Chapter 7

Question 1

What is a transient ischemic attack?

Answer 1

An episode of stroke like neurological symptoms that typically last for a few minutes or several hours and then resolves completely.

Question 2

What causes a transient ischemic attack?

Answer 2

Temporary interruption of the blood supply to the brain in the distribution of a cerebral artery

Question 3

Where is the baroreceptors assisting in reflex blood pressure control located?

Answer 3

Carotid bulb

Question 4

The carotid bulb tends to be most prominent in?

Answer 4

Normal young individuals

Question 5

What is a bruit?

Answer 5

An abnormal “blowing” or “swishing” sound heard with a stethoscope while auscultating over an artery, such as the carotid.

Question 6

When do you typically hear bruit in an artery?

Answer 6

In a stenotic artery

Question 7

What are Signal processing technique that displays the complete frequency and amplitude content of the Doppler flow signal?

Answer 7

Spectral analysis

Question 8

What is spectral broadening?

Answer 8

An increase in the “width” of the spectral waveform (frequency band) or “filling-in” of the normal clear area under the systolic peak

Question 9

What does spectral broadening represents?

Answer 9

Turbulent blood flow associated with arterial lesions

Question 10

What is most commonly defined as the angle between the line of the Doppler ultrasound beam and the arterial wall (also referred to as the “angle of insonation”?

Answer 10

Doppler angle

Question 11

What is the secondary goal of examination of the extracranial carotid artery system by duplex ultrasound?

Answer 11

To document progression of disease

Question 12

Which transducer is most commonly used to perform a duplex evaluation of the extracranial cerebrovascular system?

Answer 12

7-4 MHz linear array

Question 13

A patient presents to the vascular lab for a carotid-vertebral duplex examination. Upon questioning, the patient reveals a 2-week history of intermittent blindness in the right eye. The symptoms resolve within a few seconds. What would these symptoms indicate?

Answer 13

TIA

Question 14

How should the patient’s head be positioned in order to expedite a carotid-vertebral duplex examination?

Answer 14

Head rotated 45 degrees away from side being examined with a pillow under shoulders.

Question 15

What is the most common technique used to identify the vertebral artery?

Answer 15

View the common carotid artery and angle the transducer slightly posteriorly.

Question 16

When qualifying the appearance of plaque by ultrasound, the use of which of the following terms is discouraged owing to poor reliability?

Answer 16

ulcerated

Question 17

As plaque develops and fills the carotid bulb, what change can be expected in the Doppler waveform at this level?

Answer 17

disappearance of normal flow separation

Question 18

Which of the following will NOT result in symmetrical (i.e., seen in both carotid and sometimes vertebral arterial systems) changes in the Doppler spectra?

Answer 18

Subclavian steal

Question 19

In a normally hemodynamically low-resistance system or vessel, such as the internal carotid and vertebral arteries, what will a change to high-resistance pattern suggest?

Answer 19

distal stenosis or occlusion

Question 20

What is reactive hyperemia, a provocative maneuver used during the duplex evaluation of the extracranial cerebrovascular system, used to demonstrate?

Answer 20

A change from latent or partial to complete subclavian steal.

Question 21

Which of the following is NOT “sound” advice for sonographers who wish to prevent repetitive stress injuries while scanning?

Answer 21

Avoid doing stretching exercises

Question 22

Which of the following is NOT a characteristic of normal Doppler waveform contour?

Answer 22

Increased spectral broadening

Question 23

Why do Doppler waveforms in the common carotid arteries display a contour suggestive of relatively low-resistance flow?

Answer 23

70% of its flow supplies the ICA

Question 24

What type of flow is characterized by a blunted, resistive waveform that often occurs before total occlusion?

Answer 24

String sign flow

Question 25

How can the internal and external carotid arteries be safely differentiated?

Answer 25

Two main methods are used to differentiate the ICA from the ECA. First, the ECA is typically located medial to the ICA and has multiple branches beyond the carotid bifurcation. Second, a “temporal tap” maneuver can be used
in which the superficial temporal artery is “tapped,” sending a series of oscillations down the ECA that can be
visualized in the ECA spectral waveform.

Question 26

A patient presents to the vascular lab with a severe distal CCA obstruction; however, the internal carotid and external carotid artery remain patent. What is this lesion typically called?

Answer 26

Choke lesions