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Vascular > Midterm > Flashcards

Midterm Flashcards

1
Q

stroke can be caused by blockage of:

A
  • thrombosis
  • arterial embolism
  • hemorrhage of an aneurysm
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2
Q

what may stroke result in?

A

affected area of brain cannot function because without oxygen, cells die

  • inability to move one or both limbs on one side of the body
  • or inability to understand or formulate speech (slurred or jumbled)
  • inability to see one side of visual field
  • face may be drooping
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3
Q

ischemic stroke

A

a blood clot blocks a blood vessel, cutting off the oxygen supply

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4
Q

Transient ischemic attack (TIA)

A

a temporary blood clot blocks a blood vessel

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5
Q

is a patient comes in with symptoms of stroke, TIA, or vascular then what do we do as sonographers?

A

use cerebral vascular doppler study to visualize:

  • areas of plaque and characterization
  • high grade stenosis
  • complete occlusion
  • collaterization
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6
Q

Rt cerebral hemisphere stroke symptoms

A
  • paralysis of Lt side of body

- difficulty reasoning and thinking out simple solutions

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7
Q

Lt cerebral hemisphere stroke symptoms

A
  • paralysis of Rt side of body

- disrupts ability to speak

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8
Q

cerebellar stroke symptoms

A
  • lack of coordination (ataxia)

- imbalance, shaking, muscular difficulty

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9
Q

brainstem stroke symptoms

A

involuntary function/vegetative state

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10
Q

syncope

A

transient loss of consciousness-faintness

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11
Q

which side of the body are the symptoms experienced during a stroke?

A

contralateral side of the body

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12
Q

amaurosis fugax

A

exception to the symptoms of stroke being on ipsilateral side of body

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13
Q

what does stenoses usually involve?

A

the bulb and ICA

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14
Q

what is considered a warning sign for a stroke?

A

TIA

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15
Q

what are signs of a stroke?

A
  • weakness
  • aphasia (trouble speaking)
  • vision problems
  • headache
  • dizziness
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16
Q

what does the acronym FAST stand for?

A

F-face-ask person to smile
A-arms-can you raise both arms
S-Speech-slurred or jumbles
T-Time- call 911

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17
Q

what is the treatment for a stroke?

A

Medication

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18
Q

how do stroke drugs work?

A
  • aim to break up existing blood clots
  • thin the blood to prevent clots from starting or worsening
  • lesson bleeding in a hemorrhagic stroke
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19
Q

Anticoagulants

A

drugs that thin the blood

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20
Q

what are types of anticoagulents?

A
  • Aspirin

- Warfarin

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21
Q

Aspirin

A

prevents platelets from clotting the blood

-can be used to avoid stroke

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22
Q

Warfarin

A

blood thinner used to prevent blood clots from forming or to prevent existing clots from growing larger

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23
Q

antiplatelet drugs

A

helps prevent blood clots from forming

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24
Q

Tissue Plasminogen activator:(TPA)

A

common emergency treatment for people having an ischemic stroke. immediately breaks up clot
-injected into vein or artery

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25
Q

Statins

A

blocks an enzyme in the body needed to produce cholesterol that may clog arteries
prescribes to people with high cholesterol which may lead to TIA’s, heart attacks, e.t.c

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26
Q

what statins are commonly used?

A

Lipitor or crestor

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27
Q

Blood pressure medications

A

used to help lower blood pressure which can play a major role in hemorrhagic stroke

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28
Q

what blood pressure medications are commonly prescribed?

A
  • beta-blockers
  • angiotensin-converting enzyme (ACE) inhibitors
  • calcium channel blockers
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29
Q

what are the indications for doing an ultrasound for stroke?

A
  • identify patients who are at risk
  • facilitate treatment
  • document progressive treatment
  • detect nonatherosclerotic
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30
Q

Indications

A 
Dissection
Fibromuscular dysplasia
Trauma
Arteritis
Aneurysms
Radiation effects
Stroke/TIA symptoms
Bruit
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31
Q

Bruit

A

an abnormal swishing sound heard

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32
Q

why do we measure?

A
  • measure of doppler waveform allow for quantification of disease
  • determination of severity
  • grading allows for future treatment
  • predict situation of prox stenosis when disease is not easily seen (bowel gas)
  • comparisons can be made
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33
Q

is velocity constant across a vessel?

A

no

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34
Q

what is velocity dependant on?

A
  • left ventricular output
  • resistance of the arterioles
  • cross-sectional area of vessel
  • coarse of the vessel (kinked, tortuous)
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35
Q

what does PSV stand for?

A

peak systolic velocity

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36
Q

PSV

A

maximum velocity at any given time

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37
Q

what can be used in ratio calculations when the angle correct is employed at 60 degrees?

A

PSV

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38
Q

what does EDV stand for?

A

end diastolic velocity

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39
Q

EDV

A

velocity measured in the diastolic phase immediately prior to the systolic upstroke

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40
Q

what can measurement of EDV be used for?

A

grading a severe internal carotid stenosis

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41
Q

what is the outcome when EDV exceeds 140cm/s?

A

stenosis is in the 80-99% occluded range

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42
Q

what are ratios used for?

A

compensate for poor cardiac function

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43
Q

what must be used for carotid doppler?

A

angle correct (most accurate)

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44
Q

what must the angle correct be compared to the vessel?

A

parallel to the vessel walls in the CCA and ICA

45
Q

where is the PSV measured?

A

distal CCA-this represents the segment proximal to the critical stenosis in the ICA

46
Q

The PSV within a stenosis in the prox ICA is obtained taking how many measurements?

A

at least 3 to ensure highest measurements is recorded

47
Q

what is the ratio in carotid artery?

A

PSV ICA/PSV distal CCA

48
Q

a ratio of what is significant?

A

greater than 2

49
Q

what does a ratio greater than 2 represent?

A

this means the flow has doubled in velocity between the segments and is now hemodynamically significant

50
Q

the higher the ratio=______

A

the greater the severity of the disease

51
Q

what are ratios used for in peripheral?

A

estimate degree of stenosis in the femoral vessels

52
Q

what else in peripheral arteries must the PSV be measured?

A

proximal segment to the stenosis that exhibits normal flow

53
Q

what is the ratio in peripheral arteries?

A

stenotic zone PSV/proximal PSV

54
Q

when can ratios not be used?

A

ratios cannot be used if there is disease in the proximal segment (this is true for any ratio measurement including carotids)

55
Q

when is the angle correct at 60 degrees used?

A

both measurements

56
Q

what is the ratio dependant on?

A

angle dependant

57
Q

why is optimization important?

A

to provide accurate hemodynamic information concerning vessel patency and direction of flow which facilitates clinical management of the patient

58
Q

what contributes to the best possible exam regarding optimization?

A
  • transducers
  • scanning techniques
  • knobology
59
Q

what does interpretation of the doppler spectrum rely on?

A

topnotch technique

60
Q

what does the frequency of the transducer determine?

A

the axial image resolution and useable image depth

61
Q

what happens as the frequency increases to the resolution and depth?

A

resolution also increases but depth decreases

62
Q

what transducer is used for carotid and venous studies?

A

5-10 mHZ

63
Q

spectral anaylisis

A

allows for visualization of the doppler signal

64
Q

what info is needed to provide quantitiavie data for evaluating doppler shift?

A

spectral analysis

65
Q

what gives rise to different spectral displays?

A

high and low impedance conditions downstream

66
Q

what converts doppler shift information into a visual spectral analysis?

A

uses a fast fourier transform (FFT)

67
Q

what does FFT break down?

A

complex signals of the doppler shift into individual frequencies

68
Q

what does FFT’s display as?

A

velocity rather than frequency

69
Q

what are advantages for spectral analysis?

A
  • allows measurement of peak,mean,diastlic velocities
  • minimum flow velocities, flow direction, and characteristics of blood flow
  • presents doppler shift frequencies in frequency order
70
Q

what is the disadvantages to spectral analysis?

A

cannot accurately measure high velocities without aliasing

71
Q

what is displayed in the sample volume?

A

instantaneous spectrum

72
Q

what will happen if angle correction is applied?

A

the spectrum will represent the range of velocities in the sample volume

73
Q

where is the range of frequencies displayed in each spectrum?

A

on the vertical axis

74
Q

what is the power of each frequency component presented as?

A

as a shade of grey

75
Q

how many heart cycles are measurements best made over?

A

5 heart cycles

76
Q

what should the colour scale velocities match?

A

velocities of the expected study

77
Q

what button alters scale?

A

PRF

78
Q

will PRF be higher or lower for arteries?

A

higher than venous flow

79
Q

what arteries may require higher PRF?

A

aorta rather than renal arteries

80
Q

what does colour above the baseline indicate about flow?

A

toward transducer

81
Q

what can colour shades indicate on spectral?

A

magnitude of the velocity (mean doppler shift)

82
Q

light red

A

high velocity

83
Q

dark red

A

low velocity

84
Q

what may a range of velocities in each sample be presented as?

A

turbulence

85
Q

how do you correct aliasing?

A

increase PRF

86
Q

can the velocity scale on spectrum be changed?

A

yes, increased or decreased

87
Q

what velocity size should be displayed?

A

not too small or too large

88
Q

what button adjusts doppler gain?

A

D

89
Q

if the spectral signal is weak what must be adjusted?

A
  • gain

- angle of insonation by altering the window used

90
Q

what does grading of carotid stenosis rely heavily on?

A

using a different window to get a cleaner signal

91
Q

how should the colour box field of view be?

A

field of view should be adjusted to cover only the region of interest (maximized frame rate)

92
Q

what is an issue with colour box? length or depth?

A

length is not an issue but depth is

93
Q

aliasing

A
  • misrepresenting the pulse wave doppler shift in a negative direction
  • wrap around
  • exceeding Nyquist limit
94
Q

what is aliasing caused by?

A
  • the doppler shift exceeding one half of the PRF

- under sampling of the doppler shift

95
Q

what does aliasing manifests as?

A
  • improper representation of the information sampled
  • wraps around of the pulse wave or colour doppler display
  • incorrect flow direction
96
Q

what are methods of overcoming aliasing?

A
  • increase PRF (velocity scale)
  • increase doppler angle
  • adjust baseline closer to 0
  • decrease operating frequency
  • decrease depth of sample volume
  • change to continuous wave
97
Q

flash

A

sudden bursts of colour (colour bleeding)

98
Q

what is flash caused by?

A

tissue and transducer motion

99
Q

what is the manifestation of flash?

A

extension of colour beyond the region of blood flow

100
Q

what are the methods of overcoming flash?

A
  • increase PRF
  • decrease colour gain
  • increase filtering of low flow velocities
101
Q

range ambiguity

A

doppler shifts received are not all from the same vessel

102
Q

what is range ambiguity caused by?

A

improper placement of sample volume

103
Q

what is the manifestation of range ambiguity?

A

improper representation of doppler shift

104
Q

what are methods of overcoming range ambiguity?

A

readjust placement of sample volume

105
Q

mirror imaging

A

duplication of a vessel or Doppler shift on the opposite side of a strong reflector

106
Q

what is the cause of mirror imaging?

A

doppler gain is set too high

107
Q

what is manifestation of mirror imaging?

A

added vessel or doppler shift

108
Q

what are methods of overcoming mirror imaging?

A
  • decrease doppler or colour gain

- use a different acoustic window

Vascular (10 decks)

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