Cerebrovascular Disease USMLE Step 1 Practice Question
A 52-year-old man with a 20-pack-year smoking history and hyperlipidemia presents to the emergency department after experiencing two episodes of right-sided facial droop and arm weakness over the past week. Each episode lasted 18 minutes and resolved completely. He denies headache, vision changes, or speech difficulties. Vital signs are BP 158/92 mmHg, HR 78/min, temperature 37°C. Neurologic examination is now normal. Carotid duplex ultrasound shows 70% stenosis of the left internal carotid artery with peak systolic velocity of 230 cm/s. Laboratory values include LDL cholesterol 180 mg/dL, triglycerides 145 mg/dL, and fasting glucose 102 mg/dL. MRI brain with diffusion-weighted imaging shows no acute infarction. Which of the following is the most appropriate next step in management?
Answer choices
- AInitiate aspirin 81 mg daily and high-intensity statin therapy with repeat carotid imaging in 3 months
- BStart warfarin with target INR 2-3 for cardioembolic stroke prevention
- CPerform carotid endarterectomy within 2 weeksCorrect answer
- DRefer for carotid artery angioplasty and stenting as an alternative to surgery
- EAdminister intravenous alteplase followed by heparin infusion
- FObserve clinically with antithrombotic therapy pending results of transthoracic echocardiography
See the full explanation
Get the correct-answer rationale, why each distractor is wrong, the underlying mechanism, and high-yield associations — plus adaptive practice that targets your weak areas — with a free MedBoardPRO account.