American Board of Internal Medicine (ABIM) Certification Practice Exam

For pulmonary coccidioidomycosis in low-risk patients, what is the treatment approach?

1. Fluconazole

2. No treatment indicated

3. Itraconazole

4. Amphotericin B

The correct answer is: No treatment indicated

In the context of pulmonary coccidioidomycosis, particularly in low-risk patients, the treatment approach is often observational rather than therapeutic. This condition, which is caused by the inhalation of Coccidioides spores, can be self-limiting, especially in individuals who are otherwise healthy and without significant comorbidities. For low-risk patients—those without significant immunocompromising conditions, underlying lung disease, or other risk factors—the majority of mild or moderate cases do not require antifungal treatment. Instead, it is typically sufficient to monitor symptoms and allow for spontaneous recovery. In contrast, more aggressive treatment options like fluconazole, itraconazole, or amphotericin B are reserved for patients presenting with severe disease or those who are at higher risk for complications. Thus, the non-treatment approach aligns with clinical guidelines advocating for a conservative management strategy in asymptomatic or minimally symptomatic patients without risk factors. This approach minimizes unnecessary medication use and focuses on patient safety and care.