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Vascular > Combination > Flashcards

Combination Flashcards

1
Q

The vertberal artery arises from the:

A. arch of the aorta
B. Brachiocephalic artery
C. proximal common carotid artery
D. Subclavian artery

A

D. subclavian artery

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2
Q

Which of the following arteries is usually the first branch of the ECA?

A. the lingual artery
B. the superior thyroid artery
C. The facial artery
D. the inferior thyroid artery
E. the maxillary artery
A

B. the superior thyroid artery

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3
Q
  1. The three terminal branches of the opthalmic artery include:

A. nasal, frontal and supraorbital
B. nasal, frontal and facial
B. superficial temporal, frontal and facial
D. superficial temporal, nasa and frontal
E. non of the above

A

A. Nasal, Frontal and Supraoribital

Knowlege of periorbital circulation is necessary because next to the circle of Willis, the anastomoses between branches of the ECA and the ICA via the orbital an ophthalmic arteries the second most important source of collateral flow to the brain.

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4
Q
  1. The three primary branches arising form the Aortic arch include:

A. innominate, right subclavian and left common carotid
B. Brachiocephalic, right subclavian and left common carotid
C. innominate, right subclavian and left vertebral
D. innominate, left common carotid and left vertebral
E. non of the above

A

E. non of the above

the three are -
1 - Brachiocephalic (innominate) artery
2 - Lt. common carotid artery
3 - Lt. subclavian artery

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5
Q
  1. Veins consist of which of the following structural layers?
A. tunica intima
B. tunica adventitia
C. tunica media
D.  A and B
E. A, B and C
A

E. A, B and C

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6
Q
  1. Which of the following events is/are thought to be primarily responsible for the pathogenesis of atherosclerotic disease?
A. the development of fibrosis
B. injury to the intimal lining
C. Disposition of lipids
D. All of the above
E. None of the above
A

B. injury to the intimal lining

The most frequent cited theory is the arterial wall “injury” hypothesis. Following intimal damage by turbulence, the factors noted in choices A and C contribute to the development of atherosclerosis but are not thought be primarily responsible for it.

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7
Q
  1. If all other factors remain the same, a SUDDEN reduction in vessel diameter will result in:
A. A decrease in velocity
B. An increase in flow
C. An increase in velocity
D. A and B
E. B and C
A

C. an increase in velocity

This basic yet important fact must be understood. The fact that flow velocity increases WITHIN AND IMMEDIATELY distal to a stenosis.

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8
Q
  1. In order for the “Venous muscular pump” to function properly, which of the following MUST be present?

A. diastolic suction caused by low pressure in the right atrium following atrial systole
B. the patient patient must be in expiration to reduce abdominal pressure
C. Venous sinusoids must be present
D. the patient must be supine
E. non of the above

A

C. venous sinusoids must be present

The soleal and gastrocnemial sinusoids are an important part of the “venous muscular pump”

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9
Q
  1. The Carotid artery usually bifurcates at which of the following landmarks?
A. the hyoid bone
B. the thyroid cartilage
C. the cricoid cartilage
D. the supraclavicular fossa
E. non of the above
A

B. the thyroid cartilage

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10
Q
  1. The ECA branches lying in the carotid triangle include:
A. superior thyroid and ascending pharyngeal 
B. ascending pharyngeal and facial
C. facial and descending pahryngeal
D. A and B
E. all of the above
A

D. A and B

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11
Q
  1. Which of the following statements is/are true regarding the greater saphenous vein?

A. its origin is on the medial aspect of the ankle
B. it is a deep vein
C. it combines with the lesser saphenous vein at the popliteal vein
D. all of the above
E. non of the above

A

A. its origin is on the medial aspect of the ankle

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12
Q
  1. Which of the following veins may be contain valves?
A. the popliteal vein
B. the common femoral vein
C. the external iliac vein
D. the posterior tibial vein
E. all of the above
A

E. all of the above

the external iliac vein MAY contain A valve, pop vein, CFV and ptv always contain valves

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13
Q
  1. Which of the following arteries arise form the femoral artery?
A the deep iliac circumflex artery
B. the superficial epigastric artery
C. the superficial external pudendal artery
D. B and C
E. all of the above
A

D. B and C

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14
Q
  1. The first intracranial branch of the ICA is:
A. the anterior cerebral artery
B. the middle cerebral artery
C. the posterior communicating aratery
D. the ophthalmic artery
E. the orbital artery
A

D. the opthalmic artery

the first branch of ICA is - opthalmic arter

the first branch of ECA is - superior thyroid artery

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15
Q
  1. Which of the following statements abut atherosclerosis is /are true?
A. it develops at bifurcations
B. it is a generalized disease
C. it usually follows damage to the intima
D. it may be developed at an early age
E. All of the above
A

E. All of the above

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16
Q
  1. The renal arteries MAY arise the aorta?
A. laterally
B. anteriorly
C. below the SMA
D. A and C
E. B and C
A

D. A and C

laterally and below the SMA

the origin of the SMA is a good landmark for the renal arteries which arise laterally form the aorta, usually at or just below the origin of the SMA

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17
Q
  1. Inspiration impedes blood flow from the legs because of:

A. the resulting increase in the abdominal pressure
B. the resulting increase in thoracic pressure
C. increased flow to the lungs
D. decreased arterial output to the legs
E. inspiration does not impede blood flow for the legs

A

A. the resulting increase in abdominal pressure

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18
Q
  1. use the following Chi Square to calculate the statistical formulas;
    GOLD STANDARD
    PRESENT ABSENT
    + 60 5
    • 5 30
18. Value for accuracy :
A. .90
B. .65
C. .95
D. non of the above
  1. the value for specificity:

A. .07
B. .92
C. .86
D. non of the above

A
  1. A. Accuracy = (A+D) / A+B+C+D
    = 90 / 100
    = .90
  2. C. Specificity = D / ( B+D)
    = 30 / 35
    = .857 0r .86
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19
Q

20 present absent
+ 60 5
- 5 30

calculate the positive predictive value:

A. .07
B. .92
C. .90
D. non of the above

A

B. Positive Predictive Value = A / (A + B)
= 60 / 65
= .923 or .92

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20
Q
  1. Which of the following may be considered auxiliary “pumps” in the human circulation?

A. Calf Muscles
B. the diaphram
C. gravity
D. all of the above

A

D. all of the above

All three play a roll in assisting venous return to the heart, essentially behaving like “pumps”

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21
Q
  1. Specificity may also be called?

A. the true positive ratio
B. the true negative ratio
C. the false negative ratio
D. non of the above

A

B. Specificity is also know as the true negative ratio

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22
Q
  1. Which of the following characteristic is/are thru of hemodynamically significant stenoses?

A. they have > 50% area reduction
B. they have > 75% diameter reduction
C. they result in hemodynamically significant reduction in volume, pressure and flow
D. all of the above

A

C. they result in a hemodynamically significant reduction in volume, pressure and flow

Lesions are considered hemodynamically significant when the diameter is reduced by more thand 50% or when the area is reduced by more than 75%

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23
Q
  1. the development of atheromatous plaque usually begins in the:

A. tunica intima
B. tunica media
C. tunica externa
D. non of the above

A

A. tunica intima

The endothelial lining of the arterial lumen is part of the tunica intima

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24
Q
  1. Which of the following statements about venous valves is/are false?

A. valves in the common iliac veins are usually disease free
B. The number of valves present within a vein increases toward the foot
C. superficial veins generally contain more valves than deep veins
D. all of the statements above are false

A

A. valves in the common iliac veins are usually disease free.

The common iliac veins DO NOT contain valves

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25
Q
  1. The first branch proximal to the tibioperoneal trunk is:

A. the tibial artery
B. the peroneal artery
C. the tibioperneal artery
D. non of the above

A

D. non of the above

The first branch proximal tot the tibioperoneal trunk is the anterior tibial artery

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26
Q
  1. The principle point of resistance to arterial blood flow within the human circulation is:

A. the heart
B. the arteries
C. the arterioles
D. the veins

A

C. the arterioles

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27
Q

28 The normal communicating venous system:

A. connects the deep and superficial venous systems
B. contains valves
C. allows flow from the deep to the superficial system
D. A and B
E. A, B and C

A

D. A and B - The normal communicating system does not allow blood to flow from the deep system to the superficial system.

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28
Q
  1. Which of the following statements about the vertebral arteries is/are true?

A. the vertebral arteries exit the foramina transvesaria of the sixth cervical vertebrae
B. the vertebral arteries fuse to become the basilar vein
C. the vertebral arteries always arise from the subclavian arteries
D. non of the above

A

D. non of the above

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29
Q
  1. As pressure wave propagates through the arterial system:

A. its mean pressure increases
B. the systolic portion of the pressure wave decreases
C. it increases in amplitude
D. non of the above

A

C. it increases in amplitude

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30
Q
  1. The parasympathetic nervous system is responsible for?

A. increasing the hear rate during times of exertion
B. decreasing the heart rate during times of relaxation
C. increasing the heart rate during times of realaxation
D. non of the above

A

B. decreasing the heart rate during times of relaxation

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31
Q
  1. Which is the most likely result of total occlusion of a single vertebral artery?

A. the posterior communicating arteries will supply collateral flow to the brain via the internal carotid arteries
B. the anterior communicating arteries will supply collateral flow via the Circle of Willis
C. the basilar artery will supply flow to the brain
D. non of the above

A

C. the basilar artery will supply flow to the brain

When a single vertebral artery is occluded, the unobstructed vertebral artery provides sufficient collateral flow to supply the basilar artery. When both are occluded, the posterior communicating arteries of the Circle of Willis supply collateral flow via the internal carotid arteries

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32
Q
  1. What percent of total cardiac output is received by the brain?

A. 15%
B. 25%
C. 35 %
D. 45 %

A

A. 15%

the brain recieves 15% of total cardiac output

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33
Q
  1. When examining the deep venous system beginning at the hip, venous valves

A. decrease in number as you approach the foot
B. increase in number as you approach the foot
C. prevent retrograde flow
D. A and C
E. B and C

A

E. B and C

The statement makes sense when you consider that hydrostatic pressure is greater at the ankle than at thigh level

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34
Q
  1. When severe aorto-iliac disease is present, flow to the lower extremities may be maintained by collateral flow:
A. from the superior mesenteric artery
B. form the inferior mesenteric artery
C. from the subclavian artery
D. A and B
E. A, B and C
A

E. A, b and C

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35
Q
  1. As arteries course distally from the heartr, the ratio of elastic to muscular tissue within the arterial walls:

A. increases
B. Decreases
C. remains constant

A

B. decreases

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36
Q
  1. The internal pudendal artery is one of the branches of :

A. the umbilical artery
B. the posterior division of the hypogastric artery
C. the deep circumflex artery
D. non of the above

A

D. non of the above

the internal iliac artery (hypogastric artery)bifurcates into tow separate divisions, the anterior and posterior divisions. The anterior division includes the umbilical, obturator, INTERNAL PUDENDAL, middle rectal and inferior gluteal arteries. The external iliac artery continues distally to become the common femoral artery, but not before it gives off tow dorsal branches; the inferior epigastric and the deep iliac circumflex arteries. This leads tot the femoral arterial system.

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37
Q
  1. Buerger’s disease:

A. is uncommon in females
B. is associated with cigarette smoking
C. A and B
D. A, B and C

A

D. A and B

Buerger’s disease is uncommon and is associated with cigarette smoking

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38
Q
  1. In the United States, disease of the cerbrovascular system account for approximately ____________ deaths each year.
A. 50,000
B. 100,000
C. 150,000
D. 200,000
E. 250,000
A

D. 200,000

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39
Q
  1. The positive predictive value of a non - invasive test refers to:

A. the ability of a test to find disease when disease is present
B. The proportion of people with a positive test who actually have the disease.
C. the abillity of a test to give the correct answer
D. the proportion of people with a negative test who are free of disease

A

B. the roportion of people with a positive test who actually have the disease.

PPV is a measure of how likely it is that disease is actually present when the test result is positive. in other words, it is the proportion of people with a positive test who actually have the disease.

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40
Q

What is sensitivity?

A

The ability of a test to find disease when disease is present
A / A+C

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41
Q

What is Specificity?

A

the ability of a test to indicate no disease when there is not disease present (i.e to exclude disease when a patient is normal)

D / (D + B)

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42
Q
  1. The widest range of pressures that may be measured in the vascular system is:

A. 4-120 mmHg
B. 16 - 120 mmHg
C. 30- 120 mmHg
D. 80 - 120 mmHg

A

A. 4 - 120 mmHg

Remember that the vascular system includes both the arterial and venus systems with their widely varying pressures

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43
Q
  1. The cephalic vein drains blood from:

A. the brain
B. the scalp and face
C. the head and neck
D. non of the above

A

D. none of the above

The cephalic vein is a superficial vein in the upper extremity. Distally, the cephalic vein joins the basilic vein at the the elbow via the median cubital vein. Proximally, the cephalic vein is the last vein to join the axillary vein before it becomes the subclavian vein.

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44
Q
  1. The supraclinoid portion of the ICA gives rise to:

A. the anterior cerebral artery
B. the posterior cerebral artery
C. the ICA
D none of the above

A

D. non of the above

The supraclinoid portion of the ICA gives rise to the anterior Cerebral artery. The ECA has NO supraclinoid portion!

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45
Q
  1. The final branch of the Aorta before it bifurcates is:

A. the inferior mesenteric artery
B. the superior mesenteric artery
C. the middle sacral artery
D. non of the above

A

C. the middle sacral artery

Although the final VISCERAL branch of the aorta before the bifurcation is the inferior mesenteric artery, the FINAL branch is the middle sacral artery.

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46
Q
  1. The PRIMARY reason that blood flows in the arterial tree:

A. because there is a pressure gradient between the arterial and venous sides of the circulation
B. Because of the pumping action of the muscular venous pump
C. because the diaphragm moves.
D. because hydrostatic pressure assists venous return

A

A. because there is a pressure gradient between the arterial and venous sides of the circulation

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47
Q
  1. The greatest contributor to STROKE in the USA is:

A. Hyperlipidemia
B. atherosclerosis
C. Hypertension
D. cigarette smoking

A

C. hypertension

Although high cholesterol, cigarette smoking and atherosclerosis are certainly predisposing factors, the greatest contributor to stroke in the USA is hypertension.

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48
Q
  1. The External Carotid Artery:

A. contains branches
B. may provide collateral flow to the brain
C. is always the smaller and more medial of the CCA branches
D. A and B
E. A, B and C

A

D. A and B

Although the ECA is usually the smaller and more medial of the CCA branches, this is not always the case, and in order to definitely identify the ECA, you should look for a vessel with branches. Remember, the ICA has no extracranial branches.

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49
Q
  1. The periorbital circulation:

A. includes the frontal, nasal and supraorbital arteries
B. may provide flow around and obstructed internal carotid artery
C. is the most important source of collateral flow to the brain
D. A and B
E. A, B and C

A

D. A and B
A - includes the frontal, nasal and supraorbital arteries
B - may provide flow around an obstructed internal Carotid artery

The MOST important source of collateral flow to the brain is the Circle of Willis

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50
Q
  1. Deep venous thrombosis is indirectly responsible for approximately _______ deaths due to pulmonary embolus each year the the USA.

A. 9,000
B. 167,000
C. 200,000
D. 650,000

A

A. 9,000

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51
Q
  1. T or F
    Perforating veins, which are most prominent in the calf, also contain valves which direct blood from the deep to to superficial venous system.
A

False,
Perforators, which are most prominent in the lower leg (calf) also contain valves which direct blood from the SUPERFICIAL TO THE DEEP venous system

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52
Q
  1. T OR F
    A considerable portion of the heart’s output must be STORED during each ventricular systole to be passed on later during diastole
A

TRUE,
Because it is not possible for the capillary network to transmit 70 cc’s of blood with each heartbeat, the elastic walls of the conducting arteries serve to store this excess volume of blood by STRETCHING DURING SYSTOLE AND RELAXING DURING DIASTOLE

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53
Q
  1. T or F
    The plantar arch of the foot is formed by the deep plantar branch of the Dorsalis Pedis artery and the lateral plantar branch of the peroneal artery.
A

False,
The plantar arch of the foot is formed by the deep plantar branch of the dorsalis pedis arter and the lateral plantar branch of the posterior tibial artery ( not the peroneal artery)

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54
Q
  1. T or F
    Positive predictive value is a measure of how likely it is that disease is actually present when the test result is positive
A

TRUE,

In other words, it is the proportion of people with a positive test who actually have the disease

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55
Q
  1. T or F

Up to 22% of the population have a common origin of both common carotid arteries

A

FALSE,

Up to 22% of the population have a common origin of the BRACHIOCEPHALIC AND LEFT CCA ARTERIES NOT BOTH CCA

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56
Q
  1. T OR F

The ICA and ECA can be differentiated from on another by the fact that the ICA has no extracranial branches

A

TRUE,

This is the best way to differentiate the tow vessels. The ICA has NO extracranial branches

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57
Q
  1. T or F

Hemodynamically sighnificnt lesions ar those with > 50% diameter reduction or > 75% area reduction

A

TRUE,

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58
Q
  1. T or F
    The deep venous system of the entire lower extremity is composed of paired veins, when compared with the single arteries that supply the leg
A

False
This statement is true only for the deep system BELOW THE KNEE. Above the knee, there is only one vein for each aratery supplying the leg.

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59
Q
  1. T OR F

Arteriosclerosis obliterans is the most common cause of chronic arterial occlusive disease in the Western World

A

TRUE
Atherosclerosis is the most common cause of chorionic arterial occlusive disease in the Western World. this disease is also known as arteriosclerosis OBliterans (ASO)

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60
Q
  1. T or F

Valves are found in greater abundance in the upper extremities where there is a greater possibility of reflux

A

FALSE
Valves are found in grater abundance in the LOWER extremities where there is a greater possibility of reflux ( becuase of the greater hydrostatic pressure)

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61
Q
  1. T or F
    Compression of the subclavian artery between the first rib and the scalene muscle may result in the THORACIC OUTLET SYNDROME.
A

TRUE
Compression of the subclavian artery between the first rib and the scalene muscle may result in the thoracic outlet syndrome

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62
Q
  1. T or F

only 8% of our patients have an incomplete circle of Willis

A

FALSE

Approximately 50% of our patients have a complete circle of Willis ( meaning the other fifty percent don’t

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63
Q
  1. T or F

The right renal artery runs posterior to the IVC

A

TRUE

The right renal arataery runs posterior to the IVC, and is the only vessel to do so!

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64
Q
  1. T or F

The human brain receives the highest volume of cardiac output when compared with other organs.

A

FALSE
The human brain receives 15 % of total cardiac output and consumes 20% of the body’s oxygen supply, but the renal arteries receive approximately 25% of the total cardiac output to be processed by the kidneys.

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65
Q
  1. T or F

Vasa Vasorum supply a blood vessel’s need for a source of nutrients as well as a conduit for their own waste products

A

TRUE
Blood vessels themselves need a source of nutrients as well as a conduit for their own waste products. This function is fulfilled by tiny vessels in the tunica adventitia of both the arteries and veins called the VASA VASORUM which literally means “ vessels of vessels”

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66
Q
  1. T or F
    In a triphasic wave form, the temporary flow reversal during diastole occurs as the reflected wave hist the proximal resistance of the next oncoming wave.
A

FALSE
The temporary flow reversal during diastole occurs because of a negative pressure gradient caused by peripheral resistance to forward flow

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67
Q
  1. T or F

In addition to the heart, the AO is considered a significant “pump” within the arterial circulation

A

TRUE
The Aorta acts as a “subsidiary pump”. The aorta and other elastic arteries near the hear serve to store energy by “stretching” with each systole, acting as a RESERVOIR, storing much of the blood expelled by the heart. During diastole, the energy stored in the arterial walls dissipates the large volume of blood stored in the aorta by forcing blood forward in the arteries, causing the aorta to return to normal caliber

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68
Q
  1. T or F
    Compression of the subclavian artery between the first rib and the scalene muscle may result in thoracic outlet syndrome.
A

TRUE

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69
Q
  1. T or F

Buergers’ disease occurs in young females and in related to cigarette smoking

A

FALSE
Thromboangitis obliterans or Buerger’s disease accounts for approximately 1% of all diseases involving the large and medium size arteries. It occurs in YOUNG MALES and is related to cigarette smoking

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70
Q
  1. T OR F
    As the vessels in the circulatory system change caliber from large to small, they also change their function from conducting, to collecting and distributing and finally to functioning.
A

TRUE

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71
Q
  1. T or F

The first branch of the ECA is the opthalmic artery

A

FALSE

The first branch of the ECA is the SUPERIOR THYROID ARTERY.

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72
Q
  1. T or F

The majority of pulmonary emboli are thought to arise form the superficial veins of the lower extremities

A

FALSE
The majority of pulmonary emboli (more than 90%) are thought to arise form THE DEEP VEINS ( not superficial) of the lower extremities, many following abdominal or orthopedic surgery.

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73
Q
  1. T or F
    Currently the most popular theory explaining the formation of atheromatous plaques, is that plaque formation results form increased in plasma LDL (low density lipoproteins) with deposition into the arterial wall
A

FASLE
This is the second most popular theory. Most researchers feel that plaque develops as a response to injury of the endothelial lining of the arteries. This “injury” is caused by the turbulence that occurs at any vessel bifurcation

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74
Q
  1. T or F
    The celiac artery trunk is the aorta’s second main visceral branch, and is the origin of the splenic, left gastric and common hepatic arteries
A

FALSE
The celiac artery(or trunk or axis) is the FIRST MAIN VISCERAL BRANCH OF THE AO. It arises from the anterior surface of the aorta at the L1 level and courses ventrally only a few centimeters before it bifurcates into the splenic, left gastric and common hepatic arteries

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75
Q
  1. T or F
    As a cardiac pressure wave propagates through the arterial system, the systolic portion of the pressure wave decreases due to the increasing stiffness of the vessel walls toward the periphery
A

FALSE
As a cardiac pressure wave propagates through the arterial system, the systolic portion of the pressure wave actually INCREASES due to the increasing stiffness of the vessel walls towards the periphery

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76
Q
  1. A patient states that she can only walk for tow blocks befor pain in her calves prevents her from continuing . Her diagnosis is most likely which of the following?
A. atherosclerosis fo gthe pedal arch
B. claudication
C. lumbar disk compression
D. arthritis of the knee
E. atherosclerosis of the lower extremity arterial system
A

E. atherosclerosis of the lower extremity arterial system.

Claudication is a Symptom, NOT a diagnosis

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77
Q
  1. Blue toe syndrome is usually the result of:

A. Venous occlusion secondary to embolism
B. cold feet
C. anterior tibial artery occlusion
D. Digital artery occlusion
E. atherosclerosis of the lower extremity arterial system

A

D. digital artery occlusion

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78
Q
  1. Patients with symptoms of Raynaud’s Disease undergo finger discoloration which takes the following pattern:

A. white, red, blue
B. White, blue, red
C. red, white, blue
D. blue, red, white

A

B. white, blue, red

The finger turns white or pale immediately following the episode of vasospasm, soon to become blue (cyanotic) followed by red ( once normal tissue perfusion returns.

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79
Q
  1. The subclavian steal syndrome may result from a stenosis of which of the following vessels?
A. left subclavian artery
B. right subclavian artery
C. brachiocephalic (innominate) artery
D. all of the above
E. non of the above
A

D. all of the above

left subclavian, right subclavian, brachiocephalic (innominate) ARTERIES

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80
Q
  1. Which of the following statements regarding blood flow in the superior mesenteric artery is/are true?

A. prior to eating, flow in the SMA has a large diastolic component
B. mesenteric angina frequently results from disease
of the superior mesenteric artery alone
C. Post prandial SMA flow has a low resistance pattern
D. A and B
E. B and C

A

C. post prandial SMA flow has a low resistance pattern

Before mesenteric angina shows up, two of the three vessels supplying the bowel must be significantly stenosed.
The SMA has little or no diastolic flow prior to eating (i.. while fasting) and in fact demonstrates some diastolic flow reversal. The SMA flow pattern after eating is typical of low resistance vascular beds like the brain and kidney.

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81
Q
  1. The normal audible arterial doppler signal possesses which of the following qualities?

A. monophasic with sounds evident only in systole
B. multiphasic with sounds heard in systole and diastole
C. multiphasic with sounds heard only in diastole
D. biphasic with sounds heard only in systole
E. non of the above

A

B. multiphasic with sounds heard in systole and diastole

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82
Q
  1. The MOST LIKELY reason for inaccurate palpation of the patient’s pedal pulse is:
A. the examiner cannot locate the artery
B. the pulse is too weak to palpate
C. the examiner feels their own pulse
D. the pedal pulse is not present
E. non of the above
A

C. the examiner feels their own pulse

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83
Q
  1. Patients with intermittent claudication may complain of which of the following?

A. muscle cramps that awaken them from a sound sleep
B. pain in the knee joint that is constant
C. crampy pain in the buttock and thigh with exercise, that is quickly relieved by rest
D. Pain in the calf and thigh not relieved by rest
E. pain in the calves only while standing

A

C. crampy pain in the buttock and thigh with exercise, that is quickly relieved by rest.

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84
Q
  1. A. 22 year old athlete complains of severe pain in the left calf and foot when playing football. The pain is relieved by takin a break and sitting on the bench. Physical exam reveals normal pedal pulses and normal resting ankle pressures. Post-exercise ankle pressures reveal a 50 mm Hf pressure drop on the left side. What the most likely diagnosis?

A. occlusion of the popliteal artery on the left side
B. Deep venous thrombosis of the left calf
C. left popliteal artery entrapment
D. coarctation of the aorta
E. none of the above

A

C. left popliteal artery entrapment

These symptoms are typical of popliteal artery entrapment and you will most likely encounter at least one “ young athlete” type question on your exam. Be careful to distinguish popliteal artery entrapment from the anterior tibial compartment syndrome - arterial compression that occurs following trauma

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85
Q
  1. Patients with Chronic peripheral arterial occlusive disease demonstrate which of the following skin changes?
A. shiny skin
B. scaly skin
C. dependent rubor and pallor on elevation
D. A and B
E. all of the above
A

E. all of the above

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86
Q
  1. After performing segmental pressure measurements on a patient, teh following pressures were documented.
    Posterior tibial pressure 100mmHg
    Dorsalis Pedis pressure 125mmHF
    Peroneal 120mmHg
    left brachial 115mmHg
    right brachial 110 mmGh
    The ankle/brachialindex (ABI) is calculated as :
A. 1.04
B. 1.14
C. 0.87
D. 1.09
E. non of the above
A

D. 1.09

remember to divide the highest ankle pressure obtained by the highest arm pressure. In this case, 125 / 115 = 1.086

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87
Q
  1. Which of the following statements IS FALSE regarding the effect of vigorous exercise on the legs of a normal individual?

A. It results in increased blood flow to the muscles
B. It decreases blood pressure at the ankle level
C. it results in hyperemia when the exercise ceases
D. It causes vasodilatation of the distal arterioles
E. It causes oxygen and flow depts in the muscles used

A

B. It decreases blood pressure at the ankle level

In a normal individual, vigorous exercise should cause NO DROP
in ankle pressure and may cause a slight INCREASE in ankle pressure. When significant arterial disease is present, ther will be a definite drop in pressure distal to the stenosis when compared with the pre exercise pressure.

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88
Q
  1. Sympathetic stimuli normally affects digital volume in what manner?

A. digital volume increases with inspiration
B. Digital volume decreases with expiration
C. sympathetic stimuli does not affect digital volume
D. A and B

A

D. A and B

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89
Q
  1. Auscultation of the AO and lower extremity arteries is important because?

A. bruits usually originate from the aortic arch
B. a bruit is always an indicator of a significant stenosis
C. the absence of a bruit indicates the absence of significant arterial disease
D. the presence of a bruit may be the first indication of arterial disease
E. non of the above
D

A

D. the presence of a bruit may be the first indication of arterial disease

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90
Q
  1. A 60 year old female with orally controlled diabetes and a hx of light cigarette use gives a hx of bilateral calf and thigh pain, worse on the left side. On further questioning, she reveals that the pain is relieved by resting but quickly returns after walking only a few steps. If she continues walking, she states that the pain doesn’t progress even if she walks for several blocks.
    These symptoms are consistent with:
A. bilateral popliteal artery stenoses
B. bilateral iliac artery disease
C. distal abdominal aortic disease
D. all of the above
E. these symptoms are not typical of vascular disease
A

E. these symptoms are not typical of vascular disease

The patternof pain described by the patient in this question is not typical of vascular disease because of its lack of progression with continued walking. A patient with arterial occlusive disease would have pain necessitating a res ( to perfuse the oxygen starved tissues)

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91
Q
  1. When assessing the post transplant liver, the most important indication of refection is:

A. a high resistance flow pattern
B. a low resistance flow pattern
C. not evident using duplex ultrasound
D. hepatic artery patency

A

C. not evident using duplex ultrasound

The most important indicator of impending refection of the liver in a post transplant patient are liver function tests.

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92
Q
  1. When assessing the post transplant liver, the most immportant indication of rejection is:

A. a high resistance flow pattern
B. a low resistance flow pattern
C. Not evident using duplex ultrasound
D. hepatic artery patency

A

C. Not evident using duplex ultrasound

The most important indicator of impending rejection of the liver in a post transplant patient are liver function tests.

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93
Q
  1. A 55 y o man gives a history of pain in his left calf after walking 6-8 blocks. A single ankle pressure measurement results in an ABI of 1.10
    This finding is:

A. indicates that no arterial disease is present, and the patient requires no further follow up
B. suggests that “pseudocladication” is present
C. indicates that further testing should be done
D. indicates that the patient probably has arterial calcification
E. Non of the above

A

C. indicates that further testing should be done

Tghe lack of an abnormal pressure at rest does not necessarily rule out arterial disease, the patient requires stress testing in order to obtain more information.

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94
Q
  1. A patient gives a history of rest pain in the left foot. Your physicala examination reveals weak femoral and popliteal pulses in the right leg and no palpable pulses in the left leg. The left leg reveals dependent rubor and elevation pallor. Your ankle pressure measurements are 120 mm HG on the right side and 100mmHg on the left side. The patient’s brachial pressure is 140mmHg. Your results are:

A. consistent with the patients history
B. consisten with mild left leg arterial disease
C. Questionable unless the patient has medial calcificagion
D. consistent with an erroneous physical examination
E. None of the above

A

C. Questionable unless the patient has medial calcification

The fact that the patient has rest pain would lead you to expect an ABI of t make sense in the context of the clinical findings and should lead you to suspect possible medial calcification at the level of the left ankle.

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95
Q
  1. Distal to an occlusion at the aorto-iliac level, the common femoral artery Doppler signal may be:
A. biphasic
B. monophasic and low pitched
C. Monophasic and hight pitched
D. multiphasic but with reduced velocities
E. non of the above
A

B. monophasic and low pitched

The low pitched, monophasic flow that may be identified in the
Scenario is mosts likely due to collateral flow.

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96
Q
  1. Common signs of peripheral arterial insufficiency of the legs includes which of the following?
A. Skin pigmenation
B. loss of hair on the toes
C. dependent  rubor
D. B and C
E. all of the above
A
  1. Common signs of peripheral arterial insufficiently of the legs include witch of the following?

A. skin pigmentation
B. loss of hair on toes
D B and C
E. All of the above

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97
Q
  1. Common signs of peripheral arterial insufficienceB:
A. skin pigmentation
B. loss of hair on toes
C. Dependent rubor
D. A and C
E. all of the above
A

D. B and C

Skin pigmentation is a sigh of venous stasis and not peripheral arterial disease. Hair loss and dependent rubor are common signs of arterial disease.

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98
Q
  1. Which of the following MAY be considered a lower extremity Doppler waveform abnormality?
A. the presence of an anacrotic notch on the upslope
B. an absent revers flow component
C. decreased peak to peak bandwidth
D. A triphasic waveform
E. all of the above
A

B. an absent reverse flow component

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99
Q
  1. Which of the following statements is TRUE about diastolic flow reversal?

A. it is always absent in normal limbs
B. it may be absent in vasodialated limbs
C. it is always present in normal limbs
D. it is always present in abnormal limbs

A

B. it may be absent in vasodilated limbs

Diastolic flow reversal varies with the degree of resistance of the distal peripheral vascular bed. When the distal arterioles are fully dilated, they provide little resistance to flow.

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100
Q
  1. Which of the following sounds should be heard DIRECTLY OVER an arterial occlusion?
A. a distinct "thumping" sound
B. a low frequency sound
C. a high frequency sound
D. the sound would be similar to a norma arterial sound
E. no sound would be heard
A

A. A distinct “thump” sound

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101
Q
  1. Which of the following are possible errors that may occur during a lower extremity duplex study?

A. recording an artery and vein at the same time
B. Positioning the sample volume over part of the artery
C. using a frequency that is to high
D. compressing the artery with the Doppler probe
E. All of the above

A

E. all of the above

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102
Q
  1. During a treadmill test a patient asks to sop because of sever right cf pain. The left leg remained asymptomatic during the test. The following pressure measurements were obtain before and after stress testing. Before exercise the Rt arm pressure was 150 mmHg, right posterior tibial 120 mmHg Lt posterior tibial 120 mmHG. After exercise the rt arm pressure was 150 mmHg, rt posterior tibial 60 mm Hg, Lt. Posterior tibial 90 mmHg.

Which of the following statements is true, considering the information presented above?

A. The patient has right sided iliac disease
B. the test should be repeated to ascertain whether a further pressure drop results
C. the patient has bilateral arterial disease
D. The patient has left posterior tibial artery occlusion as well as right sided iliac disease
E. non of the above statements are true

A

C. The patient has bilateral arterial disease

Despite the fact that the patient did not have symptoms of claudication in his left leg, the pre and post-exercise pressure measurements suggest bilateral lower extremity arterial disease. The most likely reason is’ the pain the patient’s right leg stopped him Befor left sided symptoms became evident

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103
Q
  1. Reactive hyperemia:

A. is useful for stressing patients who have demonstrated and abnormal ankle brachial index
B. is a common response to exercise
C. involves measuring the patient’s thigh pressure following temporary ischemia using a thigh cuff or tourniquet
D. none of the above

A

D. none of the above

Reactive hyperemia is defines as: an increase in blood in a region following the restoration of the blood supply after a period of temporary arrest. (i.e following the application of a tourniquet, but not following exercise.)

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104
Q
  1. Rest pain:
A. is a symptom of potential limb loss
B. is located in the foot
C. may be relieved by changing to an erect position
D. A and B
E A, B and C
A

E. A, B and C

rest pain in always located in the foot, affecting to dorsum of the foot and toes primarily.
In its early stages, patients describe rest pain only at nigh and find the can relive the discomfort by hanging their feet over the edge of the bed(i.e the foot becomes dependent after this maneuver, increasing blood supply somewhat). Walking around the room (mild exercise ) may also provide some relief by increasing the blood supply to the foot

** Rest pain IS ALWAYS an indicator of far - advanced multi segmental arterial disease and is a precursor to limb loss unless medical intervention is undertaken

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105
Q
  1. Which of the following statements about arterial occlusive disease of the upper extremity are true?

A. symptomatic arterial occlusive disease of the upper extremity occurs with equal frequency in both upper and lower extremities
B. the etiology of upper extremity symptoms is usually embolic
C. Atherosclerotic disease of the upper extremity usually involves the subclavian or axcillary arteries.
D. A and B
E. A, B and C

A

C. atherosclerotic disease of the upper extremity usually involves the subclavian or axillary arteries

Upper extremity arterial disease is relatively uncommon

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106
Q
  1. Patients with hemodynamically significant arterial occlusive disease:
A. may exhibit hair loss, thickened toenails and ulcer
B. may haveabsent pedal pulses
C. bay be asymptomatic
D A and B
E. A, B and C
A

E. A, B and C

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107
Q
  1. Which of the following statements about False aneurysms is/are FALSE?

A. false aneurysms differ from true aneurysms because they are not enclosed by all three arterial wall layers
B. false aneurysms occur spontaneously
C. flow may not be detected in a false aneurysm
D. A and B
E. A, B and C

A

B. False aneurysms occur spontaneously

is a false statement

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108
Q 
31. Single digit ischemia is often the result of :
A. Beurger's disease
B. Thromoangitis obliterans
C. Takaysau's arteritis
D. an embolus
E. all of the above
A

D. and embolus

Single digit ischemia is most likely related to an embolus(Blue toe
syndrome). Buerger’s disease Or TAO affects the digits of the hands and feet.

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109
Q
  1. which of the following statements about ankle pressure measurement are true?

A. A normal ankle pressure measurement usually precludes significant arterial occlusive disease of the lower extremity.
B. Ankle pressure measurement is a tedious procedure
C. in order to measure ankle pressure, a pneumatic cuff is applied just below the knee
D. when calculating the ankle to brachial index, the highest brachial pressure is divided by the highest ankle pressure
E. Non of the above are true.

A

A. a normal ankle pressure measurement usually precludes significant arterial occlusive disease of the lower extremities

Although a normal ankle pressure at rest usually precludes significant lower extremity arterial disease, always remember to take ankle pressures before and after exercise in patients who complain of intermittent claudication

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110
Q
  1. Which of following statements regarding segmental pressure measurement are true?

A. a narrow thigh cuff may result in the measurement of an artifactually low thigh pressure.
B. the four cuff technique results in a more accurate estimation of the level of vascular disease
C. an abormal ABI indicates arterial disease distal to the position of the cuff
D. A and B
E. A, B and C

A

B. The four cuff technique results in a more accurate estimation of the level of vascular disease.

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111
Q
  1. What category of stenosis is best described by the statement “ A 40% increase in peak systolic velocity accompanied by an attenuated reverse flow component”?

A. a mild stenosis
B. a moderate stenosis
C. a severe stenosis
D. a total occlusion

A

B. a moderate stenosis

CATEGORIES OF STENOSIS MILD  	1-19%	Normal velocities and waveform contour (i.e 					triphasic) but spectral broadening is evident Moderate	20 - 49 %	Increased PSV (by 30 - 50%) with marked 					spectral broadening.  The reverse flow 						component may be attenuated, resulting in a 				biphasic waveform Severe	50-99%	Increased PSV  (BY >100%) with marked 					spectral broadening.  After 80% stenosis, flow 				diminishes and the wave forms becomes 					damped.  Revers flow component of the waveform is absent( monophasic ) with rounded upslope TOTAL OCCLUSION - NO flow systolic "thumping"
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112
Q
  1. Vasculogenic impotence should be suspected when:

A. The penile brachial index is less than .65
B. post injection peak systolic penile velocities are >= 30 cm/sec
C. the brachial to penile pressure gradient is <20 mmHG
D. A and B
E. A, B and C

A

A. the penile brachial index is less than .65

A normal PBI is 0.75 or greater (potent young males typically have ratios greater than 0.8 and usually equal to arm pressures.)
Ratios between 0.65 and 0.74 are marginal and equivocal, and ratios less than 0.65 are consistent with Vasculogenic impotence

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113
Q
  1. Vasodilation of the peripheral arteries usually results in:

A. a reduction in the amplitude of the reverse flow component
of the Doppler velocity waveform
B. a damped, monophasic waveform
C. a high velocity, stenotic waveform
D. All of the above may result from peripheral vasodilation

A

A. a reduction in the amplitude of the reverse flow component of the Doppler velocity waveform

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114
Q
  1. Rest pain may be relieved by:

A. a change in foot position
B. exercise
C. medical intervention
D. all of the above

A

D. All of the above

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115
Q
  1. Which of the following statements regarding aneurysmal dilatation of the aorta is /are true?

A. aneurysmal dilation of the aorta, ilic, femoral and popliteal arteries occurs with equal frequency
B.aneurysms by definition are greater that 5 cm. in diameter
C. Angiography is more accurate when assessing the isve of an aortic aneurysm
D. non of the above

A

D. none of the above

Aneurysms of iliac aries are LESS COMMON than abdominal aortic by a factor of ten;aortic aneurysms by definition are greater than 3 cm. in diameter and angiography only demonstrates the “true lumen” of the aneurysm not the size

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116
Q
  1. Which statement(s) best describe Raynaud’s phenomenon
A. it frequently resolves after several years
B  it may result in digital ulceration
C. it is common in young females
D A and B
E. A, B and C
A

B. it may result in digital ulceration

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117
Q
  1. In view of the fact that ABI’s below 1.0 can be used to quantitate the severity of lower extremity arterial disease, a calculated ABI 0f 0.7 is consistent with:

A. a normal examination
B. moderate claudication
C. Rest pain
D. Non of the above

A

B. moderate claudication

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118
Q

41.The audible Doppler sound found distal to a proximal significant stenosis is best described as :

A. Absent
B. described as a ‘systolic thumping”
C. monophasic
D. multiphasic

A

C. monophasic

Abnormal doppler sounds are MONOPHASIC with a systolic component but no diastolic sounds identified. This type of signal is obtained distal to a severe stenosis or occlusion, where flow may be originating from collateral sources

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119
Q
  1. The damping factor in a normal patient:

A. decreases as more proximal arateries are used for the calculation
B. increases as more proximal arteries are used for the calculation
C. is the ratio between the pulsatility index of a distal site t a proximal site
D. non of the above

A

A. decreases as more proximal arteries are used for the calculation

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120
Q
  1. What type of aneurysm is best described by the statement”and aneurysm that occurs following weakening of the arterial wall by some infectious or bacterial process”?
A. A fusiform aneurysm
B. A mycotic aneurysm
C. a saccular aneurysm
D. a berry aneurysm
E. a false aneurysm
A

B. a mycotic aneurysm

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121
Q
  1. Digital artery pressure measurement is best performed with:

A. a pneumatic cuff and doppler flow detector
B an SPG and a strip chart recorder set to DC mode
C. A PPG and an SCR set to AC mode
D. A pneumatic cuff and a SCR set to DC mode

A

C. A PPG and a SCR set to AC mode

Digital pressure measurements are best performed with A PPG and a SCR set to AC mode

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122
Q
  1. The diseased arterial segment responsible for patient symptoms is:

A. always distal to the symptomatic muscle group
B. usually distal to the symptomatic muscle group
C. always proximal to the symptomatic muscle group
D. usually proximal to the symptomatic muscle grou[

A

C. always proximal to the symptomatic muscle group

The diseased segment is always proximal o the site of musculr discomfort. Think About It!

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123
Q

46.Aortic dissection is most common in:

A. the distal abdominal aorta
B. the mid abdominal aorta
C. the proximal abdominal aorta
D. the thoracic aorta

A

D. The thoracic aorta

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124
Q
  1. The subclavian steal syndrome is best diagnosed by:

A. measuring a pressure difference greater than 20 mmHg between the patients arms
B. identifying retrograde flow in a vertebral artery
C. visualizing a stenosis of the vertebral artery with duplex scanner
D. A and B
E. A, B and C

A

D. A and B
measuring pressure difference greater thatn 20 mmHg between the patient’s arms and identifying retrograde flow in a vertebral artery

While the actual site of subclavian artery stenosis is infrequently visualized, one should always measure a pressure difference > 20 mmHg between arms and identify retrograde or oscillatory flow int the vertebral artery.

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125
Q
  1. Following cold testing, a normal patient’s digits should return to pre-test temperatures with

A. 12 -15 sec
B. 20- 25 seconds
C. 10- 15 minutes
D. 20- 25 minutes

A

C. 10- 15 minutes

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126
Q
  1. A spectral waveform that demonstrates a peak systolic velocity greater than 100 % that of a normal segment of the same artery is MOST consistent WITH:
A. a normal vessel
B. a stenosis of 10%
C. a stenosis of 25%
D. a stenosis of 35%
E. A stenosis of 75%
A

E. a stenosis of 75%

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127
Q
  1. Which of the following are considered advantages of duplex imaging over angiography?

A. duplex imaging is harmless
B. duplex imaging is relatively inexpensive
C. duplex imaging is suitable for screening patients
D. A and B
E. A, B and C

A

E. all of the above

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128
Q
  1. T or F

Patients with subclavian steal syndrome should demonstrate no difference in pressure between arms.

A

False

In general, a pressure difference greater than 20 mmHg between arms is a good indicator that a subclavian steal ma be present. Retrograde flow in the vertebral artery nails the diagnosis.

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129
Q
  1. T or F

Patients with impending gangrene usually have an ABI < 0.1

A

TRUE

Patients complaining of rest pain usually have an ABI in the -.25 - 0.30 range and patients with impending gangrene have extremely low ABI’s in the 0.05 to 0.08 range. When arterial occlusive disease is this severe, the ankle pressures measured are usually below 40 mmHg.

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130
Q
  1. T or F

One of the disadvantages of the pulsatility index is its independence form the Doppler angle used to obtain it.

A

FALSE

This is actually an advantage,

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131
Q
  1. T or F
    When performing segmental pressure measurement, the pressure obtained using the pneumatic cuff technique is at the site of the cuff, not the site of the Doppler device.
A

TRUE

The pressure measured using the pneumatic cuff technique is at the site of the cuff, not the site of the Doppler device

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132
Q
  1. T or F
    Raynaud’s Disease is vasospasm with no underlying disease, while Raynaud’s Phenomenon is vasospasm that is secondary to underlying arterial disease
A

TRUE

Raynaud’s Disease is Vasospasm with NO underlying disease, while Raynaud’s phebinenon is vasospasm that is SECONDARY to underlying arterial disease

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133
Q
  1. T or F

Triphasic waveforms are consistent with a absence of arterial disease.

A

TRUE

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134
Q
  1. T or F
    The normal penile /brachial index is usually equal to arm pressure in normal patients. Ratios less that 0.80 are consistent with vasculogenic impotency
A

FALSE

Then normal penile/brachial i ndex (PBI) is 0.80 or greater (potent young males typically have ratios grater that 0.8 and usually equal to arm pressure). Ratios between 0.06 and 0.75 are euivocal, and ratios less than 0.60 are consistent with vasculogenic impotence.

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135
Q
  1. T or F

Finger pressures may help us differentiate between Raynaud’s disease and phenomenon

A

TRUE

Normal patients demonstrate NO SIGNIFICANT PRESSURE DROP with finger cooling to 15 degrees C. Subjects with Raynaud’s disease have normal pressures until their digits are cooled to blow 15degrees C. Subjects with Raynaud’s phenomenon have pressure drops WITH OR WITHOUT a finger cooling maneuver

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136
Q
  1. T or F

Mesenteric angina is the result of partial occlusion of the celiac axis, resulting in a degree of bowel ischemia.

A

FALSE

Patients with significant SMA and/or IMA disease (not Ciliac disease) may develop severe, crampy, abdominal pain. Tjois symptoms often referred to as “mesenteric angina” and is the result of partial occlusion of the mesenteric vessels, resulting in a degree of bowel ischemia.

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137
Q
  1. T or F

Beurger’s disease is also know as pulseless disease

A

FALSE

TAKAYASU’S syndrome i or arteritis is also know as pulseless disease. It is caused by and inflammation of the media of the arterial wall and characterized by a diminishing arterial pulse noted over a period of time

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138
Q
  1. T or F

Normal portal venous flow is phasic with respiration, decreasing with inspiration and increasing with expiration

A

TRUE

The normal Doppler spectrum of flow obtained from the protal system is LOW VELOCITY, TOWARD THE LIVER AND PHASIC with RESPIRATION, decreasing with inspiration and increasing w/ expiration

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139
Q
  1. T or F

A normal patient demonstrates a slight drop in ankle pressure following excercise.

A

FALSE

A normal patient demonstrates NO DROP in ankle pressure following exercise and may show a SLIGHT INCREASE in pressure

140
Q
  1. T or F

A renin- angiotensin response may be responsible for systemic hyperetension.

A

TRUE
Hypertension secondary to renal artery disease results from the pressure drop which occurs distal tot he stenosis, which initiates a
RENIN-ANGIOTESIN RESPONSE, incresing arterial blood pressure.

141
Q
  1. T or F

A peak Graf systolic flow velocity less than 75 cm/sec is a potential sigh of graft failure

A

FALSE

A peak graft systolic flow velocity less that 45 cm/sec or a decrease in flow velocity of more than 30 cm/sec when compared to the normal arterial segment is a potential sigh of Graft failure. When this situation is present, the patient requires anticoagulant therapy to prevent thrombus formation with the graft

142
Q
  1. T or F
    Patients controlled by blood pressure medication often suffer an increase in claudication compared to their pre medication state.
A

TRUE

Patients controlled by blood pressure medication often suffer an increase in claudication becuase their uncontrolled blood pressure forced MORE blood through the stenosed arterial tree!

143
Q
  1. T or F
    Similar to segmental pressure measurement, segmental volume plethysmography is limited by calcified or non- compliant arteries
A

FALSE

Segmental volume plethysomography is especially useful in patients with calcified or non - compliant arteries, in which segmental pressure measurement is ineffective

144
Q
  1. T or F

Low pitched, monophasic flow distal to an arterial occlusion is consistent with collateral flow

A

TRUE

The sound of collateral flow distal to an arterial occlusion should be low pitched and monophasic

145
Q
  1. T or

An ABI of 0.7 calculated following segmental pressure measurement is consistent with minimal claudication

A

FALSE

An ABI of 0.7 obtained following segmental pressure measurement is consistent with moderate claudication, usually caused by single level arterial disease.

146
Q
  1. T or F

A peak flow velocity of 4 m /sec obtained from a superficial femoral artery os consistent with severe stenosis >80%

A

TRUE

In many labs today, a peak flow velocity of 200 c/sec or greater and /or a max. stenotic to pre stenotic velocity ratio of 2:1 is consistent with a significant stenosis >50 % diameter reduction. A peak flow velocity of 400 cm/sec with a ratio of 4:1 is consistent with a severe stenosis >80%

147
Q
  1. T or F

Rest pain is defined as: those symptoms that occur with exercise and are relieved by rest.

A

FALSE

The symtoms that occur with exercise ad are relieved by rest are consistent with claudication

148
Q
  1. T or F

An Allen test should be performed prior to harvesting a radial artery for coronary artery bypass graft.

A

TRUE

The modified Allen test is performed on patients prior to having surgery requiring radial artery canulation or for construction of A.V fistulae for hemodialysis, or prior to harvesting the radial artery for coronary artery bypass. If the palmer arch is not complete, a surgical procedure may result in severe ischemia of the hand

149
Q
  1. T or F

Segmental pressure measurement is a good method of assessing the success of PTFE bypass grafts

A

FALSE

in addition to the risk of occluding an otherwise functioning graft by pneumatic cuff occlusion, grafts are resistant to compression and would yield falsely elevated pressure measurements

150
Q
  1. T or F

Plethysomographs record changes in the pressure of the part being examined

A

FALSE

Students who have completed the vascular physics course will recall being examined

151
Q
  1. T or F

When performing arterial Doppler of the lower extremities, there is a gradual decrease in peak arterial velocity form common femoral to popliteal level

A

TRUE

In normal patients, peak arterial systolic velocity decreases between common femoral and proximal superficial femoral arteries and again across the adductor canal between the distal superficial femoral artery ad popliteal artery

152
Q
  1. T or F

On physical examination you notice your patient’s toes are all blue. This is consistent with acute arterial occlusion

A

FALSE

IF one toe is “blue” the acute arterial occlusion should be considered. However, if all of the patient’s toes are blue, a critical decrease in cardiac output may be the cause

153
Q

Statistically, the clinical diagnosis of deep venous thrombosis based on symptoms alone is correct _________ % of the time.

A. 25 
B. 50 
C. 75
D. 90
E. 100
A

B. 50%

154
Q
  1. Acute DVT may be the result of :
A. Compression of a deep vein
B. Cancer
C. trauma
D. A and B
E. All of the above
A

E. All of the above

Compression of a deep vein causes stasis, trauma may cause vascular wall damage and cancer may result in hyper coagulability

155
Q
  1. It is critical that DVT be quickly and accurately diagnosed when it is present because:

A. the patient may eventually develop venous insufficiency
B. a pulmonary embolus may result
C. the patient may suffer severe pain
D. the valves may be saved by early diagnosis
E. All of the above

A

B. a pulmonary embolus may result

156
Q
  1. The ulceration frequently associate with chronic venous insufficiency may be avoided if the patient follows which of the following recommendations:
A. early surgical intervention
B. use of support stockings at work
C.  frequent elevation of the legs above the heart
D. all of the above
E. B and C
A

E. B and C use of support stockings at work and frequent elevation of the legs above the heart

It is not practical to suggest surgical intervention with its related risks as method of avoiding ulceration from chronic venous insufficiency when support stockings and limb elevation may provide the same benefit. Therefore, B and C is the best response

157
Q
  1. Which of the following conditions WOULD NOT result in a false positive diagnosis of DVT?
A. external venous compression due to hyperextended leg
B. post traumatic hematoma
C. Baker's cysts
D. acute superficial cellulitis
E. lack of patient cooperation
A

D. acute superficial cellulitis

answers A-C may all result in compression of the deep venous system, resulting in an abnormal venous response during venous outflow testing( amongst others), and may suggest the presence of DVT when it does not exist, Similarly, poor patient cooperation in terms of limb positioning etc., may end in a false positive result.

158
Q
  1. Duplex examination is incapable of diagnosing DVT in which of the following veins?
A.  subclavian vein
B. jugular vein
C. posterior tibial vein
D. soleal vein
E. all of the above
A

D. Soleal vein

The diagnosis of DVT in the subclavian, jugular and posterior tibial veins can usually be made by either direct visualization or by abnormal response as discussed in Doppler examinations of the upper and lower extremity venous systems, The soleal sinuses are difficult to evaluate with /doppler because the Soleal veins are very small in caliber and are located in a portion of the body that is very well perfused (i.e the large muscular beds).

159
Q
  1. Which of the following factors associated with pregnancy may be responsible for DVT?

A. external compression of the pelvic veins
B. venous dilatation secondary to hormonal stimulation
C. venous stasis in the postpartum state
D. all of the above
E. A and C

A

D. all of the above

160
Q
  1. The normal superficial to deep venous flow pattern in the calf may be reversed when:

A. the patient has congestive heart failure
B. the patient has deep venous thrombosis
C. the patient has greater saphenous thrombophlebitis
D. the patient is exercising vigorously
D. all of the above

A

B the patient has deep venous thrombosis

patient has deep venous thrombosis
is the only choice that results i an increased pressure in the deep venous system,causing a change in the normal flow patterns. When DVT or some other reason for venous obstruction is present, flow in calf may be from the deep to the superficial system and secondary varicosities may result.

161
Q
  1. Which of the following patients would you classify as LEAST for developing DVT?

A. a 63 year old female with a history of recent transient ischemic attack
B. a 29 year old female recently diagnosed with ovarian carcinoma
C. an 80 year old female in congestive heart failure
D. a 19 year old male with recent injuries suffered in a football game
E. a 90 year old female with a recent hip fracture

A

A. a 63 year old female with a history of recent transient ischemic attack

A recent history of T.I.A does not increase the likelihood of developing DVT, while the other scenarios do.

162
Q
  1. a patient with unilateral calf and ankle edema has an essentially normal /Doppler study except for some continuous flow over the popliteal vein as well as a normal IPG. What study would you suggest next?
A. contrast venogram
B. no other test is required, the patient is normal
C. venous outflow studies
D. high resolution ultrasound imaging
E. all of the above would be useful
A

D. High resolution ultrasound imaging

Since both the IPG and /Doppler studies are normal, /DVT is unlikely. A contrast venogram is very uncomfortable and not without risk. Since the patient is symptomatic, an non - in invasive, high resolution sonogram is the best choice for further investigation in order to confirm or exclude a /Baker’s cyst (which is the most likely cause for the patient’s symptoms.)

163
Q
  1. Which of the following statements about primary and secondary varicose are true?

A. Varicose veins most often result from valve incompetence.
B. Secondary varicose veins are most often inherited, and mainly
C. Venous outflow studies
D. A and B are true
E. non of the above are true

A
  1. A. Varicose veins most often result from valve incompetence
164
Q
  1. The most common cause of edema involving one leg only is:
A. Chronic venous disease
B. Congestive heart failure
C. lymphedema
D. trauma
E. non of the above
A

A. Lymphedema usually results in swelling of the foot and lower leg, while edema of the leg is more commonly associated with DVT or chronic venous disease.

165
Q

13.Lymphedema may be the result of:

A. inflammation
B. trauma
C. abnormal lymphatic development
D. all of the above
E. non of the above
A

D. All of the above

Lymphedema is due to obstruction, destruction or hypoplasia of lymph vessels and may occur secondary to an inflammatory process.

166
Q
  1. Venous outflow plethysomography can be performed with which of the following instruments?
A. an air plethysomograph
B. a photoplethysomograph
C. a strain gauge plethysmograph
D. A and C
E. all of the above
A

D. A and C

An air plethysomograph and a strain gauge plethysmograph

In order to perform venous outflow plethysmography, we need to be able to measure the change in limb volume using a device that encircles the limb. Air, impedance and strain gauge plethysmographs all serve this purpose, while A
a PPG does not.

167
Q
  1. The acute phase of thrombus formation, during which the risk of pulmonary embolus is highest, lasts approximately:
A. 12 to 24 hrs
B. 1 to 2 days
C. 2 to 3 weeks
D. 2 to 3 months
E. non of the above
A

C. 2 to 3 weeks

2-3 weeks is the most critical time to diagnose thrombus if it is present

168
Q
  1. Which of the following skin changes are associated with chronic venous insufficiency?
A. pigmentation
B. thickened toenails
C. dermatitis
D.  A and B
E. A and C
A

E. A and C - pigmentation and dermatitis

Pigmentation and dermatitis are associated with chronic venous insufficiency. Thickened toenails are more commonly associated with chronic arterial insufficiency.

169
Q
  1. A patient with documented massive DVT in the past, followed by chronic venous insufficiency, presents in the vascular lab with a sudden onset of leg pain and edema.. The most likely diagnosis is:

A. lymphedema resulting from the patients documented chronic venous occlusion

B. superficial phelbitis
C. recurrent DVT
D. chronic arterial insufficiency
D. non of the above

A

C. recurrent DVT

Recurrent DVT cannot be ruled out and must be excluded because of its life threatening nature. Because venous hemodynamics may not be altered enough to make the diagnosis in a patient with chronic venous insufficiency, this is a very difficult situation. Duplex imaging may be the best method to investigate this patient because of the varying characteristics of acute vs. chronic venous thrombus.

170
Q
  1. Which of the following information cannot be obtained during venous occlusion plethysomography with an SPG?
A. Venous capacitance
B. Change in calf volume
C. Calf pressure
D. arterial inflow
E. C and D
A

C. Calf pressure

Calf pressure cannot be obtained during venous occlusion plethysomography using the method described in the text because the collecting cuff placed around the patient’s thigh is inflated to 50 mmHg, which will temporarily occlude venous return to the heart yet offer no resistance to arterial inflow. (recall that in order to measure pressure in a limb segment, the cuff pressure musts exceed arterial pressure)

171
Q
  1. Which of the following features of NORMAL veins are evident during duplex examination of the deep venous system?

A. they are compressed with minimal pressure
B. they are easily identified with a 10 MHz transducer
C. they contain low level internal echoes
D. A and B
E. B and C

A

A. they are compressed with minimal pressure

The deep veins are often beyond the penetrating capabilities of a 10 MHz transducer. The presence of low level internal echoes suggest thrombosis which is not present in normal veins

172
Q
  1. The three required factors for the pathogenesis of venous thrombosis are:

A. venous stasis, valve damage, hormone imbalance
B. venous stasis, arterial insufficiency, trauma
C. venous stasis, hyper coagulability, venous wall damage
D. Venous stasis, valve damage, venous wall damage
E. venous stasis, hyper coagulability, valve damage

A

C. venous stasis, hyper coagulability, venous wall damage

Virchow’s Triangle

173
Q
  1. Starling’s hypothesis describes:

A. the action of the venous muscle pump
B. why edema collects in soft tissue
C. how hyper coagulability affects venous flow
D. the direct effects of venous stasis syndrome
E. non of the above

A

B. why edema collects in soft tissue

174
Q
  1. Elevation pallor and dependent rubor are common signs of :
A. chronic venous insufficiency
B. Venous stasis syndrome
C. chronic arterial insufficiency
D. lymphedema
E. elevation pallor and dependent rubor can be seen with anyof the above
A

C. chronic arterial insufficiency

175
Q
  1. Venous valvular incompetence may be diagnosed following:

A. assessing ankle skin blood content with a PPG
B. measuring venous refilling time following foot dorsiflexion
C. duplex imaging of the deep venous system
D. A and B
E. A, B and C

A

E. A, B and C

176
Q
  1. Which of the following disorders is best described by the phrase “a clinically obvious condition resulting fron extensive thrombosis of the deep veins of the involved extremity”?
A. venous stasis syndrome
B.  Chronic venous insufficiency
C. plegmasia cerulea dolens
D. lymphedema
E. non of the above
A

C. phlegmasia cerulea dolens

177
Q
  1. Primary varicose veins:
A. are not a significant health risk
B. are often the result of deep venous thrombosis
C. lead to an increased risk of DT
D. A and B
E. A, B and C
A

A. are not a significant health risk

178
Q
  1. When performing venous reflux plethysmography, the NORMAL venous refilling time using a PPG is:
A. 30 seconds
B. 25 seconds
C. 20 seconds
D.  A and B
E. A, B and C
A

D. A and B - 30 and 25 sec,

venous refilling times < 20 are ABNORNAL

179
Q
  1. Which of the following veins may normally have absent venous sounds on Doppler evaluation?
A. the popliteal vein
B. the inferior vena cava
C. the posterior tibial vein
D. the common femoral vein
E. all of the above
A

C. the posterior tibial vein

180
Q
  1. A postive Homan’s sign is a reliable indicator of:
A. deep venous thrombosis
B. chronic venous insufficiency 
C. chronic arterial insufficiency
D. all of the above
E. non of the above
A

D. Non of the above

Homan’s sign is NOT a reliable indicator of DVT

Homan’s sign is calf pain w/ dorsi flexion of foot

181
Q
  1. Deep venous recanalization following DVT is often associated with:
A. venous insufficiency
B. venous reflux secondary to valve damage
C. pulmonary  embolus
D. A andB
E. A, B and C
A

D. A and B - venous insufficiency and venous reflux secondary to valve damage

Following DVT, valve damage often results (recall that venous thrombus often forms in the low flow and areas adjacent to the valve cusps) and if recanalization of the vein occurs, retrograde flow past the damaged valve will result. The term venous insufficiency is synonymous with valvular insufficiency, resulting in venous reflux.

182
Q
  1. Patients suspected of lower extremity venous disease complain of:
A. constant pain in the legs
B. ankle edema
C. cold feet
D. A and B
E. A, B and C
A

B. ankle edema

183
Q
  1. A pulsatile flow pattern on an analogue waveform obtained from the subclavian vein:

A. most likely indicates deep venous disease of the upper extremity
B. is probably due to jugular thrombosis
C. is a normal finding
D. non of the above

A

C. is a normal finding

The upper extremity veins proximity to the heart results in a degree of pulsatility which is normal in the upper extremity veins

184
Q
  1. The statement “superficial venous disease, without deep venous involvement” best desscribes:
A. primary varicose veins
B. chronic araterial disease
C. deep venous thrombosis
D. venous stasis syndrome
E. non of the above
A

A. primary varicose veins

185
Q
  1. SUPERFICIAL venous thrombosis is frequently associated with:

A. life threatening pulmonary embolism
B. pain or tenderness of the affected region
C. deep venous thrombosis
D. all of the above

A

B. Pain or tenderness of the affected region

186
Q
  1. Lymphedema may be the result of:
A. trauma
B. hypoplasia of the lymphatic system
C. obstruction secondary to a large pelvic mass
D. all of the above
E. non of the above
A

D. all of the above

Lymphedema is described as the accumulation of excessive lymph
fluid with associated swelling of the subcutaneous tissues. This is due to obstruction, destruction, or hypoplasia of lymph vessels.
More common in women, and is usually unilateral ad painless, presenting w/ swollen foot and lower leg. It seems to get worse with warm weather, pregnancy, before menstuation and after a prolonged period of dependency

187
Q
  1. A patient with chronic venous insufficiency may demonstrate:
A. elevation pallor and dependent rubor
B. normal ankle pulses
C. hemosiderin deposition 
D.A and B
E. B and C
A

E. B and C

normal ankle pulses, hemosidern deposition

188
Q
  1. A patient with chronic venous insufficiency may demonstrate:
A. elevation pallor and dependent rubor
B. normal ankle pulses
C. hemosiderin deposition
D. A and B
E. B and C
A

E. B and C

normal ankle pulses and hemosiderin depostion

189
Q
  1. The presence or abscence of calf vein thrombosis may be suspected following:

A. maximum venous outflow determination of the foot
B. peripheral vascular venography
C. duplex imaging of the lower extremitiy
D. A and B
E. A, B and C

A

E. A, B and C
maximum venous outflow determination of the foot peripheral vascular venography and duplex imaging of the lower extremity

Although less accurate than determining the presence of DVT above the knee, all three examination may be used.

190
Q
  1. The lesser saphenous vein originates:
A. posterior to the media malleolus
B. anterior to the medial malleolus
C. posterior to the lateral malleolus
D. Anterior to the lateral malleolus
E. none of the above
A

C. posterior to the lateral malleolus

191
Q
  1. The term ambulatory venous hypertension is best described as:

A. high pressure in the venous system caused by retrograde flow during calf muscle contraction
B. increased pressure in the deep venous system caused by valve damage or malfunction
C. increased venous pressure which is secondary to increased arterial pressure, and most common in hypertensives
D. A and B
E. B and C

A

D. A and B

192
Q
  1. Qualities of normal deep venous flow during a Doppler examination of the lower extremity include:

A. an audible increase in venous flow following compression of the limb proximal to the Doppler probe
B. a change in the Doppler signal following respirtation
C. a pulsatile flow pattern
D. A and b
E. A, B and C

A

B. a change in the Doppler signal following respiration

note that augmentation is performed DISTAL to the probe position, not proximal as suggested in selection “a”

193
Q
  1. By gently compressing the patient’s abdomen, the examiner can simulate:

A. normal respiration
B. a Valsalva maneuver
C. have a non -invasive test initially, in order to prove or exclude the diagnosis
D. non of the above

A

C. have a non-invasive test initially, in order to prove or exclude the diagnosis

note that many institutions now consider a duplex examination of the lower extremity venous system to be the gold standard in testing for DVT especially above the knee

194
Q
  1. Patients suspected of deep venous thrombosis should:

A. be anti coagulated regardless of the results of non - invasive testing to prevent death from pulmonary embolus
B. have a venogram regardless of the results of any non - invasive test in order to exclude the diagnosis
C. have a non - invasive test initially , in order to prove or exclude the diagnosis
D. non of the above

A

C. have a non - invasive test initially, in order to prove or exclude the diagnosis

Note that may institutions now consider a duplex examination of the lower extremity venous system to be the gold standard in testinf for DVT, especially above the knee

195
Q
  1. When examining a patient for venous insufficiency using a PPG attached to the patient’s ankle:

A. we are testing for the loss of normal respiratiory waves that are always evident with venous reflux
B. we are interested in the venous refilling time following temporary emptying of the calf veins
C. we are interested in identifying normal physiological dresponses to respiratory and compression maneuvers
D. non of the above

A

B. we are interested in the Venous refilling time following temporary emptying of the calf veins

196
Q
  1. The normal venous sounds heard during a lower extremity Doppler exam are:

A. phasic with respiration, showing a decrease with expiration
B. phasic with repiration, showing and increase with expiration
C. absent during respiration

A

B. phasic with respiration, showing an increase with expiration

197
Q
  1. Thrombosis of the superficial venous system is best treated with:
A. bed rest, warm compresses and aspirin
B. support stockings
C. anticoagulants
D. A and B
E A, B and C
A

A. Bed rest, warm compresses and aspirin

198
Q
  1. Absence of spontaneous venous flow in the superficial venous system:

A. is suspicious for venous thrombosis
B. is always a normal finding
C. may be insignificant
D. non of the above

A

C. may not be significant

superficial venous signals are only spontaneous when the patient is warm, and are often elicited only following foot compression.

the superficial venous signal should be phasic w/ respiration, when the signal is not phasic but continuous this finding suggests the possibility of collateral circulation or may be due to the increased flow that accompanies superficial tissue inflammation (cellulitis)

199
Q
  1. Chronic venous ulcer are:

A. usually found on the foot
B. usually found on the sides of the ankles
C. common on the great toe
D. non of the above

A

B. usually found on the sides of the ankles

200
Q
  1. Many of the examinations in this module are performed with the patient in a slightly head up position in order to:

A. facilitate venous return to the heart
B. distend the venous system by making the lower limbs dependent
C. make the patient comfortable
D. enhance the effect of respiration on venous return
E. non of the above

A

B. distend the venous system by making the lower limbs dependent

201
Q
  1. The purpose of the collection cuff used in the performance of venous outflow plethysmography is to:

A. obstruct venous out flow, causing the blood to collect in the thigh
B. prevent arterial inflow, thereby reducing the amount of blood on the venous side of the circulation
C. allow arterial flow int the limb, but prevent venous outflow, thereby causing venous blood to collect distally in the leg

A

C. allow arterial flow int the limb, but prevent venous outflow, thereby causing venous blood to collect distally in the leg

Blood collects in the calf, not the thigh

page 3-28

202
Q
  1. The presence of a deep vein thrombosis:

A. enhances the respiratory effects on venous blood flow
B. prevents the compression of deep veins with the probe during duplex examination
C. increases the maximum venous outflow from the affected limb
D. A and B
E. A , B and C

A

B. prevents the compression of deep veins with the probe during duplex examination

203
Q
  1. DVT occurs:
A. with equal frequency in both legs
B. more frequently in the right leg
C. more frequently in the left leg
D. more frequently in males
E. non of the above
A

C. more frequently on the left leg

DVT occurs on the left side with 2:1 incidence when compared with the right leg, and ore frequently in females, than in males

204
Q
  1. T OR F

Ambulatory venous hypertension occurs when the calf mm pump is activated

A

True
Ambulatory venous hypertension occurs in the presence of valve incompetence at the calf level because the calf muscle pump, which is activated with any lower extremity movement, pumps blood in a retrograde manner through the incompetent calf valves, increasing venous pressure (hence - ambulatory)

205
Q
  1. T or F
    When performing venous occlusion plethysmography, cuff deflation can only occur if the internal diameter of the tubing large enough to drain the air in the collection cuff almost instantly, for that reason, a piece of tubing with at least 20 mm inside diameter should be used
A

False

The rapid deflation of the cuff can only occur if the internal diameter of the tubing is large enough to drain the air in the collecting cuff almost instantly, For this reason = a piece of tubing with at least 17 mm inside diameter should be used

206
Q
  1. T or F

A degree of pusatility in the upper extremities veins in normal

A

True

A major difference between the upper and lower extremity veins is the upper extremity veins proximity to the heart. The necessarily results in a degree of pulsatility which is normal in the upper extremity veins, and not evident in the lower extremity veins.

207
Q
  1. T or F
    When valvular incompetence is identified using a PPG, strategically placed pneumatic cuff may be used to differentiate between superficial and deep venous disease
A

True

We can differentiate between superficial and deep venous valvular incompetence by eliminating one of the systems from the test and repeating it. If we apply a above ankle pneumatic cuff inflated to a pressure of 50 mm Hg, we will occlude the superficial system’s lesser saphenous vein, thereby eliminating its flow from the test. If the test is repeated and the results are normal (i.e venous refilling time is > 25 seconds), we know that the superficial venous system is responsible for the valvular incompetence identified during the previous abnormal test.

208
Q
  1. T or F
    Extensive thrombosis of the deep veins of the lower extremity, including the iliac, common and superficial femoral veins as well as the greater saphenous vein is know as plegmasia cerulea dolens
A

True

Phlegmasia cerulea dolens is a clinically obvious condition resulting from extensive thrombosis of the deep veins of the involved extremity, including the iliac, common and superficial femoral veins as well as the greater saphenous vein.

209
Q
  1. T or F
    Lymphedema amy e differentiated for the edema caused by venous insufficiency by the vact that lymphedema does not effect the feet.
A

False

Lyphedema may be differentiated from edema caused by venous disease by the fact that the latter is characterized by swelling in the ankles and legs, but NOT in the feet. Lymphedema also affects the feet.

210
Q
  1. T or F

The term phasicity refers to the change in the venous signal that occurs in response to patient respiration

A

True

the term phasicity refers to the change in the venous signal that occurs in response to patient respiration

211
Q

58.T or F
When performing venous outflow plethysmography, and M.V.O < 100 ml/min per 100 ml of tissue is reliable sign of large vein obsruction

A

False
A significant venous obstruction (DVT) will always result in a substantial decrease in maximum venous outflow. An M.V.O < 20 - 25 ml/min per 100 ml of tissue is a reliable sign of large vein obstruction.

212
Q
  1. T or F

The most visible superficial vein of the upper extremity is the cephalic vein.

A

True
The most visible superficial vein of the upper extremity is the cephalic vein which may be identified along the anterior border of the biceps muscle.

213
Q
  1. T or F

Venous claudication is similar to arterial claudication and defined as pain-with walking that is relieved by rest

A

False
Venous claudication is defined as: pain that results from venous distention, often secondary to chronic venous obstruction and or valvular incompetence, usually brought on by exercise and relieved by limp elevation.

214
Q
  1. T or F

In order to image the anterior tibial veins, you must first identify the interosseous membrane

A

True

The anterior tibial veins are identified on top of the interosseous membrane close to the fibula.

215
Q
  1. T or F

Acute venous disease is usually bilateral

A

False

Acute Venous disease is usually UNILATERAL

216
Q
  1. T OR F
    When comparing chronic arterial and chronic venous insufficiency, the ulceration that may occur with venous disease occurs on the toes
A

False

The ulceration that may occur with venous disease occurs on the ANKLES, not the toes

217
Q
  1. T or F
    While scanning a dialysis graft to rule out thrombosis, you identify marked turbulence through out the course of the graft. This finding is suspicious for impending raft failure.
A

False
Dialysis graft flow is typically of high velocity at the arterial end, settling down somewhat near the venous end, with moderate to marked turbulence evident throughout the course of the graft.

218
Q
  1. T or F

Homan’s sign is: calf pain with plantar flextion of the foot with the knee extended

A

False
Some patients with DVT have calf pain with DORSIFLEXION of the foot when the knee is exended. This symptom is know as Homan’s sign

DORSIFLEXION NOT PLANTARFLEXION

219
Q
  1. T OR F
    Inflammation processes like cellulitis may result in HIGH PITCHED venous doppler signals secondary to relatively increased blood flow through the the area of Inflammation
A

True

Finally, inflammatory processes involving the lower limb may result in HIGH PITCHED venous doppler signals secondary to relatively increased flow through the area of inflammation

220
Q
  1. T or F

Visualization of acute venous thrombus when it is present is easy, as it is highly echogenic in most cases

A

False
While CHRONIC is easily identified, as it is highly echogenic in most cases, acute thrombus may be difficult to visualize as it is similar in echogenicity to blood

221
Q
  1. T or F

Superficial venous thrombus, when present, should be treated in order to reduce the risk of pulmonary embolism

A

False

SUPERFICIAL venous thrombosis does not necessarily indicate that DVT is also present and in fact it seldom is. SVT does not result in P.E. or chronic venous insufficiency even when it is recurrent

222
Q
  1. T or F

When present, calf vein thrombosis makes the calf veins easier to visualize during compression maneuvers than normal veins

A

True

When examining the lower extremity veins we have tow factors in our favor. First of all, acute venous thrombosis causes the veins to BECOMe DILATED because of the clot making them easier to visalize.

223
Q
  1. T or F

Virchow’s triad includes vascular wall damage, increased blood coagulability and stasis of blood

A

True

Virchow’s triad
1 - stasis of blood
2 - increased blood coagulability
3 - vascular wall damage

224
Q
  1. T or F

When imaging the popliteal fossa to rule out DVT, the popliteal vein is located superficial to the popliteal artery

A

True

you will find the Popliteal vein SUPERFICIAL TO THE POPLITEAL ARTERY

225
Q
  1. T OR F

Starling’s hypothesis explains for us why deep venous thrombosis occurs

A

False

Starling’s hypothesis describes for us the mechanism regulating fluid passage across the capillaries

226
Q
  1. T or F
    When comparing plethysomography techniques, foot venous outflow with an IPG is the best method to evaluate the calf veins for thrombosis
A

False

The presence of multiple paired deep veins in the calf make the decrease in outflow and limb expansion less obvious than above the knee where a thrombus occluding a single deep even in such as the superficial femoral vein has easily demonstrable effects. Therefore an SPG with its increased sensitivity is best utilized for foot outflow plethysmography

227
Q
  1. T or F

Venous doppler, used alone, tests for thrombosis, not obstruction

A

False
It is important to realize that venous doppler alone test for OBSTRUCTIOIN, not thrombosis(although thrombosis is most likely the cause of the obstruction)

228
Q
  1. T or F

When performing venous reflux plethysmography with PPG, venous refilling time in normal patients is <= 25 sec

A

True

229
Q
  1. Which of the following statements best describe a transient ischemic attack (TIA) ?
A. it resolves completely within 24 hrs
B. it resolves completely with 48 hrs
C. it resolves completely with 72 hrs
D. it results in permanent neurological deficit
E. non of the above
A

A. it resolves completely within 24 hrs

230
Q
  1. Which of the following symptoms are consistent with a atherosclerotic disease?
A. syncope
B. diplopia
C. drop attack
D. asphasia
E. all of the above
A

D. aphagia

231
Q
  1. Which of the following statements about NASCET trial are true?

A. symptomatic patients with ICA stenosis greater than 50% diameter reduction should be treated surgically
B. asymptomatic patients with ICA stenoses or greater than 50% diameter reduction should be treated surgically
C. Symptomatic patients with ICA stenosis greater than 70 % diameter reduction should be treated surgically
D. non of the above

A

C. symptomatic patients with ICA stenoses greater than 70% diameter reduction should be treated surgically

232
Q
  1. Which of the following statements regarding compression of the common carotid arteries during peri orbital doppler examination are true?

A. compression should be performed for a period of one to three heart beats
B. compression is performed over the carotid bifurcation
C. Compression of the CCA in a normal patient should result in an augmented peri orbital signal
D. A and B
E. B and C

A

A. Compression should be performed for a period of one to three heart beats

233
Q
  1. Which of the following could bee considered ultrasound techniques used in the investigation of cerebrovascular disease?

A. spectral analysis of the doppler shifts resulting form blood moving across a stenosis
B. B-Mode plaque characterization
C. Flow mapping of the carotid bifurcation in a patient with an audible supraclavicular bruit.
D. B and C
E. all of the above

A

E. All of the above

All of the techniques described in this question utilize ultrasound

234
Q
  1. Which of the following procedures would be the best method of investigating a patient with recurrent TIA’s?
A. CPA
B. B-Mode imaging
C. OPG
D. pulsed doppler flow mapping
E. All are equally effective
A

B. B-Mode-imaging is the most suitable answer as high resolution imaging ma define ulceration s which may result in micro emboli

235
Q
  1. Which of the following information can be derived by a supraorbital PPG?
A. the presence of plaque ulceration
B. the presence or absence of a murmur
C. the severity of an ICA stenosis
D. the presence of and ICA occlusion
E. non of the above
A

D. the presence of and ICA occlusion

Supraorbital PPG identifies significant disease in the ICA indirectly. Choices A, B and C may all be present with non flow or pressure reducing lesions. When present the severity of ICA disease is not revealed by this test

236
Q
  1. Which of the following statements is/are incorrect regarding carotid bifurcation bruits?

A. An occluded ICA Does not result in a clinically evident bruit
B. Bruits from the ECA usually differ in quality from those in the ICA
C. Bruits never originate from a kinked ICA
D. B and C
E. all are incorrect

A

C. Bruits never originate from a kinked ICA

Recall that bruits result form turbulent flow (and Reynold’s number greater than 2000) and a kinked vessel may contribute to turbulance.

237
Q
  1. The most valuable use of TCD in a vascular lab would be:

A. To identify intracranial arterial malformations.
B. To confirm brain death
C. To confirm occlusion of the extracranial ECA
D. To monitor the effect of medications on intracranial arterial vasosplasm
E. To identify flow in the intracranial ICA if it is present

A

E. To identify flow in the intracranial ICA if it is present

The confirmation of even minimal ICA flow beyond a critical stenosis is usually sufficient grounds for surgery

238
Q
  1. Which of the following non - invasive techniques are direct examinations?
A Carotid phonoangiography
B. spectral analysis of the Doppler shifted sounds
C. OPG-G
D. A andB
E. A,B andC
A

D. A and B
A. Carotid phonoangiography
B. spectral analysis of the Doppler shifted sounds

Choices A and B examine the extracranial carotid circulation directly while choice C obtains information regarding ICA flow INDIRECTLY

239
Q

What is a direct test, and give examples

A

Direct tests are described as those examinations that investicage the site of the disease itself. The direct tests enclude :

Carotid phonoangiography
CW Doppler Carotid Examimantion
B- Mode REal Time imaging of the Carotids
PULSED DOPPLER CAROTID EXAMINATION
DOPPLER FLOW MAPPING
Apectral analysis
angiography

DIRECT TESTS INVESTIGATE THE SITE OF DISEASE

240
Q
  1. A patient suffering from a TIA of the left anterior hemisphere of the brain will most likely have symptoms affecting which side of the following?
A. the left side of the face
B. The entire body
C.  the right side of the body
D. the left side of the body
E. both eyes
A

C. The right side of the body

When the CAROTID artery is the source of the embolus, a TIA of the left anterior hemisphere will cause CONTRALATERAL hemiparesis ( often with IPSILATERAL blindness if the ophthalmic artery also suffers and embolic event)

241
Q
  1. Which of the following would you expect to be the result of a significant ICA stenosis?

A. and increase in velocity in the post-stenotic segment
B. post - stenotic turbulence
C. externalization of the CCA spectral wave form
D. an abnormal ICA /CCA ratio
E. all of the above

A

E. All of the above

Recall that a significant stenosis results in a DECREASE in flow and pressure distal to the stenosis. Immediately within a and after the stenosis, flow velocities will increase and a little further on, turbulence will result. The CCA spectral waveform will show signs of externalization (i.e a wave form typical of the ECA ) when the ICA is occluded because it now supplies a high resistance vascular bed( the face and neck) The ICA/CCA ratio is elevated when significant ICA disease is present. Therefore, a significant stenosis may result in all of the choices presented.

242
Q
  1. When a frequency spectrum obtained from the ICA has a peak of approximately 10,000 Hz ((10kHz), which of the following are true?

A. there is a significant stenosis of the ICA
B. there is usually spectral broadening as well
C. the diastolic component will be increased also
D. all of the above
E. A and B

A

D. All of the Above

When a 10kHz frequency shift is identified on spectral analysis, the stenosis is VERY severe (I.E 80 -99%) Marked spectral broadening and increased diastolic flow velocities will also be evident

243
Q
  1. In order to perform the best 2D analysis of the carotid artery, which of the following should be utilized?
A. a 5 MHz transducer
B. a 7.5 MHz transducer
C. A 10 MHz transducer
D. the highest frequency transducer that will penetrate the depth of the vessel under investigation
E. A, B or C
A

D. the highest frequency transducer that will peneetrate to the depth of the vessel under investiagion

The highest frequency transducer (i.e 10Mhz) will result in the best axial resolution, however if the patient is thick-necked a 10 MHz probe is not suitable, Therefore, the best answer is D; the highest frequency transducer that will penetrate to the depth of a vessel to be investigated.

244
Q
  1. A stenosis of the right subclavian artery will result in which of the following?

A. blue finger syndrome
B. Flow reversal in the ipsilateral vertebral artery
C. A damped monophasic brachial artery waveform finger pain
E. none of the above will necessarily occur

A

E. The word “significant” has not been used to describe the stenosis in the question, therefore non of the scenarios described will necessarily result (although several could)

245
Q
  1. The waveform labeled B is typical of the following arteries?

A. the CCA
B. the ECA
C. the ICA

A

B. The waveform in B demonstrates slightly higher velocities that A and return to baseline early in diastole, consistent with ECA flow.

246
Q
  1. The waveforms in the diagram above are the result of:
A. analogue recording
B. Plethysmography
C. spectral analysis of a Doppler signal
D. any of the above would result in a similar waveform
E. non  of the above
A

C. Spectral analysis of a Doppler signal9

247
Q
  1. The asliased waveform in the diagram above is consistent with a stenosis of approximately:
A. 0-40%
B. 40 - 60%
C. 60 - 80 %
D. 80 - 99 %
E. there is no stenosis, although aliased, this waveform is otherwise normal
A

D. The aliased waveform in the question shows > 175 cm/sec consistent with a stenosis of 80-99%

248
Q
  1. The degree of diastolic flow that is evident in the waveform shown in Diagram 2 is:
A. within normal limits
B. Slightly increased
C. artifactual because of the aliasing
D. markedly increased
E. non of the above
A

D. The aliased waveforms in this question shows flow > 175 cm/sec consistent with a stenosis of 80-99%

249
Q
  1. The internal carotid artery normally demonstrates:
A. a multi-phasic flow pattern
B. a monphasic flow pattern
C. negligible diastolic flow
D. A and C
E. B and C
A

B. The normal ICA demonstrates a Monophasic flow pattern with considerable flow in diastole.

250
Q
  1. Carotid phonoangiography:

A. allows us to ABSOLUTELY differentiate between a significant and non- significant carotid artery stenosis
B. is considered an indirect test
C. allow us to differentiate between post bifurcation and CCA bruits
D. A and B
E. A, B and C

A

C. allows us to differentiate between post bifurcation and CCA bruits

251
Q
  1. Compression of the CCA during a periorbital Doppler exam may:

A. result in cessation of the frontal artery signal on the opposite site
B. is considered by some to be a potentially dangerous maneuver
C. result in a decreased, obliterated or reversed periorbital Doppler signal
D. A and B
E. A, B and C

A

E. A, B and C

252
Q
  1. Unilateral weakness of the arm and leg on the same side as the diseased carotid may be considered:
A. a carotid territory symptom
B. a vertebrobasilar territory symptom
C. a non localizing symptom
D. any of the above
E. non of the above
A

E. A carotid territory symptoms would be unilateral weakness of the arm and leg on the oppisite side of the disease ICA.

253
Q
  1. Amaurosis fugax is often described as:
A. a shade being pulled over both eyes, one at a time
B. a "black out"
C. a nonlocalizing symptom
D. any of the above
E. non of the above
A

E. Non of the above

Amaurosis fugax affects ONE EYE not both

254
Q
  1. Transient ischemic attacks may be considered:

A. mini strokes
B. the precursors of strokes
C. multiple completed strokes
D. non of the above

A

B. the precursors of strokes

255
Q
  1. The normal flow pattern o f the frontal artery is:
A. out of the orbit
B. antegrade or above the baseline
C. unchanged with ECA branch compression
D. A and B
E. A, B and C
A

E. A, B and C

Normal frontal artery flow is out of the orbit, towards the transducer and therefore above the baseline

256
Q
  1. Diplopia is:
A. a visual disturbance
B. a vertebrobasilar territory symptom
C. a nonlocalizing symptom
D. A and B
E. A, B and C
A

D. Diplopia is the seeing of a single object as double and occurs as a BILATERAL visual field defect. It is therefore a vertebrobasilar territory symtom.

257
Q
  1. Which of the following may be considered major drawbacks of indirect testing of the extdracranial carotid system:

A. The inability to differeniate between a total occlusion and a high grade stenosis of the ECA
B. the inability to define the precise site of atherosclerotic disease
C. vessel overlap frequently causes inconclusive results
D. A, B and C

A

B.the inability to define the precise site of atherosclerotic disease

Since indirect tests evaluate the physiologic effects of cerebrovascular disease, they can only indicate SIGNIFICANT ICA disease resulting in collateral flow. The ICA disease may range form >50% diameter reduction to total occlusion with no change in the results of the indirect test. It will be positive in either case.

258
Q
  1. In order to identify the ICA when performing transcranial Doppler using the transtemporal approach:

A. first find the middle cereral arter, then position the sample volume slightly posteriorly and caudally

B. first find the middle cerebral artery, then position the sample volume slightly deeper

C. place the transducer over the temporal region and position the sample volume 2-5 cm from the transducer face

D. non of the above

A

B. first find the middle cerebral artery, then postion the samble volume slightly deeper

259
Q
  1. Which of the following may be the most sensitive indicator of mild atherosclerotic disease of the ICA?

A. physical exmination of the Carotid Arteries
B. Carotid phonoangiography
C. Spectral analysis of the Doppler signal obtained from the ICA
D. Doppler flow mapping of the Carotid Arteries
E. All of the above are equally sensitive to Carotid artery disease

A

C. Spectral analysis of the Doppler signal obtained from the ICA

Soft plaque with echogenicity similar to flowing flood may not be visible on 2D exam, but may cause enough turbulence tht spectral broadening is evident during spectral analysis. Therefoer, of the available choices, spectral anlysis is the most sensitive indicator of mild ICA atherosclerosis.

260
Q
  1. Changing the frequency of the Doppler probe during a duplex examination of the arterial system will result in:

A. a different frequency shift being meassured from identical sites in the vessel

B. identical frequency shifts being measured from identical sites in the vessel

C. aliasing of the Doppler signal obtained

D. A andC

E. B andC

A

A. A different frequency shift being measured from identical sites in the vessel

The frequency shift measurd by a Doppler instrument varies directly with the frequency of the Doppler crystal.

261
Q
  1. Pulsed Doppler flow mapping of the carotid circulation is sensitive to stenoses:

A. > 40% and therefore very reliable for the diagnosis of occlusion of the ICA

B. < 50% and therefore fairly reliable for detecting ICA disease

D. > 50% and therefore fairly reliable for detecting ICA disease

E. non of the above

A

D. > 50% and Therefoer fairly reliable for detecting ICA disease

262
Q
  1. A subclavian steal should be suspected when:

A. there is diastolic flow reversal in the subclavian artery during Doppler examination

B. There is diastolic flow reversal in the vertebral artery during Doppler examination

C. there is systolic flow deceleration in the vertebral artery during Doppler examination

D. A and B

E. B and C

A

E. B and C

  • there is diastolic flow reversal in the vertebral artery during doppler examination
  • there is systolic flow deceleration in the vertebral artery during Doppler examination
263
Q
  1. Assuming a Doppler angle of 50 degrees, a peak Doppler shifted frequency of 5kHz using a 4.5 MHz transmitted Doppler frequency is consistent with:
A.  a normal examination
B. a significant stenosis
C. a moderate stenosis
D. A mild stenosis
E. non of the above
A

B. a significant stenosis

note that a 5 kHz Doppler shift indicates a significant stenosis for both transmitted Doppler frequencies

264
Q
  1. Any process that results in the damage of the intimal lining of the internal carotid artery may result in:
A. calcific plaque formation
B. a stroke
C. a cardiac embolus 
D.A and B
E. A, B and C
A

D. A and B

  • calcific plaque formation
  • a stroke
265
Q
  1. Patients with symptoms of recurrent drop attacks should;

A. have a Doppler examination of the extra cranial carotid arteries
B. have a Doppler examination of the vertebral arteries
C. have bilateral brachial artery pressure measurements
D. A and B
E. B and C`

A

E. Drop attacks are a symptom of vertebrobasilar insufficiency, which may be the result of subclavian steal syndrome. If so, retrograde or oscillatory flow may be identified in the vertebrqal artery during Doppler sampling. Brachial pressure measurements will show a > 20 mmHg difference in pressure if a subclavian steal is present

266
Q
  1. The statement “ spectral analysis of the sounds detected with a sensitive microphone” best describes which of the following examinations?

A. duplex carotid artery Doppler examination
B. Spectral analysis of the carotid Doppler signal
C. carotid phonoangiographic analysis of a carotid bruit
D. any of the above
E. none of the above

A

C. Carotid phonangiographic analysis of a carotid bruit

Choices A and B are not correct because the question states that the spectral analysis is of a carotid bruit detected with a sensitive microphone, indicating that the data was obtained during a CPA study, not a duplex examination of the Carotid arteries

267
Q
  1. A high grade ICA stenosis may:
A. result in an easily detectable bruit
B. have not bruit at all
C. result in a bruit lasting throughout systole and diastole
D. A and B
E A, B and C
A

E. A, B and C - all of the above

268
Q
  1. The normal internal carotid artery demonstrates:

A. a multiphasic signal that demonstrates flow throughout the cardiac cycle

B. a monophasic low pitched sound with little diastolic flow

C. A multi-phasic signal with considerable diastolic flow

D. A high pitched monophasic signal with considerable flow evident during diastole

E. a prominent systolic sound with continuous diastolic flow

A

D. A high pitched monophasic signal with considerable flow evident during diastole

269
Q
  1. Real- time B- Mode imaging with gated Doppler might also be called:
A. Direct 2-D imaging
B. duplex scanning
C. Spectral analysis
D. phonoangiography
E. an indirect test
A

B. duplex scanning

270
Q
  1. A CCA signal that returns to baseline is suspicious for:
A. A high grade ECA stenosis
B. an ECA occlusion
C. a normal Study
D. an ICA stenosis
E. non of the above
A

D. an ICA stenosis

An ECA occlusion would result in 100% of CCA flow supplying the ICA, which in turn supplies the low resistance vascular bed of the brain. Therefore, the CCA signal would not return to baseline but show continuous flow in diastole. A CCA signal that returns to baseline is most suspicious of a significant ICA stenosis.

271
Q
  1. The Gold Standard for identifying and characterizing Carotid artery plaque is currently:

A. Carotid Doppler flow mapping
B. Carotid angiography
C. B- Mode imaging of the extra-cranial carotid circulation
D. spectral analysis of a carotid doppler signal
E. non of the Above

A

C. B-Mode imaging of the extracranial carotid circulation

2D imaging with ultrasound will identify plaque that does not narrow the lumen and would therefore be missed on a carotid arteriogram

272
Q
  1. The ICA is usually:

A. Smaller and more anteriomedial than the ECA and is branchless
B. branchless, larger and more posterior than the ECA
C. larger and more posterior than the ECA and gives rise to several branches
D. smaller and more posterior than the ECA with several branches
E. non of the above

A

B. Branchless, larger and more posterior than the ECA

Remember that the ICA has no extracranial branches

273
Q
  1. A Well defined spectral envelope always indicates:

A. an absence of carotid atherosclerotic disease:
B. the RBC’s being sampled are moving at a similar velocity
C. a relative absence of turbulence
D. A and B
E. B and C

A

E. B and C
B - the RBC’s being sampled are moving at a similar velocity
C - a relative absence of turbulence

A well defined Spectral envelope simply implies that all RBC’s are moving at a similar velocity. This velocity may be quite abnormal, as occurs in a tight stenosis if the Doppler sample is placed within the stenosis where velocities are high, yet flow is relatively laminar. Turbulence does not become evident until the sample volume is placed a few centimeters distal to the stenosis, where maximum turbulence will be identified.

274
Q
  1. Heterogeneous plaque is best described as:

A. plaque with uniform echo texture, but demonstrating irregular borders
B. complicated plaque containing calcium as well as areas with decreased echo-texture
C. non uniform plaque echotexture, with areas of increased and decreased echogenicity
D. shadowing plaque
E. non of the above

A

C. non uniform plaque echodtextdure, with areas of increased and decreased echogenicity

275
Q
  1. Which of the following are considered predisposing risk factors for the development of cerebrovascular disease?
A. hypertension
B. Diabetes mellitus
C. pulmonary embolus
D. A and B
E. A,  B an C
A

D. A and B
A - hypertension
B - Diabetes mellitus

276
Q
  1. When compared with spectral analysis of a continuous wave Doppler signal, a pulsed Doppler signal may demonstrate:

A. a more defined “window” than that obtained from a CW signal
B. higher velocities than those obtained with CW Doppler
C. simultaneous arterial and venous flow patterns
D. A and B
E. A, B and C

A

A. a more defined “ window” that obtained from a CW signal

remember that CW Doppler samples all velocities across the vessel, resulting i a broader spectrum of velocities on spectral analysis. Also, CW is capable of demonstrating much higer velocities, than pulsed Doppler. Finally, CW is more capable of showing arterial and venous signals simultaneously as the region of sensitivity is much larger than the sample volume used in PW Doppler.

277
Q
  1. Angiographic examination of the extra-cranial carotid circulation may be performed via:

A. a catheter placed in the aortic arch via the femoral artery
B. a catheter placed in the common carotid artery following translumbar puncture of the aorta
C. Direct puncture of the Carotid artery
D. A and B
E. A, B and C

A

E. A, B and C

Angiographic examination of the extracranial carotid arteries may be performed via Catheter following femoral, axillary, brachial, translumbar or direct carotid artery puncture

TRANSLUMBAR - access to Aortic arche - for pt significant femoral artery stenosis
DIRECT METHOD - accessed low on the neck

**angiography is considered superior to duplex examination of the carotid system with ultrasound because the entire carotid artery can be imaged regardless of pt habitus. Duplex examination is excellent for imaging the bifurcation of most patients, but falls short of angiography for imaging the proximal carotid artery and high ICA.

278
Q
  1. Which of the following is/are NOT considered a limitation(s) of Color Doppler imaging?

A. the pulse repetition frequency is much lower when imaging with color doppler
B. color flow Doppler is angle independent
C. the color of flow within a vessel indicates mean flow velocity and is not corrected for Doppler angle
D. A and B
E. All of the above

A

B. Color flow Doppler is and independent

279
Q
  1. T or F

Retrograde flow in the frontal artery during a periorbital Doppler examination is a normal finding

A

FALSE

During a periorbital Doppler examination, prior to compression, a normal patient demonstrates antegrade (forward flow towards the Doppler transducer) when the periobital arteries are examined. If flow is reversed in either the supaorbital or frontal arteries, there must be a significant (i.e >50% ) ipsilateral ICA stenosis or occlusion.

280
Q
  1. T or F
    The ICA/CCA ratio is considered a more accurate indicator of significant ICA disease than ICA peak systolic velocity alone.
A

True
More important than peak velocity measured in these vessels is the ICA/CCA VELOCITY RATIO. In general, the ICA/CCA velocity ratio is one of the most reliable indicators of significant ICA disease. This is especially true in labs that use peak flow velocities alone to categorize percent stenosis.

  • *ICA/CCA velocity ratio = Peak ICA/ Peak CCA
    • Ratios >= 4.0 is consistent with a significant stenosis (>70% stenosis)

**Ratios between 1.5 and 1.8 are considered to be in a “gray zone” my many imaging labs.

281
Q
  1. T or F

Non hemispheric cerebrovascular symptoms usually originate from the vertebrobasilar territory

A

TRUE

Many of the cerebrovascular symptoms can be classified as to the territory from which they originate. For instance, symptoms which are HEMISPHERIC are usually classified as carotid territory, while those that are non - hemispheric are often located in the VERTEBROBASILAR territory.

282
Q
  1. T or F
    Despite its insensitivity to ICA stenosis < 40%, Doppler flow mapping remains a valuable technique for detecting high grade ICA lesions.
A

FALSE
The major limitation of Doppler flow mapping is the lack of visual control of the angle of incidence of the Doppler beam. When acutely curved or kinked vessels are present, there may be a high incidence of false positives and false negative examinations

283
Q
  1. T or F

the extracranial carotid system is the only source of emboli which may result in a CVA.

A

FALSE
The extracranial carotid system is not the only source of emboli. The heart may also give rise to free floating bodies which may result from cardiac vegetations or tumors(i.e myxomas) or THROMBUS that often results from myocardial infarction

284
Q
  1. T or F

A duplex carotid examination consists of 2D imaging as well as Doppler sampling of the carotid vessels.

A

TRUE
A duplex examination consists of DIRECT 2D VISUALIZATION of the Carotid vessels as well as THE ACQUISITION OF THE FLOW INFORMATION usually obtained by simultaneous Doppler sampling from the carotid vessels.

285
Q
  1. T or F During A CPA examination, a pansystolic bruit is documented. This is consistent with a stenosis in the 70-85% range.
A

FALSE

A bruit lasting throughout systole (panslstolic) is consistent with a moderate to severe (60-75%) stenosis.

286
Q
  1. T or F
    Rouleau formations contribute to turbulence in flowing flood by disturbing the normal flow patterns of single red blood cells
A

TRUE
The term Rouleau Formation comes from theFrench word for a roll and is used to describe a stack of 3 to 10 or more erythrocytes, resembling a roll of coins. These formations contribute to turbulence in flowing blood by disturbing the normal flow patterns of single red blood cells, Rouleau formation is often the result of and increase in the patients’s plasma immunoglobulin

287
Q
  1. T or F

Color flow Doppler is of value when identifying the common bile duct.

A

True
Color Doppler also allows for the rapid determination of normal anatomy based on flow For example, the portal triad consisting of and artery, vein and duct can be accurately differentiated by flow direction in the case of the artery and vein and lack of flow in the case of the bile duct

288
Q
  1. T or F

The ICA is the most frequent site of extra- cranial atherosclerosis and common source of stroke

A

FALSE
Close, but not quite the correct answer. The CAROTID BIFURCATION is the most frequent site of extra-cranial atherosclerosis and a common source of stroke

289
Q
  1. T or F

Angiography is considered superior to duplex examination of the Carotid system with ultrasound

A

True
Angiography is considered superior to duplex examination of the carotid system with ultrasound because the entire carotid artery can be imaged regardless of patient habitus. Duplex examination is excellent for imaging the bifurcation of most patients, but falls short of angiography for imaging the proximal carotid artery and high internal carotid artery.

290
Q
  1. T or F
    The color information that appears in screen while imaging with color flow Doppler is the peak frequency of the moving reflectors being sampled int eh color box.
A

FALSE
The color information that appears on the screen is the MEAN ( not the PEAK) frequency of he moving reflectors being sampled in multiple sample volumes withe the color box.

291
Q

63 T or F
When performing a CW Doppler examination of the Carotid arteries, the change in pitch that is heard at the carotid bifurcation is due to the differing sized of the ICA and ECA

A

TRUE
The audible change in pitch is due to the CHANGE IN SIZE OF THE VESSEL as well as the difference in the vascular ben tht each branch of the carotid artery supplies.

292
Q

64.T or F
Transcranial Doppler examination allows us to differentiate between a high grade non-visualized ICA stenosis and complete occlusion of the vessel

A

True
Transcranial Doppler examination allows us to determine if there is flow in an obstructed ICA at a level that is not accessible from the neck, in other words, we can identify flow in the cranium that would not be evident with the extra cranial approach.

293
Q
  1. T or F

Aside from age, the greatest contributor to stroke is cigarette smoking

A

FALSE
Aside from age, the greatest contributor to stroke is UNCONTROLLED HYPERTENSION. High blood pressure serves to accelerate the process of atherosclerosis, damaging arterial walls, leading to aneurysm and potential risk of rupture. Along with the potential for aneurysm formation, hypertension increases the risk of embolization because of the increased flow states and turbulence that often accompany high blood pressure.

294
Q
  1. T or F
    The measurement of peak diastolic flow velocities with a stenotic ICA segment is a good indicator of the severity of disease
A

TRUE
Below 50% stenosis, only systolic flow velocities increase. Beyond 50%, diastolic flow velocities. The ratio of the systolic to diastolic flow velocities can be used as an indicator of the degree of stenosis. A systolic/diastolic ratio < 4 in the area of stenosis suggests a 70-80% stenosis.

295
Q
  1. T or F

Asymptomatic patients w ICA stenoses >70% diameter reduction should be treated surgically with endarterectomy

A

TRUE
While the North American Symptomatic Carotid Endarterectomy Trial (NASCET) suggests that most SYMPTOMATIC patients with high grade stenoses greater than 70% diameter reduction be treated surgically with endarterectomy, a second trial, the Asymptomatic Carotid Atherosclerosis Study (ACAS), suggests that even ASYMPTOMATIC patients with high grade stenosis greater thatn 60% will benefit from carotid endarterectomy.

296
Q
  1. T or F

The ICA can reliably be differentiated from the ECA because it is the larger and more posterior-lateral vessel

A

False
Although the ICA is usually the larger and more posterior lateral vessel, this is not always the case. The ICA is always branchless, so this is the best method of differentiating it from the ECA.

297
Q
  1. T or F
    Where spectral broadening is an abnormal finding in an extra cranial Doppler examination, it is the norm in Transcranial Doppler studies.
A

TRUE
When reviewing spectral analysis of intracranial blood flow during Transcranial Doppler examination, must re think our expectations.Where “spectral broadening” is abnormal in an extra-cranial Doppler exam, it is the norm in TCD because of the tiny vessel size and frequent branching.

298
Q
  1. T or F

Obesity is considered a major risk factor for the development of cerebrovascular disease.

A

FALSE
When discussing the potential for developing cerebrovascular disease, the MAJOR risk factors
UNCONTROLLED DM
HYPERTENSION
DM
Other minor risk factors include cigarette smoking, obesity, high cholesterol, coronary heart disease and a poor family history.

299
Q
  1. T or F

Doppler flow mapping is considered and indirect test

A

FALSE
Direct tests are described as those examinations that investigate the site of the disease itself, including Doppler flow mapping

300
Q
  1. T or F

The temporal tap is a useful technique for identifying the ECA

A

TRUE
In cases where the ICA is stenosed, causing the waveform to become of higher resistance (like the ECA ), and the vessels are full of shadowing plaque, making the identification of branches with 2D difficult it is helpful to perform a temporal tap to identify the ECA

301
Q
  1. T or F
    Your patient describes a recent visual disturbance as “shade being pulled over one eye”, lasting a few minutes. This is consistent w/ a stroke
A

FALSE

A stroke is defined as a PERMANENT NEUROLOGICAL DEFICIT. Your patient is describing a TIA, not a stroke

302
Q
  1. T or F
    An ICA peak systolic flow velocity of 3 m/sec, with end diastolic flow measured at 1.2 m/sec is consistent with a stenosis of >70 % diameter reduction
A

TRUE

303
Q
  1. T or F
    Power Doppler is superior to color flow Doppler because it is very sensitive to the presence of flow, as well as providing direction, speed and flow character information.
A

FALSE
Power Doppler is VERY SENSITIVE TO THE PRESENCE OF FLOW, but displays NO direction, speed or flow character information and is therefore not suitable for studies where this information is important

304
Q

From transtemporal Window, at what depth is the MCA?

A

3.0- 6.0 cm

305
Q

From a transtemporal window, the MCA flow direction is?

A

Towards the transducer

306
Q

Using a transtemporal approach in which direction does the ACA flow?

A

retrograde (away from the transducer)

307
Q

From the transtemporal window in a Transcranial Doppler, what is the depth of the ACA ?

A

5.5 to 6.5 cm

308
Q

From a transtemporal approach, the PCA flows in what direction?

A

towards the transducer

309
Q

At what depth is the PCA from a transtemporal aproach?

A

6.0 -7.0 cm

310
Q

From a transtemporal approach in which direction does the PCA flow?

A

Towards the transducer

311
Q

In a doppler of TICA (transcranial Internal Carotid artery doppler) at what depth it the ICA?
And what is the direction of flow?

A

5.5 - 6.5 cm deep

and flows toward the transducer.

312
Q

In a Suboccipital approach at what depth is the Vertebral artery, and in what direction does it flow?

A

6.0 - 9.0 cm

flow is away from transducer

313
Q

From a Sub occipital approach, at what depth is the Basilar artery and in what direction does it flow?

A

8.0 -12 cm

flows away from transducer.

314
Q

From a transorbital approach, At what depth is the Opthalmic artery, and what is the direction of flow

A

4.0 - 6.0cm

flow is toward the transducer

315
Q

Using a suboccipital Window, what is the sample volume depth and direction of flow for the Vertebral artery?

A

6.0 - 9.0 cm

flow is away from the transducer

316
Q

Using a Suboccipital Window, what is the sample volume depth and direction of flow for the Basilar artery?

A

8.0 - 12cm

flow is away from the transducer

316
Q
  1. Which of the following is not true about laminar flow?
A. Layers of fluid particles are moving against one another
B. Fastest flow is in center stream
C. A stationary layer is at the wall
D, Flow i s considered to be stable flow
E. flow patterns have flattened  profile
A

E. Flow patterns have a flattened profile

317
Q

In the cerebrovascular system, atherosclerosis occurs most commonly in the:

A. origin of internal carotid artery
B. intracranial internal carotid artery
C. Left subclavian artery
D. Innominate artery
E. Proximal common carotid artery
A

A. Origin of internal carotid artery

318
Q

Dysphasia is a:

A. Hormone imbalance causing loss of appetite
B. Psychological, not physiological, problem
C. Left-hemisphere symptom (if patient is right-handed)
D. Right- hemisphere symptom ( if patient is right- Handed)
E. Symptom associated with vertebrobasilar insufficiency

A

E. symptom associated with vertebrobasilar insufficiency

Dysphagia (with a “g” ) is difficulty with swallowing

319
Q

Convential arteriography reveal 30 percent diameter stenosis in a symptomatic patient with severe stenosis by B-mode and peak systolic velocities of 250 cm/sec in the proximal internal carotid artery. Which of the following statements about these findings are true?

A. The high velocities were caused by carotid kinking
B. Even Double - projection arteriography may fail to fully determine diameter stenosis, especially in the event of vessel overlap
C. Arteriography may fail to reveal small “berry” aneurysms in the brain
D. B - mode “plaquing” may have been background ultrasound noise
E. The ultrasound findings are not as important as the findings of an arch study.

A

B. even double - projection arteriography may fail to fully determin diameter stenosis, especially in the event of vessel overlapA. The systolic components from each arm are averaged to determine the likelihood of cerebrovascular disease

One of the main advantages of duplex is the ability to visualized in cross sections to the artery. Vessel overlap is a common problem. Kink would show up on angiography. “Background ultrasound noise” would not cause accelerated velocities.

320
Q

A patient undergoes carotid endartectomy. Six months later angiography is performed because of symptoms referable to the other side. The angiogram reveals that the operated carotid is significantly narrowed. The most likely cause is:

A.  Atherosclotic plaque recurrence
B. Carotid dissection
C. Embolic activity
D. Extrinsic Compression
E. Neointimal hyperplasia
A

E. Neointimal hyperplasia

This is common phenomenon following any trauma to an arterial wall, including endartectomy and angioplasty. It involves proliferation of smooth - muscle cells in response to the injury.

321
Q

The Doppler sample volume is usually adjusted:

A. Small, to sample flow only from center stream
B. Small, to sample flow right against the arterial walls
C. Big enough to sample flow from the entire lumen of the artery
D. Big enough to sample flow from a long segment of the artery
E. Is not an issue with pulsed-wave Doppler

A

A. Small to sample flow only from center stream

322
Q

The incidence of new strokes per year is:

A. 150,00
B. 250,00
C. 500,00
D. 1,00,000
E. 2,600,000
A

C. 500,000

323
Q

Of the following techniques , which would be the least effective in detecting significant DVT?

A. Photoplethysmography
B. Duplex ultrasound
C. Impedance  Plethysmography
D. Pneumoplethysmography
E. Strain-gauge plethysmography
A

A. Photoplethysmography

PPG is not helpful in diagnosing acute thrombosis: it is used for diagnosing chronic venous insufficiency. IPG, SPG and Air Plethysmography are all capacitance/ outflow modalities, and their tracings look essentially the same

324
Q

What is PPG (photoplethysmography ) used for

A

Diagnosing chronic venous insufficiency

325
Q

Most often, the settings for venous color flow imaging of the lower extremities

A. Are the same as those for peripheral arterial studies
B. Are the same as those for abdominal arterial scanning
C. Are the same as those for carotid scanning
D. Are the same as those for abdominal venous scanning
E. Are different from any of the above

A

E. Are different from any of the above

A low PRF (scale) setting is necessary for the slower flow in lower extremity veins.

326
Q

A TIA of the right anterior hemisphere of the brain will likely affect:

A. The entire body
B. The left side of the body
C. The right side of the body
D. The right side of the face
E. The back of the head
A

B. The left side of the Body

TIA affect the side of the body opposite that of the ischemic hemisphere.

327
Q

You perform TCD, insonating the left anterior cerebral artery. The flow is toward the beam. This finding suggests:

A. Ipsilateral carotid obstruction, with right - to - left collateralization.
B. Contralateral carotid obstruction, with left - to - right collateralization
C. Ipsilateral carotid obstruction, with posterior - to anterior collateralization.
D. Contralateral siphon disease
E. Nothing of diagnostic significance.

A

A. Ipsilateral carotid obstruction, with right - to - left collateralization

Flow in the ACA is normally away from the beam, so this is not normal. It suggests flow coming across from the other hemisphere via the anterior communicating artery.

328
Q

Chronic Deep venous obstruction will increase:

A. Venous flow
B. Arterial inflow
C. Resting supine venous pressure
D. Ambulatory venous pressure
E. Ambulatory residual venous volume
A

D. Ambulatory venous pressure

Ambulatory venous pressure increases dramatically in chronic venous obstruction

329
Q

All of the following are causes or or risk factors for acute deep venous thrombosis Except:

A. Trauma
B. Extrinsic compression upon deep veins
C. Hypercogulability
D. Arthritis
E. Cancer
A

D. arthritis

Patients with CA are at increased risk because of systemic fibrinolytic changes

330
Q

With exercise in patients with postphlebotic syndrome, which of the following is FALSE?

A. These patients usually have a small decrease in venous pressure that returns rapidly after ceasing excercies

B. They usually have a quick decrease in venous pressure that returns rapidly after ceasing exercise.

C. They sometimes have and increase in venous pressure

D. They may develope venous claudication

E. Secondary varicies may appear more prominent

A

B. They usually have a quick decrease in venous pressure that takes a minute or tow to return to pre-exercise levels

A prolonged return to pre-exercise pressure would be the normal response; return to maximum pressure should take a fairly long time in the patient with competent valves preventing reflux. In patients with complete recanalization of thrombus, the obstruction may even cause increased pressure with exercise because of congestion. Secondary varicies may fill via incompetent perforators during exercise.

331
Q

A patient presents with acute pronounce bright red discoloration and edema of the skin along the anterior calf. The most likely diagnosis is:

A. Superficial thrombophlebitis
B. Deep vein thrombosis
C. Cellulitis
D. Chronic venous insufficiency
E. Incomplete perforating veins
A

C. Cellulitis -

inflammation of skin and deeper tissues caused by and infections process - is one of the common differential diagnoses for deep venous thrombosis.

332
Q

Which of the following is/are TRUE regarding the clinical detection of a bruit?

A. A bruit is always an indication of disease

B. It means that turbulent flow exists

C. It may be indicative of valvular dysfunction in the heart

D. It may be a normal finding in parts of some vessels and during periods of enhanced flow

A

E. B,C and D

333
Q

The strongest risk factor for stroke is:

A poor diet
B. Obesity
C. Hypertension
D. Hypocholesterolemia
E. Alcohol abuse
A

C. Hypertension

334
Q

Descending venograpy is performed to diagose:

A. Femoral venous thrombosis
B. Valvular insufficiency
C. Popliteal venous thrombosis
D. Superficial venous thrombosis
E. Inferior vena cava valvular insufficiency
A

B. Valvular insufficiency

Ascending venography defines the location and extent of venous obstruction. DESCENDING venography identifies specific valvular incompetence. Answer Choice E is a dirty trick: the IVC has no valves

335
Q

In using continuous - wave Doppler with Spectral analysis to assess the internal carotid artery, which of the following operator - induced errors would most likely result in a falsely LOW frequency shift?

A. Overdriving the Doppler signal gain
B. Allowing eh signal beam to overlap both an artery and a vein
C. Changing to a higher - frequency transducer
D. Leaving the wall filter on
E. Increasing the beam angle to 70 degrees

A

E. Increasing the beam angle to 70 degrees

This would create a lower frequency shift than the proper 60 degrees( Doppler equation again) The other choices would more likely increase, not decrease, the frequency shift.

336
Q

A patient describes a 30 - minute episode of garbled speech. This is Called:

A. Dysphasia
B. Aphasia
C. Paresthesia
D. Dysphagia
E. Syncope
A

A. Dysphasia

“Aphasia” is widely used as well, but technically this is incorrect, since it means “ absence of speech”

337
Q

The optimal patient position for imaging of the lower extremity veins is:

A. Semi-Fowler's position
B. Trendelenburg's position
C. Reverse Trendelenburg's position
D. Supine, leg elevation
E. Answers A and C
A

A and C
Semi-Fowler’s position
Reverse Trendelenburg’s position

Semi - Fowler’s position is raising the trunk and head, but not the knees (True Fowler’s position includes raising teh knees, Which is what ost hospital beds do when you raise the head) Reverse Trendelenburg’s position is patient supine, head up, ad feet down. A combination of these is usually used for venous duplex studies. Trendenleburg’s position is patient supine, head down, and feet up - useful for pooling blood in the central circulation in hypotensive patients, but not for venous imaging or Doppler in the lower extremities. Supine, leg elevated is good for venous outflow plethysography.

338
Q
  1. Which of the following is not true about a hemodynamically significant stenosis?

A. there is a notable reduction in volume flow
B. A notable reduction in pressure is evident
C. A 75% diameter reduction is equivalent to a 50% area reduction
D. Distal effects may only be detectable following stress
E. Flow abnormalities depend on the length of the lesion, degree of narrowing, and other factors

A

C. A 75% diameter reduction i equivalent to a 50% area reduction

339
Q
  1. One of the following arteries normally has a lower pulse amplitude than the others.

A. Iliac Artery
B. Aorta
C. Popliteal artery
D. Femoral artery

A

B. Aorta

340
Q
  1. Which of the following will not cause vasodilation of a high resistance bed?

A. Body heating
B Exercise
C. Hyperventilation
D. Stenosis

A

C. Hyperventilation

341
Q

DESCRIBE ARTERIAL LESSIONS:

A
  • ULCERATIONS LOCATED : TIBIAL AREA, FOOT, TOES.
  • DEEP AND MORE REGULAR IN SHAPE
  • QUITE AINFUL AS COMPARED TO VENOUS ULCERS
  • DURATION OF ULCERS IMPORTANT (I,E., (DAYS, WEEKS)
  • GANGRENE: DEATH OF TISSUE; USUALLY DUE TO DEFICIENT OR ABSENT BLOOD SUPPLY.
342
Q

5 RISK FACTORS FOR ARTERIAL DISEASE

A

DIABETES

HYERTENSION

HYPERLIPIDEMIA

SMOKING

UNCONTROLLABLE - AGE, FAMILY HISTORY

343
Q

WHAT IS LERICHE SYNDROME

A

A FORM OF ATHEROSCLEROSIS - OBSTRUCTION OF AORTA: OCCURS IN MALES

FATIGUE IN HIPS, THIGHS, OR CALVES WITH EXCERCISE
ABSCNCE OF FEMORL PULSES
IMPOTENCE
OFTEN TIMES, PALLOR AND COLDNESS OF LE

344
Q

WHAT IS BUEGER’S DISEASE ( THROMBOANGITIS OBLITERANS)

A 
A FORM OF ARTERITIS
ASSOCIATED WITH HEAVY CIGARETTE SMOKING
OCCURS PRIMARILY IN MEN. < 40 YR OLD
PRESENTS WITH OCCLUSION OF DISTAL ARTERIES
RESP AIN AND ISCHEMIC ULCERATION
345
Q

WHAT IS ARTERITIS AND WHAT SYNDROME IS ASSOCIATED WITH ARTERITIS

A
  • INFLAMMATION OF ARTERIAL WALL LEADS TO THROMBOSIS OF VESSEL
  • CAN AFFECT TIBIAL AND PERONEAL VESSELS
  • TYPE - BUEGER’S DISEASE(THROMBOANGITIS OBLITERANS)
  • ASSOCIATED WITH HEAVY CIGARETTE SMOKING
  • OCCURS PRIMARILY IN MEN <40 YRS OLD
  • PATIENTS PRESENT WITH OCCLUSIONS OF THE DITAL ARTERIES
  • REST PAIN AND ESCHEMIC ULCERATION PRESENT

Vascular (1 decks)

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