American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended imaging modality for an episode of gross hematuria?

1. Ultrasound

2. CT with contrast or MRI and cystoscopy

3. X-ray

4. Pet scan

The correct answer is: CT with contrast or MRI and cystoscopy

The recommended imaging modality for an episode of gross hematuria is a combination of CT with contrast or MRI along with cystoscopy. This approach is thorough and allows for a comprehensive evaluation of the urinary tract. A urinary tract evaluation is crucial when presented with gross hematuria, as it can be indicative of various underlying conditions such as tumors, stones, or infections. A CT scan with contrast is particularly effective in identifying renal and urinary tract abnormalities, such as renal masses, calculi, or vascular issues. Furthermore, MRI can be utilized when there are specific indications, such as in patients who may have contraindications to iodinated contrast or when soft tissue characterization is needed. Cystoscopy is integral to this evaluation as well, allowing direct visualization of the bladder and urethra. It can help identify sources of bleeding that may not be visible on imaging, such as bladder tumors or lesions. In contrast, other imaging modalities, such as an ultrasound, are less comprehensive and may not provide sufficient detail for the diagnosis of conditions associated with gross hematuria. X-rays have limited applications in this context and would not be useful for evaluating soft tissue structures or the specific causes of hematuria. Similarly, PET scans are more suited for oncologic evaluations and