Rational choice of modality for a patient
Radiodiagnosis · Topic 2
Source: NMC CBME Curriculum 2024 · Volume III · Radiodiagnosis · Topic 2 · combined PDF page 457
Practice questions
- A 32-year-old pregnant woman at 14 weeks gestation presents with right lower quadrant pain, nausea, and low-grade fever. Ultrasound demonstrates an enlarged, non-compressible appendix with periappendiceal fluid. What is the most appropriate next imaging step?
- A 65-year-old man with chronic kidney disease (eGFR 28 mL/min/1.73m²) and known allergy to iodinated contrast presents with acute onset left flank pain and hematuria. What is the most appropriate initial imaging modality?
- A 7-year-old boy presents with acute onset of right lower quadrant pain and fever. The parents are concerned about radiation exposure. Which imaging modality is the most appropriate first-line test?
- A 55-year-old woman with sudden onset of severe headache and left-sided weakness arrives at the emergency department. Symptom onset was 90 minutes ago. What is the most appropriate initial imaging study?
- A 28-year-old man presents to the emergency department after a minor bicycle accident. He hit his head and has a brief loss of consciousness. He is now alert and oriented, with no focal neurological deficits. According to the Canadian CT Head Rule, what is the most appropriate imaging?
- A 35-year-old woman presents with acute onset of severe right lower quadrant pain and nausea. An ultrasound is performed and is equivocal, showing no clear appendicitis but possible ovarian cyst. What is the most appropriate next imaging step?
- A 70-year-old man is diagnosed with prostate cancer. Which imaging modality is most appropriate for local staging to assess extraprostatic extension and seminal vesicle invasion?
- A 4-year-old child is brought to the emergency department after a fall from a playground structure. There is concern for non-accidental trauma. The child has a healing rib fracture and bruises in various stages. Which imaging study is essential for further evaluation?
- A 28-year-old pregnant woman at 20 weeks gestation presents with chronic abdominal pain, diarrhea, and weight loss. Suspected Crohn's disease. Which imaging modality is most appropriate for evaluating the small bowel?
- A 45-year-old man with chronic sinusitis unresponsive to antibiotics presents for further evaluation. What is the most appropriate imaging study?
- A 50-year-old woman with newly diagnosed invasive ductal carcinoma of the breast is undergoing staging. Which imaging modality is most appropriate for detecting distant metastases?
- A 70-year-old man with known metastatic prostate cancer presents with new-onset severe back pain and bilateral lower extremity weakness. What is the most urgent imaging study?
- A 25-year-old athlete presents with chronic hip pain after a femoral neck stress fracture. Initial X-rays are normal. What is the most sensitive imaging modality to rule out avascular necrosis?
- An 80-year-old man on long-term warfarin therapy presents after a fall with head injury. He has a mild headache but is alert and oriented. What is the most appropriate initial imaging?
- A 40-year-old man with newly diagnosed Hodgkin lymphoma is being staged. Which imaging modality is the current standard for staging and response assessment?
- A 55-year-old woman presents with acute onset of dyspnea and pleuritic chest pain. She has no known allergies and normal renal function. What is the most appropriate initial imaging to evaluate for pulmonary embolism?
- A 30-year-old man presents with otorrhea and hearing loss after a temporal bone fracture. Which imaging modality is best for evaluating the fracture and potential inner ear damage?
- A 75-year-old woman presents with abdominal distension, vomiting, and no flatus for 2 days. She has a history of colon cancer. What is the most appropriate initial imaging?
- A 45-year-old woman presents with right upper quadrant pain and fever. Suspected acute cholecystitis. What is the first-line imaging modality?
- A 12-year-old boy with suspected complex congenital heart disease is being prepared for surgical repair. Which imaging modality provides the most detailed anatomical and functional assessment without radiation?
- A 30-year-old pregnant woman at 8 weeks gestation presents with acute dyspnea and chest pain. She has no allergies and normal renal function. Chest X-ray is normal. What is the most appropriate next imaging for suspected pulmonary embolism?
- A 50-year-old woman presents with visual field defects and headaches. Suspected pituitary adenoma. Which imaging modality is the most sensitive for detecting small microadenomas?
- A 9-year-old child presents with suspected acute appendicitis. Ultrasound is performed and is equivocal, with a non-compressible appendix but no definitive signs of inflammation. What is the most appropriate next imaging step to avoid radiation?
- A 65-year-old man with multiple myeloma is being evaluated for bone lesions. He has a history of chronic kidney disease (eGFR 35). Which imaging modality is most appropriate for detecting bone marrow involvement without contrast?
- A 45-year-old woman with a cochlear implant (non-MRI conditional) presents with new-onset severe headaches and hearing loss. Suspected acoustic neuroma. What is the most appropriate imaging modality?