Antifungal Route in Dysphagia — SCE Palliative Medicine MCQ

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EasyGI SymptomsAntifungal Route in DysphagiaSCE Palliative Medicine

A 60‑year‑old woman with advanced ovarian cancer and bowel obstruction is managed at home with a continuous subcutaneous infusion. She can take only sips of water. She develops oral thrush but is unable to swallow tablets. What is the most appropriate antifungal route?

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Correct answer: C — Oral fluconazole suspension if she can swallow small volumes, or IV fluconazole if not — topical nystatin alone is insufficient for presumed oesophageal involvement

Explanation lettering: B = shown as A · C = shown as B · A = shown as C · E = shown as D · D = shown as E

Option A is correct. UK palliative care guidance (e.g. NHS Scotland) recommends systemic fluconazole (capsules or suspension) for oral candidiasis, with the suspension formulation useful when tablet swallowing is impaired ([rightdecisions.scot.nhs.uk](https://www.rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/last-days-of-life/mouth-care/?searchTerm=80k+fc+points+Bes%C3%B8k+Buyfc26coins.com+Perfekt+for+%C3%A5+oppgradere+Ultimate+Team-et+mitt..vGTB&utm_source=openai)). Primary care antimicrobial guidelines (Cheshire & Merseyside) further support use of fluconazole (including suspension) in severe or extensive infection; topical agents are reserved for milder cases ([cheshireandmerseysideformulary.nhs.uk](https://www.cheshireandmerseysideformulary.nhs.uk/Mobile/chaptersSubDetails.asp?FormularySectionID=27&SubSectionID=A100&SubSectionRef=27.10&utm_source=openai)). Itraconazole capsules (B) require swallowing and offer no advantage. Crushing fluconazole capsules (C) is not recommended. Nystatin alone (D) is topical, poorly absorbed, and ineffective for oesophageal involvement. IV amphotericin B (E) is not first‑line in this context and carries a high toxicity burden.

Reference: Right Decisions: Management of oral infections (NHS Scotland Palliative Care), Cheshire & Merseyside primary care antimicrobial prescribing guidance; URLs as above. https://www.rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/last-days-of-life/mouth-care/?searchTerm=fluconazole