American Board of Internal Medicine (ABIM) Certification Practice Exam

Which procedures should be performed for patients with syncope?

1. Cardiac catheterization only

2. A careful history and physical examination

3. Magnetic resonance imaging

4. CT scan of the head

The correct answer is: A careful history and physical examination

A careful history and physical examination are critical steps in the evaluation of patients with syncope. This approach allows clinicians to identify the underlying causes or risk factors associated with the syncope, which can vary widely from cardiovascular issues to neurological conditions. The history should include details about the circumstances surrounding the syncope, any prodromal symptoms, the duration of loss of consciousness, and postictal symptoms, if present. Such an assessment is essential for determining whether further diagnostic testing or referrals are necessary. In this context, cardiac catheterization is typically reserved for patients with established heart disease rather than an initial evaluation for syncope. Imaging studies such as magnetic resonance imaging or a CT scan of the head can be important in certain scenarios but may not be the first-line procedures unless there are specific indications based on the patient's history or accompanying symptoms. Hence, the thorough history and physical examination remain the foundational steps in managing syncope.