CVTE 103 Carotid

Question 0

Rotating:

Answer 0

turning the beam around its axis.

Question 1

Angling:

Answer 1

sweeping the beam across its axis

Usually in short

Question 2

Rocking

Answer 2

the beam along its axis.

Question 3

Sliding:

Answer 3

moving the probe across the skin.

Question 4

There are only four basic kinds of probe movement—four things you can do with the ultrasound beam to alter your image.

Answer 4

Angling Rotating Rocking Sliding

Question 5

Don’t let your elbow

Answer 5

stick out to the side. Just let it drop relaxed from the shoulder. This keeps you from bending at the wrist into the “carpal tunnel position”.

Question 6

The brain is perfused by …

Answer 6

the two carotid and two vertebral arteries

Question 7

The ophthalmic arteries arise just…

Answer 7

proximal to the circle of Willis.

Question 8

The internal carotid arteries perfuse

Answer 8

the eyes

Question 9

The external carotid arteries perfuse

Answer 9

the face and scalp.

Question 10

ophthalmic artery branches from

Answer 10

ICA just proximal to the circle of Willis and the brain.

Question 11

Common carotid artery arises from

Answer 11

the aortic arch on the left, from the innominate bifurcation on the right.

Question 12

The CCA bifurcates into

Answer 12

internal carotid and external carotid arteries at about the level of the laryngeal prominence (Adam’s apple).

Question 13

Transverse divides things into

Answer 13

superior and inferior.

Question 14

The right carotid artery is the first branch off of the aorta. The first branch off of the aorta is the innominate and it bifurcates into

Answer 14

the right subclavian and the right common coratid artery.

Question 15

The left common carotid artery comes off of

Answer 15

the aorta.

Question 16

Most strokes are caused by

Answer 16

atheromatous plaque at the carotid bifurcation.

Question 17

Other possible causes of stroke include

Answer 17

hemorrhagic stroke and embolic activity from the heart.

Question 18

Superficial temporal artery and the temporal artery can provide

Answer 18

collateral circulation if the ICA is blocked.

The superficial temporal artery is the superior part of the ECA.

Question 19

The superior thyroid is just a landmark to find

Answer 19

the ECA

Question 20

Superficial is

Answer 20

on the top next to the surface

Question 21

Deep is

Answer 21

farther down than superficial

Question 22

Medial is to the

Answer 22

right on the right, to the left on the left.

Question 23

Transverse procedure:

Answer 23

Start low in the neck, bumping the clavicle.

Keep the CCA centered and move distally to the bifurcation.

Identify the branches, then go as far distally as possible in the ICA.

Question 24

Orientation in sagittal:

Answer 24

Feet are always to the right of the screen.

Move toward feet; tissue should come into the screen from the right.

(From transverse, rotate clockwise.)

Question 25

How do you keep the walls clear?

Answer 25

Angle and rotate, rotate and angle.

Question 26

Identifying the branches:

ICA is usually

ECA is usually

Answer 26

ICA: the larger one, and usually the lateral one.

ECA: smaller and medial.

Question 27

Approaches on the neck:

Answer 27

Anterior

Lateral

Posterior

Question 28

These refer to the position of the probe relative to the principal landmark on the neck:

the sternocleidomastoid muscle:

Answer 28

It makes a good acoustic window, so we stay conscious of using it for good image quality.

Question 29

You must progressively lay the probe _________ to keep aiming at the artery as you move from anterior to lateral and posterior approaches.

Answer 29

back

Question 30

The best approaches:

1. Start
2. Then

Default to

Answer 30

Start anterior low in the neck to get as far proximal as possible.

Then move quickly to a lateral approach— almost always best image quality (using the SCM muscle as a window).

lateral, anterolateral, and posterolateral approaches unless the anatomy dictates otherwise.

Question 31

Most common error in carotid performance test year after year:

Answer 31

Stuck anterior. Usually makes for a fuzzy image. And usually the result of tension.

Question 32

Image problems and how to fix:

Transverse: Artery not centered.

Answer 32

Fix by rocking the beam to move it to the center of the field of view. (Or maybe just a small scoot of the probe face.)

Question 33

Image problems and how to fix:

Sagittal problems: Ends closed off.

Answer 33

Fix by rotating to line up with the artery. (Sometimes it’s just one end—then rotate that end.)

Question 34

Image problems and how to fix:

Sagittal problems: Walls fuzzing out.

Answer 34

Not sending beam through largest diameter of artery.

Question 35

Image problems and how to fix:

Sagittal problems: Artery not level.

Answer 35

Fix by rocking the beam to level it. (A bit more pressure on the deeper end of the artery…)

Question 36

Controls on scanner

Depth

Answer 36

Set so that there’s clearance under vessels, but not so deep that there’s a lot underneath. 4 cm is almost always good for most carotid patients.

Question 37

Controls on scanner

Gain

Answer 37

This is the amount of amplification of the return echoes. Master gain is overall amplification.

Question 38

Controls on scanner

TGC:

Answer 38

Time gain compensation Controls gain at different depths, to compensate for loss of echo strength (attenuation) at deeper structures.

Question 39

Controls on scanner

TCG

Answer 39

The TGCs usually need to be pulled down in the near field (to keep it from being too bright), and boosted in the far field (to keep it from being too dark).

TRY TO EVEN OUT THE GRAY SCALE THROUGHOUT THE FIELD

Question 40

Sagittal is divided into

Answer 40

Left and right

long axis or longitudinal