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: Ophthalmology
[{'content': 'A 48-year-old diabetic with orbital cellulitis presented with a corneal ulcer. An aqueous tap showed branched hyphae. Diagnosis is - \nSelect and explain. \nA. Herpetic ulcer, B. Mycotic Ulcer, C. Bacterial Ulcer, D. Anterior staphyloma', 'role': 'user'}, {'content': 'Answer: B \nExplanation: Mycotic (fungal) corneal ulcer The incidence of corneal ulceration due to fungi has increased significantly due to long-term unwarranted use of antibiotic and steroid.\nThe most common mode of infection is an injury by vegetative material such as crop leaf, horn, wooden stick.\nThe causative fungus is Aspergillus fumigatus (most common), Candida albicans and fusarium. Clinical features\xa0\n\nSymptoms are similar to bacterial corneal ulcers but in general, they are less marked than the equal size bacterial ulcer.\n\nOn the other hand, signs are very prominent, i.e. signs are more prominent than symptoms,\n\nFollowing signs can be seen: -\n\ni) Greyish-white dry looking ulcer with the elevated rolled out feathery & hyphate margins.\nii) Feathery finger-like extension into surrounding stroma under intact epithelium.\niii) A sterile immune ring (yellow line) of Wesseley.\niv) Multiple small satellite lesions.\nv) Non-sterile (infected) hypopyon (Pseudohypopyon-Hence penetrated the endothelium)\nvi) Perforation is rare and comes vascularization is conspicuously absent. Diagnosis o Examination of wet KOH will show:-\ni) Filamentous fungi (branched septate hyphae ):- Aspergillus fumigatus, Fusarium.\nii) Non-filamentous (yeast-like fungi): - Candida. Treatment of fungal corneal ulcer \xa0Treatment of corneal fungal ulcer involves:-\n1) Specific (definitive) treatment, and\n2) Adjunctive (concurrent) treatment.\n1) Definitive treatment: - It includes antifungal drugs: -\nA) Topical antifungals -\ni) For filamentous fungi (Aspergillus, Fusarium):- Natamycin (5%) eye drops (drug of choice), Miconazole ointment, Amphotericin B drops.\nii) For yeast (Candida): - Amphotericin B (Drug of choice), nystatin, flucytosine.\nB) Systemic antifungals: - May be required in severe cases. Fluconazole or ketoconazole may be used.\n2) Adjunctive/Concurrent therapy: - This follows the same principles as in any other infectious corneal diseases. Cycloplegic (1% atropine ointment or drop is the DOC) should be used to: -\ni) Reduce pain from ciliary spasm;\nii) Prevent posterior synechiae;\niii) Reduce uveal inflammation. \xa0Topical steroids enhance fungal replication and corneal\xa0invasion and are contraindicated during early therapy of a fungal corneal ulcer.', 'role': 'assistant'}]