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Vascular Ultrasound > Abdominal Vascular Studies > Flashcards

Abdominal Vascular Studies Flashcards

1
Q 
What branch of the abdominal aorta sends blood to the spleen via the splenic artery?
A. Superior mesenteric artery
B. Inferior mesenteric artery
C. Celiac artery
D. Gastroduodenal artery
A

C. The celiac axis has three branches: the left gastric artery, not usually seen by ultrasound, the common hepatic artery, and the splenic artery.

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2
Q 
Which blood vessel acts as a collateral in the presence of celiac artery obstruction?
A. Proper hepatic artery
B. Inferior mesenteric artery
C. Left gastric artery
D. Gastroduodenal artery
A

D. The gastroduodenal artery (GDA) is a branch of the common hepatic artery, and connects to the superior mesenteric artery (SMA) via collaterals. The GDA acts as a collateral in the presence of celiac axis obstruction.

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3
Q 
The terminal branches of the renal artery are the
A. Interlobular arteries
B. Interlobar arteries
C. Segmental arteries
D. Arcuate arteries
A

A. The interlobular branches are the most distal branches in the kidneys. They originate from the arcuate arteries.

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4
Q 
The anatomic position of the left renal vein is typically anterior to the 
A. IVC
B. Aorta
C. Superior mesenteric artery
D. Right renal artery
A

B. The left renal vein typically lies between the SMA and the aorta. In some patients the left renal vein has an aberrant course posterior to the aorta, but this is not the typical presentation.

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5
Q 
Which of the following is a systemic vein?
A. Main portal vein
B. Left hepatic vein
C. Superior mesenteric vein
D. Splenic vein
A

B. The left hepatic vein is part of the systemic circulation, while the other vessels listed are part of the portal venous circulation.

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6
Q 
Which of the following vessels follow a course that is posterior to the inferior vena cava?
A. The left renal vein
B. The right renal vein
C. The left renal artery
D. The right renal artery
A

D. The right renal artery is the only major blood vessel that lies posterior to the inferior vena cava (IVC).

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7
Q 
The paraumbilical vein is a terminal branch of the
A. Left hepatic vein
B. Left portal vein
C. Right hepatic vein
D. Cardinal vein
A

B. The paraumbilical vein, also known as a recanalized umbilical vein, is a collateral that originates from the left portal vein. A remnant of fetal circulation, that may become patent in the presence of portal hypertension.

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8
Q 
The hepatic veins terminate at the
A. Inferior vena cava
B. Superior vena cava
C. Main portal vein
D. Portal splenic confluence
A

A. The hepatic veins drain the liver and form a confluence in the superior portion of the liver that drains into the IVC.

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9
Q 
Which blood vessel is not usually seen with ultrasound imaging?
A. Inferior mesenteric artery
B. Left gastric artery
C. Superior mesenteric vein
D. Splenic artery
A

B. The left gastric artery, a branch of the celiac axis, is not usually visualized with ultrasound.

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10
Q 
The portal splenic confluence is made up of the splenic vein and which portal vessel?
A. Splenic artery
B. Inferior mesenteric vein
C. Superior mesenteric vein
D. Middle hepatic vein
A

C. The SMV and the splenic vein form a confluence called the portal splenic confluence. The main portal vein originates from this confluence.

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11
Q 
Which mesenteric vessel originates from the anterior aorta in between the origin of the celiac axis and the origins of the renal arteries?
(A) Superior mesenteric artery
(B) Inferior mesenteric artery
(C) Left inferior phrenic artery
(D) Right gonadal artery
A

(A) The SMA originates from the anterior aorta just inferior to the celiac axis origin and just superior to the origin of the renal arteries.

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12
Q 
Most of the oxygenated blood to the liver comes from the
(A) Portal vein
(B) IVC
(C) SMA
(D) Hepatic artery
A

(D) The hepatic artery supplies oxygenated blood to the liver. The main portal vein supplies the majority of the blood to the liver, but it is poorly oxygenated.

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13
Q 
The left gastric vein is also known as what vessel?
(A) Cystic vein
(B) Coronary vein
(C) Inferior mesenteric vein
(D) Renal vein
A

(B) The left gastric vein, an important collateral in the presence of portal hypertension, is also known as the coronary vein.

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14
Q 
The liver receives approximately what portion of its blood from the portal vein?
(A) 25%
(B) 50%
(C) 75%
(D) 95%
A

(C) The liver receives approximately 75% to 80% of its blood from the portal vein. This blood is poorly oxygenated, so most of the oxygen comes via the hepatic artery.

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15
Q

Portal veins may be differentiated from hepatic veins by which of the following characteristics?
(A) Hepatic veins have brighter walls
(B) Portal veins get smaller as they exit the liver toward the right atrium
(C) Hepatic veins originate from the portal venous system
(D) Portal veins originate inferior to the liver

A

(D) The main portal vein (MPV) originates from the portal splenic confluence, posterior to the pancreatic head. The MPV then travels into the liver via the porta hepatis, the liver’s hilum.

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16
Q 
Which blood vessel is tortuous and lies posterosuperior to the pancreas?
(A) Splenic artery
(B) Splenic vein
(C) Hepatic artery
(D) Superior mesenteric vein
A

(A) The splenic artery, a branch of the celiac axis, is a tortuous vessel that lies posterior and superior to the pancreas.

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17
Q

What structures form the portal triad?
(A) Portal vein, hepatic artery, splenic artery
(B) Splenic vein, SMV, main portal vein
(C) Hepatic artery, bile duct, portal vein
(D) Hepatic vein, hepatic artery, portal vein

A

(C) The portal triad consists of a portal vein branch, a hepatic artery branch, and a bile duct tributary.

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18
Q 
The hepatic vein confluence is sometimes referred to as
(A) The seagull sign
(B) The ballerina
(C) The Playboy bunny
(D) The leaping squirrel
A

(C) The hepatic vein confluence is the region where the left, middle, and right hepatic veins terminate at the IVC. When the left and middle hepatic veins are visualized going into the IVC, it has the appearance of the iconic “Playboy bunny” symbol.

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19
Q 
The hepatic artery branch that originates from the celiac axis is the
(A) Proper hepatic artery
(B) Right hepatic artery
(C) Left hepatic artery
(D) Common hepatic artery
A

(D) The common hepatic artery originates from the celiac axis. The proper hepatic artery is the branch that becomes left and right hepatic arteries.

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20
Q 
The lobar branch of the renal artery is a direct branch off of what vessel?
(A) The segmental branch
(B) The interlobular branch
(C) The arcuate branch
(D) The interlobar branch
A

(A) The order of renal artery branches, from central to peripheral, is segmental, lobar, interlobar, arcuate, and interlobular.

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21
Q 
Which of the following would not likely be affected in portal hypertension?
(A) Right renal vein
(B) Splenic vein
(C) Left portal vein
(D) Superior mesenteric vein
A

(A) The right renal vein is part of the systemic circulation. Portal hypertension typically affects the portal venous circulation, although it eventually causes collaterals to form that bypass the liver and form an aberrant connection to the systemic circulation.

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22
Q

Which of the following is a true statement?
(A) An abdominal aorta measuring greater than 2.5 cm is always an aneurysm
(B) Saccular aneurysms are more common than fusiform
(C) An abdominal aortic aneurysm measuring greater than 3 cm is a surgical emergency
(D) Abdominal aortic aneurysms may present as black toes

A

(D) Abdominal aortic aneurysms (AAA) may present as embolic showers to the toes, causing black toes as the presenting clinical symptom.

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23
Q

“Nutcracker syndrome” may occur when
(A) The right renal artery passes posterior to the IVC
(B) The left renal vein passes posterior to the aorta
(C) The left renal vein passes anterior to the SMA
(D) The right renal vein passes anterior to the aorta

A

(B) The normal course of the left vein is between the SMA and the aorta. One form of “nutcracker syndrome” occurs when the left renal vein is compressed by the aorta as it passes posterior to the aorta. Another type of “nutcracker syndrome” occurs when the left renal vein is impinged by the SMA and aorta, causing backup of flow in the left renal vein.

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24
Q 
Which of the following is a typical measurement for the common iliac arteries?
(A) 0.25 cm
(B) 0.75 cm
(C) 1.75 cm
(D) 2.25 cm
A

(B) The common iliac arteries typically measure <1.5 cm in diameter. A measurement over 1.5 cm is considered aneurysmal.

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25
Q

What does a tardus parvus waveform in the common iliac arteries imply?
(A) This is a normal pattern in the common iliac arteries
(B) There is a more distal obstruction
(C) There is a more proximal obstruction
(D) There is a renal artery stenosis

A

(C) Tardus parvus waveforms imply a more proximal obstruction. In this example, the disease is most likely in the aorta.

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26
Q 
From where does most of the portal venous system blood originate?
(A) The liver
(B) The IVC
(C) The lower extremities
(D) The gastrointestinal tract
A

(D) The gastrointestinal (GI) supplies most of the blood to the portal venous system for processing by the liver.

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27
Q 
Which lobe of the liver is not usually affected in cirrhosis?
(A) Right lobe
(B) Left lobe
(C) Caudate lobe
(D) Quadrate lobe
A

(C) The caudate lobe is usually spared in cirrhosis due to its unique blood supply.

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28
Q

In a fasting patient, which of the following waveform patterns is normal for an SMA?
(A) Low-resistance flow
(B) High-resistance flow
(C) Monophasic flow with a tardus parvus pattern
(D) To-and-fro flow

A

(B) In the normal, fasting patient, the GI tract is not working hard, so the peripheral arterioles are constricted. Therefore, the SMA will have a high-resistance flow pattern.

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29
Q

Which of the following is not usually seen in portal hypertension?
(A) Reversal of flow in the right portal vein
(B) Splenorenal varices
(C) IVC thrombus
(D) Hepatomegaly

A

(C) Although it is possible to have IVC thrombus in portal hypertension, it is far more common for a patient to present with reversal of flow in the right portal vein, splenorenal varices, and hepatomegaly.

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30
Q 
Which of the following is synonymous with “normal flow into the liver”?
(A) To-and-fro
(B) Hepatopetal
(C) Hepatofugal
(D) Retrograde
A

(B) Hepatopetal is the term used for forward flow into the liver. Reversal of flow, away from the liver, is termed hepatofugal.

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31
Q 
Which of the waveforms would be seen distal to a hemodynamically significant stenosis of the origin of the main renal artery?
(A) High-resistance waveform
(B) To-and-fro flow
(C) Multiphasic waveform
(D) Tardus parvus waveform
A

(D) The tardus parvus waveform implies a delayed upstroke distal to a stenosis.

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32
Q 
Thrombosis of the IVC and hepatic veins is known as
(A) Arnold–Chiari syndrome
(B) cavernous transformation
(C) vena caval thrombophlebitis
(D) Budd–Chiari
A

(D) Budd–Chiari is a syndrome characterized by thrombus in the hepatics veins and/or IVC

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33
Q 
Which of the following is the most common cause of cirrhosis in the United States?
(A) Biliary tract disease
(B) Alcohol abuse
(C) Schistosomiasis
(D) Hepatic artery aneurysm
A

(B) In the United States, alcohol abuse and hepatitis are the two most common causes of cirrhosis. Schistosomiasis is a common cause in developing nations.

34
Q 
What is the venous collateral seen in the region of the falciform ligament in the presence of portal hypertension?
(A) Ductus venosus
(B) Ductus arteriosus
(C) Recanalized umbilical vein
(D) Recanalized portal vein
A

(C) The recanalized umbilical vein, also known as the paraumbilical vein, is a common collateral in portal hypertension. It lies in the region of the falciform ligament in the liver and originates at the left portal vein.

35
Q 
Which of the following pathologies is often described as appearing like a “string of beads”?
(A) Cavernous transformation
(B) Thrombus
(C) Tardus parvus
(D) Fibromuscular dysplasia
A

(D) Fibromuscular dysplasia (FMD) is often characterized as appearing like a “string of beads.” Although this appearance is more easily visualized on angiography, it can be seen on
ultrasound, especially when it occurs in the carotid arteries.

36
Q 
Hepatic veins typically exhibit what type of flow pattern?
(A) Monophasic
(B) Hepatopetal
(C) Bidirectional
(D) Unidirectional
A

(C) Hepatic veins tend to be bidirectional because of the influence by the right atrium.

37
Q 
Within a TIPS shunt, which of the following would be considered normal flow?
(A) Flow toward the right atrium
(B) Flow with a velocity >200 cm/s
(C) Flow with a velocity of <50 cm/s
(D) Multiphasic flow
A

(A) Flow within a TIPS should be in the direction toward the IVC, which leads into the right atrium. Flow should not be <50 cm/s or >200 cm/s, and it is usually a little pulsatile due to right atrial influences, but monophasic.

38
Q 
Which of the following represents an abnormal renal-aorta ratio (RAR)?
(A) Less than 2
(B) Less than or equal to 3
(C) Greater than 2.5
(D) Greater than 3.5
A

(D) The RAR should be less than 3.5. An elevated RAR implies a greater than 60% stenosis of the renal artery, assuming the aortic velocity is within normal limits.

39
Q 
Which of the following represents normal renal lengths in an adult?
(A) 5 to 7 cm
(B) 7 to 10 cm
(C) 10 to 12 cm
(D) 13 to 15 cm
A

(C) The normal adult kidney measures 9 to 13 cm. Although that exact number is not presented as a possible answer, always pick the best answer of the choices listed.

40
Q 
The normal, fasting SMA typically has peak systolic velocities less than
(A) 50 cm/s
(B) 175 cm/s
(C) 275 cm/s
(D) 300 cm/s
A

(C) SMA velocities greater than 275 cm/s in a fasting patient indicate stenosis.

41
Q 
A monophasic fasting SMA is indicative of what?
(A) A normal waveform 
(B) SMA disease
(C) Median arcuate ligament syndrome
(D) Portal hypertension
A

(B) When there is significant disease in the mesenteric vessels, the distal arterioles dilate to permit more blood flow to the organs, even in the fasting (resting) state. This persistent dilatation causes a low-resistance bed, and the waveforms in the feeding vessels will take on a low-resistance waveform.

42
Q 
What Doppler angle should be used when obtaining the resistive index from the interlobular or arcuate arteries of the kidneys?
(A) 0 degree
(B) 30 to 60 degrees
(C) 60 degrees
(D) 90 degrees
A

(A) When the vessels are too small to visualize, and only indices (not velocities) are needed, no angle correction is needed.

43
Q 
How many mesenteric vessels must be abnormal in order to have mesenteric ischemia?
(A) None”
(B) One
(C) Two
(D) Three
A

(C) Two mesenteric vessels need to have significant disease before there will be mesenteric ischemia.

44
Q 
What is the most common vascular complication of renal transplant?
(A) Venous thrombosis
(B) Arterial stenosis
(C) AV fistula
(D) Pseudoaneurysm
A

(B) Arterial stenosis is the most common vascular complication of renal transplants, although rejection is the most common complication overall.

45
Q 
Above what velocity is the celiac axis considered abnormal?
(A) 150 cm/s
(B) 185 cm/s
(C) 200 cm/s
(D) 250 cm/s
A

(C) The celiac axis should be less than or equal to 200 cm/s.

46
Q

A 56-year-old patient presents in the emergency department with painful black toes. Which study should be performed first?
(A) Lower extremity venous for DVT
(B) Upper extremity arterial for thoracic outlet syndrome
(C) Lower extremity plethysmography with segmental pressures
(D) Aorta to rule out abdominal aortic aneurysm

A

(D) AAA can be an emergency if ruptured or leaking. Sometimes the only symptom of AAA is embolic showers distally. Black toes are not a classic symptom of DVT, and the segmental pressure study is not an emergent examination.

47
Q 
Which of the following is not a clinical symptom of portal hypertension?
(A) Splenomegaly
(B) Ascites
(C) Esophageal varices
(D) Renal vein thrombus
A

(D) While renal vein thrombus may incidentally occur in a patient with portal hypertension, it is far more likely that portal hypertension will directly result in splenomegaly, esophageal varices, and ascites.

48
Q 
The normal spleen is typically
(A) 3 to 10 cm
(B) 7 to 14 cm
(C) 15 to 20 cm
(D) 20 cm
A

(B) The normal splenic length is less than 13 cm.

49
Q 
Which collateral commonly seen in portal hypertension has the potential to be the most life threatening?
(A) Hemorrhoids
(B) Patent paraumbilical vein
(C) Splenorenal varices
(D) Esophageal varices
A

(D) Although portal hypertension has many adverse consequences, the most dangerous is rupture of esophageal varices, which may lead to death.

50
Q 
Impingement of the left renal vein causing hematuria and flank pain is termed
(A) Budd–Chiari syndrome
(B) Nutcracker syndrome
(C) Renovascular hypertension
(D) Nephrotic disease”
A

(B) Nutcracker syndrome is a result of left renal vein impingement, which may cause flank pain and hematuria.

51
Q

In which portion of the aorta are most abdominal aneurysms located?
(A) Distal aorta to include common iliac arteries
(B) Proximal aorta superior to renal arteries
(C) Thoracic and proximal abdominal aorta
(D) Infrarenal aorta

A

(D) Most AAAs are located in the infrarenal aorta.

52
Q 
The term “cavernous transformation” is used in which pathologic process?
(A) Thrombosis of the main portal vein
(B) Inferior vena cava thrombus
(C) Hepatic vein and IVC thrombus
(D) Occluded hepatic artery
A

(A) Thrombosis with subsequent collateral formation is termed cavernous transformation of the portal vein.

53
Q 
A TIPS shunt is placed when
(A) The renal arteries fail to provide sufficient flow
(B) There is severe portal hypertension
(C) There is Budd–Chiari syndrome
(D) There is severe aortic insufficiency
A

(B) A transjugular intrahepatic portal systemic shunt (TIPS) is placed when there is severe portal hypertension. The TIPS relieves pressure on the portal system by bypassing the severely diseased liver.

54
Q

Which of the following is a characteristic of aortic pseudoaneurysms?”
(A) They lack the normal layers of the vessel wall
(B) They are very common
(C) They have an intimal lining but no media or adventitia
(D) They contain a neck with forward flow only into the pseudoaneurysm

A

(A) Aortic pseudoaneurysms are rare, but all pseudoaneurysms lack the normal layers of a true vessel wall aneurysm. Pseudoaneurysms are outpouchings caused by blood leaking into the tissue adjacent to the vessel.

55
Q 
In a patient under 50 years of age, what is the most common cause of renovascular hypertension?
(A) Atherosclerotic disease
(B) Raynaud disease
(C) Fibromuscular dysplasia
(D) Diabetes
A

(C) In a patient under the age of 50, fibromuscular dysplasia is the most common cause of renovascular hypertension.

56
Q 
What is the normal value for acceleration time in the renal artery?
(A) <100 ms
(B) <100 m/s
(C) <100 m/s2
(D) >100 m/s2
A

(A) Only one of the values listed is a “time.” The normal AT is <100 ms, or <0.1 s.

57
Q 
What is the name of a small, round, true aneurysm that protrudes from the aorta?
(A) Fusiform
(B) Saccular
(C) Pseudoaneurysm
(D) False aneurysm
A

B) Saccular aneurysms are typically small, round, true aneurysms that protrude from the aorta. They are not as common as fusiform aneurysms, which are circumferential enlarging of the aorta.

58
Q 
What is the term used when aortic blood escapes the endovascular graft into the aneurysmal sac?
(A) Endoleak
(B) Pseudoaneurysm
(C) Dissection
(D) Aortic rupture
A

(A) Endoleak is the term used when an EVAR leaks into the sac around the graft, potentially leading to rupture.

59
Q 
Which of the following diseases has aortic dissection as a risk factor?
(A) Arnold–Chiari II
(B) Budd–Chiari
(C) Median arcuate ligament syndrome
(D) Marfan syndrome
A

(D) Marfan disease is a genetic disease characterized by an increased risk of aortic dissection. Although the dissection more commonly occurs in the thoracic aorta, it may track down into the abdominal aorta and be visible to the vascular sonographer.

60
Q

You are scanning a patient who is unable to provide a history and was admitted by ambulance to the ER. On visual examination you note the patient has jaundice and a distended abdomen. On ultrasound, there is a small liver with ascites present. In the right lobe are two parallel, echogenic lines in a superior to inferior orientation. What is the most likely reason for the right lobe structure?
(A) Patient has TIPS shunt
(B) Patient had angioplasty for hepatic artery stenosis
(C) Patient has schistosomiasis
(D) Patient had gastric artery bypass

A

(A) The TIPS shunt appears as two parallel echogenic lines in the right lobe, most commonly connecting the right portal vein to the right hepatic vein.

61
Q 
Reversal of diastolic flow in a renal artery may be a sign of
(A) Proximal obstruction
(B) Pseudoaneurysm of the renal artery
(C) Renal vein thrombosis
(D) Normal functioning kidney
A

(C) Reversal of diastolic flow in a renal artery may be a sign of renal vein thrombosis causing outflow obstruction.

62
Q 
Central venous emboli can be potentially fatal due to what pathologic process?
(A) Middle cerebral artery occlusion
(B) Aortic occlusion
(C) Pulmonary embolism
(D) Lower extremity emboli
A

(C) Pulmonary emboli are usually a result of embolic venous thrombus, most commonly from lower extremities.

63
Q

Which of the following is true about renal artery stenosis examinations?
(A) Patients need not fast prior to the examination
(B) Angle-corrected Doppler of the arcuate arteries is essential
(C) The kidney length must be measured as part of the examination
(D) Peak systolic velocity information is not needed

A

(C) It is important to measure renal length during any kidney examination. In severe kidney disease, the kidney will shrink. The normal renal length is 9 to 13 cm.

64
Q

In median arcuate ligament syndrome, which of the following is true?
(A) The compression is relieved with inhalation
(B) The compression is relieved with deep exhale
(C) There is an increase in celiac PSV with inhalation
(D) There is an increase in SMA velocities with inhalation

A

(A) Median arcuate ligament syndrome is relieved with inhalation, which is why it might be missed on routine examination unless exhalation spectral Doppler waveforms are also documented.

65
Q

A Type I aortic endoleak
(A) Is from a branch of the aorta communicating with the sac
(B) Is from a tear in the graft itself
(C) Is from a poor seal at one end of the graft
(D) Is from a nonspecified source

A

(C) Type I EVAR endoleaks are caused by a poor seal in one or more ends of the graft.

66
Q

When measuring the abdominal aorta, which of the following is true?
(A) The most important measurement is the length of the aneurysm
(B) Only a true transverse measurement should be used
(C) Only a true AP measurement should be used
(D) The widest cross-sectional measurement should be used

A

(D) The widest measurement obtained (not length) should be used as the size of the aorta. In the transverse plane, it may not always be a “true” transverse measurement, but is the widest cross-sectional measurement.

67
Q

Which of the following would be a reason for a normal CTA of the celiac axis but an abnormal US?
(A) CTA is less sensitive than US for celiac artery studies
(B) CTAs are usually performed without radiopaque contrast agents
(C) CTA is typically performed with deep inspiration
(D) Unlike computed tomography, CTA does not use ionizing radiation

A

(C) Most computed tomography angiography (CTA) examinations are performed with deep inspiration. The celiac artery in median arcuate ligament syndrome is normal in deep inspiration, and abnormal in expiration.

68
Q

A 63-year-old female presents with epigastric pain after eating. She complains of weight loss without trying to lose weight. You notice occlusion of the celiac axis but you identify flow in the proper hepatic and splenic arteries. Which of the following is a likely finding?
(A) There is a duplicated celiac artery
(B) There is retrograde flow in the gastroduodenal artery
(C) There is retrograde flow in the superior mesenteric artery
(D) There is a high-grade stenosis in the abdominal aorta

A

(B) The GDA is a potential collateral for the liver and spleen in the presence of celiac artery occlusion. When celiac artery stenosis or occlusion is suspected, the GDA should be sampled for reversal of flow.

69
Q 
Blood is flowing in a hepatopetal direction in the left portal vein status post-TIPS placement. Which of the following is likely true?
(A) Patent TIPS
(B) Arteriovenous fistula in shunt
(C) Main portal vein thrombus
(D) TIPS stenosis or failure
A

(D) Status post TIPS, the left portal vein should be hepatofugal as blood travels toward the low-pressure TIPS. If blood is traveling in a hepatopetal direction in the left portal vein after TIPS, the TIPS must have failed.

70
Q

Why does angle correction need to be used when measuring acceleration index (AI) in the renal artery?
(A) Angle corrections are not needed for AI
(B) Because of the pulsatile nature of renal arteries
(C) Because velocities are needed to measure AI
(D) Because angle correction is needed for all measurements

A

(C) Velocity information is needed to measure acceleration index (AI). Therefore, angle correction is needed. Acceleration time (AT) does not require velocity information, so no angle correction would be needed.

71
Q 
What is the maximum angle correction that may be used when measuring velocities?
(A) 0 degree
(B) 45 degrees
(C) 60 degrees
(D) 89 degrees
A

(C) Angle correction greater than 60 degrees should not be used because the degree of error is too high.

72
Q

The main purpose of a TIPS is to
(A) Relieve pressure leading to esophageal varices
(B) Increase the pressure in the MPV to force the blood through the liver
(C) Increase flow through the paraumbilical vein
(D) Connect the systemic arterial system to the systemic venous system

A

(A) Of the choices listed, A is the best answer because a TIPS is placed to relieve the portal hypertension. Portal hypertension can lead to potentially life-threatening esophageal varices.

73
Q 
What are the reasons TIPS are covered in PTFE?
(A) Easier to insert
(B) Less chance of failure
(C) Blood can travel faster
(D) Keep it warm in winter
A

(B) TIPS covered in PTFE are less prone to failure than bare stents.

74
Q 
A patient has severe abdominal pain after eating. Which vessel should be evaluated?
(A) Superior mesenteric artery
(B) Main portal vein
(C) Hepatic artery
(D) Left gastric artery
A

(A) Of the vessels listed, the superior mesenteric artery (SMA) is the best choice. The SMA supplies part of the GI tract with blood, along with the celiac axis tributaries and inferior mesenteric artery (IMA).

75
Q 
The renal artery
(A) Typically has a delayed upstroke
(B) Is a high-resistance vessel
(C) Has an acceleration index >300 cm/s2
(D) Typically has reversal of diastolic flow
A

(C) The renal artery acceleration index should be greater than 300 cm/s2. Even if that answer was not known, the others are incorrect: renal arteries should not have a delayed upstroke, they are not high-resistance vessels, and do not normally have reversed diastolic flow.

76
Q 
A non-aneurysmal dilatation of the aorta <3 cm is called
(A) Ectasia
(B) Saccular dilatation
(C) Pseudoaneurysm
(D) Aortic stenosis
A

(A) If the aorta is widened but not aneurysmal, it is called ectasia of the aorta.

77
Q 
Which of the following is a prime concern in the patient with cirrhosis?
(A) Renal cell carcinoma
(B) Hepatoma
(C) Focal nodular hyperplasia
(D) Metastasis
A

(B) Hepatoma, or hepatocellular carcinoma, is a concern in the patient with chronic liver disease.

78
Q

During an abdominal ultrasound, ascites and splenomegaly are seen. Which of the following might also be seen?
(A) Hepatopetal flow in the MPV
(B) Hepatofugal flow in the paraumbilical vein
(C) Hepatofugal flow in the splenic vein
(D) Distal IVC thrombus

A

(C) The patient may have portal hypertension with findings of ascites and splenomegaly. Hepatofugal flow in the splenic vein would confirm this finding.

79
Q 
Which potential collateral originates from the portal vein and leads to esophageal veins?
(A) Rectal veins
(B) Paraumbilical vein
(C) Splenorenal collaterals
(D) Coronary vein
A

(D) The coronary vein, or left gastric vein, drains the esophageal veins. In portal hypertension, this flow backs up, causing esophageal varices.

80
Q

Which of the following is a criterion for TIPS failure?
(A) Velocity difference of 20 to 40 cm/s from one sampling point to another
(B) Absence of thrombus
(C) Flow velocity <50 cm/s in TIPS
(D) Flow velocity >30 cm/s in MPV

A

(C) Flow velocities in a TIPS should be >50 cm/s, among other criteria.

81
Q 
Normal flow through the coronary vein should be
(A) Toward the portal vein
(B) Toward the esophagus
(C) Toward the spleen
(D) Toward the inferior mesenteric vein
A

(A) Normal flow in the coronary (left gastric) vein is from the esophageal vessels to the portal vein. Backup of flow in this vessel due to portal hypertension leads to esophageal varices.

82
Q 
What is the most common type of visceral arterial aneurysm?
(A) Splenic artery
(B) Renal artery
(C) Common hepatic artery
(D) Superior mesenteric artery
A

(A) Aneurysm of the splenic artery is the most common visceral arterial aneurysm.

Vascular Ultrasound (8 decks)

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