aspergillus, Cephalosporium, Fusarium,
Acreconium and Scopulariopsis are implicated as well.
A 56-year-old male with HIV presents with multiple umbilicated brown papules on
the face. Which of the following is the least likely cause of his lesions?
1

Cryptococcus
2

Histoplasmosis
3

Coccidiomycosis
4

Penicilliosis
30

5

Blastomycosis
A 56-year-old male with HIV presents with multiple umbilicated brown papules on
the face. Which of the following is the least likely cause of his lesions?
5

Blastomycosis
This patient has molluscum-like lesions on the face in the setting of
immunosuppression. The differential for such papules includes cryptococcus,
histoplasmosis, coccidiomycosis, and penicilliosis. Blastomycosis can cause
sporotrichoid lesions, warty vegetations, papillomatous proliferations, and
osteomyelitis; it usually does not produce molluscum-type papules.
A 12 year old boy has a pruritic bullous eruption on his feet. A KOH is positive and a
fungal culture shows microconidia in grape-like clusters. The etiology is:
1

2

Microsporum canus
3

4

Microsporum gypseum
5

A 12 year old boy has a pruritic bullous eruption on his feet. A KOH is positive and a
fungal culture shows microconidia in grape-like clusters. The etiology is:
3

Trichophyton mentagrophytes is the dermatophyte primarily responsible for bullous
tinea pedis. It typically has septate, spiral hypahe with cigar or grape like thin-walled
microconidia.
A 49-year-old man has painless subcutaneous nodules on his feet with sinus tracts and
abscesses. Pathology shows "grain" in sinus tract drainage. A diagnosis of eumycotic
mycetoma is made. What is the most common cause in the United States?
1

Acremonium
2

Curvalaria
3

Exophilia jeanselmei
4

5

Nocardia
A 49-year-old man has painless subcutaneous nodules on his feet with sinus tracts and
abscesses. Pathology shows "grain" in sinus tract drainage. A diagnosis of eumycotic
mycetoma is made. What is the most common cause in the United States?
4

Eumycotic mycetoma is fungal and can be caused by Pseudallescheria boydii (most
31

common in US), Madurella, Acremonium, curvalaria, and Exophilia jeanselmei.
Actinomycotic mycetoma is bacterial and maybe caused by Nocardia asteroids or
brasiliensis, Streptomyces, and Actinomyces.
Which of the following is the most useful morphologic feature in identifying the
mycelial phase of Histoplasma capsulatum?
1

Arthroconidia in every other cell
2

Encapsulated spores 2-5 um
3

Tuberculate macroconidia 8-14 um
4

Small oval conidia on long thin conidiophores
5

Microconidia laterally along the hyphae strand
Which of the following is the most useful morphologic feature in identifying the
mycelial phase of Histoplasma capsulatum?
3

Tuberculate macroconidia 8-14 um
On artificial media the mould form of Histoplasmosis produces hyphae with tear drop
microconidia and round thick wall tuberculate macroconidia.
Which of the following statements regarding lobomycosis is FALSE?
1

Itraconazole is the treatment of choice
2

It resembles a chain of coins on histopathology
3

It is also known as keloidal blastomycosis
4

Lacazia (formerly Loboa) loboi is the number one cause
5

The infection also occurs in dolphins
Which of the following statements regarding lobomycosis is FALSE?
1

Itraconazole is the treatment of choice
Lobomycosis, also know as keloidal blastomycosis is caused by Lacazia loboi
(formerly Loboa loboi). It is endemic to Brazil and the Caribbean and is associated
with dolphins. Clinically, the disease presents with painless keloidal papules and
plaques, ulcerative lesions and/or verrucous lesions. Biopsy specimens display
multiple budding thick-walled cells attached with a bridge, often referred to as a
chain of coins. Surgical treatment is necessary as antifungal medications are
ineffective.
Which of the following organisms would you expect to recover from a fluorescent
tinea capitis?
1

T. tonsurans
2

M. gypseum
3

M. canis and M. gypseum
32

4

T. violaceum
5

T. rubrum
Which of the following organisms would you expect to recover from a fluorescent
tinea capitis?
3

M. canis and M. gypseum
M. gypseum may occasionally produce a dull fluorescence - all other organisms are
nonfluorescent.
Which of the following most accurately describe conidia?
1

Cells produced on the end or sides of hypha or conidiophore
2

Spores that are produced in a sac
3

Thick-walled round cell
4

Formed by budding
5

Formed by fragmentation of hyphae
Which of the following most accurately describe conidia?
1

Cells produced on the end or sides of hypha or conidiophore
Conidia are cells produced on the end or sides of hypha or conidiophore, the size and
shape arrangement are generally characteristic of the organism. The remaining
descriptions are of specific types of conidia. Spores produced in a sac are sporangia,
thick-walled round cells that are resistant to the environment are chlamydoconidia,
blastoconidia are formed by budding and arthroconidia are formed by fragmentation
of hyphae.
The etiologic agent responsible for White Piedra is:
1

Candida albicans
2

Pityrosporum obiculare
3

Corynebacterium tenuis
4

Piedra hortai
5

Trichosporon ovoides
The etiologic agent responsible for White Piedra is:
5

Formerly known as T. beigelii.
What is the most frequently reported cause of primary cutaneous aspergillosis?
1

Aspergillus flavus
2

Aspergillus fumigatus
33

3

Aspergillus niger
4

Aspergillus solani
5

Aspergillus marneffei
What is the most frequently reported cause of primary cutaneous aspergillosis?
1

Aspergillus flavus
Primary cutaneous aspergillosis is a rare disease reported mostly frequently in
children with hematologic malignancies who developed skin lesions at the site of IV
canulas.
Penicillium marneffei is an infection endemic to which part of the world?
1

Mexico
2

South America
3

Africa
4

Southeast Asia
5

The Caribbean
Penicillium marneffei is an infection endemic to which part of the world?
4

Southeast Asia
Penicillosis is a recently recognized disease caused by infection with Penicillium
marneffei, a dimorphous fungus that is contracted through inhalation. Cases have
been described in Vietnam, China, and Thailand as well as imported cases in the U.S.
in veterans returning from Vietnam. Bamboo rats in these areas have been shown to
be infected with P. marneffei and may represent a reservoir. Although penicillosis has
a tendency to occur in immunocompromised hosts opportunistically, it has also been
described in normal hosts. Clinical presentation is typically with pulmonary or
disseminated disease which can affect the skin, gastrointestinal tract, spleen, lymph
nodes, skin, and bone marrow. Cutaneous features include multiple umbilicated
papules which can enlarge and ulcerate occurring commonly on the face and trunk.
Diagnosis is by culture or histopathology. Treatment is with itraconazole. Severe
cases may require amphotericin B.
A creamy white colony might be any of these organisms except:
1

Candida albicans
2

Prototheca wickerhamii
3

Curvularia
4

Sporothrix schenckii at 37 C
5

A creamy white colony might be any of these organisms except:
34

3

Curvularia
Is a dematiaceous organism and is the only organism listed that does not produce
creamy white colonies.
Which of the following statements regarding histoplasmosis is TRUE?
1

Terbinafine is the treatment of choice
2

Histoplasma capsulatum is a yeast at 25C
3

The organisms are intracellular on histological examination
4

The disease is most common in the San Joaquin Valley
5

The disease is primarily a mucocutaneous infection
Which of the following statements regarding histoplasmosis is TRUE?
3

The organisms are intracellular on histological examination
Histoplasmosis is primarily a pulmonary infection that can disseminate to other
organs. It is endemic to the Ohio, Missouri and Mississippi River Valleys where the
bird and bat droppings in the soil contain the fungus. Primary cutaneous disease is
extremely rare. At 25C it displays septate hyphae and at 37C H. capsulatum is a
yeast. Itraconazole is the treatment of choice. On histopathological examination,
intracellular organisms that display a halo are seen. The halo is not the result of a
capsule but rather shrinkage artifact.
Which of the following methods of direct microscopic examination is chitin specific?
1

Chlorazol black E
2

Calcofluor white
3

Gomori Methenamine Silver
4

Fontana-Masson
5

KOH
Which of the following methods of direct microscopic examination is chitin specific?
1

Chlorazol black E
Chlorazol black E is chitin specific. Calcofluor white is glucan specific. Gomori
Methenamine Silver (GMS) and Fontana-Masson are histology stains. KOH is a
rapid, easy, reliable method for diagnosing fungal infections, but is not chitin-specific.
Which pathogen is not inhibited by cycloheximide?
1

Cryptococcus
2

Candida albicans
3

Prototheca
4

Scopuloniopsos brevicaulis
35

5

Scytalidium species
Which pathogen is not inhibited by cycloheximide?
2

Candida albicans
Cycloheximide is used is fungal culture media to reduce contaminants.
Which dermatophyte is most commonly responsible for tinea corporis gladiotorum?
1

T. mentag
2

T. tonsurans
3

T. schonlenleinii
4

T. rubrum
5

E. floccosum
Which dermatophyte is most commonly responsible for tinea corporis gladiotorum?
2

T. tonsurans
Tinea corporis gladiotorum is caused by Trychophyton tonsurans. Clinically, it
appears as well-defined, scaly plaques usually located on the arms, neck, and head.
Which of the following dermatophytes causes endothrix tinea capitis?
1

Microsporum gypseum
2

3

4

Microsporum canis
5

Microsporum ferrugineum
Which of the following dermatophytes causes endothrix tinea capitis?
3

Organisms that cause an ectothrix pattern of tinea capitis include M. canis, M.
audouinii, M. ferruginosum, M. distortium, M. gypseum and occasionally T. rubrum.
T. tonsurans, T. violaceum, T. soudanense, T. gourvilli, T. yaoundei, and occasionally
T. rubrum cause an endothrix pattern. T. schoenleinii causes favus in which hyphae
and air spaces are seen in the hair shaft. A bluish-white fluorescence pattern is seen
with Woods lamp. Clinically, patients have thick, yellow, cup-shaped crusts
(scutula); scarring and secondary infection may result. M. canis, M. audouinii, M.
ferruginosum, M. distortium display a yellow fluorescence on Woods lamp
examination.
All of the following are features of mycetoma except:
1

Swelling
36

2

Self-limited
3

Granules
4

Fascia and bone involvement
5

Draining sinuses
All of the following are features of mycetoma except:
2

Self-limited
Mycetomas may be subdivided into eumycetoma and actinomycetoma . Mycetomas
generally begin as subcutaneous swellings occurring on the feet. Later, sinuses,
granules, and nodules may be seen. The skin and subcutaneous tissue may also
become involved. Treatment is difficult in later stages.
Septate true hyphae are characterized by:
1

Transverse cross walls forming within the hyphae
2

Discrete unicellular bodies
3

Constrictions at septations
4

Branching occuring at septations
5

A terminal cell that is smaller than the others
Septate true hyphae are characterized by:
1

Transverse cross walls forming within the hyphae
Hyphae are vegetative tube-like structures. In septate hyphae, transverse cross walls
form within the hyphae. Pseudohyphae, seen in yeast, resemble true hyphae except
that they are constricted at septations, branching occurs at septations, and the terminal
cell is smaller than the others.
Which of the following causes tinea imbricata?
1

2

3

Trichophyton rubrum
4

5

Which of the following causes tinea imbricata?
2

Tinea imbricata is characterized by concentric, annular, scaly rings resembling
erythema annulare centrifugum. The causative agent is T. concentricum, which is
endemic to the South Pacific, South and Central America and Asia. The infection is
usually chronic.
37

This 16 year-old patient was recently diagnosed with HIV, the diagnosis is:
1

Distal Onychomycosis
2

Proximal Subungual Onychomycosis
3

Proximal White Subungual Onychomycosis
4

White Superficial Onychomycosis
5

Paronychia with Candida Onychomycosis
This 16 year-old patient was recently diagnosed with HIV, the diagnosis is:
3

Proximal White Subungual Onychomycosis
Proximal White Subungual onychomycosis is an AIDS marker, nails have a
characteristic white opaque appearance beginning in the region of the lunula and
extending distally under the nail plate.
Yeast:
1

Are filamentous fungi
2

Are characterized by tubular branching cells
3

Form fuzzy colonies
4

Form smooth colonies
5

Are unicellular oval to round cells that reproduce by budding or fission
Yeast:
5

Are unicellular oval to round cells that reproduce by budding or fission
All of the listed features are those of molds. Yeast are unicellular, oval to round cells
that reproduce by budding or fission. They form moist colonies, not smooth or fuzzy
colonies.
Which one of the following is not caused by a Candida infection?
1

Angular cheilitis
2

Balanitis
3

Median rhomboid glossitis
4

Leukoplakia
5

Mycetoma
Which one of the following is not caused by a Candida infection?
5

Mycetoma
Candidal infections may clinically present as thrush/leukoplakia, perleche/angular
cheilitis, vulvovaginitis, balanitis, paronychia, onychomcosis, intertrigo, and
38

folliculititis. Median rhomboid glossitis is now also associated with candidal
infections. Mycetomas are caused by true fungi (eumycetoma) or filamentous bacteria
(actinmycetoma).
Which of the following usually does not fluoresce bright green upon Woods lamp
examination?
1

M. audouinii
2

M. canis
3

T. violaceum
4

T. schoenleinii
5

M. distortum
Which of the following usually does not fluoresce bright green upon Woods lamp
examination?
3

T. violaceum
Fluorescent-positive infections are caused by:"Dogs And Cats Fight Some Gypsies"
M. Distortum M. audouinii M canis M. ferrugineum T. schoenleinii M. gypsium
(occasionally)
Erythematous to violaceous papules that may progress to nodular and necrotizing skin
lesions in neutropenic patients may be caused by which of the following organisms?
1

Trichosporon asahii
2

3

4

Trichosporon inkin
5

Trichophyton rubrum
Erythematous to violaceous papules that may progress to nodular and necrotizing skin
lesions in neutropenic patients may be caused by which of the following organisms?
1

Trichosporon asahii
Trichosporon asahii can cause trichosporanosis, which presents with disseminated
disease in neutropenic patients. Patients may present with erythematous to violaceous
papules that may progress to nodular and necrotizing skin lesions. Trichosporon
beigelii (new nomenclature: Trichosporon ovoides and Trichosporon inkin) causes
white piedra and other superficial infections.
A child presents with several yellowish, cup-shaped crusts on the scalp, some with
single hairs piercing through the center. KOH prep reveals arthroconidia and airspaces
within the hair shaft. A likely cause is:
1

M. gypseum
39

2

M. canis
3

T. tonsurans
4

T. verrucosum
5

T. mentagrophytes
A child presents with several yellowish, cup-shaped crusts on the scalp, some with
single hairs piercing through the center. KOH prep reveals arthroconidia and airspaces
within the hair shaft. A likely cause is:
1

M. gypseum
This child is presenting with the characteristic scutula of favus. Favus is most often
caused by T. schoenleinii, T. violaceum, and M. gypseum.
Which of the following statements about arthroconidia is correct?
1

Arthroconidia are formed by budding
2

Arthroconidia are formed by fragmentation of hyphae
3

Arthroconidia are thick-walled round cells
4

Arthroconidia are spores that are produced in a sac
5

Arthroconidia are yeast forms of dimorphic fungi
Which of the following statements about arthroconidia is correct?
2

Arthroconidia are formed by fragmentation of hyphae
Arthroconidia are formed by fragmentation of hyphae and may appear as thick or thin
walled rectangular cells. An example would be the mould form of Coccidioides
immitis. The remaining options are incorrect.
A patient has a positive Wood's light exam that is caused by pteridine. What is the
causative condition?
1

2

Corynebacterium
3

4

Pseudomonas
5

A patient has a positive Wood's light exam that is caused by pteridine. What is the
causative condition?
1

Wood's light positive dermatophytes (M. canis, M. audouinii, M. distortum, M.
ferrugineum, M gypseum, and T. schoenleinii) fluoresce secondary to pteridine.
Corynebacterium can fluoresce as well due to coproporphyrin III. Pseudomonas
40

fluoresces from production of pycyanin. The other organisms do not react with a
Wood's light.
Which of the following is a fluorescent ectothrix dermatophyte?
1

Trichophyton rubrum
2

3

4

5

Microsporum nanum
Which of the following is a fluorescent ectothrix dermatophyte?
3

Fluorescent ectothrix dermatophytes include M. canis, M. audouinii, M. distortum, M.
ferrugineum, and sometimes M. gypseum and T. schoenleinii ("Cats And Dogs Fight
and Growl Sometimes.") Nonfluorescent ectothrix dermatophytes include T.
mentagrophytes, T. rubrum, T. verrucosum, T. megninii, and M. nanum. Endothrix
dermatophytes include T. rubrum, T. gourvilli, T. yaounde, T. tonsurans, T.
schoenleinii, T. soudanense, and T. violaceum.
Which of the following stains is specific for chitin?
1

KOH
2

KOH with DMSO
3

Swartz Lamkins
4

Chlorazol Black E
5

Calcofluor White
Which of the following stains is specific for chitin?
4

Chlorazol Black E
Chlorazol Black E is a chitin specific stain. The remaining options are useful in direct
microscopic examination for fungal elements, but are not chitin specific.
Two weeks after a bicycle accident a 25-year-old female diabetic patient complained
of a swollen tender right cheek The PAS biopsy demonstrated ring forms and
distorted wide hyphae with few septations and right angle branching. The diagnosis
is:
1

Aspergillosis
2

Actinomycosis
3

Mucormycosis
4

Dermatophytosis
41

5

Fusariosis
Two weeks after a bicycle accident a 25-year-old female diabetic patient complained
of a swollen tender right cheek The PAS biopsy demonstrated ring forms and
distorted wide hyphae with few septations and right angle branching. The diagnosis
is:
3

Mucormycosis
Having diabetes is a risk factor for Mucormycosis, ring forms in the biopsy are the x-
section of the wide sparsely septate hyphae.
Cryptococcus neoformans resides in:
1

The Mississippi Valley region
2

Chicken roosts
3

Pigeon droppings
4

Sandy soil
5

None of these answers are correct
Cryptococcus neoformans resides in:
3

Pigeon droppings
This organism is ubiquitous and is abundant in soil enriched with pigeon droppings.
A fungal culture demonstrates a suedelike cream-colored colony of teardrop and
balloon-shaped microconidia which produce a red-brown pigment. Which of the
following is true of this organism?
1

Causes ectothrix infection
2

Requires partial thiamine for growth
3

Does not have arthroconidia
4

Causes fluorescent hair infection
5

Is not a cause of tinea unguim
A fungal culture demonstrates a suedelike cream-colored colony of teardrop and
balloon-shaped microconidia which produce a red-brown pigment. Which of the
following is true of this organism?
2

Requires partial thiamine for growth
Trichophyton tonsurans is an anthropophilic dermatophyte that causes non-fluorescent
endothrix hair invasion. It can cause black dot tinea capitis, tinea corporis, tinea pedis,
and tinea unguium. An important identifying feature of T. tonsurans is its red-brown
pigment that diffuses into the medium. Also, abundant tear-drop or club shaped
microconidia can be found. It grows best in the presence of thiamine.
42

This agent causes a superficial, asymptomatic infection usually on the palms of the
hands. The lesions are flat, nonscaly and appear as irregularly shaped brown macules:
1

Piedra hortae
2

Cladosporium carrionii
3

Aureobasidium pullulans
4

Phaeoannellomyces werneckii
5

Exophiala jeanselmei
This agent causes a superficial, asymptomatic infection usually on the palms of the
hands. The lesions are flat, nonscaly and appear as irregularly shaped brown macules:
4

Phaeoannellomyces werneckii
These lesions often have a deeper pigment at the advancing border. The other
organisms are dematiaceous but are not the etiologic agent of tinea nigra.
Which of the following is true regarding Dermatophyte Test Media (DTM)?
1

DTM contains chlortetracycline and minocycline
2

Alizarin red is the indicator present in DTM
3

Non-dermatophytes cause the media to turn yellow due to acid byproducts
4

DTM is useful for culturing dermatophytes from skin and nails, but not hair.
5

Dermatophytes utilize glucose as a carbon source, producing alkaline by-
products.
Which of the following is true regarding Dermatophyte Test Media (DTM)?
3

Non-dermatophytes cause the media to turn yellow due to acid byproducts
Dermatophyte Test Media (DTM) contains peptones, dextrose, gentamicin,
chlortetracycline, cycloheximide, and phenol red. Dermatophytes utilize protein as a
carbon source producing alkaline byproducts causing the media to turn from amber to
red. Nondermatophytes cause the media to turn yellow due to acid byproducts.
A whitish, heaped and convoluted colony with growth submerged into the agar and a
colorless reverse was isolated from the scalp of a 35-year-old male. The organism did
not produce any conidia. The diagnosis most likely is:
1

Microsporum canis
2

3

Trichophyton rubrum
4

5

43

A whitish, heaped and convoluted colony with growth submerged into the agar and a
colorless reverse was isolated from the scalp of a 35-year-old male. The organism did
not produce any conidia. The diagnosis most likely is:
5

Produces a white cerebriform colony lacking any conidia. M. ferrugineum produces a
rust colored colony with bamboo-like hyphae without conidia. The other organisms
produce micro and macroconidia.
A 37 year old woman from New Mexico, now 30 weeks pregnant, presents with flu-
like symptoms. Chest x-ray revealed diffuse miliary infiltrates, with blood cultures
growing Coccidioidis immitis. What is the treatment of choice?
1

Amphotericin B
2

Terbinafine
3

Itraconazole
4

Griseofulvin
5

No therapy
A 37 year old woman from New Mexico, now 30 weeks pregnant, presents with flu-
like symptoms. Chest x-ray revealed diffuse miliary infiltrates, with blood cultures
growing Coccidioidis immitis. What is the treatment of choice?
1

Amphotericin B
There is an increased risk of dissemination of Coccidiomycosis in pregnant women,
especially during the third trimester and the post-partum period. In a review by Crum
et al, maternal demise correlated with disease diagnosed later in pregnancy, with only
45% of patients diagnosed in the third trimester surviving (Am J Medicine
2006;119(11):Pages 993.e11-993.e17). Given that azoles have been shown to cause
teratogenicity, amphotericin B is recommended as the therapy in pregnant women.
Which of the following is NOT used for histologic examination for fungal infection?
1

Chlorazol Black-E
2

Gormori Methanamine Silver
3

Periodic Acid Schiff
4

Fontana-Masson
5

Mayer's mucicarmine
Which of the following is NOT used for histologic examination for fungal infection?
1

Chlorazol Black-E
Chlorazol Black-E is a stain specific for chitin and is used in direct examination, not
histologic preparations. The remaining options are histology stains useful in fungal
identification in tissue.
44

What is the most likely cause of this infection?
1

T. tonsurans
2

T. schoenleinii
3

M. canis
4

T. mentag
5

T. rubrum
What is the most likely cause of this infection?
3

M. canis
M. canis and T. tonsurans both cause tinea capitis. M. cains is more commonly
associated with inflammatory tinea capitis and kerion formation.
An elderly lady with moccasin-type tinea pedis has a fungal culture which
demonstrates smooth, teardrop-shaped microconidia which produce a port-wine
pigment. The organism is:
1

2

Microsporum canus
3

Trichophyton rubrum
4

Microsporum gypseum
5

An elderly lady with moccasin-type tinea pedis has a fungal culture which
demonstrates smooth, teardrop-shaped microconidia which produce a port-wine
pigment. The organism is:
3

Trichophyton rubrum
Trichophyton rubrum is an anthropophilic dermatophyte that is a cause of T. pedis, T.
manum, T. corporis, T. cruris, onychomycosis, Majocchis granuloma, and rarely T.
capitis. Colonies appear as fluffy to granular white to cream colored with reverse non-
diffusible port-wine or red pigment. Macroconidia are rare, thin-walled pencil shaped.
Microconidia are delicate teardrop shaped.
Clinically, actinomycotic mycetoma and eumycotic mycetoma appear identical. The
importance of identifying the etiologic agent is
1

Academic
2

Selecting the appropriate therapy
3

Ordering appropriate stains
4

Determine if the infection is contagious
5

Determine if amputation is necessary
45

Clinically, actinomycotic mycetoma and eumycotic mycetoma appear identical. The
importance of identifying the etiologic agent is
2

Selecting the appropriate therapy
The etiologic agents of actinomycotic mycetoma are filamentous bacteria that require
antibiotics, whereas fungal agents causing eumycotic mycetoma require antifungal
therapy.
The organism that causes white piedra:
1

Does not cause onychomycosis
2

Is known as Piedraia hortae
3

May also cause post-operative wound infections
4

Grows as small, compact, black-greenish velvety colonies
5

Can only be treated by cutting off affected hairs
The organism that causes white piedra:
3

May also cause post-operative wound infections
Trichosporon beigelii (new nomenclature: Trichosporon ovoides and Trichosporon
inkin) causes white piedra as well as other superficial infections, including post-
operative wound infections, paronychia, and onychomycosis. It grows as cream to
yellow-colored pasty colonies when cultured. Treatment is with topical amphotericin
B lotion, benzoic acid, salicylic acid, or cutting off affected hair. Black piedra is
caused by Piedraia hortae, which grows as small, compact, black-greenish velvety
colonies when cultured, and can be treated only by cutting off affected hairs.
Which of the following methods of direct microscopic examination for fungi is glucan
specific?
1

KOH
2

Swartz Lamkins
3

Chlorazol black E
4

Calcofluor white
5

Mayer's mucicarmine
Which of the following methods of direct microscopic examination for fungi is glucan
specific?
4

Calcofluor white
Calcofluor white is a glucan specific stain. Chlorazol black E is chitin specific. KOH
is a rapid, easy, reliable method of diagnosing fungal infections but is not glucan
specific; Swartz Lamkins contains a counterstain but is not glucan specific. Mayer's
mucicarmine is a histology stain.
Which of the following is FALSE with regards to asexual reproduction of fungi?
46

1

Arthroconidia are formed by the fragmentation of hyphae
2

Sporangia are spores that are produced in a sac
3

Chlamydoconidia are thin-walled and are susceptible to environmental injury
4

Conidia are cells produced on the sides or ends of hyphae
5

Dematophytes produce conidia
Which of the following is FALSE with regards to asexual reproduction of fungi?
3

Chlamydoconidia are thin-walled and are susceptible to environmental
injury
The structures formed during asexual propagation of fungi are termed either spores or
conidia depending on their mode of production and they arise following mitosis of a
parent nucleus. Conidia arise either by budding off conida-producing hyphae (on the
sides or ends) or by differentiation of preformed hyphae. The size and shape are
generally characteristic of the organism. Dermatophytes produce conidia.
Arthroconidia are produced when hyphae fragment or lyse. They may appear as thick-
or thin-walled cells and are typically larger than the hyphae from which they came.
The separation occurs at the septae. The mold form of Coccidioides immitis
reproduce in such a fashion. Sporangia are sacs or cases that are multicellular
structures in which spores are produced. Zygomycetes reproduce in this way.
Chlamydoconidia are thick-walled, round conidia that are formed during unpleasant
environmental conditions. Trichophyton tonsurans produces these structures.
Numerous umbilicated nodules resembling molluscum contagiosum developed in a
patient with recently diagnosed HIV infection. Which of the following fungi might be
the causative agent(s)? 1. Candida tropicalis 2. Cryptococcus neoformans 3.
Aspergillus fumigatus 4. Histoplasma capsulatum 5. Penicillium marneffei
1

2
2

3
3

2, 4
4

4, 5
5

2, 4, 5
Numerous umbilicated nodules resembling molluscum contagiosum developed in a
patient with recently diagnosed HIV infection. Which of the following fungi might be
the causative agent(s)? 1. Candida tropicalis 2. Cryptococcus neoformans 3.
Aspergillus fumigatus 4. Histoplasma capsulatum 5. Penicillium marneffei
5

2, 4, 5
All three organisms are seen in AIDS patients and can produce molluscum-like
lesions.
Which of the following is most likely to be a primary cutaneous infection?
1

North American Blastomycosis
47

2

Histoplasmosis
3

Paracoccidioidomycosis
4

Cryptococcosis
5

Penilliosis
Which of the following is most likely to be a primary cutaneous infection?
1

North American Blastomycosis
All other mycoses are primary pulmonary infections, which may disseminate to the
skin.
Black granules are found in mycetoma caused all the following organisms except:
1

Madurella grisea
2

M. mycetomatis
3

Exophiala jeanselmei
4

Curvularia
5

Black granules are found in mycetoma caused all the following organisms except:
5

All organisms listed other than S. apiospermum are dematiaceous agents of
mycetoma.
A patient with a pulmonary infection and cervical adenopathy has vesicles, papules
and ulcerations on the oral and nasal mucosa. Tissue culture reveals yeast with
multiple buds giving a mariners wheel appearance. The organism is:
1

Penicillium marneffei
2

3

4

Blastomyces dermatitidis
5

Leishmania mexicana
A patient with a pulmonary infection and cervical adenopathy has vesicles, papules
and ulcerations on the oral and nasal mucosa. Tissue culture reveals yeast with
multiple buds giving a mariners wheel appearance. The organism is:
3

Paracoccidioides brasiliensis causes a chronic progressive infection that is most
commonly seen in rural areas of South America. Patients may have constitutional
symptoms, lung involvement, ulcers of the upper respiratory and digestive tract, and
verrucous/ulcerated cutaneous lesions. Classically, Paracoccidioides brasiliensis has a
48

mariners wheel appearance.
Tinea imbricata is most frequently caused by:
1

T. mentagrophytes
2

M. Audouinii
3

T. concentricum
4

E. floccosum
5

M. furfur
Tinea imbricata is most frequently caused by:
3

T. concentricum
Tinea imbricata or Tokelau, an unusual type of tinea corporis causing polycyclic scaly
lesions, is endemic in the South Pacific Islands, Far East and C. & S. America.

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