American Board of Internal Medicine (ABIM) Certification Practice Exam

In what circumstances is screening for intracranial cerebral aneurysms recommended for patients with autosomal dominant polycystic kidney disease?

1. Family history of aneurysm or previous rupture

2. History of hypertension

3. Older age over 60 years

4. Severe kidney dysfunction

The correct answer is: Family history of aneurysm or previous rupture

Screening for intracranial cerebral aneurysms in patients with autosomal dominant polycystic kidney disease (ADPKD) is particularly recommended for those with a family history of aneurysms or a previous rupture. This recommendation stems from research indicating that individuals with ADPKD have an increased risk of developing intracranial aneurysms, and this risk is significantly heightened when there is a family history of such conditions. Patients with a known familial predisposition may have genetic factors that increase their likelihood of both cerebral aneurysm formation and rupture. Therefore, proactive screening in these cases can lead to early detection and management, ultimately reducing the potential for serious complications associated with ruptured aneurysms, such as subarachnoid hemorrhage. While hypertension, older age, and severe kidney dysfunction can contribute to overall cardiovascular risk, they do not serve as primary criteria for initiating screening for cerebral aneurysms in ADPKD patients. Thus, focusing on familial history highlights the genetic component of the risk associated with this condition.