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Vascular board review (myultrasoundtutor) > Duplex Upper and Lower Extremities > Flashcards

Duplex Upper and Lower Extremities Flashcards

1
Q

Localize stenosis/ occlusion/aneurysm is a capability of what

A

duplex upper extremity

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2
Q

A connection between an artery and vein is what type of graft

A

Hemodialysis Access graft

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2
Q

Name the 2 types of grafts and describe them

A

1) autologous= brescia-cimino (radial artery and cephalic vein)
2) synthetic= straight or looped (brachial artery to axillary vein)

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3
Q

Having the arm extended laterally and 45 degrees to the body describes what position

A

Pledge position

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4
Q

Normal native arteries for a hemodynamic access graft should be

a) high resistance
b) low resistance

A

a) high resistance

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5
Q

A stenosis should be

a) qualitative
b) quantitative

A

a) qualitative
- no velocity criteria

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6
Q

Focally elevated velocities and PST =

A

stenosis

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7
Q

What should a normal hemodialysis waveform of the proximal artery (inflow) be like

A

Low resistance and increased EDV

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8
Q

What should a normal hemodialysis waveform of the distal artery be like

A

back to normal high resistance (triphasic)

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9
Q

What should a normal hemodialysis waveform of a fistula be like

A

low resistance and high PSV and EDV

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10
Q

What should a normal hemodialysis waveform of a proximal vein (outflow) be like

A

pulsatile

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11
Q

Thumping high resistance in proximal artery or graft would be an abnormal finding of

A

graft occlusion

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12
Q

Low velocity dampened and continuous is a abnormal finding of

A

proximal inflow problem

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13
Q

A focal elevated velocity is an abnormal finding of

A

graft stenosis

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14
Q

Where is the most common location for focal elevated velocities

A

outflow vein

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15
Q

Evaluates location and severity of stenosis vs occlusion/ aneurysm is a capability of

A

Duplex lower extremity

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16
Q

A connection between an artery to an artery describes what type of graft

A

Bypass graft

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17
Q

what is the purpose of a bypass graft

A

Reroute blood flow in presence of significant extensive arterial obstruction

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18
Q

Name the 3 types of arterial bypass grafts

A

1) synthetic
2) in situ saphenous vein graft
3) reversed saphenous vein graft

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19
Q

What type of graft uses a PTFE

A

synthetic

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20
Q

What type of graft is used when the vein is kept in place, is removed from venous and connected to arterial and the branches must be ligated and valves removed

A

In situ saphenous vein graft

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21
Q

For an In situ saphenous vein graft where do you evaluate it

A

The body due to risk of AFV from branches

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22
Q

What type of graft is used when the vein is removed and flipped upside down, the branches are ligated, and valves kept in place

A

Revered saphenous vein graft

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23
Q

Where would you evaluate a reversed saphenous vein graft

A

Proximal anastomosis due to small size

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24
Q

Where would you evaluate a synthetic bypass graft

A

Anastomosis sites for possible leakage

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25
Q

A 2:1 ratio is what percentage diameter reduction

A

50%
- PSV doubles at stenosis

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26
Q

A 4:1 ratio is what percentage diameter reduction

A

75%
- PSV quadruples at stenosis

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27
Q

Any velocity greater than ______ cm/sec is a 75% diameter reduction

A

400 cm/sec

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28
Q

Retrograde flow in the native artery at distal anastomosis is

a) normal
b) abnormal

A

a) normal

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29
Q

An aneurysm would be considered an increase in what % diameter

A

50%

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30
Q

An aneurysm that has increase in diameter of 50% peripherally is most likely seen where

A

In the popliteal

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31
Q

When measuring the aorta to get AP measurement you must be

a) parallel
b) perpendicular

A

a) parallel

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32
Q

In the transverse view of the aorta you must scan in what plane to the aorta

a) parallel
b) perpendicular

A

b) perpendicular

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33
Q

What is the correct way to measure the true lumen of the aorta

A

outer to outer

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34
Q

How many cm is a AAA

A

> 3 cm

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35
Q

For a dissection you must be able to visualize what

A

An intimal flap

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36
Q

A RAR of 3.5 is what percentage of diameter reduction

A

60%

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37
Q

During a RAR tardus parvus is seen distally in what artery

A

segmental artery

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38
Q

A RAR cant be used if the Aorta is < ______ cm/s or >______ cm/s

A

<40 cm/s
>90 cm/s

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39
Q

Renal disease =

A

Nephrosclerosis

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40
Q

A normal kidney should be

a) high resistance
b) low resistance

A

b) low resistance

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41
Q

In a normal kidney the EDR should be

A

> 0.2

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42
Q

In a normal kidney the RI should be

A

<0.7

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43
Q

An abnormal kidney would have _______ resistance which = ________

A

increased resistance, nephrosclerosis

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44
Q

Abdominal pain and cramping 15-30 minutes after eating is what condition

A

mesenteric ischemia

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45
Q

Name the 3 vessels that are considered splanchnic vessels

A

1) Celiac
2) SMA
3) IMA

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46
Q

A normal celiac should be _____ resistance with _____ EDV

A

low resistance
high EDV

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47
Q

A celiac with a PSV of _____ cm/s is what % diameter reduction

A

> 200 cm/s
70% diameter reduction

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48
Q

A fasting SMA should have _____ resistance and ____ EDV

A

high resistance and low EDV

49
Q

A post-prandial SMA should have ______ resistance and _____ EDV

A

low resistance and increased EDV

50
Q

The SMA PSV of _____ cm/sec is what % diameter reduction

A

> 275 cm/sec
70%

51
Q

Which splanchnic vessel is not easily visualized

A

IMA

52
Q

If the IMA is imaged and the velocity is high this is considered to be

a) normal
b) abnormal

A

b) abnormal

53
Q

2 out of 3 abnormal sphlanchnic vessels is what condition

A

Chronic mesenteric ischemia

54
Q

Compression of the celiac by the median arcuate ligament of the diaphragm describes what syndrome

A

Celiac band syndrome

55
Q

What syndrome is most often seen in young athletic women and is only compressed during expiration

A

Celiac band syndrome

56
Q

During a renal transplant the donor vessels are connected to what vessels

A

External iliac vessels

57
Q

During a liver transplant what 3 vessels are evaluated

A

1) hepatic artery
2) portal vein
3) hepatic veins

58
Q

Normal transplants should have what type of flow pattern

a) high resistance
b) low resistance

A

b) low resistance

59
Q

During a liver transplant what should the flow be in the portal vein

a) hepatopedal
b) hepatofugal

A

a) hepatopedal

60
Q

During rejection of a transplant what happens to the EDV

A

decreases of loss of EDV

61
Q

Name the 3 indications of organ transplant rejection

A

1) organ will increase in size
2) altered echogenicity
3) possible thrombosis of veins

62
Q

For preoperative mapping the epigastric artery using what type of flap

A

TRAM

63
Q

What type of flap for the epigastric artery is used in breast reconstruction

A

TRAM flap

64
Q

What is another name for the internal mammary artery

A

Internal thoracic artery

65
Q

Before the radial artery can be used for a coronary artery bypass graft what test must be peformed first

A

Modified Allens Test

66
Q

For vein mapping what is the minimum mm that can be considered

A

2 mm

67
Q

What type of fistula has communication between an artery and vein

A

Arteriovenous fistula

68
Q

What type of atypical disorder is acquired usually from post procedure and has 1 connection

A

Traumatic

69
Q

What type of atypical disorder is a malformation that you are born with and has numerous connections

A

Congenital

70
Q

Closer to the heart that is larger has an increase risk of

A

CHF

71
Q

What syndrome is swelling within fascial compartments causing compression and increased pressure to capillary vascular beds

A

Compartment syndrome

72
Q

What syndrome compresses the tibial artery and causes a decrease in arterial perfusion

A

Anterior compression syndrome

73
Q

What would indicate a total occlusion of the hemodialysis access graft

a) thumping patterns in the proximal vein
b) retrograde flow in the distal artery
c) high velocity, turbulent flow at its origin
d) little or now diastolic flow in the proximal artery

A

d) little or no diastolic flow in the proximal artery

74
Q

What is the expected flow pattern in the artery proximal to the Brescia-Cimino fistula

a) low resistance
b) triphasic or biphasic
c) retrograde
d) high velocity and high resistance

A

a) low resistance

75
Q

What describes the reversed saphenous vein graft

a) the proximal end is larger and the distal end is smaller
b) a valvutome must be used to remove the valves
c) the most common location for graft stenosis is the distal anastomosis
d) the distal end is larger and the proximal end is smaller

A

d) the distal end is larger and the proximal end is smaller

76
Q

What is the most common location for arterial obstruction in the lower extremities

a) tibeoperoneal trunk
b) distal SFA
c) common femoral artery
d) bifurcation of the popliteal

A

b) distal SFA

77
Q

Disease in which of the following can cause monophasic, continuous waveforms documented at the common femoral artery

a) SFA
b) common iliac artery
c) deep formal artery
d) internal iliac artery

A

b) common iliac artery

78
Q

What is the normal doppler waveform pattern of the pre-prandial SMA

a) low end diastolic velocity
b) triphasic
c) low resistance
d) increased end diastolic velocity

A

a) low end diastolic velocity

79
Q

What is the criteria for the renal artery to aorta ratio

a) normal is < 3.5
b) abnormal is <3.5
c) normal is less than 2:1
d) abnormal RAR is <1.0

A

a) normal is <3.5

80
Q

The post prandial SMA is noted to have a PSV of 108 cm/s and EDV of 2 cm/s. What is the significance of these findings

a) prominent SMA collaterals
b) distal SMA obstruction
c) proximal SMA stenosis
d) normal hemodynamic pattern

A

b) distal SMA obstruction

81
Q

In order to calculate the renal artery to aorta ratio, how should the aorta velocity be obtained

a) proximal to the SMA and distal to the celiac trunk
b) At the level between the take off of the SMA and renal arteries
c) inferior to origin of the renal arteries
d) at any location of the abdominal aorta avoiding aneurysm if present

A

b) At the level between the take off of the SMA and renal arteries

82
Q

What sonographic finding most likely indicates renal transplant rejection

a) increased diastolic flow
b) increased organ size
c) perirenal fluid
d) absent diastolic flow

A

d) absent diastolic flow

83
Q

When obtaining ankle blood pressures, what is the primary reason for having the patient in a flat, supine position

a) patient comfort
b) venous pressure reduction
c) easier doppler placement
d) reduce/eliminate hydrostatic pressure

A

d) reduce/eliminate hydrostatic pressure

84
Q

Which of the following ankle/brachial indices is most consistent with the symptom of ischemic rest pain

a) 0.3
b) 0.5
c) 0.8
d) 1.0

A

a) 0.3

85
Q

Which of the following conditions would cause an abnormal PVR at the high-thigh location

a) SFA occlusion
b) Internal iliac artery stenosis
c) popliteal artery occlusion
d) significant aortoiliac disease

A

d) significant aortoiliac disease

86
Q

The reported advantage of a 4 cuff segmental pressure test over a 3 cuff method is differentiating which of these diseased segments

a) aorta disease from iliac disease
b) femoral artery from popliteal artery disease
c) aortoiliac from femoral artery disease
d) common femoral artery from profunda femoris disease

A

c) aortoiliac from femoral artery disease

87
Q

Photoplethysmography uses which of the following modalities for blood flow evaluation

a) pulse volume recording
b) ultrasound
c) ultraviolet
d) infrared

A

d) infrared

88
Q

Which of the following lower arterial test modalities provides diagnostic quantitative information

a) segmental pressures
b) continuous-wave doppler waveforms
c) photoplethysmography
d) pulse volume recording

A

a) segmental pressures

89
Q

For accurate blood pressure determination, the cuff bladder should be ______ of the limb circumference

a) 10%
b) 20%
c) 30%
d) 40%

A

40%

90
Q

PRV is a form of which of the following methods/techniques

a) impedance plethysomography
b) pneumo-plethysomography
c) photoplethysmography
d) segemental pressures

A

b) pneumo-plethysomography

91
Q

While performing segmental pressures on a lower extremity, you note a pressure gradient between 2 cuffs to equal 15 mmHg. What does this finding indicate

a) normal result, no big deal
b) stenosis in the arterial segment proximal to the lowest cuff
c) total occlusion of the arterial segment
d) stenosis in the arterial segment distal to the lowest cuff

A

a) normal result, no big deal

92
Q

Leg pain with exercise that is not due to arterial occlusive disease is often referred to as

a) buergers disease
b) pseudo-claudication
c) rest pain
d) arteritis

A

b) pseudo-claudication

93
Q

The most common vein used for “in situ” bypass grafts is

a) SSV
b) popliteal vein
c) basilic vein
d) GSV

A

d) GSV

94
Q

Which of the following is not a potential complication of a reversed femoro-popliteal vein graft

a) neointimal hyperplasia
b) graft aneurysm
c) fistula via non-ligated perforator vein
d) graft kink

A

c) fistula via non-ligated perforator vein

95
Q

The radial artery terminates in which vessel

a) palmar arch
b) ulnar artery
c) brachial artery
d) interosseous artery

A

a) palmar arch

96
Q

In which bypass graft procedure is a valvulotome used

a) in situ vein bypass
b) radial artery harvest
c) reversed vein bypass
d) aorto-bifemoral

A

a) in situ vein bypass

97
Q

A hyperemic waveform existing in the PTA weeks status-post a femoral to distal vein bypass is most likely due to which of these conditions

a) graft occlusion
b) vasoconstriction
c) graft stenosis
d) chronic vasodilation

A

d) chronic vasodilation

98
Q

What is the most common cause of in situ vein bypass graft stenosis

a) atherosclerosis
b) intimal hyperplasia
c) collagen vascular disease
d) arteritis

A

b) intimal hyperplasia

99
Q

A potential complication of a EVAR is back-bleeding into the aneurysm sac from the IMA or lumbar arteries. This endoleak is classified as which of the following types

a) type 1
b) type 2
c) type 3
d) type 4

A

b) type 2

100
Q

The left brachial pressure is 20 mmHg lower than the right brachial pressure. Whats up?

a) stenosis of the brachiocephalic artery
b) stenosis of the subclavian artery
c) stenosis of the brachial artery
d) its a normal pressure gradient

A

b) stenosis of the subclavian artery

101
Q

Buergers disease is an arterial disorder involving which of the following vessels

a) renal arteries
b) coronary arteries
c) pelvic arteries
d) digital arteries

A

d) digital arteries

102
Q

What is cold or vibration induced digital vasospasm

a) marfan syndrome
b) arteritis
c) buergers disease
d) raynauds syndrome

A

d) raynauds syndrome

103
Q

Which of the following is the standard recovery time following a cold immersion test for Raynauds

a) 2 minutes
b) 5 minutes
c) 7 minutes
d) 10 minutes

A

b) 5 minutes

104
Q

Which of the following best describes the Brescia-Cimino procedure

a) a brachial artery to median cubital vein fistula
b) a straight Teflon graft from radial artery and the basilic vein
c) a radial artery to cephalic vein fistula
d) an indwelling hemodialysis catheter

A

c) a radial artery to cephalic vein fistula

105
Q

In a patient with a hemodiaylsis access forearm loop graft, digital ischemia can result from which of the following conditions

a) thrombosed hemodialysis access graft
b) incomplete palmar arch
c) pseudoaneurysm
d) venous outflow obstruction

A

b) incomplete palmar arch

106
Q

Which of the following grafts is impenetrable by ultrasound

a) gore-tex
b) bovine
c) atrium
d) vectra

A

d) vectra

107
Q

Reverse flow detected in the distal radial artery of an ipsilateral radial artery to basilic vein graft indicates which of the following conditions

a) impending graft failure
b) occluded ulnar artery
c) incompetent palmar arch
d) patent palmar arch

A

d) patent palmar arch

108
Q

Which of the following vessels is not usually used in hemodialysis access grafts or fistulas

a) cephalic vein
b) brachial vein
c) basilic vein
d) median cubital vein

A

b) brachial vein

109
Q

Antegrade, triphasic flow in a radial artery distal to a brachial artery to basilic vein loop hemodialysis access graft indicates which of the following

a) normal radial artery flow
b) venous outflow obstruction
c) pseudoaneurysm at anastomosis
d) graft failure

A

a) normal radial artery flow

110
Q

Which access graft does not require maturation time

a) vectra (polyurethane)
b) gore-tex
c) atrium
d) imptra PTFE

A

vectra (polyurethane)

111
Q

The post-prandial SMA is noted to have a PSV of 108 cm/s and EDV of 2 cm/s. What is the significance of these findings?

a) Normal hemodynamic pattern
b) Proximal SMA stenosis
c) Prominent SMA collaterals
d) Distal SMA obstruction

A

d) Distal SMA obstruction

-The normal post-prandial SMA would show an increased EDV. An abnormally high resistance waveform when it should be low resistance means there is a problem distally (in other words, blockages is upahead)

112
Q

In order to calculate the renal artery to aorta ratio, how should the aorta velocity be obtained?

a) Proximal to the SMA and distal to the celiac trunk
b) At the level between the take off of the SMA and the renal arteries
c) Inferior to origin of the renal arteries
d) At any location of the abdominal aorta avoiding aneurysms if present

A

b) At the level between the take off of the SMA and the renal arteries

-This should be obtained between the renal arteries and the SMA. The doppler should be placed proximal to the renal artery origin and just distal to the SMA

113
Q

What sonographic finding most likely indicates renal transplant rejection?

a) Increased diastolic flow
b) Increased organ size
c) Perirenal fluid
d) Absent diastolic flow

A

d) Absent diastolic flow

114
Q

What is the threshold diameter for the popliteal artery to be considered aneurysmal?

a) 0.5 cm
b) 1.0 cm
c) 2.0 cm
d) 3.0 cm

A

b) 1.0 cm

115
Q

In the presence of an SFA occlusion, what vessel usually provides collateral flow?

a) popliteal artery
b) common femoral artery
c) greater saphenous vein
d) deep femoral artery

A

d) deep femoral artery

116
Q

The most important tibial vessel to assess pre-operatively for a femoral to distal bypass is the

a) Gastrocnemius artery
b) Peroneal artery
c) Anterior tibial artery
d) Posterior tibial artery

A

d) Posterior tibial artery

117
Q

A hyperemic waveform existing in the posterior tibial artery 3 weeks status-post a femoral to distal vein bypass is most likely due to which of these conditions

a) Graft occlusion
b) Vasoconstriction
c) Graft stenosis
d) Chronic vasodilation

A

d) Chronic vasodilation

118
Q

Antegrade, triphasic flow in a brachial artery proximal to a radial artery to basilic vein hemodialysis access graft indicates which of the following?

a) Normal radial artery flow
b) Venous outflow obstruction
c) Pseudoaneurysm at anastomosis
d) Graft failure

A

d) Graft failure

119
Q

While scanning a renal transplant patient you observe low resistance in segmental arteries this is

a) rejection
b) stenosis of the donor renal artery
c) renal vein thrombosis
d) normal

A

d) normal

Vascular board review (myultrasoundtutor) (23 decks)

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