A 67-Year-Old Woman with Stable Angina Pectoris Comes to the Office

question 540

Multiple Choice

A 67-year-old woman with stable angina pectoris comes to the office for follow-up.  She has occasional retrosternal chest pain on heavy exertion, which improves with sublingual nitroglycerin.  The patient has had no shortness of breath, palpitations, headache, or focal neurological symptoms.  Medical history is significant for hypertension, type 2 diabetes mellitus, peripheral vascular disease, and a 3.5-cm abdominal aortic aneurysm.
Physical examination shows a carotid bruit.  Duplex ultrasonography reveals complete occlusion of the right internal carotid artery and mild stenosis of the left internal carotid artery.
Which of the following is the best management for this patient's carotid disease?

• A)Carotid artery bypass surgery
• B)Carotid artery stenting
• C)Carotid endarterectomy
• D)Medical therapy only

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Definitions:

Soil

The top layer of earth in which plants grow, composed of organic matter, minerals, gases, liquids, and organisms that together support life.

Pore Spaces

Voids or gaps found within soil or rock, where air or fluid can be stored.

Leaching

The process by which dissolved materials are washed away or carried with water down through the various layers of the soil.

Rhizobacteria

Beneficial bacteria that reside in the soil close to plant roots, often enhancing plant growth or protecting against pathogens.