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  #1  
Old 02-08-2012
qurat21's Avatar
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Default pt with impaired vision

A 55-year-old man presents to the emergency room with a sudden loss of vision in his left eye 10 minutes ago. He states that it was as though a curtain descended on his vision and stopped half way. He denies any associated pain, nausea, vomiting, or symptoms in his other eye. On examination, the superior visual field of the left eye is impaired. A left side carotid bruit is detected. The remainder of the examination is within normal limits. While drawing blood for laboratory investigation, the patient suddenly notices that his vision has been restored. Further visual field examination confirms resolution of the patient's symptoms. Duplex ultrasonography reveals 90% stenosis in the left carotid artery and 40% stenosis in the right carotid artery. What is the most appropriate management to prevent mortality in this patient?
A. Aspirin
B. Aspirin and clopidogrel
C. Carotid endarterectomy
D. Clopidogrel
E. Contrast angiography
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  #2  
Old 02-08-2012
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Quote:
Originally Posted by qurat21 View Post
A 55-year-old man presents to the emergency room with a sudden loss of vision in his left eye 10 minutes ago. He states that it was as though a curtain descended on his vision and stopped half way. He denies any associated pain, nausea, vomiting, or symptoms in his other eye. On examination, the superior visual field of the left eye is impaired. A left side carotid bruit is detected. The remainder of the examination is within normal limits. While drawing blood for laboratory investigation, the patient suddenly notices that his vision has been restored. Further visual field examination confirms resolution of the patient's symptoms. Duplex ultrasonography reveals 90% stenosis in the left carotid artery and 40% stenosis in the right carotid artery. What is the most appropriate management to prevent mortality in this patient?
A. Aspirin
B. Aspirin and clopidogrel
C. Carotid endarterectomy
D. Clopidogrel
E. Contrast angiography
C. cuz of significant left carotid stenosis (>70% occlusion). The patient experienced amaurosis fugax (due to embolism from carotid plaque into opthalmic artery)
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  #3  
Old 02-08-2012
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ya C.is it?
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  #4  
Old 02-08-2012
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A? Aspirin

My gut was to say C, but wouldn't that be the next step in management, not what would decrease mortality?
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Old 02-08-2012
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Going with c is right for the carotid is over 90% stenosis
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Old 02-09-2012
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C. Carotid endarterectomy.
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  #7  
Old 02-09-2012
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Yeah.....for this patient appropiate management would be definitely option C)Carotid endarterectomy
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