If you palpate a left-sided thrill along the carotid artery, what should you do next?

• A. Auscultate for bruits
• B. Percuss for dullness
• C. Carotid sinus massage
• D. Egophony

Answer: (A)

A palpable thrill along the carotid indicates turbulent, high-velocity flow through a narrowed vessel, which is most concerning for carotid stenosis. The next step is to auscultate the carotid arteries with a stethoscope to listen for a bruit, an audible sign of that turbulence. If a bruit is heard, it supports carotid disease as the cause of the abnormal flow.

Percussing for dullness isn’t relevant to carotid assessment, as it’s used for chest or abdominal findings. Carotid sinus massage is not appropriate here because manipulating the carotid in the setting of suspected stenosis can dislodge debris and risk a stroke. Egophony is a lung exam finding and doesn’t help evaluate carotid pathology.