What is the recommended initial assessment for carotid bruits?

• A. MRI first
• B. Auscultation with a bell, then Doppler
• C. Palpation only
• D. CT angiography first

Answer: (B)

Auscultation with the bell of the stethoscope is the initial step. Focused listening over the carotid arteries can detect a carotid bruit, which signals turbulent blood flow from potential atherosclerotic stenosis. If a bruit is heard or there’s continued clinical concern, follow with carotid duplex ultrasonography (Doppler) to quantify stenosis, assess plaque, and evaluate blood flow. MRI or CT angiography are advanced imaging options used for detailed anatomy or preoperative planning, not first-line screening. Palpation alone is unreliable for detecting bruits and isn’t sufficient as an initial assessment.