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Q1: Definition & risk (2 min)
"Define a TIA and tell me why it matters."
- Tissue-based definition: transient focal neurological dysfunction from brain, spinal cord or retinal ischaemia WITHOUT acute infarction (replaces old under-24 h time-based definition).
- Typical duration under 1 hour; resolves completely.
- NOT benign: stroke risk 5 to 10 percent within 48 h, 10 to 20 percent within 90 days without treatment.
- A TIA is a warning shot / medical emergency — it predicts the imminent completed stroke.
Q2: ABCD2 score (2 min)
"Reproduce the ABCD2 score."
- Age over 60 → 1
- BP over 140 systolic or 90 diastolic → 1
- Clinical: unilateral weakness → 2 (max); speech impairment alone → 1
- Duration: over 60 min → 2; 10 to 59 min → 1; under 10 min → 0
- Diabetes → 1
- Range 0 to 7. Low 0 to 3, moderate 4 to 5, high 6 to 7 (high band ~8 percent two-day stroke risk).
- Limitation: predicts RISK (triage urgency) — does NOT diagnose TIA or exclude mimics; underperforms in young patients.
Q3: Investigations & mimics (3 min)
"How do you work up a suspected TIA, and what must you exclude?"
- Specialist assessment + imaging within 24 h (admit if ABCD2 over 4).
- CT brain first (exclude haemorrhage); MRI DWI confirms/excludes infarction (tissue definition).
- Carotid Doppler within 24 h for anterior-circulation events (CTA/MRA to plan surgery).
- ECG for atrial fibrillation; echo; Holter/loop recorder for paroxysmal AF if cryptogenic.
- Mimics (always exclude hypoglycaemia with a finger-prick glucose first): migraine aura (positive, marching symptoms), postictal/Todd paresis (preceded by seizure), syncope, functional, subdural, vestibular vertigo (HINTS — a 'bad'/central sign points to stroke).
Q4: Secondary prevention (3 min)
"What secondary prevention do you offer, and how does it differ for AF?"
- Non-cardioembolic: dual antiplatelet (aspirin + clopidogrel) for 21 days then monotherapy (CHANCE / POINT); high-intensity statin; BP under 130/80; smoking cessation; glycaemic control.
- Cardioembolic (AF): anticoagulation (DOAC preferred), NOT antiplatelets — start immediately for TIA (no infarct, no haemorrhagic-transformation delay).
- Carotid stenosis over 70 percent (symptomatic): endarterectomy within 2 weeks (NNT 3 for over 70 percent; benefit collapses with delay).
- Aggressive bundle prevents up to 80 percent of predicted 90-day strokes.
Q5: Prognosis & pitfalls (2 min)
"What predicts the worst outcome, and what mistakes do candidates make?"
- Highest risk: ABCD2 over 6, carotid stenosis, AF, recurrent (crescendo) events, positive DWI.
- Pitfalls: labelling a mimic (hypoglycaemia, migraine, seizure) as TIA, or dismissing a true TIA as trivial; not excluding haemorrhage before antiplatelets; delaying CEA beyond 2 weeks; giving antiplatelets instead of anticoagulants in AF.