Examkin

Question

Difficulty: MediumOrdering Imaging Studies

Match each clinical presentation with the single most appropriate initial or next step in diagnostic imaging.

  • A 45-year-old man with a Glasgow Coma Scale score of 14 and two episodes of emesis following a 10-foot fall from a ladder.Non-contrast computed tomography (CT) of the head
  • A 14-month-old boy with intermittent, severe abdominal pain, drawing up of his legs, and a palpable right-sided abdominal mass.Ultrasound of the abdomen
  • A 40-year-old woman with sudden-onset unilateral neck pain, ipsilateral ptosis, and miosis following minor cervical trauma.Computed tomography angiography (CTA) of the head and neck
  • A 58-year-old man with diabetes presenting with a chronic plantar ulcer that probes to the bone, with normal initial plain radiographs.Magnetic resonance imaging (MRI) of the foot with and without contrast

Answer

Presentation 1 matches with Non-contrast CT of the head; Presentation 2 matches with Ultrasound of the abdomen; Presentation 3 matches with CTA of the head and neck; Presentation 4 matches with MRI of the foot with and without contrast.
Each imaging modality is chosen based on evidence-based guidelines that prioritize diagnostic yield, speed of acquisition (when emergent), and safety profile (e.g., avoiding radiation in children).

Step-by-Step Solution

1
Analyze the head trauma presentation.
Identified high-risk criteria (GCS < 15, emesis, dangerous mechanism) warranting emergent evaluation for intracranial hemorrhage.
To accurately apply established clinical decision rules for brain imaging.
2
Evaluate the pediatric abdominal pain presentation.
Recognized signs of intussusception and prioritized a radiation-free, highly sensitive initial modality.
To minimize radiation exposure while accurately diagnosing a pediatric abdominal emergency.
3
Assess the post-trauma neck pain and Horner syndrome.
Correlated symptoms with cervical artery dissection, requiring emergent vascular imaging.
To identify intimal tearing or vessel occlusion efficiently.
4
Determine the next step for suspected osteomyelitis with normal X-rays.
Selected MRI as the definitive imaging study for bone involvement.
To confirm osteomyelitis early in its course when plain radiographs still lack sensitivity.

Key Concept

Selecting the most appropriate initial and confirmatory imaging modalities based on clinical presentation, patient demographics, and evidence-based guidelines.
Rate this question

Topics

Ordering Imaging Studies

More questions from this topic