*extra attention* Flashcards
how long do the blood pressure cuffs need to be inflated for with reactive hyperemia?
3-5 minutes
with reactive hyperemia the thigh cuffs are inflated to supra systolic pressure that are usually ___- ____mmHg above the higher brachial
20-30
with reactive hyperemia patients who have single level disease experience a ____% drop in ankle pressure
<50%
with reactive hyperemia testing patients have multilevel arterial disease experience a pressure drop of what?
>50%
T/F the standard allen test identifies whether the radial after can be used for bypass
true
T/F when performing the standard allen test. if the color does not reappear after unclenching hand you suspect the radial artery is occluded or palmar arch obstruction
false ulnar artery is occluded
all of the following techniques/ instruments can be used as “end point detectors” except? a. photoplethysmography b. displacement plethysmography c. stethoscope d.volume plethsmography e. CW doppler
B. displacement plethysmography is for the entire hang not for end points
finger/ brachial indices of about __-__ characterize normal upper extremity digits
.8-.9 anything less is consistent with arterial disease
normal toes have pressures that range from ___% -___% of the brachial pressures
60-80% anything less has arterial occlusive disease
what is normal PBI? abnormal?
>=.75, <.65
when performing a impotency study what must you obtain?
ABI, obtain penile pressures using PPG or Doppler, apply pressure cuffs on upper arms, ankles and prox shaft of penis
what is pop entrapment syndrome?
compression of pap artery by medial head of gastrocnemius muscle
Pop entrapment syndrome is found in who? and is bilateral in _____ of cases
young athletic men, 1/3
what is the significance of finding a PSV of 85 cm/sec in a dialysis graft?
you suspect the patient has arterial inflow problem
t/f higher velocities are normally seen throughout the graft and spectral broadening
true , PSV of 280 okay
T/F an ABI is reduced by >.15 compared to previous exam this is wnl
false
what would the significance of finding PSV of 70cm/sec in the aorta and 240 cm/sec in th elect renal artery?
it would be wnl because its 3 and anything less than 3.5 is considered wnl
what is a normal RAR?
<3.5
what is a abnormal RAR? what does it indicate?
>=3.5, 60% or greater diameter reduction
t/f when evaluating flow in a native artery of the upper extremity PSVs can sidle vary secondary to changes in temp?
true
t/f when interpreting flow in a native artery of the upper extremity, there is no criteria consistent with a >50% diameter reduction
true
t/f when interpreting flow in a native artery of the upper extremity, the stenosis profile is not evident in upper extremity disease
false, stenosis profile is evident
t/f when interpreting flow in a native artery of the upper extremity, distal emboli may be associated with subclavian aneurysm
true
when performing a study that includes segmental pressure measurements you understand the cuff size matters, which is the LEAST accurate statement about the selection of blood pressure cuffs? a. the length of the cuff is a critical factor in obtaining accurate pressures
b. narrow cuff can result in high pressure
c. with of the cuff should be 20% of limb diameter
d. a wide cuff can result in low pressures
a.
during inspiration what happens to intrathoracic pressure and venous flow to the upper extremities?
intrathoracic pressure decreases, abd pressure increases and upper extremities increase venous flow while lower extremities decrees venous flow
T/f vasoconstriction and vasodilation of the arterioles change peripheral resistance and profoundly affect blood flow in large arteries
true
A thrombosis in the ICA can be secondary to what of the CCA?
dissection. a thrombi is created from the false lumen and lodge distally
a venous duplex study provides important info to help determine if ablation would be viable treatment for venous reflux. which of the flowing factors is least important for successful outcome? a. caliber and depth b. duration of reflux c. presence of venous stasis changes d. course of the vesssle
b. if we are doing an ablation we already know there is venous reflux so it is not helpful while performing surgery
a patient complains about aphasia, left hemiplegia, facial and arm weakness and behavioral changes where is the blockage?
RT middle cerebral artery… rt controls left; left controls rt
angiography reveals a stenotic right ICA artery with residual lumen of 3 and true lumen of 9 what is the diameter reduction?
67% (1-3/9)x100
for duplex scanning the criterion for deterring a >50% diameter reduction of the femoral artery is?
ratio of stenotic to prestenotic PSV >2:1
a 20 year old male has high blood pressure and bilateral lower extremity pain with walking 3-4 blocks what disease process is most likely?
coarctation of the aorta, congenital narrowing or stricture of the thoracic ao may affect abdominal ao. clinical findings may include hypertension, due to decreased kidney perfusion and lower extremity ischemia
the dicrotic notch is related to what action of the heart??
opening of the bicuspid valve
with PtcO2 readings what is normal and what is abnormal?
normal >50mmHg . critical limb iscemia more often <20
fasciotomy would be considered in what condition?
compartment syndrome
what is compartment syndrome?
swelling within the osteofascial compartments of the leg, arm or abdomen.
the plantar arch consists of what two vessels?
deep plantar artery and lateral plantar artery
a true aneurysm is a dilatation of what layers of the arterial wall?
all three layers
Where is the most common location for arterial aneurysm?
infrarenal ao
the neck of a pseudoaneurysm has a unique waveform what is that wave form?
to and fro
where are the sited for ausculation ( listening through stethoscope) for arteries??
abdominal ao, the carotid, femoral and pop arteries
what is pulsatility index? equation
PI=peak to peak frequency/ mean frequency
a PI of ______ is normal for the common femoral artery, while a normal PI for the pop artery is?
>5.5, 8.0
a PI of ______ in the common femoral artery with a patent superficial femoral artery has a good predictive value and indicates proximal aortoiliac occlusive disease
<5.0 some even say <4.0 pg 67 for iamges
the acceleration time of _____msec in the CFA suggests the presence of significant iliac disease
>=133
what is the advantage of a 4 cuff method
provides proximal and distal thigh pressure measurements
what is the disadvantage of the 4 cuff method?
is that artifactually elevated pressures are obtaines IE the pressures at the high thigh level is normally >=30mmHg more than the higher brachial pressure
the high thigh pressure is ___ mmHg greater than the HIGHER brachial pressures
30
T?F the DIameter and length of a Arteriorvenous fistula predicts the resistance?
true
AV fistula has what type of flow pattern?
bidirectional
with AV fistula compared to normal artery, an artery proximal to the fistula has _____ flow. especially during diastole because the fistula markedly reduces ____.
increased flow, resistance
With a AV fistula depending on the size, once blood flows past it there may be what type of flow beyond in the distal artery?
normal, triphasic
with AV fistula blood pressure in the distal artery is always somewhat _____.
reduced
venous flow approaching the AVF has _____ velocities, but the venous signal has increased pulsatility because of the connection with the artery.
elevated
venous flow moving away from the AVF has ___ velocities throughout
elevated
RAR calculation? normal and abnormal?
Renal artery PSV/ Aortic PSV <3.5 normal >= 3.5 abnormal, indicates 60% or greater diameter reduction
RI for the kidneys equation? wnl and Abnl
PSV-EDV/ PSV normal:=.7
What doe PRR measure?
Resistance with in the kidney parenchyma
what is the equation for EDR aka PRR? wnl? abnl
end- diastolic- velocity/ peak systolic velocity normal: >=.2
a lower resistance RRIV value of __ is associated with improvement in both blood pressure and renal function after correction in renal artery stenosis
what is the calculation of RRIV:
1-EDV/PSV
when evlauating kidney arterial flow an acceleration time ( AT) of >= 100msec is most consistent with what diameter reduction?
>=60%
TRAM flap is surgically utilized in?
breast reconstruction
What does IVUS stand for? what is it used for?
intravascular ultrasound uses ultrasound to see inside blood vessels
in order for a stenosis to be 75% or greater the Stenosis PSV would have to be _____ x’s greater.
4 times
if a patient has a ABI of .6 what disease range does that ABI fit into?
claudication
T/F with laser doppler the optic light wave transmits a high power beam of light to the skin through a fiber optic cable
False, low power
what is laser doppler used for?
determine of wound healing and amputation level, pedal arterial flow in diabetic patients
Skin perfusion pressure (SPP) of _____ mmHg indicates likely to heal. what is abnormal?
>40. <30mmHg
T/F volume pulse recordings ( PV) are incorporated in laser doppler exam
true
What is associated with the systolic upstroke on analog or spectral analysis.
opening of the aortic valve
at the end of systole the aortic valve closes what part of this is on analog analysis or spectral?
peak systole
during late systole what happens for the waveform?
temporary flow reversal
with photoplethysmography cutaneous blood flow determines the reflection. any increase in blood flow results in increased attenuation with _______ the reflection
decreases
a patient may have calcified vessels that elevated blood pressure. another name for this is
medial calcinosis….. in the medial layer
Normal ptcO2 on the foot is?
>50mmHg
critical limb ischemia PtcO2 ( rest pain, ulcer, gangrene) is?
<20mmHg
transcutaneous oximetry the electrode does what to the skin after it has been calibrated? why does it do this?
heats up, increasing blood flow and melting a lipid layer in the fatty tissue
the TcPO2 measures what?
how much oxygen comes through the skin
with TIA depending on the cerebral territory involved symptoms may include what?
sensory and motor dysfunction of arms or legs. hemiparythesis is a common symptom
T/F DC coupling is an electrical voltage that uses either positive or negative with current only flowing in one direction
true
T/F AC coupling flows unidirectional
false
T/F AC coupling is used for venous studies
False DC because it detects slower changes in blood content
T/F DC coupling is use for venous studies because it detects slower changed in blood
T
AC coupling is used for what?
Arterial because of it requires more intense changes to produce a measurement
T/F a wall outlet is an example of DC coupling
False, AC coupling, it delivers 120 volts of AC current
Vessel coaptation refers to what?
compressibility
vein that is able to accommodate increased flow volume with out significance in venous pressure is called what?
venous compliance
acute onset of swelling, pallor and pain is associated with what?
phlegmasia alba dolens, acute iliofemoral vein thrombosis
phlegmasia cerulea dolensis what?
another limb threatening complication on an acute iliofemoral vein thrombosis
ascending venography is used to evaluate what?
acute deep venous thrombosis, congenital cenous disease and evlauate chronic changes
descending venography is used for what?
to detect and quantify reversed flow from incompetent venous valves
ascending phlebography is used for what?
deep vein thrombosis not incompent valves
ascending venography requires that contrast agent is injected into what?
vein on the dosum of the foot
descending venography usually has the contrast agent injected into what?
CFV
T/F increased pressure gradient is usually evident between venules and arterioles when a patient has DVT
false…. decreased pressure gradient
volume pleythsmography aka air plethysmography does what?
uses cuffs to infliate and deflate and give a reading in analog waveform
what is photoplethysmography?
detects cutaneous blood flow and records pulsations rather than volume changes. sends infrared light into tissue. digital artery disease is detected
all of the following are considered types of plethysmography except?
a. volume
b. photo
c. air
d. displacement
e. pressure
E pressure
spectral doppler arterial signal obtained from the presence of a proximal high grade stenosis of occlusion would result in what?
tardus parvus, dampened or prolonged upstroke
low velocities and increased acceleration time resulting in a more rounded waveform of the common carotid artery are consistent with what?
proximal disease
severe cardiomyopathy may result in deminished velocities as well as an _______ in acceleration time is suggestive of proximal disease. explain
increased acceleration time. after flowing through a stenosis the flow becomes disturbed. the acceleration time is increased because it has to regain momentum. which means slower ( increased accelertation time) from peak to peak
