American Board of Internal Medicine (ABIM) Certification Practice Exam

For a patient experiencing multiple recurrent TIAs, what is the recommended course of action?

1. Immediate outpatient care

2. Hospitalization for monitoring

3. Increased physical activity

4. Home health services only

The correct answer is: Hospitalization for monitoring

In cases of multiple recurrent transient ischemic attacks (TIAs), hospitalization for monitoring is essential due to the increased risk of stroke. TIAs serve as warning signs for potential cerebrovascular events, indicating that the patient has significant underlying arterial disease or other risk factors that require close evaluation and management. Hospitalization allows for comprehensive diagnostic work-up, including imaging studies such as CT or MRI to assess for any acute intracranial pathology, and vascular imaging to identify potential sources of embolism or significant stenosis in carotid or vertebral arteries. Additionally, it provides an opportunity to monitor neurological status closely, initiate acute management, and when necessary, adjust medications or start interventions to reduce stroke risk, such as antiplatelet therapy or anticoagulants. Immediate outpatient care lacks the necessary oversight and interventions that can prevent progression to a full-blown stroke, while increased physical activity and home health services would not address the urgent need for comprehensive evaluation and risk stratification that hospitalization provides. In summary, monitoring and treatment in a controlled hospital environment is crucial for patients with recurrent TIAs to ensure their safety and optimize preventative strategies against future strokes.