If the patient is middle-aged or elderly, you should auscultate for bruits. A bruit is often, but not always, a sign of arterial narrowing and risk of a stroke.

• Place the bell of the stethoscope over each carotid artery in turn. You may use the diaphragm if the patient's neck is highly contoured

• Ask the patient to stop breathing for a moment

• Listen for a blowing or rushing sound-a bruit.
  Do not be confused by heart sounds or murmurs transmitted from the chest