Rosh Internal Medicine Boost Practice Exam

What is the first-line imaging for suspected pneumonia in a patient with respiratory symptoms?

1. CT scan

2. Chest X-ray

3. MRI

4. Ultrasound

The correct answer is: Chest X-ray

The first-line imaging modality for suspected pneumonia in a patient presenting with respiratory symptoms is a chest X-ray. This is due to its wide availability, cost-effectiveness, and the ability to provide quick results. A chest X-ray can effectively identify the presence of infiltrates or consolidation that suggest pneumonia, including distinguishing between types of pneumonia such as lobar or bronchopneumonia. While other imaging techniques, such as a CT scan, can provide more detailed information and be valuable in specific cases (like evaluating complications or atypical pneumonia), they are not considered the first step due to higher costs, increased radiation exposure, and longer time to obtain results. MRI is not routinely used for lung pathology because of its limitations in imaging air-filled structures and the motion artifacts associated with breathing. Ultrasound can be beneficial in certain clinical situations, such as in evaluating pleural effusions or guiding procedures, but it does not replace the need for an initial X-ray in cases of suspected pneumonia.