This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: ENT
[{'content': 'Which among the following is true regarding fungal sinusitis -a) Surgery is required for treatmentb) Most common organism is Aspergillus nigerc) Amphoterecin B i.v is used for invasive fungal sinusitisd) Hazy appearance on X-ray with radio-opaquee) Seen only in immunodeficient conditions \nSelect and explain. \nA. acd, B. ad, C. bc, D. bde', 'role': 'user'}, {'content': 'Answer: A \nExplanation: Fungal Sinusitis\nMost common cause: Aspergillus\nMost common species: A. fumigatus (90%) > A. niger > A. flavus.\nOther offenders are: Mucor, Rhizopus, Alternaria\n\nFungal infection can be of following types:\n\ni. Fungus ball\nii. Allergic fungal rhinosinusitis\niii. Chronic or indolent invasive fungal sinusitis\niv. Acute fulminant fungal rhinosinusitis\nFungus Ball\n\nFungus ball occurs in adults females\nM/C agent: Aspergillus\nMost common sinus involved – Maxillary > sphenoid sinus\nM/C symptom – unilateral postnasal discharge\nMost Important Investigation-CT scan\nFungus ball is the main fungal rhinosinusitis in an immunocompetent patient.\nSurgery (FESS) is the most effective treatment for fungus ball.\n\nAllergic Fungal Rhinosinusitis\n\nAFS is a noninvasive fungal rhonosinusistis\nDermatiaceous species are the fungal agents mostly responsible for AFRs.\nSeen in immunocompetent hosts with allergy to fungus.\nClinical and biological criteria for diagnosis is still under debate, and include nasal polyps, thick mucin, hypersensitivity type I for fungus, eosinophilic mucin.\nSinus opacities with bone extension are frequently seen on CT scan.\nDiagnosis of all allergic fungal rhinosinusitis is supported by allergic and fungal criteria (Refer to Ans. 11 for criteria).\nTreatment = Antifungals\n\nChronic or Indolent Invasive Fungal Rhinosinusitis\n\nChronic invasive fungal rhinosinusitis is a rare pathology occurring mostly in immunocompetent patients.\nAspergillus is the most frequent agent isolated in this pathology.\n\nAcute Fulminant Fungal Rhinosinusitis\n\nFulminant invasive fungal rhinosinusitis occurs in immunocompromised patients (HIV, diabetes, chemotherapy)\nEarly diagnosis and control of primary immunological disorders is essential for the prognosis.\n\nThus from the above description it can be concluded\nOption – a – Surgery is required for treatment – (correct) as in all forms of fungal sinusitis – some or the other form of surgery is required.\nOption – b – M/c organism is Aspergillus niger.\nIncorrect – M/c is A. fumigatus\nOption – c – Amphotericin IV is used for invasive fungal sinusitis\nCorrect\nOption – d – Hazy appearance on X-ray with radiopaque density\nCorrect – Sinusitis gives hazy appearance on X-ray\nOption – e – Seen only in immunodeficient condition\nIncorrect – only the acute fulminant form is more common in immunodeficient state whereas others are seen in immnocompetent hosts.', 'role': 'assistant'}]