American Board of Internal Medicine (ABIM) Certification Practice Exam

What condition requires spinal cord imaging of the cervical and thoracic spines for diagnosis?

1. Stroke

2. Multiple sclerosis

3. Herniation

4. Spinal stenosis

The correct answer is: Multiple sclerosis

Multiple sclerosis is a condition that can result in a diverse array of neurological symptoms due to the demyelination of nerve fibers within the central nervous system, including the brain and spinal cord. One pivotal aspect of diagnosing multiple sclerosis is the necessity for spinal cord imaging, particularly of the cervical and thoracic regions, to detect lesions characteristic of the disease. In multiple sclerosis, imaging techniques such as MRI may reveal high-signal lesions within the white matter of the spinal cord, which are indicative of the demyelination process. These lesions appear in areas where neurological symptoms are manifest and help confirm the diagnosis, especially if the clinical presentation is atypical or if the diagnosis is uncertain. The recognition and documentation of lesions in the spinal cord can assist healthcare professionals in differentiating multiple sclerosis from other neurological conditions that may present similarly but do not produce the same pattern of lesions on imaging studies.