Step 3

Question 1

Multiple sclerosis
The confirmatory test for diagnosis is MRI of brain and spine.
Acute exacerbation of multiple sclerosis with optic neuritis is treated with IV corticosteroids because oral corticosteroids are associated with increase risk of recurrent optic neuritis. If Patient do not respond to corticosteroid therapy then plasmapheresis is considered.
For chronic maintenance therapy disease modifying agents are used such as beta interferon or glatiramer acetate.
During pregnancy, the severity of multiple sclerosis naturally decreases and increases postpartum, therefore disease modifying agents can be discontinued during pregnancy, because these agents carry category B and C pregnancy risk. Two drugs are absolute contraindicated teriflunomide and mitoxantrone.
Multiple sclerosis overall increases the risk of Caesarean delivery and vaginal assisted delivery .

Question 2

“Allergic bronchopulmonary aspergillosis”
~ hypersensitivity disorder that occurs in patients with pre-existing asthma or cystic fibrosis.
~ Pathophysiology is an exaggerated IgG and IgE response to Aspergillus fungus.
~ Clinical features include recurrent asthma exacerbation, fever, cough with production of brown mucus plug (due to eosinophils and aspergillus), occasional hemoptysis and fleeting infiltrates on chest x-ray (transient infiltrates in different parts of lungs).
~ diagnostic criteria include an immediate reaction to aspergillus antigen skin test, increase IgE levels, peripheral eosinophilia, and central bronchiectasis on HRCT.
~ after confirming the diagnosis treatment includes glucocorticoids and itraconazole.