Neurology: carotid stenosis and stroke prevention: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Neurology: carotid stenosis and stroke prevention

Sample item

A 66-year-old man had a 5-minute episode of painless blindness in the right eye three days ago. Carotid Doppler shows 80% stenosis of the right internal carotid artery, and MRI shows no infarct. What is the best management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Carotid endarterectomy within 2 weeks, with antiplatelet and statin therapy

Amaurosis fugax, a transient ischaemic event of the retina, is ipsilateral to the carotid stenosis. In recently symptomatic patients with 70 to 99% stenosis, endarterectomy gives the greatest benefit when done within 2 weeks of the event. Antiplatelet therapy and a high-intensity statin are used alongside.

Option by option

  • A. Warfarin anticoagulation alone

    Anticoagulation has no advantage over antiplatelet therapy in carotid atherosclerosis.

  • B. Carotid endarterectomy within 2 weeks, with antiplatelet and statin therapy (correct)

    Correct. Early endarterectomy prevents a subsequent disabling stroke.

  • C. Urgent intravenous thrombolysis

    The symptoms have fully resolved, so thrombolysis is not indicated.

  • D. Medical therapy alone with review in one year

    Medical therapy alone suits asymptomatic or low-grade stenosis and leaves a high early stroke risk here.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Carotid endarterectomy within 2 weeks, with antiplatelet and statin therapy. Amaurosis fugax, a transient ischaemic event of the retina, is ipsilateral to the carotid stenosis.

Why is "Warfarin anticoagulation alone" not the answer?

Anticoagulation has no advantage over antiplatelet therapy in carotid atherosclerosis.

Why is "Urgent intravenous thrombolysis" not the answer?

The symptoms have fully resolved, so thrombolysis is not indicated.

Why is "Medical therapy alone with review in one year" not the answer?

Medical therapy alone suits asymptomatic or low-grade stenosis and leaves a high early stroke risk here.

What concept does this question test?

It tests Neurology: carotid stenosis and stroke prevention in General Medicine. In recently symptomatic patients with 70 to 99% stenosis, endarterectomy gives the greatest benefit when done within 2 weeks of the event. Antiplatelet therapy and a high-intensity statin are used alongside.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neurology: carotid stenosis and stroke prevention?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.