Carotid Artery Disease — MCQs
Investigation of choice for screening of proximal internal carotid artery stenosis is :
All of the following come under priority of Stroke control programme EXCEPT:
Following are the risk factors of atherosclerosis, except?
Anterior choroidal artery is a branch of which of the following arteries?
A woman presenting with abrupt onset of "the worst headache of her life" Which is the best investigation?
Which of the following is NOT a risk factor for atherosclerosis?
Which of the following is the best management for radiation induced occlusive disease of carotid artery?
Which of these is a palliative shunt procedure created between the left subclavian artery and pulmonary artery to treat cyanotic congenital heart disease?
Following endarterectomy on the right common carotid, a patient is found to be blind in the right eye. It appears that a small thrombus embolized during surgery and lodged in the artery supplying the retina. Which artery would be blocked?
What type of ulcer is shown below?
Carotid Artery Disease Indian Medical PG Practice Questions and MCQs
Question 1: Investigation of choice for screening of proximal internal carotid artery stenosis is :
- A. Doppler ultrasound (USG) (Correct Answer)
- B. CT angiography
- C. Magnetic resonance imaging (MRI)
- D. Digital subtraction angiography (DSA)
Explanation: ***Doppler ultrasound (USG)*** - **Doppler ultrasound** is the investigation of choice for screening carotid artery stenosis due to its **non-invasive nature**, widespread availability, and cost-effectiveness. It provides excellent anatomical information and hemodynamics, including **blood flow velocity** and presence of **plaque**. - It can effectively estimate the degree of **stenosis** based on flow characteristics and is safe for serial monitoring. *CT angiography* - **CT angiography** provides detailed anatomical imaging of the carotid arteries but involves **ionizing radiation** and **iodinated contrast agents**, making it less suitable for routine screening, especially in patients with renal impairment or contrast allergies. - While it offers higher resolution for certain plaque characteristics, it’s typically reserved for cases where ultrasound findings are inconclusive or for surgical planning. *Magnetic resonance imaging (MRI)* - **MRI** and **MR angiography (MRA)** can visualize carotid stenosis without ionizing radiation but are more expensive and time-consuming than ultrasound, and can be limited by artifacts from patient movement. - Patients with **claustrophobia** or **metallic implants** may not be suitable for MRI, making it less ideal for general screening. *Digital subtraction angiography (DSA)* - **Digital subtraction angiography (DSA)** is the **gold standard** for diagnosing carotid stenosis as it provides the most detailed and accurate images of the arterial lumen. However, it is an **invasive procedure** associated with risks such as stroke, arterial dissection, contrast nephropathy, and radiation exposure. - Due to its invasiveness and potential complications, DSA is typically reserved for cases with **discordant non-invasive findings** or prior to intervention rather than as a primary screening tool.
Question 2: All of the following come under priority of Stroke control programme EXCEPT:
- A. Control of alcoholism (Correct Answer)
- B. Control of smoking
- C. Control of diabetes
- D. Control of hypertension
Explanation: ***Control of alcoholism*** - While **alcoholism** is a health concern, its direct and immediate impact as a primary modifiable risk factor for stroke in large-scale stroke control programs is generally less emphasized compared to other factors. - Stroke control programs typically prioritize risk factors with a more direct and significant impact on stroke incidence and severity, such as hypertension, diabetes, and dyslipidemia. *Control of smoking* - **Smoking** is a major modifiable risk factor for stroke, significantly increasing the risk of both ischemic and hemorrhagic stroke due to its effects on atherosclerosis and clotting. - Quitting smoking is a cornerstone of any stroke prevention strategy, and thus its control is a high priority. *Control of diabetes* - **Diabetes** significantly increases the risk of stroke by promoting atherosclerosis and affecting blood vessel health. - Strict glycemic control is essential in preventing stroke and is a priority in stroke control programs. *Control of hypertension* - **Hypertension** is the most important modifiable risk factor for stroke, contributing to both ischemic and hemorrhagic strokes. - Effective blood pressure management is critical for primary and secondary stroke prevention and is a top priority in stroke control programs.
Question 3: Following are the risk factors of atherosclerosis, except?
- A. Diabetes
- B. Regular moderate exercise (Correct Answer)
- C. Obesity
- D. Hypertension
Explanation: ***Obesity*** - Obesity is considered a **modifiable risk factor** for atherosclerosis as it can be addressed through lifestyle changes like diet and exercise. [2] - It is associated with increased levels of **LDL cholesterol** and other metabolic disturbances that contribute to vascular disease. [5] *Hypertension* - Hypertension is also a **modifiable risk factor** and can be managed through medication and lifestyle changes. [4] - Elevated blood pressure contributes to **endothelial damage** and atherosclerosis progression. [1] *Diabetes* - Diabetes is a significant **modifiable risk factor** as it can worsen atherosclerosis through high blood sugar levels damaging blood vessels. [4] - Management of diabetes through diet, exercise, and medication can significantly reduce cardiovascular risk. [3] *Physical inactivity* - Physical inactivity is a **modifiable risk factor** as regular exercise can improve cardiovascular health and lower atherosclerosis risk. - Increased physical activity helps maintain a healthy weight and reduces **blood pressure** and blood sugar levels.
Question 4: Anterior choroidal artery is a branch of which of the following arteries?
- A. Basilar artery
- B. Anterior cerebral artery
- C. Posterior cerebral artery
- D. Internal carotid artery (Correct Answer)
Explanation: ***Correct: Internal carotid artery*** - The **anterior choroidal artery** is a direct branch of the **internal carotid artery**, specifically originating from its **supraclinoid segment**. - It supplies crucial structures such as the **choroid plexus of the lateral ventricle**, parts of the **hippocampus**, **amygdala**, and the **posterior limb of the internal capsule**. - This is a clinically important vessel, as occlusion can lead to significant neurological deficits. *Incorrect: Basilar artery* - The basilar artery is part of the **posterior circulation**, formed by the union of the vertebral arteries. - It gives rise to branches like the **pontine arteries**, **superior cerebellar arteries**, and **posterior cerebral arteries**, but not the anterior choroidal artery. *Incorrect: Anterior cerebral artery* - The anterior cerebral artery is a terminal branch of the **internal carotid artery**, but it primarily supplies the **medial surface of the frontal and parietal lobes**. - It does not give rise to the anterior choroidal artery; instead, the anterior choroidal artery branches off the internal carotid artery more **proximally**, before the terminal bifurcation. *Incorrect: Posterior cerebral artery* - The posterior cerebral artery is a terminal branch of the **basilar artery** and is part of the posterior circulation. - It supplies the **occipital lobe** and parts of the **temporal lobe**. - Its branches include **posterior choroidal arteries** (not anterior choroidal artery), which supply the choroid plexus of the third ventricle and lateral ventricles.
Question 5: A woman presenting with abrupt onset of "the worst headache of her life" Which is the best investigation?
- A. Vessel carotid Doppler
- B. NCCT of the head (Correct Answer)
- C. No imaging
- D. MRI
Explanation: ***NCCT of the head*** - A **non-contrast CT scan of the head** is the immediate and most appropriate first imaging study for a suspected **subarachnoid hemorrhage (SAH)**, often presenting as the "worst headache of her life" [1]. - It can rapidly detect blood in the **subarachnoid space** with high sensitivity, particularly within the first 6-12 hours of symptom onset [1], [2]. *Vessel carotid Doppler* - **Carotid Doppler ultrasound** is primarily used to assess **carotid artery stenosis** or dissection, which would not be the initial investigation for a sudden severe headache [2]. - It does not visualize intracranial blood or vascular abnormalities within the brain parenchyma or subarachnspace. *No imaging* - Given the severe, abrupt onset "worst headache of her life," **subarachnoid hemorrhage (SAH)** is a critical differential, making no imaging an inappropriate and potentially dangerous choice. - Delaying imaging could lead to severe neurological consequences if SAH is missed. *MRI* - While **MRI** can detect SAH, it is generally less accessible, takes more time to perform, and is less suitable for the initial rapid assessment of **acute SAH** compared to NCCT [3]. - **MRI** is often used for follow-up evaluation or when CT findings are equivocal, but not as the first-line emergency investigation.
Question 6: Which of the following is NOT a risk factor for atherosclerosis?
- A. Smoking
- B. High blood pressure
- C. High cholesterol
- D. Normal LDL cholesterol (Correct Answer)
Explanation: ***Normal LDL cholesterol*** - Maintaining **normal LDL cholesterol levels** indicates a healthy lipid profile and does not promote the accumulation of plaque in arteries, thus it is not a risk factor for atherosclerosis. - In fact, keeping LDL cholesterol within the normal range is a **protective factor** against the development and progression of atherosclerosis. *Smoking* - **Smoking** is a significant risk factor for atherosclerosis as it damages the **endothelium** (the inner lining of blood vessels), making it more susceptible to plaque formation. - It also reduces **HDL cholesterol** (good cholesterol) and increases **blood viscosity**, further contributing to arterial damage and clot formation. *High blood pressure* - **High blood pressure (hypertension)** is a major risk factor because it creates increased force against the artery walls, leading to **endothelial injury** and promoting the infiltration of lipids [1], [2]. - This chronic stress on the arterial walls accelerates the development of **atherosclerotic plaques** and stiffening of arteries [1]. *High cholesterol* - Specifically, **high levels of LDL cholesterol** (low-density lipoprotein, often referred to as "bad" cholesterol) directly contribute to atherosclerosis by depositing cholesterol within the arterial walls [3], [4]. - These deposits form **fatty streaks** that can progress into mature atherosclerotic plaques, narrowing arteries and impeding blood flow [3].
Question 7: Which of the following is the best management for radiation induced occlusive disease of carotid artery?
- A. Carotid endarterectomy
- B. Low dose aspirin
- C. Carotid bypass procedure
- D. Carotid angioplasty and stenting (Correct Answer)
Explanation: ***Carotid angioplasty and stenting*** - **Radiation-induced carotid artery disease** often involves the distal part of the carotid artery, making it less amenable to surgical endarterectomy. - **Angioplasty and stenting** offer a less invasive approach with good technical success in these challenging cases, especially given the increased fragility and fibrosis of radiated tissues. *Carotid endarterectomy* - **Carotid endarterectomy** in previously radiated fields is associated with a significantly higher risk of complications, including **cranial nerve injury**, **wound infection**, and **carotid artery rupture**, due to tissue fibrosis and scarring. - The disease often extends beyond the easily accessible segment for endarterectomy in radiation-induced cases. *Low dose aspirin* - **Low-dose aspirin** is an important component of medical therapy for **atherosclerotic disease** and **stroke prevention**, but it is insufficient as a sole treatment for symptomatic or high-grade occlusive disease of the carotid artery. - It helps manage the underlying **atherosclerotic process** but does not directly address the severe stenosis or occlusion. *Carotid bypass procedure* - **Carotid bypass procedures** are complex surgical interventions usually reserved for cases of **carotid artery occlusion** or **recurrent stenosis** after previous interventions where endarterectomy or stenting is not feasible. - While an option, it is more invasive and technically demanding than angioplasty and stenting, particularly in already radiated tissues with compromised vascular integrity.
Question 8: Which of these is a palliative shunt procedure created between the left subclavian artery and pulmonary artery to treat cyanotic congenital heart disease?
- A. Waterston's shunt
- B. Lieno renal shunt
- C. Gott’s shunt
- D. Blalock-Taussig shunt (Correct Answer)
Explanation: **Blalock-Taussig shunt** - This procedure creates a **systemic-to-pulmonary artery shunt** by anastomosing a systemic artery (often the **subclavian artery**) to the pulmonary artery, increasing **pulmonary blood flow**. - It is a palliative measure for **cyanotic congenital heart diseases** where there is reduced pulmonary blood flow, such as **Tetralogy of Fallot**. *Waterston's shunt* - This is an older, no longer commonly used palliative shunt connecting the **ascending aorta to the right pulmonary artery**. - It was associated with a high incidence of complications, including **pulmonary overcirculation** and **pulmonary vascular disease**. *Lieno renal shunt* - This refers to a shunt created between the **splenic vein (lienal vein)** and the **left renal vein**. - It is primarily used to treat **portal hypertension** by decompressing the portal venous system, not congenital heart disease. *Gott's shunt* - This involves a **temporary bypass shunt** often used during **thoracic aortic surgery** to protect the spinal cord from ischemia. - It maintains blood flow to the distal aorta during aortic clamping and is not related to congenital heart disease palliation.
Question 9: Following endarterectomy on the right common carotid, a patient is found to be blind in the right eye. It appears that a small thrombus embolized during surgery and lodged in the artery supplying the retina. Which artery would be blocked?
- A. Nasociliary artery
- B. Infraorbital artery
- C. Lacrimal artery
- D. Central artery of the retina (Correct Answer)
Explanation: ***Central artery of the retina*** - The **central artery of the retina** is a branch of the **ophthalmic artery** that supplies blood to the inner two-thirds of the retina, including the **photoreceptors** and **ganglion cells**. - Its occlusion, often due to an **embolus** like in this scenario, leads to sudden, **painless monocular vision loss**, often described as a "curtain" coming down, which aligns with **blindness in the right eye**. *Nasociliary artery* - The **nasociliary artery** supplies structures like the **ethmoid sinuses**, **dura mater**, and part of the **nasal cavity**. - It does not directly supply the **optic nerve** or the **retina** and its occlusion would not cause blindness. *Infraorbital artery* - The **infraorbital artery** supplies structures in the **maxilla**, **lower eyelid**, and part of the **cheek**. - Its occlusion would primarily affect these areas and would not result in **blindness**. *Lacrimal artery* - The **lacrimal artery** primarily supplies the **lacrimal gland**, which produces tears, as well as parts of the **eyelids** and **conjunctiva**. - While it's a branch of the ophthalmic artery, its occlusion would not directly cause **blindness** by affecting the retina or optic nerve.
Question 10: What type of ulcer is shown below?
- A. Venous ulcer
- B. Arterial ulcer (Correct Answer)
- C. Trophic ulcer
- D. Diabetic foot
Explanation: ***Arterial ulcer*** - The image depicts an ulcer with a **punched-out appearance**, often found on the toes, heels, or shin, indicative of **arterial insufficiency**. - The surrounding skin appears **pale** and might show signs of **trophic changes** (e.g., hair loss, shiny skin), consistent with poor arterial blood supply. *Venous ulcer* - Venous ulcers typically occur around the **medial malleolus**, are superficial, and have irregular borders with a **"gaiter" appearance** (brawny edema and hyperpigmentation). - The ulcer bed is usually ruddy red with **exudate** and the surrounding skin often shows signs of **venous stasis changes**. *Trophic ulcer* - "Trophic ulcer" is a broad term for an ulcer caused by **poor nutrition** or nerve supply, and can encompass arterial or neuropathic ulcers. - This term is less specific than identifying the underlying vascular etiology shown in the image. *Diabetic foot* - Diabetic foot ulcers often occur on **pressure points** of the foot, such as the plantar surface or the heel, and can be neuropathic or neuro-ischemic. - While this image could potentially be associated with diabetes due to microvascular complications, the **punched-out, ischemic appearance** more strongly points to an arterial origin which can occur independently of diabetes.
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