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Adult Echocardiography > Arterial Nonimaging > Flashcards

Arterial Nonimaging Flashcards

1
Q

All of the following are limitations of Doppler segmental pressure exam except:

A

Artifactually lower high thigh pressures are obtained when narrow cuff is used on thigh

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2
Q

You are completing a segmental pressure study with exercise, Pt complains of pain in calf, wants to stop treadmill, what is next to evaluate?

A

Stop the exercise, then obtain ankle pressures.

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3
Q

Palpitating arterial pulses are?

A

Popliteal, PTA, brachial, facial

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4
Q

Things that would affect quality of PPG tracings?

A

Extremity tremor, cold weather, smoking, stress or nervousness

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5
Q

What does not affect PPG tracings?

A

A gym workout

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6
Q

The plantar arch consists of what 2 vessels?

A

Deep plantar A, branch of dpa ,lateral plantar (branch of pta)

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7
Q

Spectral analysis free of recording drawbacks, what is not considered a drawback

A

Low velocities are underestimated, draw backs are: noisy, less sensitive, high velocities are underestimated

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8
Q

True about transcutaneous oximetry (ToP02)

A

Manual calibration required prior to each measurement, utilizes a electrode/sensor, will discover if wound will heal, amputation level will heal, non healing(poor values) = 10-15 mm hg

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9
Q

Completing a plethysmographic on a Pt with severe intermittent claudication the wave form?

A

Utilizes volume changes in the extremity to determine overall flow changes

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10
Q

ABI’s with claudication?

A

Range is 0.5-0.9

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11
Q

Symptom found in Leriche syndrome that’s unique in causing arterial obstruction?

A

Impotence

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12
Q

Volume flow equation compared to Ohms law(current) these are correct:

A

Resistance compares to resistance, pressure compares to voltage, volume flow compares to current, volume(Q)= P/R

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13
Q

All of the following arteries can be auscultated?

A

Carotid, femoral, popliteal, aorta. The peroneal can not be auscultated.

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14
Q

A common to/fro patter is a distinctive pattern:

A

Dissection(false luman), vertebral artery(incomplete subclavian steal) or pseudo aneurysm(neck)… Except Arteriovenous fistula

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15
Q

A Pt with single level disease, how long does it take ankle pressure to increase back to resting values after its dropped to low u recording levels?

A

2-6 minutes

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16
Q

A Pt is complaining of pain while walking on treadmill R pta = 170, L pta = 60. R brachial pressure =175 & L= 170.

A

Left pressure is 60 divided by highest brachial pressure 175. The left abi is .34

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17
Q

Plantar arch is comprised of what artery branches?

A

Lateral plantar A & deep plantar A

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18
Q

All arteries with pulsatile(high resistance) flow patterns?

A

Lateral plantar, CFA, PTA, fasting SMA, ECA

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19
Q

A man has impotance, his ABI’s bilaterally is 1.2 & his penile/brachial(PBI) of 80.

A

Signs & symptoms may be related to increased venous outflow

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20
Q

Most likely cause of artherosclerosis?

A

Hypertension, family history, diabetes

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21
Q

A difference in spectral analysis #1, from analogue recording #2 all is true:

A

Flow reversal is observed in #1, not in #2, spectral broadening noted in #1, #1 is triphasic a total of 3 phases forward, reverse, forward. #2 monophasic(forward only)

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22
Q

Healthy arteries that have lowest peak systolic velocities (PSV)?

A

Aorta, with a large vessel PSV’s are lower, if artery luman is small PSV’s are higher

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23
Q

A study to determine if a wound is healing & level of amputation?

A

Transcutaneous oximetry

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24
Q

When calculating ankle/brachial index(ABI) what value is consistent with peripheral disease?

A

Lower than .5

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25
Q

What is the significance of a pulse during digital plethysmography?

A

Peaked pulse is consistent with a vasospastic process called Raynaud’s

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26
Q

Expected with a hemodynamically significant stenosis less than 50% except:

A

Decreased diastolic flow. You will see elevated systolic velocities, post-steno tic flow, spectral broadening

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27
Q

A Pt had arm pain, 40-50 difference in both arms, a plethysmography exam is suggestive of?

A

L subclavian/axial art occlusive disease, abnormal plethysmographic significant disease is proximal to level of tracing, severity is generally underestimated.

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28
Q

All are limitations or contributions to exercise:

A

Previous stroke affecting gait, hypertension(over 200mmHg), can’t use cane/walker, SOB. Age is not a limitation.

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29
Q

A PT with diabetes has deep ulcer on lateral malleolus, what is cause of ulcer?

A

Arterial insufficiency, found medial or lateral, regular in shape & deeper

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30
Q

True fact about transcutaneous oximetry(TcP02)?

A

After manual calibration, takes about 15-20 mins/site to obtain P02

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31
Q

The Allen test evaluates?

A

Patency of the Palmer arch

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32
Q

A PT has onset of painful blue toes, PPG tracings are abnormal w/ poor pressures & both ABI’s are 1.0, these findings are consistent w/ ?

A

Abdominal aortic aneurysms, they contain thrombosis, emboli can shower to extremities usually ending up in sm. arterial branches like toes

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33
Q

Obtaining Doppler pressure during a penile exam, what is PBI cutoff that’s considered abnormal?

A

Less than 0.65

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34
Q

Laminar(parabolic) flow has characteristic of:

A

Higher frequencies located center stream

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35
Q

ABI’s # that places the PT into a rest pain category?

A

Greater than .5

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36
Q

Plantar arch compromises what arterial branches?

A

Lateral & deep plantar artery

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37
Q

A PT had a angiographic procedure on R. CFA, next day great R. Toe is cyanotic, what is this condition?

A

Blue toe syndrome

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38
Q

A PT has hemodialysis in arm, which was placed 2 mo. Before, PT now has pain on exertion, pallor & coolness, what does this condition suggest?

A

Steal syndrome

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39
Q

When interpreting digit arterial plethysmographic waveforms, what wave form is considered obstructive?

A

Organic and fixed

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40
Q

True about arterial dissection:

A

Flow velocities differ in each luman, tear in intima that leaks into the media, can lead to stenosis or occlusion & flow reversal in dissection lumen

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41
Q

Normal flow in an artery of a lower extremity?

A

Triphasic

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42
Q

A capabilities of the physiologic(blind study) what is true?

A

Assess presence of arterial disease, evaluate severity of arterial disease, can follow disease progression. Unable to discriminate between stenosis/occlusion.

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43
Q

Velocity and pressure energy is inversely related, when pressure is higher, can cause flow to move towards transducer(color changes to blue).

A

At the wall pressure is higher- velocity lower

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44
Q

Photo-plethysmography( infrared light emitted into tissue exam. Blood attenuates light, more cutaneous blood flow?

A

The less reflection occur

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45
Q

An digit arterial exam reveals a PT w/ symptoms of pain in fingers & scabs over finger tips, what does PT have?

A

Buerger’s disease

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46
Q

A PT w/ thromboangitis is most likely to have inflammation of which arterial wall layers?

A

Intimal layer only. If it was thrombi agoutis obliterans (buerger’s) than all layers & connective tissue

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47
Q

A PT must have PPG tracings(monitor blood flow) in there radial artery during manual compression

A

If used as a bypass graft for heart surgery

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48
Q

True about popliteal artery aneurysm:

A

Spectral broadening, large diameter = less resistance, small diameter = more resistance more proximal to popliteal

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49
Q

Total energy contained in moving fluid is all: gravitational, potential, pressure and kinetic

A

Resistance not included

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50
Q

True about blood pressure cuff artifact:

A

If cuff too large for limb, BP is falsely lower

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51
Q

True about heart: cardiac contraction distends the arteries, pressure greater in heart, pumping action maintains high pressure gradient between arteries & veins.

A

Not true: cardiac output does not determine the amount of blood they leaves arterial system . It’s arterial pressure & total peripheral resistance that determined the amount of blood that leaves arterial system

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52
Q

Another term for hypogastric artery?

A

Internal iliac artery

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53
Q

Evaluating component outlet syndrome, blood supply is evaluated in arm at rest in multiple positions, what happens to brachial blood pressure when arm is at 90 degrees?

A

Blood pressure will be lower, cuff above the heart makes it lower

54
Q

Another term for volar?

A

Palmer arch

55
Q

A palpable(vibration) or thrill over pulse site is indicative of:

A

Dialysis access site, post-stenotic turbulence, or fistula

56
Q

ABI’s in a PT vary on the R & L after treadmill test, it took 10 minutes to return to resting level on the R what is true:

A

Multilevel disease on R. suggested when it takes the ankle pressure 6-12 min to return to resting level

57
Q

On a Doppler exam can distinguish between bilateral or single findings:

A

Bilateral is: aorto-iliac occlusive disease.

Single findings: ilio-femoral occlusive disease

58
Q

True about arterial dissection:

A

Complications include stenosis or occlusion, tear in intima leaks into media, velocities differ in each luman

59
Q

Abnormal cold sensitivity is likely if wave form fails to return to baseline levels within?

A

5mins

60
Q

A PT has a single level disease, how long does it take for the ankle pressure to increase back to resting values after it has dropped to low or unrecordable levels?

A

2-6mins

61
Q

Physiologic exams detect presence of arterial disease, follow disease progression, and severity of disease, terminology is obstructive or occlusive

A

Unable to differ between stenosis & occlusion

62
Q

15-20mmHg drop in pressure from upper arm to forearm all is possible:

A

Obstruction in both radial & ulnar arteries, single arm artery that has decreased in pressure, brachial artery obstruction distal to upper cuff. Not subclavian artery high grade stenosis

63
Q

All of the following are palpable pulses:

A

Popliteal, vertebral, ulnar, common carotid

64
Q

Fasciotomy would be considered for what conditions?

A

Compartment syndrome

65
Q

Abnormal vessels can have thrill in a palpitation in all of the following:

A

Common femoral artery, popliteal artery, femoral artery. Not peroneal

66
Q

The inguinal ligament represents the termination of which artery?

A

External iliac artery

67
Q

A PT has vascular exam & a stress test, all of the following will be incorporated into interpretation?

A

Pressure changes before & after exercise, distance they walk, duration of exercise, length of time to recover back to resting levels, not location of collateralization

68
Q

What determines the amount of blood that leaves the arterial system?

A

Arterial pressure & total peripheral resistance

69
Q

If there was pain & swelling on both lower extremities, possible sign of disease of the aorta

A

Rule out if on one side only

70
Q

The closer a hemodialysis access or AVF is to the heart, this is high potential for?

A

Heart failure

71
Q

What would you expect to see in Doppler wave forms in lower extremities following exercise to pre-exercise waveforms?

A

Flow is low resistant

72
Q

Resistance is not a part of energy gradient

A

Forms of energy: pressure, memetic, potential, gravitational

73
Q

What layer of arterial wall contains the vasa vasorum?

A

Adventitial layer(outer layer). Vasa vasorum are tiny vessels carry blood to walls of artery

74
Q

Abnormal plethysmographic wave forms always reflect hemodynamically significant disease?

A

Proximal to level of tracing

75
Q

What inguinal ligament represents the termination of which artery?

A

External iliac artery

76
Q

A poor DPA Doppler signal, what should you do?

A

Apply more transmission gel, nice probe distally or proximally, PT does not have to flex foot

77
Q

All are possible limitations of a doppler segmental pressures?

A

Can’t determine between CFA & external iliac disease, difficult to interpret in presence of multi-level disease, uncompensated CHF can result in decreased ABI’s, calcified vessels have false elevated Doppler pressures

78
Q

When obtaining doppler pressures, remember to ensure accurate info obtained?

A

If the cuff is too wide for limb, a false low blood pressure will be obtained

79
Q

A Pt has pain unilateral in R. Hip/thigh after walking blocks, relieved when at rest, what vessels has arterial occlusive disease?

A

Right external iliac artery, this disease is always proximal to the symptoms, if symptoms where bilateral then the vessels would be aorto-iliac system

80
Q

Most frequent complication of a peripheral aneurysm?

A

Embolization

81
Q

Name the condition in which digits, skin color may include: pallor, cyanosis & rubor?

A

Raynaud’s

82
Q

A PT w/ week pedal pulses, ulceration on R.ankle, ABI’s of 0.5, what involves this type of ulceration?

A

More regular in shape are arterial ulcers, deep & painful, tiny ooze

83
Q

A plethysmographic study used on a PT that complains of severe intermittent claudication, true about plethysmography:

A

Utilizes volume changes in the extremity to determine overall flow characteristics

84
Q

With interpreting ABI’s, if a PT has ABI of 0.6, what disease range does this fall into?

A

Claudication

85
Q

A PT in the ER has an acute arterial occlusion, what are signs/symptoms?

A

Paresthesia, pulselessness, & pain. Not dependent rubor

86
Q

Factors affecting resistance to flow?

A

Diameter, viscosity, length, elevated hematocrit, size of vessel & friction. Not energy gradient, does not effect resistance, but energy gradient must be present in order for there to be any flow

87
Q

Another term for buerger’s disease is?

A

Thromboanglitis

88
Q

A PT comes in w/ a weak pulse, ABI’s of .05 and ulcer on R ankle, this type of ulcer is?

A

Arterial ulcers are more regular in shape, deep, tiny ooze & severe pain

89
Q

A ZpT has sudden blue toes, pain bilaterally, PPG tracings are abnormal w/ poor pressure in great toes & both ABI’s are 1.0, this is consistent with?

A

Abdominal aortic aneurysm contain thrombus/emboli can shower/travel yo extremities & end in the smallest arterial branches(digits)

90
Q

Characteristics of to/fro Doppler pattern is distinctive, all are common seen in?You called?

A

Vertebral artery(incomplete subclavian steal), pseudoaneurysm neck, dissection(false lumen). Won’t see to/fro with Arteriovenous fistulas

91
Q

Palpable vibration/thrill over a pulse is indicative of:

A

Post-stenotic turbulence, fistula or a PT dialysis access site, not greater than 90%

92
Q

A PT has pain on right side of hip/thigh after walking, pain relieved at rest/standing, the arterial occlusive disease are in what vessels?

A

Right external iliac artery. This disease is always proximal to the symptoms. Unilateral is R external iliac, if symptoms were bilateral would be aorta-iliac system

93
Q

Plantar arch comprised of what artery branches?

A

Lateral plantar artery & deep plantar artery

94
Q

A key symptom found with leriche syndrome that’s unique that cause arterial obstruction?

A

Impotance

95
Q

What type of Doppler of the lower extremities is expected with exercise compared to pre-exercise?

A

With exercise flow will be low resistant

96
Q

When calculating an ABI, what value is most likely consistent with peripheral arterial disease?

A

.5

97
Q

What is similar between air plethsmorgraphy(APG) & tcP02?

A

Require manual calibration

98
Q

Cardiac surgeon wants to know if a PT’s radial artery is good to use for heart bypass, PPG’s measure blood flow in each finger(digit) at a time, how could the hand be compromised if radial was removed?

A

PPG tracings are not present during manual compression of the radial artery

99
Q

When obtaining Doppler pressures, what’s the effect of BP if cuff is too small in diameter?

A

An abnormally high BP(blood pressure)

100
Q

Abnormal vessels with a possible thrill?

A

Common femoral, femoral, popliteal arteries. Not peroneal art

101
Q

What term describes normal flow pattern in an artery of the lower extremities?

A

Triphasic

102
Q

Post stenotic turbulence has all these characteristics:

A

Vortic/eddys, multi directional changes, produces spectral broadening & energy expanded as heat, won’t be laminar or parabolic(normal)

103
Q

Condition that changes skin color in digits including possible pallor, cyanosis or rubor?

A

Raynaud’s disease

104
Q

Normal(healthy) flow in arteries that have the lowest peak systolic velocities(PSV’s)?

A

Aorta, largest artery in body, when lumen is large PSV’s low, if artery lumen is small PSVs will be higher

105
Q

A PT has popliteal entrapment of the right leg, true about this condition:

A

PPG pulses obliterate during plantar decision of foot, use of end point detector(monitor big toe), surgery for a release of gastrocnemius muscle or fibrous bands. PT won’t have rest pain(not a symptom)

106
Q

All are considered non-atherosclerosis conditions:

A

Vasospastic, coarctation of aorta, popliteal entrapment,thromboangitis obliterans. Not embolism

107
Q

What to expect with hemodynamically significant stenosis of >50%?

A

Spectral broadening, elevated systolic velocities, post-stenotic flow. Won’t see decreased diastolic velocities

108
Q

What is the significance of a peaked pulse during digital plethysmography?

A

Peaked pulse is consistent w/ a specific type of vasospastic process(raynaud’s disease)

109
Q

A PT w/ diabetes has a deep punched out ulcer on the lateral malleolus, what’s the cause of ulceration?

A

Arterial insufficiency. Arterial ulcers are deeper w/ regular shape. Found medial, lateral & near tibia as well

110
Q

True why teed mill testing is preferred over reactive hyperemia?

A

More quantitative, defines if PTs symptoms are from true claudication,can reproduce pts ischemic symptoms & produces a physiological overall stress

111
Q

Thromboangitis is likely to have inflammation in what arterial wall?

A

Intimal layer. If it was thromboangitis obliterans(Buerger’s) then it would be in all layers even connective tissue

112
Q

Common to/fro pattern seen in:

A

Vertebral art(incomplete steal), pseudoaneurysm (neck), dissection(false lumen)

113
Q

Why 3 cuff perfected over 4 cuff?

A

More accurate, thigh pressure same or greater, 4 cuff low thigh BP too high 20-30 mmHg, due to smaller cuff use on large part of leg

114
Q

All are limitations of Doppler segmental pressures:

A

Calcified vessels create false elevated Doppler pressures, can’t distinguish between CFA & iliac disease, difficult in presence of multi-level disease, uncompensated CHF can result in decreased ABI’s

115
Q

What ABI number places the PT into rest pain?

A

.5

116
Q

Diabetes affects the arteries by:

A

Medial calcification, higher incidence of disease in distal popliteal & tibial arteries, development of atherosclerosis in a younger age

117
Q

A PT in for impotence, ABI’s are 1.2 bilaterally w/ penile/brachial index(PBI) of .80, what this explanation?

A

The PT’s signs/symptoms maybe related to increased venous outflow

118
Q

A PT is in lab to evaluate impotency, ABI’s are normal limits, has a PBI of .46, what is the preliminary impression?

A

Bilateral hypogastric artery occlusive disease

119
Q

All are considered visceral branches:

A

Celiac art, SMA, IMA and renal artery. Not included circumflex artery

120
Q

What major factor for peripheral vascular disease, how does this disease affect arteries?

A

Diabetes can affect distal popliteal art and tibial art, atherosclerosis at younger age, medial calcification develops

121
Q

If a PT has a is of 0.6, what range does this fall in?

A

Claudication 0.5-0.9

122
Q

Calculating an ABI, what number is consistent w/ peripheral arterial disease?

A

.5

123
Q

Reasons for evaluating upper extremity arteries?

A

Hemodialysis, rayanud’s , arteritis least reason is Atherosclerosis

124
Q

Limitation of Doppler segmental pressure exam:

A

Uncompensated CHF result in decreases ABI’s, difficult in presence of multi level disease, calcified vessels render false elevated pressures, can’t determine between CFA and external iliac disease

125
Q

A PT w/ unilateral R hip/thigh after walking, relieved by standing/resting, what arterial vessel is occluded?

A

R external iliac artery

126
Q

Evaluating digit arterial supply, a PT w/ scabs on finger tips, what is this?

A

Buerger’s disease

127
Q

What is the effect on BP if cuff applied is too small in diameter?

A

An abnormally high BP

128
Q

A result of stenosis leads to inflow arterial pressure falls, also:

A

Peripheral resistance decreases, decrease in pulsatility, maintain flow and vasodilate

129
Q

Exercise can alter blood flow by:

A

Vasodilation and increased blood flow

130
Q

True about popliteal entrapment of right leg?

A

Abnormal is PPG pulses obliterate in active plantar flexation of foot, end point detector for big toe. Rest pain is not a sign/symptom

Adult Echocardiography (13 decks)

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