American Board of Internal Medicine (ABIM) Certification Practice Exam

When is imaging indicated for neck pain?

1. Only in elderly patients

2. When there is weakness or clinical evidence of spinal cord involvement

3. In all cases of neck pain

4. When neck pain persists for more than a week

The correct answer is: When there is weakness or clinical evidence of spinal cord involvement

Imaging for neck pain is indicated primarily when there is weakness or clinical evidence of spinal cord involvement. This recommendation is based on the need to identify serious underlying conditions such as herniated discs, spinal stenosis, or other pathology that could lead to neurological deficits. If a patient presents with symptoms such as weakness, altered sensation, or changes in reflexes, it raises concerns for potential spinal cord compression or other serious deformities that necessitate prompt evaluation via imaging. In contrast, not all cases of neck pain require imaging; many patients may present with muscular or mechanical issues that can be managed conservatively. Imaging immediately in all instances could lead to unnecessary exposure to radiation and may not change management, especially when the clinical presentation does not suggest serious conditions. Similarly, while elderly patients may be more susceptible to conditions necessitating imaging due to age-related degenerative changes, we do not limit the indication solely to this demographic. Lastly, considering persistence of neck pain alone, such as pain lasting more than a week, is insufficient for determining the need for imaging since many cases will resolve naturally or with conservative treatment.