Bronchi

2. Findings and Diagnosis

3. Clinical

Page 4 – Info

Table 1 – General Clinical Definition and Context

---

Table 2 – Broader Radiologic Patterns and Modality Use

---

Key Points and Pearls (Page 4)

• ABPA = Asthma + central bronchiectasis + eosinophilia + IgE elevation

• Imaging + labs = essential duo for diagnosis

• Early treatment prevents irreversible lung damage

• Think ABPA when asthmatic patient presents with “dirty lungs” on X-ray

4. Historical and Cultural

🧠 Multiple Choice Questions

Basic Science (2 Questions)

---

Q1. What type of hypersensitivity reaction is primarily involved in ABPA?
A) Type I (IgE-mediated)
B) Type II (antibody-mediated cytotoxic)
C) Type III (immune complex-mediated)
D) Type IV (delayed-type)

Correct Answer: A

• Explanation: ABPA is predominantly a Type I hypersensitivity reaction mediated by IgE to Aspergillus fumigatus.

• Incorrect Answers:

  • B) Type II involves cytotoxic antibodies, seen in conditions like Goodpasture’s.

  • C) Immune complexes play a role in conditions like SLE.

  • D) Type IV is T-cell mediated, such as in contact dermatitis.

---

Q2. Which cytokine plays a central role in eosinophil activation in ABPA?
A) IL-1
B) IL-4
C) IL-5
D) IL-17

Correct Answer: C

• Explanation: IL-5 is key for eosinophil maturation and activation, central to ABPA pathology.

• Incorrect Answers:

  • A) IL-1 is pro-inflammatory, but nonspecific.

  • B) IL-4 promotes IgE production but does not activate eosinophils directly.

  • D) IL-17 is more related to neutrophilic inflammation.

---

Clinical (2 Questions)

---

Q3. Which of the following clinical features is most characteristic of ABPA?
A) Sudden-onset hemoptysis in a healthy adult
B) Chronic cough in a smoker with emphysema
C) Brownish sputum plugs in an asthmatic patient
D) Fever and pleuritic chest pain in a post-op patient

Correct Answer: C

• Explanation: ABPA often presents with cough and brown mucus plugs due to fungal elements and eosinophilic debris.

• Incorrect Answers:

  • A) Could suggest pulmonary embolism.

  • B) Suggests COPD.

  • D) Suggests postoperative pneumonia or PE.

---

Q4. What is the most specific laboratory finding in ABPA?
A) Positive sputum culture for Aspergillus
B) Peripheral eosinophilia
C) Elevated total IgE > 1000 IU/mL
D) Positive skin prick test to dust mites

Correct Answer: C

• Explanation: Elevated total IgE (>1000 IU/mL) is highly suggestive of ABPA in the appropriate clinical context.

• Incorrect Answers:

  • A) Aspergillus in sputum is common in healthy people.

  • B) Eosinophilia is supportive but nonspecific.

  • D) Dust mite allergy is unrelated.

---

Radiology (3 Questions)

---

Q5. What radiologic finding is most classic for ABPA on CXR?
A) Diffuse ground-glass opacity
B) Pleural effusion
C) Finger-in-glove opacity
D) Cavitary lesion with air-fluid level

Correct Answer: C

• Explanation: The “finger-in-glove” sign represents mucus-impacted bronchi.

• Incorrect Answers:

  • A) Seen in infections or edema.

  • B) Not typical for ABPA.

  • D) Suggests abscess or TB.

---

Q6. What CT finding is highly specific for ABPA?
A) Tree-in-bud nodules
B) Peripheral ground-glass opacity
C) High-attenuation mucus in central bronchi
D) Subpleural reticulation

Correct Answer: C

• Explanation: Central bronchiectasis with high-attenuation (dense) mucus is nearly pathognomonic.

• Incorrect Answers:

  • A) Common in infections or aspiration.

  • B) Nonspecific; seen in many ILDs.

  • D) Seen in pulmonary fibrosis.

---

Q7. What is the role of MRI in ABPA?
A) Preferred modality for early diagnosis
B) Can identify cavitary lesions better than CT
C) Not routinely used but may show T1 hyperintense mucus
D) Critical for assessing vascular invasion

Correct Answer: C

• Explanation: MRI is rarely used but may show T1 hyperintense mucus due to dense fungal elements.

• Incorrect Answers:

  • A) CT is preferred.

  • B) CT is superior for cavity detection.

  • D) MRI is not useful for that in ABPA.

5. MCQs

Memory Image Idea: “The Fungal Glove in the Bronchial Tree”

 

• Imagine a bronchial tree as an actual tree, with a gloved hand made of mucus wrapped around one of its central branches.

• The “finger-in-glove” sign becomes literal: fungal fingers filling up central bronchi.

• Behind the glove: storm clouds (asthma), vines of eosinophils, and a hazy background (representing hazy imaging findings).

• Style: Surrealism, inspired by Salvador Dalí — mucus-glove melting into the bronchial landscape, with spores floating in the air like pollen.