American Board of Internal Medicine (ABIM) Certification Practice Exam

In the context of surgery for an intracranial aneurysm, when should clinical signs be considered?

1. When the aneurysm is smaller than 6 mm

2. Only if the patient has a history of seizures

3. When the aneurysm shows rapid growth

4. Only in emergency situations

The correct answer is: When the aneurysm shows rapid growth

In the context of intracranial aneurysm management, clinical signs are particularly significant when there is evidence that the aneurysm is showing rapid growth. This growth suggests an increase in the risk of rupture or complications that could be detrimental to the patient’s health. Rapid growth may indicate changes in the structural integrity of the aneurysm or surrounding vasculature, necessitating a more proactive surgical approach. When an aneurysm is smaller than 6 mm, it is generally considered to have a lower rupture risk, and routine surveillance is often adequate unless symptomatic. A history of seizures alone does not typically influence the surgical decision unless directly related to an aneurysmal rupture or other complications. In emergency situations, while clinical signs are crucial, they are not the only consideration regarding surgical intervention; the unique circumstances of each case must be evaluated. Thus, recognizing rapid growth as a critical factor in aneurysm management underscores the importance of actively monitoring changes in aneurysmal characteristics, which can inform and guide clinical decision-making for surgical intervention.