MKSAP: 57-year-old man is seen after results of a carotid ultrasound

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old man is seen for follow-up evaluation after results of a carotid ultrasound obtained to investigate a left neck bruit show a mixed density plaque at the origin of the left internal carotid artery. Stenosis is estimated to be 60% to 80%. He has had no focal neurologic symptoms or visual loss. The patient has coronary artery disease (CAD) with stable angina, hypertension, dyslipidemia, type 2 diabetes mellitus, and mild kidney failure. He has a 30-pack-year smoking history but stopped smoking 7 years ago when CAD was diagnosed. Medications are aspirin, metoprolol, lisinopril, metformin, and nitroglycerin, as needed. He was taking rosuvastatin but discontinued the medication 2 years ago after developing muscle aches. On physical examination, blood pressure is 132/78 mm Hg, pulse rate is 78/min and regular, and respiration rate is 16/min. The left neck bruit is unchanged. Cardiopulmonary examination has normal results. All other findings from the general medical and neurologic examinations are unremarkable. Which of the following is the most appropriate next step in management? A. Carotid endarterectomy B. Magnetic resonance angiography of the neck C. Resumption of statin therapy D. Substitution of clopidogrel for aspirin Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out...
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Heart Source Type: blogs