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Transient ischaemic attack — SCE Acute Medicine MCQ

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ModerateAcute Neurological PresentationsTransient ischaemic attackSCE Acute Medicine

A 67-year-old man is assessed on the acute medical unit. He had 20 minutes of right arm weakness and dysphasia that resolved. CT head is not indicated immediately and there is no anticoagulant use. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: D — Start aspirin and arrange urgent specialist assessment

Start aspirin and arrange urgent specialist assessment is the best answer because suspected TIA should receive immediate aspirin unless contraindicated and urgent stroke specialist assessment. Commence fixed-rate intravenous insulin infusion is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: The old ABCD2-based urgency approach has been superseded by rapid specialist review.

Reference: NICE NG128