American Board of Internal Medicine (ABIM) Certification Practice Exam

What should be done for patients exhibiting an enlarging aneurysm in the posterior circulation?

1. Begin medication therapy

2. Immediate surgical intervention

3. Close monitoring only

4. Referral to radiology for further assessment

The correct answer is: Immediate surgical intervention

In the context of an enlarging aneurysm in the posterior circulation, immediate surgical intervention is recommended. Posterior circulation aneurysms can lead to serious complications such as subarachnoid hemorrhage or stroke, particularly if they are expanding in size, indicating a higher risk of rupture. The rapid growth of an aneurysm is a significant warning sign, necessitating prompt treatment to prevent potentially life-threatening events. Surgical options may include clipping or endovascular coiling, both aimed at securing the aneurysm and preventing rupture. Early intervention significantly improves outcomes and decreases mortality rates associated with ruptured aneurysms, especially in critical vascular regions like the posterior circulation, which supplies the brainstem and cerebellum. Although monitoring and other conservative strategies may be appropriate for stable or smaller aneurysms, the urgent nature of an enlarging aneurysm justifies surgical intervention as a proactive approach to safeguard the patient's health.