American Board of Internal Medicine (ABIM) Certification Practice Exam

What screening should be performed for ADPKD patients with a family history of hemorrhagic stroke or ICA?

1. MRI of the cerebral arteries

2. CT scan of the abdomen

3. Ultrasound of the kidneys

4. Cerebral angiography

The correct answer is: MRI of the cerebral arteries

In patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD) who have a family history of hemorrhagic stroke or internal carotid artery (ICA) issues, performing an MRI of the cerebral arteries is crucial due to the increased risk of intracranial aneurysms associated with ADPKD. These aneurysms can lead to hemorrhagic strokes, particularly if there is a family history indicating a genetic predisposition to vascular issues. MRI of the cerebral arteries provides a non-invasive and highly sensitive method for detecting cerebral aneurysms and other vascular anomalies that may not be visible on other imaging modalities. Given the patient’s family history of hemorrhagic strokes, this screening can help identify any abnormalities that may need to be monitored or treated to prevent potential complications. While CT scans of the abdomen and ultrasounds of the kidneys are relevant for monitoring kidney function and complications associated with ADPKD, they do not address the central nervous system vascular concerns. Cerebral angiography, although detailed for vascular assessment, is more invasive compared to MRI and is typically reserved for cases where there is already a high suspicion of an aneurysm that needs intervention. Thus, the most appropriate and effective screening tool for this specific concern is an MRI of