Respiratory medicine: allergic bronchopulmonary aspergillosis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Respiratory medicine: allergic bronchopulmonary aspergillosis

Sample item

A 32-year-old man with long-standing asthma has recurrent wheeze and expectorates brownish mucus plugs. Radiographs show fleeting upper lobe infiltrates, and HRCT shows central bronchiectasis. Blood eosinophils are 1,200 per microlitre, total IgE is 3,500 IU/mL and the Aspergillus skin test is positive. Which treatment is most appropriate?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Oral prednisolone, with itraconazole as a steroid-sparing agent

Allergic bronchopulmonary aspergillosis is a hypersensitivity response to Aspergillus fumigatus colonising the airways of asthmatic or cystic fibrosis patients. Oral glucocorticoids suppress the immune reaction and clear infiltrates, and itraconazole reduces fungal burden and steroid need. Total IgE falls with treatment, so it is used to monitor response.

Option by option

  • A. Empirical anti-tubercular therapy

    Tuberculosis is a common mimic in India, but eosinophilia, high IgE and a positive skin test point to ABPA.

  • B. Oral prednisolone, with itraconazole as a steroid-sparing agent (correct)

    Correct. Steroids treat the allergic inflammation and itraconazole lowers antigen load.

  • C. Intravenous amphotericin B for invasive aspergillosis

    Invasive aspergillosis occurs in the immunosuppressed with tissue invasion, which is not this immune-mediated condition.

  • D. Surgical lobectomy of the affected lobe

    Surgery has no role in this diffuse hypersensitivity disease.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Oral prednisolone, with itraconazole as a steroid-sparing agent. Allergic bronchopulmonary aspergillosis is a hypersensitivity response to Aspergillus fumigatus colonising the airways of asthmatic or cystic fibrosis patients.

Why is "Empirical anti-tubercular therapy" not the answer?

Tuberculosis is a common mimic in India, but eosinophilia, high IgE and a positive skin test point to ABPA.

Why is "Intravenous amphotericin B for invasive aspergillosis" not the answer?

Invasive aspergillosis occurs in the immunosuppressed with tissue invasion, which is not this immune-mediated condition.

Why is "Surgical lobectomy of the affected lobe" not the answer?

Surgery has no role in this diffuse hypersensitivity disease.

What concept does this question test?

It tests Respiratory medicine: allergic bronchopulmonary aspergillosis in General Medicine. Oral glucocorticoids suppress the immune reaction and clear infiltrates, and itraconazole reduces fungal burden and steroid need. Total IgE falls with treatment, so it is used to monitor response.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Respiratory medicine: allergic bronchopulmonary aspergillosis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.