docdoc9
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45. A 72-year-old man comes to the physician because of a 2-month history of episodes of tingling and numbness in the fingers of the left hand and a 2-week history of weakness of the left arm and vertigo. He has angina pectoris well controlled with nitrate therapy. His temperature is 37°C (98.6°F), blood pressure is 110/85 mm Hg in the left arm and 140/92 mm Hg in the right arm, pulse is 80/min and regular, and respirations are 20/min. Examination shows a bruit in the left clavicular region. There is no cyanosis, clubbing, or cardiac murmur. He has a slightly ataxic gait. Which of the following is the most appropriate next step in diagnosis?
A) Thallium stress test
B) Magnetic resonance angiography
C) Ultrasonographyof the carotid arteries
D) Ventilation-perfusion lung scans
E) CT scan of the head
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| jmkhanzada
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i think MRI/..............
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| nightflight1945
banned
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B) Magnetic resonance angiography
vertebrobasilar ischemia
the best next step would be doppler of vartebrobasilar or MRA
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| ngaybinhyen
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 MRI angio
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| docdoc9
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| altabban
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MRA, i's smelling aneurysim.
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| bppboom
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Why not C (ultrasonogrophy of the carotid)? Wouldn't that be the next best step? MRA is invasive, wouldn't that come after??? Someone explain?
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| vanshita
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why not c they ask best next step
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| ngaybinhyen
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The patient has vertebrobasilar ischemia.
Carotid U/S is used for anterior ischemia
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| vanshita
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Thank you
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| ngaybinhyen
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| insight
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Weak or absent radial and ulna pulse in the presence of ipsilateral reduced blood pressure (change > 20 mm HG) when compared to the contralateral arm suggest SSS.
I suggest the subclavian steal syndrome .
US: SSS most commonly is diagnosed incidentally during carotid and vertebral artery color Doppler US.
So the presffered examination is color Doppler US.
emedicine.
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| enitor
Forum Newbie
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although you are correct about subclavian steal syndrome, the answer choice is ultrasound of the CAROTID, which is not correct because you want to demonstrate flow reversal in the vertebral artery
so, B is the next best choice, and an accurate one for diagnosing SSS
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