American Board of Internal Medicine (ABIM) Certification Practice Exam

What is recommended for patients with cryptogenic ischemic stroke to assess for atrial fibrillation?

1. Short-term telemetry monitoring

2. Prolonged cardiac monitoring

3. Regular ECG screenings

4. Holter monitoring for 24 hours

The correct answer is: Prolonged cardiac monitoring

Prolonged cardiac monitoring is the recommended approach for patients with cryptogenic ischemic stroke to assess for underlying atrial fibrillation. This strategy is crucial because atrial fibrillation may be paroxysmal, meaning it does not occur constantly and may not be detected during short monitoring periods. By utilizing prolonged monitoring, typically extending from weeks to several months, physicians can capture intermittent episodes of atrial fibrillation that might have led to the stroke. On the other hand, short-term telemetry monitoring and Holter monitoring for just 24 hours generally provide too limited a time frame to detect these irregular rhythms effectively, especially since atrial fibrillation can occur sporadically. Regular ECG screenings also fall short, as they are typically conducted during routine check-ups and are not continuous, thus missing the opportunity to catch transient atrial fibrillation episodes. Therefore, prolonged cardiac monitoring offers the best chance at identifying these occurrences, making it the preferred method in this context.