Non Imaging Testing Flashcards
Detecting the presence/absence of arterial occlusive disease and able to approximate level of disease are capabilities and limitations of what
CW Doppler analysis
- How it looks
- NOT measurable
- waveform contour
all describe
a) qualitative
b) quantitative
a) qualitative
-How it measures
- Velocities, ratios, indices
- % diameter reduction
all describe
a) qualitative
b) quantitative
b) quantitative
What does pulsatility index measure
Resistance
What equation is this
peak to peak frequency/ mean frequency
Pulsatility index
A normal PI should increase or decrease as you go down the limb
Increase
Any drop in PI between levels means there disease where
Disease between those levels
Time from beginning of systole to peak systole describes
Acceleration time
What is another name for acceleration time
upstroke
When the acceleration time is > 133 msec is disease proximal or distal
Proximal
Name 3 non imaging testing
1) CW
2) pressure testing
3) plethysmographic studies
Deterioration in signal contour from one level to the next means disease is located where
disease located between those levels
-Presence/ absence of disease
- Approximate level and severity
-Not exact location or stenosis vs occlusion
All are capabilities and limitations of what
Segmental pressure testing
Medial calcinosis= ________ vessels
incompressible
________ _________ is often seen in diabetics and end stage renal disease
Medial calcinosis
If width of cuff is too wide what happens to the pressure
pressure is falsely low
If width cuff is too narrow what happens to the pressure
pressure is falsely high
To obtain the systolic pressure inflate to cuff pressure to _____ higher than last audible signal
30
Pressures must be taken
a) proximal to distal
b) distal to proximal
b) distal to proximal
What is the 4 cuff method
using 2 thigh cuffs, a calf and ankle
What is the 3 cuff method
Using 1 large thigh, a calf and ankle
To complete the study what pressure are used
use higher of 2 ankle pressures on each leg
To calculate an ABI the ankle pressure is divided by what
the highest brachial pressure
True or False
-Normal ankle pressures should be about the same as the brachial
True
In the presence of arterial disease what happens to the pressure?
Drops
If the ankle pressure is less than the brachial what does this indicate
Indicates there is disease
If the ankle pressure is greater than the brachial what does this indicate
No disease proximally
An ABI of what indicates the vessels are likely incompressible
> 1.3
-This is not accurate
An ABI of what is considered normal
1.0
An ABI of 0.9-1.0 indicates
Within normal limits/ minimal disease
An ABI of 0.8-0.9 indicates
Mild disease
An ABI of 0.5-0.8 indicates
Moderate disease (claudication)
An ABI of <0.5 indicates
Severe disease (rest pain)
Pressures drop abnormally _____ to disease
Distal
For segmental criteria one would compare the thigh pressure to the _______ ______
highest brachial
During a 3 cuff study the thigh pressure should be _____ or _____ than the brachial
same or higher
During a 4 cuff study the high thigh should be ______ or _____ more higher than the highest brachial
30 or more
It is important to look for drops of ______ or more between consecutive _______ levels
30, vertical
A less than 30 difference between levels is considered
a) normal
b) abnormal
a) normal
A 30 or more drop means disease is located where
disease is located between those levels
Arterial obstructive disease will always ______ the pressures ______
decrease, distally
What test allows to distinguish true vs pseduo claudication
Exercise testing
What are the 3 contraindications of exercise testing
1) difficulty walking/breathing
2) severe hypertension
3) cardiac problems
For exercise testing no change or an increase in ankle pressures indicates
a) normal
b) abnormal
a) normal
For exercise testing a decrease in ankle pressures indicates
a) normal
b) abnormal
b) abnormal
During exercise testing if the pressures are abnormal how often do you repeat pressures until they return to resting
every 2 minutes
During exercise testing if pressure returns in less than 6 minutes what is the level of disease
a) single level
b) multi level
a) Single level
During exercise testing if pressure returns longer than 6 minutes what is the level of disease
a) single level
b) multi level
b) multi level
The purpose of what test produces physiologic stress on circulation and reproduces ischemia
Exercise testing
This is for patients that can not do treadmill testing
Reactive hyperemia
________ _______ purpose is to produce ischemia and distal vasodilation
Reactive hyperemia
For reactive hyperemia you inflate the thigh cuff to suprasystolic pressures for how long
3-5 minutes
For reactive hyperemia a transient drop in pressure that returns to resting within 1 minute is considered
a) normal
b) abnormal
a) normal
For reactive hyperemia a big drop in pressures is considered
a) normal
b) abnormal
b) abnormal
A <50 % drop in reactive hyperemia means
a) single level
b) multi level
a) single level
A >50% drop in reactive hyperemia means
a) single level
b) multi level
b) multi level
For upper extremity segmental pressure testing the pressures should be within how many mmHg of eachother?
20 mmHg
For upper extremity segmental pressures if the pressure difference is greater than 20 where is the disease located
proximal disease on arm with lower pressure
Arterial obstructive disease will increase or decrease the pressures
decrease
For upper extremity segmental pressure testing disease is proximal or distal to the lower pressure
proximal
What is the purpose of the Allens Test
evaluate patency of the palmar arch
During the Allens Test 50% means
incomplete palmar arch
Allens test may be used to confirm usability of what artery for possible harvesting?
a) radial
b) ulnar
a) radial
What study is usually performed with segmental pressure studies and evaluates functional aspects of disease
Plethysmography
What study is not vessel specific and can underestimate disease
Plethysmography
What type of plethysmography using pneumatic cuffs to detect changes in volume
true or air plethysmography
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
photoplethysmography
What study is useful in patients with cold sensitivity and medical calcinosis
Digital pressure and PPG
What are the 3 steps for a Raynauds cold stress test
1) perform at rest
2) soak in ice water for 3 minutes
3) obtain pressures and waveforms
What is a normal finger index
> 0.8
What is a normal toe index
> 0.6
Dropped pressure and dampened waveforms during digital pressure and PPG means
fixed arterial disease (secondary Raynauds)
Normal resting waves and pressures means
a) primary raynauds
b) secondary raynauds
a) primary raynauds
After a cold stress test a peaked pulse means
Functional disease
What study evaluates for vasculogenic impotence
Penile pressure testing
Termial aorta obstruction is related to what syndrome
Leriche
Leriche syndrome has risk factors or what
chronic PAD
What is a normal PBI
> or equal to 0.65
A normal ABI with abnormal PBI means disease is located where
isolated to internal iliac vessels
Abnormal ABI bilaterally and abnormal PBI is related to what syndrome
Leriche syndrome
A dorsal venous velocity that is > 4 cm/s is what type of leak
venous leak
What evaluates would healing potential and determines amputation level
Trancutaneous Oximetry
What is a normal TcPO2
> 50 mmHg
What is a poor TcPO2
< 40 mmHg ( impaired wound healing)
What is a critical TcPO2
< 30 mmHg ( non healing)
Compression of the popliteal artery by the medial head of the gastrocnemius muscle or fibrous bands describes what syndrome
Popliteal Entrapment
Popliteal entrapment syndrome is usually what type of people
Young men complaining of claudication in calf with exercise
Compression of neurovascular bundle by shoulder structures describes what syndrome
Thoracic outlet syndrome
What is the most common cause of thoracic outlet syndrome
Neurogenic (nerves)
What position is a patient put into to test for thoracic outlet syndrome
exaggerated military stance (shoulders back)
What maneuver is the exaggerated military stance with head turned sharply toward the arm being tested
Adson manuever
For thoracic outlet syndrome how high is the arm being tested raised
90 degrees to body
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
d) it does not provide for range resolution
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
b) tardus parvus
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
c) 1.0
peak to peak/mean
60-20= 40
mean(average) 60+20=80/2= 40
40/40=1
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
d) waveform contour
What would be a means of interpretive criteria that is considered quantitative
a) acceleration time
b) waveform amplitude
c) waveform contour
d) turbulence
a) acceleration time
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
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
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
c) 138 msec
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
d) higher than expected
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
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
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
b) perform exercise testing
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) ABI’s 0.6 bilaterally and PBI of 0.58
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
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
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
c) trigger vasodilation and distal ischemia
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
b) in the presence of an obstructed vascular supply
What would be a means of interpretive criteria that is considered quantitative?
a) Acceleration time
b) Waveform amplitude
c) Turbulence
d) Waveform contour
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
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
d) Aorta to external and internal iliac arteries
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
b) Ischemia like symptoms when arm is placed in a position such as when arm is raised
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) 0.3
Photoplethysmography uses which of the following modalities for blood flow evaluation?
a) Pulse volume recording
b) Ultrasound
c) Ultraviolet
d) Infrared
d) Infrared
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) Segmental pressures
Pulse volume recording is a form of which of the following methods/techniques?
a) Impedance plethysmography
b) Pnemo-plethysmography
c) Photoplethysomography
d) Segmental pressures
b) Pnemo-plethysmography
