American Board of Internal Medicine (ABIM) Certification Practice Exam

What test is recommended for evaluating suspected reflex syncope under specific conditions?

1. Electrophysiological studies

2. Heart ultrasound

3. Tilt-table testing

4. Holter monitoring

The correct answer is: Tilt-table testing

Tilt-table testing is recommended for evaluating suspected reflex syncope under specific conditions because it effectively reproduces syncope episodes in a controlled setting. This test is particularly useful for patients who experience recurrent unexplained fainting spells, helping to differentiate between syncope due to reflex mechanisms (like vasovagal syncope) and other potential causes such as orthostatic hypotension or structural heart disease. During tilt-table testing, the patient is secured on a table that tilts from a horizontal to a vertical position, allowing for the assessment of blood pressure and heart rate responses. The test can provoke syncope in susceptible individuals, making it easier to observe the physiological changes that occur during an episode. This information is critical for both diagnosis and management, guiding potential therapeutic interventions. Other tests mentioned, like electrophysiological studies or Holter monitoring, primarily focus on identifying arrhythmias or electrical abnormalities in the heart, which may not be the root cause of reflex syncope. Heart ultrasound (echocardiogram) is used to assess structural heart abnormalities but does not typically evaluate the mechanisms behind syncope effectively. Thus, tilt-table testing provides the best direct insight into reflex syncope and its triggers.