Immunology Review Corner

Immunology Review Corner: Chapter 74 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al.

Prepared by Drs. Karla R. Davis, Walter Reed Medical Center; Anne K. Ellis, McMaster University; and Soo Kim-Delio, Walter Reed Army Medical Center.

Chapter 74: Allergic Bronchopulmonary Aspergillosis

1. Which of the following clinical or laboratory features is essential for the diagnosis of Allergic Bronchopulmonary Aspergillosis (ABPA)?
A. Chest roentgenographic infiltrate
B. Elevated total serum immunoglobulin E (IgE) >2,000 ng/mL
C. Immediate cutaneous reactivity to Aspergillus
D. Peripheral blood eosinophilia

2. Which of the following stages of Allergic Bronchopulmonary Aspergillosis (ABPA) is most likely to be associated with a normal chest roentgenogram?
A. I (Acute)
B. II (Remission)
C. III (Exacerbation)
D. IV (Corticosteroid-dependent asthma)

3. Describe the role of Aspergillus fumigatus in complement activation.
A. Aspergillus fumigatus is not known to activate complement
B. Aspergillus fumigatus activates the alternative pathway of complement
C. Aspergillus fumigatus activates the classical pathway of complement
D. Aspergillus fumigatus activates the lectin pathway of complement

4. Which of the following is a common presenting finding of an Aspergilloma?
A. Dyspnea
B. Hemoptysis
C. Hypoxia
D. Retractions

5. Most of the radiographic findings of Allergic Bronchopulmonary Aspergillosis (ABPA) occur in the dilated central bronchi. In which segments of the lung are they most likely to occur?
A. Anterior segments, upper lobes
B. Posterior segments, upper lobes
C. Anterior segments, lower lobes
D. Posterior segments, lower lobes

6. Which of the following describes the most common plain film finding in patients with Allergic Bronchopulmonary Aspergillosis (ABPA)?
A. Homogeneous consolidation
B. Infiltrates
C. Parallel-line shadows
D. Ring shadows

7. Aspergillus precipitins occur in patients with asthma who do not have Allergic Bronchopulmonary Aspergillosis (ABPA). Which of the following best represents the number of patients with asthma that have Aspergillus precipitins?
A. 1 percent
B. 5 percent
C. 10 percent
D. 15 percent

8. Which of the following statements regarding Aspergillus species is the most accurate?
A. Aspergillus species are thermosensitive and are not capable of growing at temperatures from 15 degrees to 53 degrees Celsius.
B. Aspergillus flavus is the species of Aspergillus that most frequently infects humans, followed by Aspergillus fumigatus.
C. Hyphae from Aspergillus species are too small to be visualized on microscopic examination of sputum.
D. Aspergillus spores are 2.0 to 3.5 micrometers in diameter, which permits penetration to the smaller airways.

9. Which of the following glycoproteins of Aspergillus fumigatus is a member of the mitogillin family of cytotoxins (ribotoxins)?
A. Asp f 1
B. Asp f 2
C. Asp f 6
D. Asp f 16

10. Which of the following glycoproteins of Aspergillus fumigatus, when used together, are of value in distinguishing Allergic Bronchopulmonary Aspergillosis (ABPA) from asthma?
A. Asp f 1, Asp f 2, Asp f 3
B. Asp f 1, Asp f 3, Asp f 5
C. Asp f 2, Asp f 4, Asp f 6
D. Asp f 1, Asp f 2, Asp f 5

Answers:
1. C, page 1355
2. B, page 1355
3. B, page 1359
4. B, page 1354
5. B, page 1361
6. B, page 1361
7. C, page 1365
8. D, page 1353
9. A, page 1367
10. C, page 1367