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Vas > Ch. 17, 30,31 > Flashcards

Ch. 17, 30,31 Flashcards

1
Q

Two pulmonary veins enter posteriorly in which one of the following?
A. Right ventricle
B. Left atrium
C. Left ventricle
D. Right atrium

A

Left atrium

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2
Q

The inferior vena cava is guarded by a fold of tissue called the _____ valve, whereas the coronary sinus is guarded by the _____ valve

A. thebesian; eustachian
B. eustachian; coronary
C. eustachian; thebesian
D. eustachian; atrial

A

eustachian; thebesian

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3
Q

Atrial contraction follows the _________ on an electrocardiogram (ECG).
A. S wave
B. P wave
C. T wave
D. QRS complex

A

P wave

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4
Q

Which of the following has a slight bulge seen at the aortic valve cusps?

A. Sinus of Valsalva
B. Recess of the oblique sinus
C. Crista supraventricularis
D. Coronary sinus

A

Sinus of Valsalva

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5
Q

Most coronary venous drainage is into the ________________.

A. thespian veins
B. coronary sinus
C. coronary veins
D. atrial sinus

A

Coronary sinus

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6
Q

The base of the heart is formed by the ______________.
A. Right ventricle
B. Left atrium
C. Left ventricle
D. Right atrium

A

left atrium

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7
Q

The mitral valve separates which of the following sets of structures?

A. Right and left ventricles
B. Left atrium and left ventricle
C. Right and left atria
D. Right atrium and right ventricle

A

Left atrium and left ventricle

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8
Q

The greatest muscle mass in the heart is found in which one of the following structures?

A. Right atrium
B. Right ventricle
C. Left ventricle
D. Left atrium

A

Left ventricle

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9
Q

The forceful contraction of the cardiac chambers is ___________, and the relaxed phase of the cycle is ___________.

A. diastole; systole
B. systole; diastole
C. systole; dicrotic
D. up slope; down slope

A

Systole, diastole

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10
Q

The _____________ is the pleural reflection between the costal and diaphragmatic portions of the parietal pleura.

A. costophrenic sinus
B. costal pleura
C. mediastinal pleura
D. diaphragmatic pleura

A

costophrenic sinus

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11
Q

Which one of the following structures initiates the normal cardiac impulse?

A. Bundle of His
B. Sinoatrial node
C. Purkinje fibers
D. Atrioventricular node

A

Sinoatrial node

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12
Q

Defects in the valves may cause turbulence or regurgitation on auscultation, which is called _____________.
A. insufficiency
B. arrhythmia
C. stenosis
D. murmur

A

murmur

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13
Q

The apex of the heart is formed by the _____________.

A. left ventricle
B. right ventricle
C. left atrium
D. right atrium

A

left ventricle

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14
Q

Which valve prevents retrograde flow between the aorta and left ventricle?

A. Tricuspid
B. Mitral
C. Semilunar
D. Atrioventricular

A

Semilunar

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15
Q

The tricuspid valve opens when the:

A. pulmonic valve opens.
B. papillary muscle contracts.
C. right ventricle pressure drops below the right atrial pressure.
D. velocity of blood flow in the right ventricle exceeds the velocity of flow in the right atrium.

A

right ventricle pressure drops below the right atrial pressure.

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16
Q

The pericardial sac protects the heart from:

A. hernia invasion.
B. tumor.
C. diaphragmatic motion.
D. friction.

A

D. Friction

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17
Q

The roof of the right ventricle is occupied by the _______________, which lies between the tricuspid and pulmonary orifices.

A. crista supraventricularis
B. fossa ovalis
C. coronary sinus orifice
D. right atrial appendage

A

A. crista supraventricularis

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18
Q

The superior vena cava (SVC) enters the right atrium __________.

A. medially
B. anteriorly
C. posteriorly Incorrect
D. ventrally

A

A. Medially

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19
Q

The outflow tract of the right ventricle is also called the _______________.

A. infundibulum
B. conus arteriosus
C. right atrial appendage
D. crista terminalis

A

A. infundibulum

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20
Q

The wall of the aorta bulges slightly at each semilunar cusp to form which one of the following?

A.Sinus of Valsalva
B. Coronary arteries
C. Chordae tendinae
D. Arantius nodule

A

A.Sinus of Valsalva

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21
Q

The right border of the heart is formed by the ______________.

A. right ventricle
B. superior vena cava
C. pulmonary trunk
D. right atrium

A

D. Right atrium

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22
Q

Approximately how many beats per minute is the normal adult heart rate?

A. 50
B. 90
C. 100
D. 70

A

D. 70

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23
Q

The most posterior chamber to the left of the sternum is the ___________.

A. left atrium
B. right ventricle
C. left ventricle
D. right atrium

A

A. Left atrium

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24
Q

Select the structure that the medial wall of the right atrium contains.

A. Interventricular septum
B. Right upper pulmonary vein
C. Interatrial septum
D. Right lower pulmonary vein

A

C. Interateial septum

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25
Q

What is the first major branch arising from the abdominal aorta?

A

Celiac Artery

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26
Q

What is the most common indication of mesenteric artery duplex evaluation?

A

Chronic Mesenteric ischemia

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27
Q

How many arteries are typically involved in atherosclerotic occlusive disease before a patient becomes symptomatic?

A

2

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28
Q

When does the abdominal pain many patients feel, which is associated with chronic mesenteric ischemia, typically occur?

A

After eating

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29
Q

Because of the abdominal pain, which of the following do patients often experience?

a. overeating and weight gain
b. fear of exercise
c. nausea and vomiting
d. fear of food and weight loss

A

Fear of food (sitophobia) and weight loss

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30
Q

Which of the following is a collateral system that is present in the mesenteric vascular system?
A. Pancreaticoduodenal arcade
B. Arc of Roland
C.Internal Iliac to inferior mesenteric artery connections
D. All of the Above

A

D. All of the above

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31
Q

From which vessel does a replaced right hepatic artery originate most often?

a. celiac artery
b. SMA
c. Right renal artery
d. IMA

A

Superior Mesenteric Artery

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32
Q

With a patient in a fasting state, what should the superior mesenteric artery exhibit?

a. High-resistance flow pattern
b. low-resistance flow pattern
c. mixed high and low resistance flow pattern
d. respiratory phasic flow pattern

A

High-resistance flow pattern

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33
Q

What vessels make the seagull sign?

A

Celiac, hepatic and splenic arteries

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34
Q

What type of flow obtained from the celiac, splenic and hepatic arteries is demonstrated on Doppler?

A

Low-resistance flow

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35
Q

During a mesenteric artery evaluation, retrograde flow is noted in the common hepatic artery. What does this finding suggest?

a. common hepatic artery stenosis
b. celiac artery occlusion
c. superior mesenteric artery stenosis
d. replaced right hepatic artery

A

Celiac artery occlusion

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36
Q

What is the transient compression of the celiac artery origin during exhalation, which is relieved by inhalation?

A

Median accurate ligament compression syndrome

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37
Q

Visceral artery aneurysms (rare) usually occur in which vessel?

A

Splenic artery

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38
Q

The celiac artery is best visualized with the transducer oriented in a _______________ plane, where as the superior mesenteric artery is best visualized with the transducer oriented in a _________________ plane

A

Transverse
Sagittal

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39
Q

Postprandial abdominal pain that occurs when there is insufficient visceral blood flow to support the increased oxygen demand required by intestinal motility, secretion and absorption is often termed

A

Chronic Mesenteric Ischemia

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40
Q

The inferior mesenteric artery arises from the aorta just proximal to the ___________ _____________

A

Aortic Bifurcation

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41
Q

The superior mesenteric artery changes dramatically from ____________ resistance flow to ______________ resistance flow after eating

A

High, Low

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42
Q

When performing a spectral Doppler and high velocities are noted in a mesenteric artery, it is important to document ___________ ___________ to confirm a flow-limiting stenosis

A

Post-stenosis turbulence

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43
Q

What technique can be used to decrease movement of the mesenteric vessels and help capture Doppler waveforms with a correct angle?

A

Have the patient suspend breathing

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44
Q

If the celiac artery is occluded, the common hepatic artery almost always demonstrates ______________ flow

A

Retrograde

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45
Q

Increased velocities in the absence of stenosis could be the result of _____________ flow

A

Compensatory

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46
Q

An advantage or using duplex ultrasound to evaluate median arcuate ligament compression syndrome is that Doppler waveforms can be obtained during changes in _________________

A

Respiration

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47
Q

Splenic artery aneurysm, when discovered during pregnancy, is associated with a 95% ____________ rate, leading to high maternal and fetal mortality

A

Rupture

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48
Q

Visceral artery dissections are most common in the _____________ and often extensions of aortic dissection

A

SMA

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49
Q

In patients with suspected MALS, if the velocities fail to normalize with inspiration, the patient can be put in a _____________ position

A

Standing

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50
Q

Embolus to or thrombosis of the mesenteric arteries can lead to _________ _________ __________

A

Acute mesenteric ischemia

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51
Q

Symptoms of Acute mesenteric ischemia are typically described as pain ______ ____ ___________ to physical findings

A

Out of proportion

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52
Q

The findings below describe which disease
* 2-3 of the mesenteric vessels may be affected
* Abdominal pain and cramping after eating
* presence of abdominal bruitt
* weight loss secondary to sitophobia & Diarrhea

A

Chronic Mesenteric Ischemia

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53
Q

What is the purpose of using a “test meal” when evaluating the mesenteric vessels?l

A

Because after eating the SMA changes dramatically from triphasic high resistance flow to low resistance flow. Post prandial US can increase specificity

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54
Q

Relating to additional blood vessels that aid or add to circulation

A

Collateral flow

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55
Q

Relating to or affecting the viscera

A

Splanchnic

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56
Q

Relating to internal organs or blood vessels in the abdominal cavity

A

Visceral

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57
Q

Term for “after a meal”

A

Postprandial

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58
Q

Lack of blood flow to the viscera is

A

Mesenteric ischemia

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59
Q

According to one study, when end diastolic velocities are used as thresholds for >50% stenosis the corresponding velocities are ___________ cm/s in the celiac artery and ________ cm/s in the SMA

A

55; 45

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60
Q

According to one study, a PSV in the celiac artery of >200 cm/s and a PSV in the SMA of > 275 cm/s corresponded to a stenosis of _____________%

A

> 70 %

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61
Q

Recent studies suggest velocity guidelines for IMA stenosis, with a PSV of _________________ corresponding to a >50% stenosis

A

> 200-250

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62
Q

When evaluating the SMA, Doppler waveforms should be obtained from _________, _________ and _________ segments

A

Proximal, mid and distal

63
Q

To examine the Inferior mesenteric artery, the aortic bifurcation should be located and then scan _________ ____ to ____ cm

A

Proximal 1 to 3 cm

64
Q

True or False
The IMA typically does not change after eating

A

True

65
Q

Flow direction is important when the ________ _________ is occluded or severely stenosis. Retrograde flow in common hepatic artery

A

Celiac artery

66
Q

When evaluating the mesenteric vessels, ___________ can hide important features such as intimate flap in dissections, stents, atherosclerotic plaque, wall abnormalities. Therefore, ____________ imaging is preferred

A

Color; B-mode

67
Q

True stenosis usually demonstrates what two things?

A
  • increased flow
  • poststenotic turbulence/spectral broadening
68
Q

___________ _____________ has little spectral broadening and no stenotic profile

A

Compensatory flow

69
Q

___________ ___________ ___________ can result from an embolus to mesenteric arteries and/or thrombosis of an artery with existing chronic disease

A

Acute mesenteric ischemia

70
Q

____________ ___________ is a common treatment for mesenteric ischemia

A

Bypass grafting

71
Q

60% of visceral artery aneurysms occur in the _________ ___________ and women are ________ affected than men.

A

Splenic artery, more affected

72
Q

Causes pain referred to as “intestinal angina”

A

Chronic Mesenteric Ischemia

73
Q

Fear of food is called

A

Sitophobia

74
Q

This vessel usually lies 1-2 cm below the diaphragm

A

Celiac artery

75
Q

This vessel typically arises from the anterior surface of the aorta 1-2 cm below the celiac

A

SMA

76
Q

This vessel arises from the distal aorta just proximal to the bifurcation

A

IMA

77
Q

Replaced right hepatic artery anomaly has a prevalence of _______%

A

17%

78
Q

Describe the normal celiac Doppler waveform

A

Sharp systolic upstroke and a low resistance flow pattern with forward flow throughout the cardiac cycle

79
Q

When the celiac artery is occluded or severely stenotic, SMA collaterals divert blood towards the liver and spleen through the ___________

A

GDA

80
Q

The most common locations for a stenosis in the bypass graft

A

Proximal and distal anastomoses

81
Q

MALS stands for

A

Median arcuate ligament compression syndrome

82
Q

Ratio of female to male occurrence of splenic artery aneurysm

A

3:1

83
Q

The collateral system that bridges the IMA to the SMA

A

Arc of Roland

84
Q

Color Bruitt in a vessel indicates

A

Significant stenosis

85
Q

Sonographic (color) appearance of celiac compression syndrome

A

Increase in color velocity with exhalation

86
Q

Sonographic (color) appearance of stenosis (>50%)

A

High velocity flow with aliasing
Color bruitt

87
Q

Sonographic (color) appearance of dissection

A

Color separation with separate flow channels

88
Q

________ of patients with Acute mesenteric ischemia are women around _______ years of age

A

Two-thirds
70 yrs

89
Q

Downfalls to percutaneous visceral artery intervention

A
  • restenosis
  • recurrent symptoms
  • requirement for re-do intervention
90
Q

The uterine arteries in a non-gravid uterus typically demonstrate which of the following flow characteristic with Doppler interrogation?
A) low resistance throughout the menstrual cycle
B) increasing resistance with age
C) no change in velocity or resistance at any menstrual phase
D) low velocity flow

A

B) increasing resistance with age

91
Q

Doppler analysis of blood flow to the ovaries in the periovulatory and luteal phases commonly demonstrates?
A) a high resistive index value
B) low resistance in the ovary with the dominant follicle
C) minimal arterial and venous flow to both ovaries

A

B) low resistance in the ovary with the dominant follicle

92
Q

In women of menstruating age, arterial Doppler waveforms of a potential ovarian malignancy may not be reliable. At what ovarian phase should assessment be done?
A) late luteal
B) early follicular
C) ovulatory
D) early luteal

A

B) early follicular

93
Q

Metabolically active tissue, such as an ovarian malignancy, has all of the following Doppler characteristics except?
A) color Doppler flow evident in the solid components of the mass
B) low resistance and high velocity
C) obvious flow throughout the cardiac cycle
D) low velocity and high resistance

A

D) low velocity and high resistance

94
Q

Typical Doppler waveforms of an ovarian malignancy exhibit which of the the following?
A) minimal flow throughout the cardiac cycle
B) low resistance, high velocity
C) peripheral flow only
D) low velocity, high resistance

A

B) low resistance, high velocity

95
Q

Umbilical artery resistance is evaluated during gestation for what purpose?
A) to predict erythroblastosis fetalis
B) to determine possible placental insuffiency
C) to determine if the fetus is at risk for asphyxia
D) to predict preterm labor

A

B) to determine possible placental insuffiency

96
Q

Describe the spectral Doppler patterns associated with the uterus and ovaries.

A

The UTERINE ARTERIES exhibit moderate to high velocity/high resistance flow. The uterine and radial arteries exhibits flow which is higher resistance in the proliferative phase than in secretory.
Flow in the OVARY during the follicular phase is often low velocity and high resistance. Following ovulation, the impedance drops dramatically on the side with the dominant follicle, resulting in low resistance flow. The ovaries display high resistance flow in postmenopausal women.

97
Q

Which of the following best describes the normal ovarian Doppler flow during the secretory phase of the menstrual cycle?
A) varies with respiration
B) low-resistance flow pattern
C) decreased
D) high-resistance flow pattern

A

B) low-resistance flow pattern

98
Q

The Doppler analysis of malignant ovarian masses often reveal:
A) increased vascularity
B) decreased vascularity
C) lower diastolic flow
D) higher diastolic flow

A

D) higher diastolic flow

99
Q

During the menstrual and proliferative phases of the menstrual cycle, normal ovarian flow is said to be:
A) high-resistant
B) phasic
C) diminished
D) low-resistant

A

A) high resistant
(Typical ovarian flow is said to be high-resistant during the menstrual and proliferative phases and low-resistant at mid cycle)

100
Q

In the third trimester, symmetric intrauterine growth restriction (IUGR) may be associated with which if the following Doppler findings?
A) low-resistance umbilical artery
B) low-resistance renal artery
C) low-resistance middle cerebral artery
D) low-resistance ductus venosus

A

C) low-resistance middle cerebral artery

101
Q

Doppler waveforms obtained from an artery supplying an intracranial arteriovenous malformation will exhibit:
A) absent diastolic flow
B) low diastolic velocity
C) a low pulsatility index
D) triphasic flow
E) decreased velocities

A

C) a low pulsatility index

102
Q

Doppler waveforms of the uterine arterial flow typically show:
A) high-velocity, high-resistance pattern
B) high-velocity, low-resistance pattern
C) low-velocity, high-resistance pattern
D) low-velocity; low-resistance pattern
E) reverse-flow pattern

A

A) high-velocity, high-resistance pattern

103
Q

Doppler waveforms of arterial flow in the dominant ovary in a premenopausal woman typically show:
A) low-velocity, low-resistance pattern
B) high-velocity, high-resistance pattern
C) high-velocity, low-resistance pattern
D) reverse-flow pattern
E) low-velocity, high resistance pattern

A

A) low-velocity, low-resistance pattern

104
Q

All of these Doppler ultrasound findings in the uterine arteries are associated with a growth-restricted pregnancy except:
A) reversal of end-diastolic flow
B) increase of end-diastolic flow on serial surveillance
C) decrease of end-diastolic flow on serial surveillance
D) no end-diastolic flow
E) C and D

A

B) increase of end-diastolic flow on serial surveillance

105
Q

On color Doppler sonography, most malignant ovarian tumors yield flow signals that are best characterized as:
A) variable
B) low-impedance
C) high-impedance
D) lacking flow
E) avascular

A

B) low-impedance

106
Q

The spectral Doppler measurement that provides the best indicator of diastolic runoff into a distal vascular bed is the:
A) S/D ratio
B) pulsatility index
C) resistivity index
D) end-diastolic velocity
E) thermal index

A

B) pulsatility index

107
Q

The diastolic notch is best describe as:
A) flow reversal in early diastole
B) late diastolic flow reduction
C) early diastolic reduction
D) flow reversal in late diastole
E) none of the above

A

C) early diastolic reduction

108
Q

In the umbilical artery absent diastolic flow in the umbilical artery is?

A

Not good.

109
Q

In the umbilical artery if there is reversed diastolic flow it indicates?

A

Really bad, sign of impending demise.

110
Q

The uterine artery in the second and third trimesters is _____ resistance.

A

Low resistance.

111
Q

In the uterine artery appearance of a “notch” in Doppler waveforms is _____, and thought to predict what 2 things?

A

Abnormal.
Placental insufficiency and IUGR.

112
Q

The ductus venosus has which kind of waveform?

A

Triphasic forward flow.

113
Q

If the the ductus venosus has an abnormal waveform (flow below baseline) is associated with?

A

Chromosome abnormalities and IUGR.

114
Q

Middle cerebral artery (MCA) Doppler can help determine the likelihood of?

A

Fetal anemia.

115
Q

The volume of blood ejected from each ventricle during a contraction is called the

A

stroke volume

115
Q

Ultrasound results should be compared to a:

A

gold standard test

116
Q

Gold standard tests:

A

Digital subtraction angiography
CTA (computerized tomography angiography with contrast)
MRA (magnetic resonance angiography)
Surgical findings
Clinical outcome

117
Q

Gold Standard for Venous Imaging Comparison:

A

Venography (seldom performed)
Repeat exam within 3 days
Repeat exam by another sonographer- do results concur?
Exam interpreted by a second physician.
Compare to clinical outcome (was there a PE?)

118
Q

For carotid QA, coordinate the reporting method with the

A

interpreter of the gold standard.

119
Q

if you report 70-99 % ICA stenosis, and the radiologists reports “moderate to severe disease”, results:

A

cannot be compared in a meaningful fashion

120
Q

Make sure your carotid criteria is based on the same method used to:

A

measure arteriogram , CTA, or MRA, e.g., Bulb or NASCET methods.

121
Q

the ability of a test to find disease when it’s present

A

sensitivity

122
Q

The ability of a test to show there is no disease when there is no disease present

A

specificity

123
Q

The portion of individuals with a POSITIVE test result that actually have the condition.

A

Positive Predictive Value (PPV)

124
Q

The portion of individuals with a NEGATIVE test result that actually do NOT have the condition.

A

Negative Predictive Value (NPV)

125
Q

When TP, TN, TN and TP are considered, then:

A

overall accuracy can be calculated.

126
Q

TP:

A

truly positive

127
Q

FP:

A

falsely positive

128
Q

TN:

A

truly negative

129
Q

FN:

A

falsely negative

130
Q

The proportion of all individuals whose tests results agree with their condition. The percentage of time the Ultrasound exam was correct.

A

Accuracy

131
Q

Used to calculate statistics:

A

2 x 2 square

132
Q

What is the 2x2 square sometimes called?

A

Chi Square

133
Q

If there are 91 positive venograms, 85 positive ultrasounds, and 82 of those ultrasounds agreed with the venograms, how many are true positives and false positives?

A

82 true positives, and 3 false positives

134
Q

If there are 53 negative venograms, and ultrasound indicated 59 negatives, venography found 50 legs to be normal and 9 positive for DVT…how many true negatives and how many false negatives?

A

50 true negatives, and 9 false negatives

135
Q

Once the 2 x 2 square is filled in, it’s easy to calculate the following stats:

A

Sensitivity
Specificity
Positive Predictive Value (PPV)
Negative Predictive Value (NPV)
Accuracy
Prevalence

136
Q

Equation for sensitivity:

A

TP / [TP + FN ] x 100%

137
Q

Equation for specificity:

A

TN/[FP + TN] x 100%

138
Q

Equation for Positive Predictive Value:

A

PPV= TP/[TP + FP] x 100%

139
Q

Equation for Negative Predictive Value:

A

NPV= TN/ [FN + TN]

140
Q

Combine sensitivity and specificity

A

accuracy

141
Q

Equation for accuracy:

A

[TP + TN]/ [TP + FN + FP+ TN]

142
Q

the proportion of individuals in the study that have the disease

A

Prevalence

143
Q

If prevalence is low, it’s best to have a test with

A

high sensitivity

144
Q

Prevalence data is important because:

A

if the study population is loaded with disease versus no disease statistics can be skewered.

145
Q

Equation for Prevalance

A

[TP+ FN]/ [TP + FN + FP + TN]

146
Q

For the RVT exam, beware that Headings might be:

A

switched

147
Q

Both sensitivity and specificity deal with test

A

“ability”

148
Q

Predictive values deal with:

A

how “good” is a test result

149
Q

The portion of individuals with a POSITIVE test result that actually have the condition.

A

Positive Predictive value (PPV)

150
Q

When the test result is NEGATIVE, how many times is it truly NEGATIVE

A

Negative Predictive Value (NPV)

151
Q

The proportion of all individuals whose tests results agree with their condition

A

Accuracy

152
Q

How would you explain the difference between laminar and parabolic flow?

A

Laminar flow all has the same velocity, while parabolic flow has slow flow at the outer areas

153
Q

If a study produced no false positive results it would have 100% ____.
A. Accuracy
B. Sensitivity
C. Specifity
D. Negative predicitve value

A

C. Specifity

Vas (10 decks)

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