Rosh Emergency Medicine Practice Test

In an older patient presenting with confusion, what imaging study is commonly indicated to evaluate for a potential cause?

1. X-ray of the chest

2. CT scan of the head

3. Ultrasound of the abdomen

4. MRI of the brain

The correct answer is: CT scan of the head

In cases of confusion in an older patient, a CT scan of the head is commonly indicated to evaluate for potential causes such as cerebrovascular accidents (strokes), hemorrhages, or lesions that may be contributing to the altered mental status. This imaging method is particularly useful because it provides quick results and effectively visualizes the brain, allowing for the swift identification of acute changes. CT scans are favored in emergency situations, especially for older adults who may have increased risks of intracranial pathology. Additionally, the speed of obtaining a CT scan compared to an MRI is crucial in an emergency setting, where time-sensitive decisions are necessary for treatment. While other imaging modalities have their uses, such as MRI for more detailed images of brain structure or ultrasound for abdominal issues, they are not the first-line studies in the context of confusion. X-rays of the chest might assess for pulmonary problems or infections, but they do not provide information about brain pathology.