American Board of Internal Medicine (ABIM) Certification Practice Exam

Routine diagnostic studies for nonspecific low back pain should be reserved for which of the following conditions?

1. Patients with minor pain relief after 2 weeks

2. Patients with severe or progressive neurologic deficits

3. All patients after 1 month of conservative management

4. Patients without any chronic conditions

The correct answer is: Patients with severe or progressive neurologic deficits

Routine diagnostic studies for nonspecific low back pain are primarily indicated in cases where there are severe or progressive neurologic deficits. This is because neurologic deficits can be indicative of a serious underlying pathology, such as a herniated disc or spinal stenosis, which may require urgent intervention. In patients presenting with significant neurologic symptoms, such as weakness, numbness, or changes in bowel or bladder function, timely imaging studies like MRI may be essential to guide treatment decisions and prevent potential complications like permanent disability. For other scenarios, such as patients with minor pain relief after 2 weeks, it is often appropriate to continue conservative management rather than immediately resorting to imaging studies. Similarly, routine imaging for all patients after 1 month of conservative management is typically not warranted unless specific red flags or severe symptoms are present. Patients without any chronic conditions may not need routine imaging unless there are alarming features. Therefore, the focus for obtaining diagnostic studies should be on identifying significant neurologic compromise, making the presence of severe or progressive neurologic deficits a critical factor in determining the need for further investigation.