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RIU 436 Lecture Notes - Lecture 37: Internal Carotid Artery, Atrial Fibrillation, Brad DelsonExam

Radiation and Imaging - Ultrasound
Course Code
RIU 436
Miram Teft
Study Guide

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1. A woman in her late 80s referred from the Stroke Prevention
Clinic presented with transient right arm weakness that had
persisted for approximately 6 hours. The patient had a history of
atrial fibrillation and was being treated with warfarin.
Laboratory analysis demonstrated a subtherapeutic
international normalized ratio (INR) of 1.4. Therapeutic levels for
this laboratory test that monitors the relative degree of
anticoagulation should be between 2.0 and 3.0.6 At that time, her
warfarin dose was readjusted to regulate her INR into the
therapeutic range, and she was referred for a carotid duplex
sonogram. Her past history included a mild stroke in 2004 with
residual left facial asymmetry.
Which side would you expect to see arterial disease on?
A. Right OR
B. Left
C. Bilateral
D. Inconclusive
 
2. The following images were taken from the above patient’s
carotid duplex:

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What pathology is most suspicious based on these images:
A. Bilateral carotid stenosis
B. A more proximal stenosis on the right side
C. A more distal occlusion on the right side
D. Proximal stenosis on the left; distal occlusion on
the right
3. A 72-year-old female with a past medical history of
hypertension and hyperlipidemia presented to the cardiology
office for a consultation. The patient was noted to have carotid
atherosclerotic plaque seen on an outside screening
examination. She was asymptomatic at presentation for the

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sonogram. To further evaluate this abnormal screening exam
result, a carotid duplex imaging was performed. The carotid
duplex gray-scale imaging showed that her right and left
common and internal carotid arteries contained very mild
atherosclerotic plaque. Additionally, a 1.6 × 1.8 × 1.5 cm mass was
noted at the left common carotid bifurcation (Figure 1).
What is the most likely underlying pathology?
A. Pseudoaneurysm
B. Lymphadenopathy
C. Carotid body tumor
D. Carotid dissection
4. A 39-year-old woman with Graves disease, after
radioisotope therapy, and suffering from polycystic ovary
syndrome, was admitted to the hospital due to paraparesis
reported on the third day postpartum. Two years earlier she
suddenly developed transient right Horner syndrome, alteration
in the bitter taste (a symptom of dysgeusia), and right mandible
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