Which maneuver should be avoided to prevent dislodging plaque if a carotid obstruction is suspected?

• A. Auscultate for bruits
• B. Deep palpation
• C. Palpate both carotids
• D. Apply cold compress

Answer: (B)

In suspected carotid obstruction, the danger is that fragile atherosclerotic plaque can be dislodged by manipulation of the artery. Deep palpation applies firm pressure directly to the vessel, which can push loose plaque fragments into the bloodstream and travel to the brain, causing an embolic stroke. For this reason, deep carotid palpation should be avoided.

Auscultation for bruits is safe and useful because it detects turbulent flow from stenosis without disturbing the plaque. Palpating the carotids, especially on both sides, isn’t helpful for diagnosing obstruction and could increase risk. Applying a cold compress doesn’t address the vascular issue and isn’t a protective or diagnostic maneuver here.