Mock Exam - Vascular Flashcards
What vessel is most likely affected by right sided heart failure?
A. common carotid artery
B. hepatic veins
C. portal vein
D. aorta
B. hepatic veins
- Rt sided heart failure affects IVC and its branches
- Lt sided heart failure affects Aorta and its branches
How is the ECA vessel identification best confirmed?
visualization of branches
- ECA has extracranial branches
- ICA has NO extracranial branches
*** What are aneurysms most often caused by?
atherosclerosis
What treatment removes plaque?
A. angioplasty
B. stenting
C. embolectomy
D. endarterectomy
D. endarterectomy
Endarterectomy removes the actual plaques and intimal lining of artery.
Angioplasty and Stenting only dilate the vessel size and put a stent in, in order to hold it open, but everything stays in place.
Embolectomy is the removal of embolism, not plaques.
What is the significance of a PSV at the proximal SFA of 242cm/s if the distal CFA PSV is 90cm/s?
> /=50% diameter reduction (2:1 ratio)
Since we’re talking about the arterial system in the LE, we’re going to use our velocities stenosis criteria.
2:1 ratio = >/=50% DR
4:1 ration = >/=75% DR
242/90 = 2.68…this is over doubled but not yet quadrupled, so it still falls under 2:1 ratio
*** What clinical finding is most indicative for chronic peripheral arterial disease?
A. pain and muscle fatigue w/ activity, relieved with rest
B. Pain in the calf at rest, relieved upon dependency
C. Pain in the limb while dependent, relieved upon elevation
D. Skin discoloration in calf and ankles
A. pain and muscle fatigue w/ activity, relieved with rest
For PAD, we’re looking for clinical findings such as claudication, rest pain, or appropriate descriptions of ulcers or trophic changes. So out of these choices we have here, our correct answer would be “pain and muscle fatigue with activity relieved with rest” because it accurately describes claudication. Other answers are not accurate descriptions of claudication or rest pain.
I picked B and it’s not correct because rest pain is not found in the calf, it’s found in the feet and heels and relieved upon dependent.
Skin discoloration is pale and any ulcers would be found in most distal regions such as tips of the toes, not in the calfs and ankles.
Calculate the ABI’s of the following segmental pressure study:
Rt brachial: 140
Lt brachial: 138
Rt ankle: 78
Lt ankle: 106
Rt ABI: 78/140 = 0.5
Lt ABI: 106/140 = 0.7
Use ankle pressure on each leg divide it by the highest brachial pressure.
In the lower extremity arterial system, what is the most common site of atherosclerosis for general population?
distal superficial femoral artery (SFA)
In the lower extremity arterial system, what is the most common site of atherosclerosis for diabetic patients?
tibial vessels
What is the hemodynamic result with an ineffective calf muscle pump?
A. increased venous pressure
B. increased venous return
C. decreased venous volume
D. decreased venous pressure
A. increased venous pressure
Calf muscle pumps that are ineffective have valvular incompetence, which means the venous pressure and volume increases as the patient walks or stands.
So, increasing venous volume, venous pooling, and therefore, increased venous pressure.
*** What is the most likely significance of the following doppler waveform?
(image of a flattened peak and slow upstroke waveform of Rt SFA, PSV: -41.3cm/s, EDV: 0cm/s)
A. distal AVF
B. proximal obstruction
C. distal occlusion
D. aneurysmal disease
B. proximal obstruction
The shape of the peripheral arterial waveform is abnormal. It does not have a sharp peak, sharp upstroke, rapid downslope, and diastolic flow reversal.
In the image, the peak is flattened and the upstroke is slow. Whenever that waveform contour shows those findings, that tells us we have a proximal arterial obstruction.
I picked “A: distal occlusion” because I mistakenly read it as high resistance waveform with loss of EDV.
Which vessel is most likely to have retrograde flow in the presence of an ICA occlusion?
A. common carotid artery
B. contralateral ICA
C. ophthalmic artery
D. vertebral artery
Retrograde flow in any vessel because of a coexisting ICA occlusion means that that vessel is acting as a collateral vessel.
There are 3 types of collateralization:
1) cross-over
2) external to internal
3) posterior to anterior
Only the two, the cross-over and the external to internal have flow direction changes inside the collateral vessel.
- In cross-over collateralization, it was the ACA that changed the flow direction (retrograde to antegrade)
- In external to internal, it’s the ophthalmic artery that changes the direction (antegrade to retrograde)
So out of the choices we have here, that’s going to be “C: ophthalmic artery”
What best explains the findings documented in the image?
Image of the Left Vertebral Artery seen with retrograde flow.
Left subclavian steal
When the vertebral arteries are retrograde, it indicates a subclavian steal on the same side of those vertebral.
So, if retrograde flow is seen in Left Vertebral Artery, it means the patient has Left Subclavian Steal.
Where would a dampened waveform be found in the presence of a flow altering stenosis?
distal to the stenosis
“dampened waveform” = tardus parvus (flattened peaks, slow upstroke, rounding of the waveform, low velocity)
tardus parvus indicates stenosis proximal to the waveform.
What state is associated with valvular incompetence?
A. decrease venous volume
B. systemic hypertension
C. decrease venous pressure
D. venous hypertension
D. venous hypertension
Valvular incompetence means the patient will experience venous reflux. In other words, the venous blood is not successfully emptying out of the leg. This is going to increase the venous volume and pressure.
Abnormally increased venous volume and venous pressure is termed “venous hypertension”.
Where should pressure be applied during a pseudoaneurysm compression procedure?
neck of pseudoaneurysm
During a manual compression procedure, you want to ensure that the neck of the aneurysm can be totally and fully compressed.
Where should the needle be placed for thrombin injection is the case of pseudoaneurym?
body of pseudoaneurysm
What is the pulsatility index used to calculate?
resistance
What vessels form the confluence of the main portal vein?
splenic vein and SMV
Where would a tardus parvus waveform most likely be noted in the presence of renal artery stenosis?
segmental artery
Tardus parvus waveform is found distal to stenosis. So, if the stenosis is found at renal artery, tardus parvus has to be found in the vessel segment that is distal to renal artery. Segmental artery is the terminal branches of renal artery and is distal to renal artery.
What does it mean if both an arterial and a venous doppler signal are seen on the same side of the baseline at the level of the porta hepatis?
normal finding
Portal vein and hepatic artery both supply blood to the liver (hepatopedal).
*** What causes the area of blue in the proximal ICA?
Image of proximal ICA seen with retrograde flow (indicated by red) with some are of antegrade flow (indicated by blue).
A. turbulent flow
B. dissection
C. laminar flow
D. Bernoulli effect
D. Bernoulli effect
According to Bernoulli effect, when we have a lower velocity, we have an increase in pressure and that can momentarily spin our vessel around.
Other correct answers could be:
- flow separation
- increase in pressure due to a decrease in velocity
***What best describes the normal peripheral arterial doppler contour?
A. high acceleration time with no diastolic component
B. prominent phasicity with respiration
C. sharp systolic peak and prominent diastolic flow reversal
D. sharp systolic peak, continuous diastolic flow with dicrotic notching
C. sharp systolic peak and prominent diastolic flow reversal
The normal peripheral arterial system is vasoconstricted, meaning higher resistance. So we would expect a nice sharp peak and diastolic flow reversal.
I picked “D” and it’s incorrect because that describes a normal low resistance pattern, not triphasic waveform that should be found in peripheral arterial system.
***Where are the terminal branches of the renal artery?
segmental artery
“Terminal” means where the vessel ends. Typically, an artery ends at bifurcation, so the renal artery terminates when it splits into the segmental arteries at the level of the renal sinus.