Cerebrovascular Disease USMLE Step 1 Practice Question
A 68-year-old man with hypertension and a 40 pack-year smoking history presents to his primary care physician with a history of two episodes of left-sided facial droop and arm weakness over the past 6 weeks, each lasting 15-25 minutes before completely resolving. He has no residual neurological deficits on examination. Vital signs are BP 156/94 mmHg, HR 86/min, RR 16/min, SpO2 97% on room air. Carotid duplex ultrasound reveals 70% stenosis of the right internal carotid artery with peak systolic velocity of 230 cm/s. MRI of the brain with diffusion-weighted imaging shows no acute infarction and no prior territorial infarcts. Which of the following is the most appropriate next step in management?
Answer choices
- AInitiate dual antiplatelet therapy with aspirin and clopidogrel and arrange follow-up duplex ultrasound in 6 weeks
- BRefer for carotid endarterectomy after confirming with CT or MR angiographyCorrect answer
- CPerform transcranial Doppler ultrasound to assess for right-to-left cardiac shunting
- DInitiate anticoagulation with apixaban and perform cardiac workup including echocardiography and Holter monitoring
- EObtain CT angiography of the head and neck followed by carotid artery stenting
- FTreat with aspirin monotherapy and manage cardiovascular risk factors without further intervention
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.