Vascular Disease USMLE Step 1 Practice Question
A 64-year-old man with hyperlipidemia and hypertension taking lisinopril presents with recurrent episodes of monocular transient vision loss lasting 5-10 minutes. Vital signs: BP 148/92 mmHg, HR 78/min, RR 16/min, temp 37°C. Duplex ultrasound demonstrates 50% stenosis of the right internal carotid artery with heterogeneous plaque; LDL cholesterol 165 mg/dL. No acute stroke on brain MRI. Which intervention is most appropriate?
Answer choices
- APerform emergent carotid endarterectomy within 24 hours
- BInitiate intravenous thrombolytic therapy
- CObserve conservatively without intervention
- DInitiate aspirin and schedule elective carotid endarterectomyCorrect answer
- EStart high-dose anticoagulation with warfarin immediately
- FIncrease lisinopril dose and add amlodipine for better blood pressure control
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