During an examination of a 65-year-old, right-handed male who smokes and has type 2 diabetes mellitus, you hear a bruit over the left carotid artery, but not the right. You suspect __________. To confirm your suspicion, you might recommend the patient have ________________.

Question

Quizplus · Accepted Answer

You suspect the patient has a focal atherosclerotic obstruction of the left internal carotid artery (peripheral arterial disease); you recommend carotid ultrasonography to see how significant the obstruction may be, and whether it would benefit from bypass. In a right-handed person, a left-sided obstruction could potentially lead to a dominant stroke, affecting not just movement of the right side of the body, but also interrupting a patient's ability to speak. The other answers are incorrect. Cardiac murmurs typically are heard in both, rather than one carotid artery. It is unwise to assume the bruit is benign, especially in a person with serious risk factors for atherosclerotic vascular disease.

During an Examination of a 65-Year-Old, Right-Handed Male Who Smokes