American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the most appropriate test to exclude significant atherosclerotic disease in a patient with a suspected transient ischemic attack?

1. Magnetic resonance imaging

2. CT angiography

3. Noninvasive carotid ultrasonography

4. Cerebral angiography

The correct answer is: Noninvasive carotid ultrasonography

Noninvasive carotid ultrasonography is the most appropriate test to exclude significant atherosclerotic disease in a patient with a suspected transient ischemic attack (TIA). This imaging technique allows for the direct visualization of the carotid arteries, which are crucial in assessing blood flow to the brain. It can effectively identify stenosis or occlusions in the carotid arteries caused by atherosclerosis, helping to establish the likelihood of cerebrovascular events. Carotid ultrasonography is non-invasive, widely available, and does not involve exposure to ionizing radiation or contrast materials, making it a safe first-line choice for evaluating patients with a suspected TIA. While magnetic resonance imaging can provide valuable information about cerebral ischemia and assess for other potential causes of TIA symptoms, it does not specifically evaluate the status of the carotid arteries. CT angiography is also useful for assessing vascular pathology but is generally used when a more extensive evaluation of intracranial vessels or acute conditions is necessary. Cerebral angiography, being an invasive procedure, is typically reserved for cases where more definitive vascular intervention may be indicated or if noninvasive studies suggest the need for further evaluation.