Mycology: allergic bronchopulmonary aspergillosis: practice question

A Microbiology 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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Microbiology · Mycology: allergic bronchopulmonary aspergillosis

Sample item

A 30-year-old man with long-standing asthma has recurrent wheeze, expectoration of brownish mucus plugs, peripheral eosinophilia and a total serum IgE of 2,500 IU/mL. CT shows central bronchiectasis, and the Aspergillus fumigatus skin test is positive. What is the best treatment?

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

The answer and the reasoning

D. Oral prednisolone, with itraconazole as a steroid-sparing adjunct

This is allergic bronchopulmonary aspergillosis, a type I and type III hypersensitivity reaction to A. fumigatus growing in the airways of asthmatic or cystic fibrosis patients. Oral corticosteroids control the immune response and an azole such as itraconazole reduces the fungal burden and steroid dependence. Response is followed by serum IgE.

Option by option

  • A. Inhaled corticosteroid alone

    Inhaled steroid alone does not control the allergic bronchopulmonary reaction.

  • B. Intravenous amphotericin B

    This is not tissue invasion, so systemic amphotericin B is unnecessary and toxic.

  • C. Surgical lobectomy of the affected lung

    Surgery is for complications such as massive haemoptysis, not routine management.

  • D. Oral prednisolone, with itraconazole as a steroid-sparing adjunct (correct)

    Correct. Steroids suppress the hypersensitivity reaction and itraconazole spares steroid dose.

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 Microbiology question

What is the answer to this Microbiology question?

The best answer is D, Oral prednisolone, with itraconazole as a steroid-sparing adjunct. This is allergic bronchopulmonary aspergillosis, a type I and type III hypersensitivity reaction to A.

Why is "Inhaled corticosteroid alone" not the answer?

Inhaled steroid alone does not control the allergic bronchopulmonary reaction.

Why is "Intravenous amphotericin B" not the answer?

This is not tissue invasion, so systemic amphotericin B is unnecessary and toxic.

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

Surgery is for complications such as massive haemoptysis, not routine management.

What concept does this question test?

It tests Mycology: allergic bronchopulmonary aspergillosis in Microbiology. fumigatus growing in the airways of asthmatic or cystic fibrosis patients. Oral corticosteroids control the immune response and an azole such as itraconazole reduces the fungal burden and steroid dependence. Response is followed by serum IgE.

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 Mycology: allergic bronchopulmonary aspergillosis?

Make a one-line identity card for each organism: shape and stain, defining test, toxin, disease and drug. Then use the flashcards and the other Microbiology 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.