Rosh Emergency Medicine Practice Test

In the case of a patient with a transient ischemic attack, what is the most appropriate intervention?

1. Administer alteplase and admit to the neurology unit

2. Begin aspirin, initiate a loading dose of clopidogrel, and admit to the neurology unit

3. Begin aspirin, initiate a loading dose of clopidogrel, and discharge home with neurology follow-up

4. Start heparin infusion and admit to the neurology unit

The correct answer is: Begin aspirin, initiate a loading dose of clopidogrel, and admit to the neurology unit

In the case of a transient ischemic attack (TIA), initiating aspirin and a loading dose of clopidogrel represents a standard guideline-recommended approach. TIAs are often precursors to full-blown strokes, and immediate management focuses on preventing recurrence and further cerebrovascular events. Aspirin is an antiplatelet medication that works by inhibiting platelet aggregation, thus helping to prevent thrombus formation. The loading dose of clopidogrel, another antiplatelet agent, can provide additional protection against ischemic events. The combination of these two medications has been shown to be effective in reducing the risk of subsequent strokes in individuals who have experienced a TIA. Furthermore, admission to the neurology unit allows for close monitoring and further evaluation of the patient's cerebrovascular risk profile. This is important as patients with TIAs may need additional diagnostic workup, such as carotid imaging or assessing other risk factors. This management offers both immediate treatment and a pathway for comprehensive care planning. The other interventions generally do not align with the standard management protocols for TIA. Administering alteplase is specifically reserved for patients with acute ischemic stroke, given its stringent time limitations and eligibility criteria. Starting a heparin infusion is typically not indicated