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Vascular board review (myultrasoundtutor) > Non Imaging Testing > Flashcards

Non Imaging Testing Flashcards

1
Q

Detecting the presence/absence of arterial occlusive disease and able to approximate level of disease are capabilities and limitations of what

A

CW Doppler analysis

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2
Q
  • How it looks
  • NOT measurable
  • waveform contour
    all describe

a) qualitative
b) quantitative

A

a) qualitative

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3
Q

-How it measures
- Velocities, ratios, indices
- % diameter reduction
all describe

a) qualitative
b) quantitative

A

b) quantitative

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4
Q

What does pulsatility index measure

A

Resistance

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5
Q

What equation is this
peak to peak frequency/ mean frequency

A

Pulsatility index

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6
Q

A normal PI should increase or decrease as you go down the limb

A

Increase

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7
Q

Any drop in PI between levels means there disease where

A

Disease between those levels

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8
Q

Time from beginning of systole to peak systole describes

A

Acceleration time

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9
Q

What is another name for acceleration time

A

upstroke

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10
Q

When the acceleration time is > 133 msec is disease proximal or distal

A

Proximal

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11
Q

Name 3 non imaging testing

A

1) CW
2) pressure testing
3) plethysmographic studies

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12
Q

Deterioration in signal contour from one level to the next means disease is located where

A

disease located between those levels

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13
Q

-Presence/ absence of disease
- Approximate level and severity
-Not exact location or stenosis vs occlusion
All are capabilities and limitations of what

A

Segmental pressure testing

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14
Q

Medial calcinosis= ________ vessels

A

incompressible

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15
Q

________ _________ is often seen in diabetics and end stage renal disease

A

Medial calcinosis

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16
Q

If width of cuff is too wide what happens to the pressure

A

pressure is falsely low

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17
Q

If width cuff is too narrow what happens to the pressure

A

pressure is falsely high

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18
Q

To obtain the systolic pressure inflate to cuff pressure to _____ higher than last audible signal

A

30

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19
Q

Pressures must be taken

a) proximal to distal
b) distal to proximal

A

b) distal to proximal

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20
Q

What is the 4 cuff method

A

using 2 thigh cuffs, a calf and ankle

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21
Q

What is the 3 cuff method

A

Using 1 large thigh, a calf and ankle

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22
Q

To complete the study what pressure are used

A

use higher of 2 ankle pressures on each leg

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23
Q

To calculate an ABI the ankle pressure is divided by what

A

the highest brachial pressure

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24
Q

True or False
-Normal ankle pressures should be about the same as the brachial

A

True

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25
Q

In the presence of arterial disease what happens to the pressure?

A

Drops

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26
Q

If the ankle pressure is less than the brachial what does this indicate

A

Indicates there is disease

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27
Q

If the ankle pressure is greater than the brachial what does this indicate

A

No disease proximally

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28
Q

An ABI of what indicates the vessels are likely incompressible

A

> 1.3
-This is not accurate

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29
Q

An ABI of what is considered normal

A

1.0

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30
Q

An ABI of 0.9-1.0 indicates

A

Within normal limits/ minimal disease

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31
Q

An ABI of 0.8-0.9 indicates

A

Mild disease

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32
Q

An ABI of 0.5-0.8 indicates

A

Moderate disease (claudication)

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33
Q

An ABI of <0.5 indicates

A

Severe disease (rest pain)

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34
Q

Pressures drop abnormally _____ to disease

A

Distal

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35
Q

For segmental criteria one would compare the thigh pressure to the _______ ______

A

highest brachial

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36
Q

During a 3 cuff study the thigh pressure should be _____ or _____ than the brachial

A

same or higher

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37
Q

During a 4 cuff study the high thigh should be ______ or _____ more higher than the highest brachial

A

30 or more

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38
Q

It is important to look for drops of ______ or more between consecutive _______ levels

A

30, vertical

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39
Q

A less than 30 difference between levels is considered

a) normal
b) abnormal

A

a) normal

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40
Q

A 30 or more drop means disease is located where

A

disease is located between those levels

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41
Q

Arterial obstructive disease will always ______ the pressures ______

A

decrease, distally

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42
Q

What test allows to distinguish true vs pseduo claudication

A

Exercise testing

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43
Q

What are the 3 contraindications of exercise testing

A

1) difficulty walking/breathing
2) severe hypertension
3) cardiac problems

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44
Q

For exercise testing no change or an increase in ankle pressures indicates

a) normal
b) abnormal

A

a) normal

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45
Q

For exercise testing a decrease in ankle pressures indicates

a) normal
b) abnormal

A

b) abnormal

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46
Q

During exercise testing if the pressures are abnormal how often do you repeat pressures until they return to resting

A

every 2 minutes

47
Q

During exercise testing if pressure returns in less than 6 minutes what is the level of disease

a) single level
b) multi level

A

a) Single level

48
Q

During exercise testing if pressure returns longer than 6 minutes what is the level of disease

a) single level
b) multi level

A

b) multi level

49
Q

The purpose of what test produces physiologic stress on circulation and reproduces ischemia

A

Exercise testing

50
Q

This is for patients that can not do treadmill testing

A

Reactive hyperemia

51
Q

________ _______ purpose is to produce ischemia and distal vasodilation

A

Reactive hyperemia

52
Q

For reactive hyperemia you inflate the thigh cuff to suprasystolic pressures for how long

A

3-5 minutes

53
Q

For reactive hyperemia a transient drop in pressure that returns to resting within 1 minute is considered

a) normal
b) abnormal

A

a) normal

54
Q

For reactive hyperemia a big drop in pressures is considered

a) normal
b) abnormal

A

b) abnormal

55
Q

A <50 % drop in reactive hyperemia means

a) single level
b) multi level

A

a) single level

56
Q

A >50% drop in reactive hyperemia means

a) single level
b) multi level

A

b) multi level

57
Q

For upper extremity segmental pressure testing the pressures should be within how many mmHg of eachother?

A

20 mmHg

58
Q

For upper extremity segmental pressures if the pressure difference is greater than 20 where is the disease located

A

proximal disease on arm with lower pressure

59
Q

Arterial obstructive disease will increase or decrease the pressures

A

decrease

60
Q

For upper extremity segmental pressure testing disease is proximal or distal to the lower pressure

A

proximal

61
Q

What is the purpose of the Allens Test

A

evaluate patency of the palmar arch

62
Q

During the Allens Test 50% means

A

incomplete palmar arch

63
Q

Allens test may be used to confirm usability of what artery for possible harvesting?

a) radial
b) ulnar

A

a) radial

64
Q

What study is usually performed with segmental pressure studies and evaluates functional aspects of disease

A

Plethysmography

65
Q

What study is not vessel specific and can underestimate disease

A

Plethysmography

66
Q

What type of plethysmography using pneumatic cuffs to detect changes in volume

A

true or air plethysmography

67
Q

What type of plethysmography it not true and has a small sensor used on digits that send infrared light and capillary pulsations to reflect the light

A

photoplethysmography

68
Q

What study is useful in patients with cold sensitivity and medical calcinosis

A

Digital pressure and PPG

69
Q

What are the 3 steps for a Raynauds cold stress test

A

1) perform at rest
2) soak in ice water for 3 minutes
3) obtain pressures and waveforms

70
Q

What is a normal finger index

A

> 0.8

71
Q

What is a normal toe index

A

> 0.6

72
Q

Dropped pressure and dampened waveforms during digital pressure and PPG means

A

fixed arterial disease (secondary Raynauds)

73
Q

Normal resting waves and pressures means
a) primary raynauds
b) secondary raynauds

A

a) primary raynauds

74
Q

After a cold stress test a peaked pulse means

A

Functional disease

75
Q

What study evaluates for vasculogenic impotence

A

Penile pressure testing

76
Q

Termial aorta obstruction is related to what syndrome

A

Leriche

77
Q

Leriche syndrome has risk factors or what

A

chronic PAD

78
Q

What is a normal PBI

A

> or equal to 0.65

79
Q

A normal ABI with abnormal PBI means disease is located where

A

isolated to internal iliac vessels

80
Q

Abnormal ABI bilaterally and abnormal PBI is related to what syndrome

A

Leriche syndrome

81
Q

A dorsal venous velocity that is > 4 cm/s is what type of leak

A

venous leak

82
Q

What evaluates would healing potential and determines amputation level

A

Trancutaneous Oximetry

83
Q

What is a normal TcPO2

A

> 50 mmHg

84
Q

What is a poor TcPO2

A

< 40 mmHg ( impaired wound healing)

85
Q

What is a critical TcPO2

A

< 30 mmHg ( non healing)

86
Q

Compression of the popliteal artery by the medial head of the gastrocnemius muscle or fibrous bands describes what syndrome

A

Popliteal Entrapment

87
Q

Popliteal entrapment syndrome is usually what type of people

A

Young men complaining of claudication in calf with exercise

88
Q

Compression of neurovascular bundle by shoulder structures describes what syndrome

A

Thoracic outlet syndrome

89
Q

What is the most common cause of thoracic outlet syndrome

A

Neurogenic (nerves)

90
Q

What position is a patient put into to test for thoracic outlet syndrome

A

exaggerated military stance (shoulders back)

91
Q

What maneuver is the exaggerated military stance with head turned sharply toward the arm being tested

A

Adson manuever

92
Q

For thoracic outlet syndrome how high is the arm being tested raised

A

90 degrees to body

93
Q

What is true regarding CW doppler analysis

a) It can not provide spectral analysis display
b) It has a higher Nyquist limit that PW doppler
c) The signal depth allows for vessel identification
d) It does not provide range resolution

A

d) it does not provide for range resolution

94
Q

What waveform characteristic would be most likely documented distal to the site of the stenosis

a) increased resistance
b) tardus parvus
c) decreased diastolic velocity
d) aliasing

A

b) tardus parvus

95
Q

Calculate the pulsatility index: PSV 60 cm/s and EDV 20 cm/s

a) 3.0
b) 0.5
c) 1.0
d) 1.5

A

c) 1.0

peak to peak/mean

60-20= 40
mean(average) 60+20=80/2= 40
40/40=1

96
Q

What is the most important basis of interpretation for CW doppler analysis

a) peak systolic velocity
b) waveform amplitude
c) quantitative criteria
d) waveform contour

A

d) waveform contour

97
Q

What would be a means of interpretive criteria that is considered quantitative

a) acceleration time
b) waveform amplitude
c) waveform contour
d) turbulence

A

a) acceleration time

98
Q

What would be the appearance of the doppler waveform in the presence of a distal occlusion

a) normal waveform contour
b) tardus parvus
c) absent doppler signal
d) increased resistance

A

d) increased resistance

-Distal occlusion means the obstruction is ahead of us and we are dopplering proximal to it. Since the blood is approaching a blockage, it will demonstrate higher resistance and little or no diastolic flow

99
Q

What would be an example of an abnormal acceleration time at the groin

a) 125 msec
b) 133 msec
c) 138 msec
d) 110 msec

A

c) 138 msec

99
Q

An ankle pressure of 120 mmHg is documented in a patient complaining of rest pain and evidence of color dependency changes. This pressure seems to be

a) within normal limits ruling out vascular disease
b) lower than expected
c) consistent with patient presentation
d) higher than expected

A

d) higher than expected

99
Q

What happens to segmental systolic pressures in the presence of a hemodynamically significant arterial obstruction

a) increases proximally
b) decreases proximally
c) decreases distally
d) increases distally

A

c) decreases distally
-Due to energy losses and volume flow interpretations, the pressures always decrease after or distal to disease. When there is a significant drop in pressure, the disease is found between those levels

99
Q

Patient has symptoms of claudication but initial segmental pressure values are within normal limits What step would be the most appropriate?

a) perform CW doppler analysis
b) perform exercise testing
c) perform reactive hyperemia
d) complete the exam and read as normal

A

b) perform exercise testing

100
Q

What findings are consistent in a patient with Leriche syndrome

a) ABI’s 0.6 bilaterally and PBI of 0.58
b) ABI’s 1.3 bilaterally and PBI of 0.61
c) ABI’s 1.0 bilaterally and PBI of 0.74
d) ABI’s 0.4 bilaterally and PBI of 0.78

A

a) ABI’s 0.6 bilaterally and PBI of 0.58

101
Q

What technique is used when performing a pneumoplethysmography study

a) inflate the cuff to suprasystolic pressures and begin recording when pulsation returns
b) inflate the cuff to 40-65 mmHg to allow the sensor to detect and display PVR waveforms
c) use an infrared sensor on the digits to capture capillary pulsations
d) after performing the intial plethysomographic study, soak the digits in ice water for 3-5 minutes and then repeat

A

b) inflate the cuff to 40-65 mmHg to allow the sensor to detect and display PVR waveforms

-Pneumoplethysmography is the same as true or air plethysmography that uses pneumatic cuffs with a special sensor to sense and display the changes in blood volume. In order to detect the volume, there must be just enough pressure on the limb so the sensor can detect the flow but not too much to completely close it off

102
Q

What is the purpose of reactive hyperemia

a) differentiate primary and secondary raynauds disease
b) provide a physiologic stress on the arterial circulation
c) trigger vasodilation and distal ischemia
d) stimulate vasoconstriction and distal vasospasm

A

c) trigger vasodilation and distal ischemia

103
Q

In which patients does secondary raynauds phenomenon occur

a) in patients with mechanical musculoskeletal compression of the upper extremity vessels
b) in the presence of an obstructed vascular supply
c) in those with a history of severe venous insufficiency
d) in vasospastic disease without the presence of an obstructed vascular system

A

b) in the presence of an obstructed vascular supply

104
Q

What would be a means of interpretive criteria that is considered quantitative?

a) Acceleration time
b) Waveform amplitude
c) Turbulence
d) Waveform contour

A

a) Acceleration time
-Quantitative means something we can measure. Qualitative means shapes and qualities that are not measurable but can be interpreted such as waveform contour

105
Q

What arteries are connected by the common iliac arteries

a) Aorta to common femoral artery
b) Internal iliac artery to common femoral artery
c) External iliac artery to internal iliac artery
d) Aorta to external and internal iliac arteries

A

d) Aorta to external and internal iliac arteries

106
Q

What best describes a patient experiencing thoracic outlet syndrome?

a) Numbness and swelling in arm after repeated motion
b) Ischemia like symptoms when arm is placed in a position such as when arm is raised
c) Arm claudication when performing exercise
d) Discoloration of fingertips when exposed to different positions

A

b) Ischemia like symptoms when arm is placed in a position such as when arm is raised

107
Q

Which of the following ankle/brachial indices (ABI) is mot consistent with the symptom of ischemic rest pain?

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

A

a) 0.3

108
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

109
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

110
Q

Pulse volume recording is a form of which of the following methods/techniques?

a) Impedance plethysmography
b) Pnemo-plethysmography
c) Photoplethysomography
d) Segmental pressures

A

b) Pnemo-plethysmography

Vascular board review (myultrasoundtutor) (23 decks)

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