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ARDMS ABD REVIEW > Abdominal Vasculature > Flashcards

Abdominal Vasculature Flashcards

1
Q

in the SAG plane, you recognize a circular, anechoic vascular structure posterior to the IVC. Which of the following would this structure be most likely?

abdominal AO
LRV
RRA
SMA

A

RRA

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2
Q

a disorder of the connective tissue characterized by tall stature and aortic and mitral balance insufficiency is:

wilms syndrome
meckel-gruber syndrome
marfan syndrome
kleinman syndrome

A

marfan syndrome

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3
Q

the inner wall layer of a vessel, closest to the passing blood is the:

tunica media
tunica intima
tunica rugae
tunica adventitia

A

tunica intima

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4
Q

what vessel can be often noted coursing between the SMA and abdominal AO in the TRV scan plane?

LRV
LRA
RRV
RRA

A

LRV

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5
Q

the first main visceral branch of the abdominal AO is the:

SMA
celiac artery
renal arteries
hepatic arteries

A

celiac artery

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6
Q

an aneurysm associated with infection is termed:

recanalized
saccular
fusiform
mycotic

A

mycotic

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7
Q

which is NOT true about the abdominal AO?

the abdominal AO bifurcates into the common iliac arteries

the prox AO is situated more anterior than the distal AO

the AO has a thicker tunica media than the IVC

the third major branches of the abdominal AO are the renal arteries

A

the prox AO is NOT situated more anterior than the distal AO

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8
Q

all of the following are branches of the celiac axis EXCEPT:

right gastric artery
hepatic artery
splenic artery
left gastric artery

A

right gastric artery

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9
Q

the outer wall layer of a vessel is the:

tunica media
tunics intima
tunica rugae
tunica adventitia

A

tunica adventitia

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10
Q

what should the postprandial flow pattern be within the SMA?

high resistance
low resistance

A

low resistance

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11
Q

the second main branch of the abdominal AO is the:

SMA
celiac artery
renal arteries
hepatic artery

A

SMA

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12
Q

which vessel shows a different flow pattern after eating?

celiac artery
splenic artery
renal artery
SMA

A

SMA

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13
Q

what flow pattern would the postprandial SMA yield in a small bowel ischemia?

high resistance
low resistance

A

high resistance

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14
Q

an AAA is present when the diameter of the abdominal AO exceeds:

10 mm
2.5 mm
3 cm
2 mm

A

3 cm

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15
Q

occlusion of the hepatic veins describes:

marfan syndrome
klinefelter syndrome
morrison syndrome
budd-chiari syndrome

A

budd-chiari syndrome

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16
Q

the most common shape of an AAA is:

saccular
bulbous
true
fusiform

A

fusiform

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17
Q

what branch and its tributaries of the abdominal AO appear as a “seagull” in the TRV plane?

SMA
hepatic artery
celiac artery
common iliac artery

A

celiac artery

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18
Q

which vascular structure may be confused for the main pancreatic duct?

hepatic artery
left gastric artery
SMA
splenic artery

A

splenic artery

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19
Q

the IVC terminates at the:

common iliac veins
right atrium
left atrium
left ventricle

A

right atrium

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20
Q

A patient presents with unexplained abdominal pain for a vascular assessment of the SMA. sonographically, you note that the patient’s SMA yields a persistent high-resistive flow pattern. This is indicative of:

crohn disease
intussusception
bowel obstruction
small bowel ischemia

A

small bowel ischemia

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21
Q

the MPV is created by the union of the:

splenic vein and SMV
SMV and IMV
splenic vein and IMV
splenic vein and gastroduodenal vein

A

splenic vein and SMV

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22
Q

the veins seen attaching to the IVC just below the diaphragm are the:

renal veins
SMV
hepatic veins
celiac axis

A

hepatic veins

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23
Q

the AO originates at the:

left atrium
right atrium
left ventricle
right ventricle

A

left ventricle

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24
Q

which is not a section of the IVC?

postrenal
pancreatic
prerenal
hepatic

A

pancreatic

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25
Q

the hepatic artery should demonstrate:

high resistance flow
low resistance flow

A

low resistance flow

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26
Q

clinical findings of an AAA include all of the following EXCEPT:

LE pain
back pain
abdominal bruit
elevated hematocrit

A

elevated hematocrit

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27
Q

An outpatient with a history of back pain and HTN presents to the ultrasound department for an abdominal aortic sonogram. Sonographically, you visualize a 6 cm infrarenal aortic aneurysm with an echogenic linear structure noted gently swaying in the aortic lumen. What is the most likely diagnosis?

aortic rupture
chronic aortic aneurysm
aortic dissection
pseudoaneurysm

A

aortic dissection

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28
Q

the left gonadal vein drains directly into the:

IVC
SMV
LRV
left iliac vein

A

LRV

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29
Q

which would most likely yield a high-resistance flow pattern?

celiac artery
common iliac artery
splenic artery
RRA

A

common iliac artery

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30
Q

what vessel may attach to the splenic vein before reaching the portal confluence?

LRV
IMV
RRV
celiac vein

A

IMV

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31
Q

what vessel travels directly anterior to the LRA?

LRV
hepatic artery
RRV
SMV

A

LRV

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32
Q

what abnormality would the failure of an EVAR to isolate an aneurysm from circulation most likely result in?

endoleak
aortic dissection
pulmonary embolism
DVT

A

endoleak

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33
Q

A patient presents to the sonography department with a history of marfan syndrome. The sonographic evaluation reveals a linear echo within the aortic lumen that extends from the celiac axis to the iliac arteries. Color doppler reveals flow throughout the AO on both sides of the linear echo. The patient has has no surgeries and there is no AAA. What does the linear echo most likely represent?

calcific thrombus
intimal flap
EVAR
aortic filter

A

intimal flap

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34
Q

which vessel would be the shortest in length?

RRV
RRA
LRV
LRA

A

RRV

35
Q

which would have a pulsatile, triphasic blood flow pattern?

renal veins
hepatic veins
gonadal veins
common iliac veins

A

hepatic veins

36
Q

the diameter of the IVC should never exceed:

1.5 cm
2.5 cm
3.5 cm
8 mm

A

2.5 cm

37
Q

which statement about the IVC is NOT true:

the diameter of the IVC is variable
respiration can affect the size
it is located to the left of the AO
it is considered retroperitoneal

A

the IVC is NOT located to the left of the AO

38
Q

which statement about the abdominal AO is NOT true:

most aneurysms located within the abdominal AO are false aneurysms

the abdominal AO is located just left of the midline

the most common location of an AAA is infrarenal

the abdominal AO is considered to be retroperitoneal

A

most aneurysms located within the abdominal AO are NOT false aneurysms

39
Q

which three structures compose the portal triad?

HA, PV, and bile duct
HV, HA, and bile duct
HV, HA, and PV
LPV, LHA, and Lig Teres
porta hepatis, MPV, and CBD

A

HA, PV, and bile duct

40
Q

what vessel is anterior to the uncinate process and posterior to the neck of the pancreas?

SMA
IMA
confluence of portal and splenic vein
IMV
common HA

A

confluence of portal and splenic vein

41
Q

what is the relationship of the LRV to the AO and SMA?

posterior to both
anterior to both
parallel and to the left of both
anterior to AO, posterior to SMA
superior to AO, inferior to SMA

A

anterior to AO, posterior to SMA

42
Q

which shows the correct plane for measuring the diameter of this aortic aneurysm?

A
B
C
D
both B and C are correct

A

B

SAG plane, perpendicular to the long axis of the vessel at its widest point

43
Q

You are performing a doppler study of the hepatic venous system and cannot obtain a color doppler signal from the MPV. What should you do?

increase the color dynamic range
increase the system high pass filter
decrease the system PRF
increase the doppler angle of incidence
decrease color gain

A

decrease the system PRF

more “listening” time increases sensitivity to slow flow

44
Q

which is NOT a direct branch of the abdominal AO?

celiac trunk
SMA
external iliac artery
IMA
renal artery

A

external iliac artery

45
Q

A 57 year old woman has been referred for an abdominal ultrasound with a history of an abdominal bruit. What pathology are you searching for?

cholecystitis
para-aortic lymphadenopathy
retroperitoneal fibrosis
varices
vascular compromise involving the AO or its branches

A

vascular compromise involving the AO or its branches

(stenosis or aneurysm)

46
Q

you are performing a doppler study on a patient with median arcuate ligament syndrome. what vessel are you studying?

IMA
renal artery
PV
SMV
celiac trunk

A

celiac trunk

median arcuate ligament of the diaphragm lies anterior to the abdominal AO just proximal to the origin of the celiac trunk

47
Q

a 54 year old man has been referred for an abdominal doppler ultrasound with a history of uncontrollable high BP. what pathology are you searching for?

vascular compromise of the superior mesenteric, inferior mesenteric, and celiac trunk

hepatofugal PV flow

RA stenosis

splenic varices

aortic aneurysm

A

RA stenosis

uncontrollable HTN is an indication of doppler evaluation of the RAs

48
Q

while performing a doppler evaluation of the abdominal vessels, you detect a stenosis in the RRA. which is NOT a sign of stenosis with spectral analysis?

spectral broadening distal to the stenosis

increased PSV at the stenosis

increased PDV proximal to the stenosis

increased pulsatility proximal to the stenosis

dampening of the waveform distal to the stenosis

A

increased PDV proxminal to the stenosis

proximal to the stenosis, the flow is typically dampened with decreased diastolic

49
Q

You are performing an ultrasound exam on a patient with a history of chronic pancreatitis and abdominal bruit. What vascular abnormality is associated with this history?

AAA
RA stenosis
IMA occlusion
retroaortic RV
pseudoaneurysm of the hepatic or splenic artery

A

pseudoaneurysm of the hepatic or splenic artery

50
Q

the IVC empties blood into which of the following?

abdominal AO
right atrium
left atrium
right ventricle
left ventricle

A

right atrium

51
Q

which does NOT drain directly into the IVC?

renal vein
right hepatic vein
common iliac vein
splenic vein
middle hepatic vein

A

splenic vein

splenic vein joins the SMV to form the portal vein, does not empty into IVC

52
Q

You are imaging the common hepatic artery and detect its division into two branches. What are these two branches?

proper hepatic artery and right gastric artery

right gastric artery and gastroduodenal artery

left gastric artery and proper hepatic artery

proper hepatic artery and gastroduodenal artery

gastroduodenal artery and left gastric artery

A

proper hepatic artery and gastroduodenal artery

53
Q

in “replaced” hepatic artery, the right hepatic artery originates from what artery?

celiac trunk
SMA
abdominal AO
IMA
left hepatic artery

A

SMA

54
Q

which describes the anatomic course of the gastroduodenal artery?

caudal course, anterior to the pancreatic head

caudal course, posterior to the pancreatic head

cranial course, anterior to the duodenum and medial to the pancreatic neck

cranial course, posterior to the pancreatic head

lateral course, cephalic to the pancreatic head

A

caudal course, anterior to the pancreatic head

55
Q

which artery supplies the small intestines, right colon, and most of the transverse colon?

celiac trunk
splenic artery
superior mesenteric
inferior mesenteric
left gastric

A

superior mesenteric

56
Q

what are the symptoms of chronic mesenteric ischemia?

weight gain, abdominal gas, bloating

postprandial abdominal pain and weight loss

flank pain radiating toward the hip

RUQ pain radiating to the left shoulder

HTN, weight gain, abdominal pain

A

postprandial abdominal pain and weight loss

57
Q

what vessels will you study in a patient with chronic mesenteric ischemia?

portal, superior mesenteric, and splenic veins

AO, renal, and common iliac arteries

main renal and intrarenal vessels

distal AO, common iliac, external iliac, and common femoral arteries

celiac trunk, superior mesenteric, and inferior mesenteric arteries

A

celiac trunk, superior mesenteric, and inferior mesenteric arteries

58
Q

A 38 year old female has been referred for a doppler study of the liver with a history of ETOH abuse and cirrhosis. What vascular condition is associated with this history?

mesenteric ischemia
PHTN
HA fibromuscular dysplasia
splenic artery pseudoaneurysm
budd-chiari syndrome

A

PHTN

59
Q

which describes the waveform you will see in the PV in a normal study?

bidirectional
triphasic
mildly undulating
highly pulsatile
continuous

A

mildly undulating

60
Q

which is the biggest risk factor for rupture of an AAA?

aneurysm location
aneurysm size
patient age
flow velocity through the aneurysm
presence of laminar thrombus

A

aneurysm size

61
Q

you cannot obtain a clear image of the AO in a midline SAG view due to overlying bowel gas. what should you do?

have the patient return after fasting overnight

have the patient perform a valsalva maneuver while scanning the same area

roll the patient into either decubitus position and image the AO from a coronal plane

scan the patient in a reverse trendelenberg position

scan the AO from a probe position

A

roll the patient into either decubitus position and image the AO from a coronal plane

62
Q

You have detected an AAA. Considering this finding, you should tailor your exam to include which of the following?

evaluation of the common iliac arteries

measurement of TRV and AP diameter

assessment of intraluminal thrombus

location of aneurysm in relation to renal arteries

all of the above

A

all of the above

63
Q

You are scanning a patient with marfan’s syndrome. Ultrasound findings reveal a linear band throughout the length of the abdominal aorta that is mobile in relation to the cardiac cycle. What pathology is most likely present?

aortic pseudoaneurysm
aortic dissection
micotic aortic aneurysm
inflammatory aortic aneurysm
fibromuscular dysplasia of the AO

A

aortic dissection

64
Q

what is the most significant clinical consequence of PHTN?

respiratory compromise
ascites
variceal hemorrhage
liver ischemia
vascular thrombosis

A

variceal hemorrhage

hemorrhage from esophageal varies is a life threatening condition associated with PHTN

65
Q

You are performing an abdominal doppler study and suspect the presence of median arcuate ligament syndrome.To rule out this condition, which of the following should be done?

obtain baseline doppler values, give patient a fatty meal, and rescan 10, 20, and 30 min following the meal

obtain doppler readings during both inspiration and expiration and in both the supine and upright positions

obtain doppler readings at an angle of 45 degrees and then repeat at an angle of 60 and 90 degrees

obtain baseline doppler readings and have the patient return in approximately two weeks for a comparison study

obtain doppler readings from the prox, mid, and distal aspect of the artery

A

obtain doppler readings during both inspiration and expiration and in both the supine and upright positions

66
Q

which describes cavernous transformation of the PV?

retrograde PV flow

PV thrombosis

tumor invasion of the PV

network of vessels replacing obliterated PV

PV aneurysm

A

network of vessels replacing obliterated PV

67
Q

You are performing an ultrasound study on a patient with an aortoiliac graft and suspect the presence of a pseudoaneurysm at the graft site. What is the typical waveform in the neck of a pseudoaneurysm?

continuous
low velocity, monophasic
tardus parvus
high velocity, bidirectional
high velocity, low resistance

A

high velocity, bidirectional

68
Q

which visceral artery is most commonly involved with aneurysmal formation?

hepatic artery
splenic artery
SMA
IMA
gastroduodenal artery

A

splenic artery

69
Q

which vessel normally follows a retroaortic course?

LRV
RRV
SMV
IMA
none of the above

A

none of the above

70
Q

which courses posterior to the IVC?

right hepatic artery
LRV
RRA
LRA
none of the above

A

RRA

71
Q

what is the relationship of the splenic vein to the pancreas?

posterior and superior
posterior and inferior
anterior and superior
anterior and inferior

A

posterior and inferior

72
Q

which vessels course intersegmental in the liver?

PVs
HVs
HAs
both PVs and HVs
both PVs and HAs

A

HVs

73
Q

A patient has been referred for a doppler study to rule out the presence of RA stenosis. A thorough knowledge of the renal vasculature is required to perform this study. Which of the following is NOT true regarding the renal vasculature?

multiple RAs are rare, occurring in fewer than 5% of individuals

RAs lie posterior to the RVs

RAs branch off the AO immediately below the SMA

RRV is shorter than the LRV

RVs drain into the IVC

A

multiple RAs are NOT rare

occur in approximately 30% of individuals

74
Q

within the liver, the IVC lies along the posterior surface of what lobe?

left lobe
caudate lobe
anterior segment right lobe
posterior segment right lobe
quadrate lobe

A

caudate lobe

75
Q

what vessel is this waveform from?

SMV
PV
renal vein
hepatic vein
splenic vein

A

hepatic vein

76
Q

You are performing an ultrasound on a patient with a recent aortoiliac graft and detect this waveform adjacent to the graft site near a pulsating hematoma. This waveform was most likely obtained from which of the following?

graft stenosis
graft occlusion
neck of pseudoaneurysm
normal graft
graft aneurysm

A

neck of pseudoaneurysm

the waveform obtained from the neck of a pseudoaneurysm typically displays a high-velocity, bidirectional, or “to-and-fro” signal.

due to the changes in pressure between the native vessel and aneurysm with the cardiac cycle

during systole the pressure is lowest in the pseudoaneurysm and flow courses in that direction. during diastole the pressure is lowest in the native vessel and blood flows back into it.

77
Q

what is the vessel labeled A?

abdominal AO
IVC
RRV
LRV
SMV

A

IVC

78
Q

what vessel is labeled C?

RRV
LRV
RRA
LRA
SMA

A

RRA

79
Q

what is the vessel labeled E?

right internal iliac artery
left external iliac artery
right common iliac vein
left internal iliac vein
right common iliac artery

A

right common iliac artery

80
Q

this image was obtained in what plane?

TRV
SAG
coronal
oblique
none of the above

A

coronal

81
Q

which vessel were you most likely sampling?

HV
HA
IVC
PV
AO

A

PV

82
Q

what vessel lies immediately posterior to the pancreatic head?

abdominal AO
IVC
SMV
splenic vein
PV

A

IVC

83
Q

which describes the fusiform aneurysmal shape?

bulbous enlargement with a sharp junction between the normal and abnormal segment

dilation with a gradual transition between the normal and abnormal segment

figure eight appearance to the aneurysm

intimal flap within the aneurysm

sharp, sudden sac-like protuberance

A

dilation with a gradual transition between the normal and abnormal segment

84
Q

which defines an aortic aneurysm?

when the length of the dilated segment exceeds 3 cm

a dilation of the AO exceeding 3 cm in any dimension

a focal dilation of any segment exceeding 4 mm

when the AO becomes tortuous and dilated with an AP diameter greater than 4 can

when the diameter of the AO is greater than 2.5 cm

A

a dilation of the AO exceeding 3 cm in any dimension

ARDMS ABD REVIEW (27 decks)

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