American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the usual initial radiographic study used to evaluate nonresponsive pneumonia?

1. Chest X-ray

2. Chest CT

3. MRI of the thorax

4. Ultrasound of the chest

The correct answer is: Chest CT

The usual initial radiographic study employed to evaluate nonresponsive pneumonia is a chest X-ray. In cases of pneumonia that do not respond to typical treatment, a chest X-ray is typically the first imaging test used to help assess the situation. It can help identify complications related to pneumonia, such as a parapneumonic effusion or abscess formation, and can provide valuable information about the extent of the infection. It is a standard and widely available imaging modality that is recommended before more advanced imaging techniques like a chest CT. Chest CT may be utilized later if the chest X-ray reveals concerning findings or if there's a need for further evaluation of the lung parenchyma, but it is not generally the first imaging study for initial evaluation. MRI of the thorax is not routinely used in pneumonia assessment due to various factors, including limited availability and lower practicality in acute settings. Ultrasound of the chest may help in evaluating pleural effusions but is not the initial study for pneumonia itself. Thus, the correct answer highlights the use of a chest X-ray as the first-line imaging study to evaluate nonresponsive pneumonia, ensuring effective management and prompt identification of potential complications.