American Board of Internal Medicine (ABIM) Certification Practice Exam

When are radiographs typically needed in cases of acute knee pain?

1. When there is no swelling

2. When a traumatic fracture is suspected

3. When there is obvious dislocation

4. When pain is present without injury

The correct answer is: When a traumatic fracture is suspected

In cases of acute knee pain, radiographs are typically indicated when a traumatic fracture is suspected. This is critical because an appropriate imaging study can confirm or rule out the presence of a fracture, which can significantly influence the management plan. Radiographs are particularly valuable in guiding treatment decisions and in determining whether further intervention, such as surgery, is necessary. When a fracture is suspected, assessing the integrity of the bony structures is crucial to ensure that any potential fractures are not overlooked, as these may require prompt treatment to restore function and prevent complications. Other scenarios, such as having no swelling or experiencing pain without injury, generally do not necessitate immediate radiographic evaluation since these conditions may not indicate a serious underlying acute bony injury. While a visible dislocation is an important finding, the suspicion of a fracture associated with it drives the need for imaging to effectively assess the situation and ensure appropriate care. Hence, suspicion of a traumatic fracture is the key indication for performing radiographs in these cases.