American Board of Internal Medicine (ABIM) Certification Practice Exam

In the assessment of joint diseases, what is an important imaging consideration?

1. Using contrast-enhanced images only

2. Obtaining standing views for more accurate evaluation

3. Relying solely on ultrasound findings

4. Performing MRI in all cases

The correct answer is: Obtaining standing views for more accurate evaluation

Obtaining standing views for the evaluation of joint diseases is important because these positions can provide additional information about the alignment, integrity, and function of the joint under weight-bearing conditions. Standing views help visualize the relationship of the joint surfaces in a position that mimics normal function, allowing for the assessment of any joint deformities, wear patterns, or subtle changes that may not be evident in supine positions. For instance, conditions such as osteoarthritis can manifest differently when the joint is subjected to load, highlighting issues like varus or valgus deformities that may not be visible otherwise. This is particularly relevant for weight-bearing joints such as the knees and hips. In contrast, using contrast-enhanced images only may not be necessary for all conditions, as many joint diseases can be evaluated adequately with standard imaging techniques. Relying solely on ultrasound findings does not provide a complete picture, as ultrasound may miss deeper bony changes or other intra-articular pathology that other imaging modalities can identify. Performing MRI in all cases may not be practical due to cost, availability, and the need for more conservative imaging approaches when appropriate. Therefore, obtaining standing views is a strategic method in the comprehensive assessment of joint diseases.