American Board of Internal Medicine (ABIM) Certification Practice Exam

Which diagnostic method is recommended for patients with a family history of aneurysm?

1. CT scan of the abdomen

2. Magnetic resonance angiography of the brain

3. Ultrasound of the carotids

4. Standard CT angiography

The correct answer is: Magnetic resonance angiography of the brain

For patients with a family history of aneurysm, particularly concerning cerebral aneurysms, magnetic resonance angiography (MRA) of the brain is the preferred diagnostic method. This imaging technique is non-invasive and does not involve ionizing radiation, making it safer for screening purposes, especially given the familial implications that may necessitate multiple screening assessments over time. MRA is excellent for visualizing blood vessels and can detect the presence of cerebral aneurysms effectively. This method allows for detailed imaging of the cerebral vasculature, which is crucial in identifying any abnormalities that may not present clinically but pose significant risks, especially in individuals with a genetic predisposition to aneurysms. Other imaging modalities may also detect aneurysms but have limitations in the context of familial screening. For instance, CT scans of the abdomen may not directly assess cerebral blood vessels, ultrasound of the carotids focuses primarily on the carotid arteries and does not visualize intracranial structures, and standard CT angiography involves radiation exposure, which is less desirable for routine screening in at-risk populations. Thus, MRA of the brain stands out as the most suitable diagnostic method for these patients.