Vascular Disease USMLE Step 1 Practice Question
A 45-year-old man with a 20-year smoking history and uncontrolled hypertension (BP 168/98 mmHg, HR 92 bpm) presents with transient monocular vision loss lasting 15 minutes that completely resolved. Neurologic examination is intact with no focal deficits. Carotid ultrasound reveals 70% stenosis of the right internal carotid artery with irregular ulcerated plaque. LDL cholesterol is 156 mg/dL. Which of the following is the most appropriate management?
Answer choices
- AWarfarin anticoagulation to prevent cardioembolic stroke
- BImmediate thrombolytic therapy for acute stroke
- CCarotid endarterectomy or endovascular stenting plus medical optimizationCorrect answer
- DAspirin monotherapy with serial carotid ultrasound surveillance
- EConservative observation with blood pressure control alone
- FCilostazol monotherapy with close neurologic follow-up
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