American Board of Internal Medicine (ABIM) Certification Practice Exam

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How is allergic bronchopulmonary aspergillosis (ABPA) diagnosed?

  1. CT scan showing bronchial wall thickening

  2. Skin test reactivity to Aspergillus antigens

  3. Serum eosinophil count only

  4. Airway biopsy

The correct answer is: Skin test reactivity to Aspergillus antigens

Allergic bronchopulmonary aspergillosis (ABPA) is primarily diagnosed through a combination of clinical history, imaging studies, and specific serological tests. Among the diagnostic options, skin testing for reactivity to Aspergillus antigens is particularly significant because it helps establish an allergic response to the fungus. In ABPA, patients typically show positive skin test reactivity to Aspergillus species, indicating an IgE-mediated hypersensitivity reaction, which is a hallmark of the disease. Other diagnostic approaches support the diagnosis but do not provide definitive evidence of the allergic component. For instance, a CT scan might reveal bronchial wall thickening, which can indicate inflammation, but it does not specifically confirm ABPA. A serum eosinophil count can be elevated in various allergic and inflammatory conditions, making it a non-specific marker. An airway biopsy can help in diagnosing various pulmonary conditions, but it is more invasive and not standard for diagnosing ABPA specifically. In summary, the positive skin test reactivity to Aspergillus antigens is a direct measure of the allergic component of ABPA and is central to confirming the diagnosis, making it the most appropriate choice.