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VASCULAR URR > Pathology > Flashcards

Pathology Flashcards

1
Q

What is associated with spectral broadening

A

increased bandwidth

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2
Q

Bilateral tardus parvus waveforms in the carotid arteries can indicate

A

mitral stenosis

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3
Q

A patient presents for a carotid ultrasound. The chart states there is a history of dilated cardiomyopathy and an intra-aortic balloon pump is present. Describe how to evaluate the patient for carotid stenosis

A

waveforms from the CCA will have 2 systolic peaks and the first one should be measured to determine the peak velocity

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4
Q

What can lead to systolic flow reversal in the hepatic veins

A

significant tricuspid regurgitation

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5
Q

An acute, occlusive thrombus is identified in the femoral vein in the adductor canal. What vein will demonstrate related blood stasis

A

small saphenous

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6
Q

A critical stenosis will have what effect on the ipsilateral MCA flow

A

decreased diastolic flow

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7
Q

If there is an occlusion at the proximal ICA, what will happen to the flow in the CCA

A

damped with increased resistance/decreased diastolic flow

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8
Q

While scanning through the suboccipital window with midline angulation, the mean flow velocity increased from 55 cm/s to 145 cm/s at 105mm in depth. What do these findings mean

A

significant stenosis is present in the basilar artery

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9
Q

What is the most common cause of upper extremity DVT in the normal ambulatory patient population

A

paget-schroetter syndrome

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10
Q

What correctly describes the standard protocol for performing cerebral angiography

A

the seldinger technique is used to puncture the common femoral artery in order to insert a catheter that will be advanced to the aortic arch for contrast administration

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11
Q

If the external iliac is occluded, what vessels provide the potential for collateral flow to the extremity

A

inferior epigastric artery and deep circumflex artery

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12
Q

Significant valvular disease in the right heart usually leads to

A

pulsatile flow in the lower extremity veins

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13
Q

If there is a 75% stenosis of the distal axillary artery, which of the following arteries will demonstrate a triphasic waveform

A

subclavian

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14
Q

Hemodynamically significant stenosis of the celiac axis is diagnosed with the PSV greater than

A

2.0 m/s

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15
Q

The external carotid artery normally demonstrates a velocity below

A

150 cm/s

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16
Q

Why is the carotid compression technique performed

A

to evaluate the presence of intracranial collateral formation

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17
Q

What is part of the virchow’s triad

A

blood stasis, trauma, hypercoagulability/polycythemia vera

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18
Q

The most common location of valvular insufficiency is

A

GSV and CFV junction

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19
Q

How is hemispheric index calculated

A

using the MCA peak systolic velocity and dividing it by the distal ICA peak systolic velocity

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20
Q

Amaurosis fugax can be described as

A

TIA of the eye

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21
Q

The most accurate doppler predictor of ICA stenosis is

A

end diastolic velocity

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22
Q

What are symptoms of ICA/MCA disease

A

unilateral visual disturbances, receptive aphasia, expressive aphasia

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23
Q

An autosomal dominant disorder that affects the vasculature of multiple organs. It is characterized by multiple AVMs

A

hereditary hemorrhagic telangiectasia AKA osler-weber rendu syndrome

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24
Q

In the circle of willis, if a difference ________ is present between the velocities taken in the same vessel on both sides, this can indicate intracerebral disease

A

> 30%

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25
Q

The _______ refers to a critical stenosis that only allows a thin string of blood through the tiny opening. The flow velocity will be very low with decreased pulsatility

A

string flow sign

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26
Q

_______ is a nonspecific sign of DVT. It is defined as pain experienced upon quick dorsiflexion of the foot

A

homan sign

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27
Q

Type of visual disturbance where half of the field of view is disrupted in the eye

A

homonymous hemianopia

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28
Q

Leak at the branch vessels

A

type 2 endoleak

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29
Q

Potential signs of an unstable AAA sac

A

echolucent areas within the sac, changes in aneurysm shape and/or sac size, increased pulsatility of the sac

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30
Q

TIA = stroke symptoms lasting ________
CVA= stroke symptoms lasting ________

A

24 hours or less,
more than 24 hours

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31
Q

What is not a complication of a liver transplant

A

cirrhosis

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32
Q

What vessel can provide a pathway for collateral flow from the vertebral system to the MCA on the same side of the body

A

posterior communicator arteries

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33
Q

What arteries are evaluated during a penile duplex exam for erectile dysfunction

A

cavernosal

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34
Q

If there is a 90% stenosis in the left carotid siphon the left iCA flow will be

A

high resistance

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35
Q

Wernicke aphasia (AKA receptive aphasia) is defined as

A

inability to understand speech, speak or follow directions

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36
Q

A bilateral visual symptom, such as diplopia, is commonly associated with disease in which artery

A

vertebral

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37
Q

If a left ICA occlusion is present, the ________ will demonstrate decreased or absent flow

A

left MCA

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38
Q

Elevated erythrocyte sedimentation rate and C-reactive protein (CRP) levels are associated with

A

giant cell arteritis

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39
Q

A patient presents with left arm paresthesia and intermittent blurring of vision in the right eye. These clinical findings are most consistent with

A

Rt ICA stenosis

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40
Q

What renal arteries are evaluated with doppler in an ultrasound exam that is used to perform an indirect evaluation for renal artery stenosis

A

segmental and parenchymal arteries

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41
Q

Broca aphasia (expressive aphasia) can be defined as

A

inability to speak but can understand and follow directions

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42
Q

What is the most common cause of cerebrovascular disease

A

atherosclerosis

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43
Q

A patient presents 3 days after left hip surgery for a DVT evaluation. There is severe edema from the hip to the ankle and the leg has a mild cyanotic appearance. You identify acute thrombus from the common femoral vein through the calf veins. The GSV is also occluded by thrombus. What is the diagnosis for this condition

A

phlegmasia cerulea dolens

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44
Q

Phlegmasia cerulea dolens causes

A

cyanosis

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45
Q

Phlegmasia alba dolens causes

A

pallor

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46
Q

Aside from the carotid artery, what other vessels are commonly affected by FMD

A

renal and mesenteric arteries

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47
Q

What structure compresses the artery in popliteal entrapment

A

medial head of the gastrocnemius muscle

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48
Q

Takayasu arteritis normally affects the

A

aorta, subclavian and renal arteries

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49
Q

A 30 year old male who smokes 2-3 packs per day is referred for an arterial evaluation for pain and pallor of both forearms and hands. The bilateral radial and ulnar arteries demonstrate diffuse, homogeneous intimal thickening and monophasic flow. The arterial lumen characteristics and flow in the upper arms and shoulders are normal. These findings are most consistent with

A

buerger disease

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50
Q

Renal artery stenosis is considered hemodynamically significant when it is greater than

A

60%

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51
Q

What can be caused by congestive heart failure

A

decreased ankle pressures

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52
Q

_________ uses a catheter with a rotating head to break up the plaque and suction capabilities to remove it from the artery

A

an atherectomy procedure

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53
Q

_________ refers to thrombophlebitis of the jugular veins with oropharyngeal infection, such as pharyngitis/tonsillitis. Duplex evaluation can demonstrate thrombus within the jugular vein or other neck and facial veins

A

lemierre syndrome

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54
Q

A patient presents for an exam due to a history of lemierre syndrome. What vessels should be evaluated for associated findings

A

bilateral internal jugular veins

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55
Q

Which of the following vessels can provide a collateral pathway to redistribute flow from one side of the brain to the other side

A

anterior communicator and basilar artery

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56
Q

What describes an abnormal response to proximal augmentation

A

flow reversal begins at the onset of the augmentation maneuver

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57
Q

According to the bernoulli principle, where will you find the lowest pressure in a vessel with stenosis

A

at the site of stenosis

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58
Q

What symptoms would be most suggestive of significant disease in the MCA

A

contralateral face and arm paresis

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59
Q

_________ feeds the portions of the brain responsible for the face and arm motion

A

MCA

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60
Q

What is the main risk factor for a stroke

A

systemic HTN

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61
Q

A patient presents for a lower extremity venous doppler exam due to a history of klippel-trenaunay-weber syndrome. What are the expected findings on the exam

A

absence of the deep veins in the leg with multiple dilated varicosities present

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62
Q

When a hammer pulse is identified in the carotid arteries, what cardiac complication should be suspected

A

severe aortic regurgitation

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63
Q

Restenosis of a carotid stent most commonly occurs

A

at the stent attachment sites

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64
Q

If flow in the left ophthalmic artery is reversed in a transorbital evaluation, what is the expected flow pattern in the right ophthalmic artery

A

increased systolic and diastolic velocities

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65
Q

A 60yr old male presents for a carotid ultrasound due to two recent episodes of syncope. He also has a history of CHF. What describes the doppler waveforms you expect to see on this exam

A

bilateral CCA waveforms will demonstrate decreased resistance and velocity

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66
Q

Stanford type A

A

dissection that involves the ascending aorta and arch

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67
Q

Stanford type B

A

dissection that involves the aorta from the left subclavian artery to the iliac bifurcation

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68
Q

DeBakey type 1

A

dissection that involves the ascending and descending aorta

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69
Q

DeBakey type 2

A

dissection that involves only the ascending aorta

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70
Q

DeBakey type 3

A

dissection that involves the descending aorta only, starting after the origin of the left subclavian artery

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71
Q

While performing an aortic duplex exam, you identify an intimal flap that begins just below the renal arteries and measures 2.5cm in length. According to the stanford classification, this is a _________ and the DeBakey classification calls it a

A

type b dissection, type 3 dissection

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72
Q

What terms would be used to describe flow identified just proximal to a 95% ICA stenosis

A

damped

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73
Q

The scimitar sign is associated with

A

adventitial cysts

74
Q

________ refers to valve damage in the veins after thrombus formation

A

post-phlebitic syndrome

75
Q

When evaluating a liver transplant, you must use angle correction during doppler evaluation of

A

hepatic arteries and portal veins

76
Q

A patient presents for a carotid doppler exam due to bilateral diplopia and dizziness. These findings are most suggestive of stenosis in

A

vertebral arteries

77
Q

A 65 yr old female presents with left leg swelling for over one year. Mild hyperpigmentation is present in the distal calf and ankle area. These clinical findings are most suggestive of

A

chronic insufficiency

78
Q

A patient presents for a carotid ultrasound. The chart states there is a history of myocardial infarction and a left ventricular assist device is present. What describes the expected flow pattern in the normal CCA

A

low velocity flow with delayed upstroke and loss of pulsatility

79
Q

Thrombolytic therapy is used to treat ___________ and ___________

A

extensive acute DVT, acute arterial obstruction by thrombus

80
Q

Dilated venous collaterals adjacent to the area of interest

A

AV malformation

81
Q

Transorbital doppler is used to evaluate the

A

ophthalmic artery

82
Q

Periorbital doppler is used to assess

A

flow direction in frontal artery

83
Q

FMD most commonly affects which portion of the carotid arteries

A

mid or distal segment of the ICA

84
Q

An acute occlusion occurs in the common iliac artery on the left side. What vessels will also have absent flow

A

common femoral, external and internal iliac artery

85
Q

If the left proximal CCA demonstrates a PSV of 35 cm/s and the right proximal CCA demonstrates a PSV of 115 cm/s, what would explain the finding

A

left ICA occlusion

86
Q

__________ refers to the formation of upper extremity DVT due to excessive motion

A

paget schroetter

87
Q

A 55yr old with a history of alcoholism, jaundice and cirrhosis is referred for a liver doppler exam. What is an expected abnormal finding

A

increased resistance in the hepatic artery

88
Q

What is the most common indication for an upper extremity arterial duplex exam

A

evaluate hemodialysis graft performance

89
Q

An aortic dissection most commonly origintes

A

in the ascending aorta

90
Q

Venous gangrene usually involves _________ while arterial gangrene usually involves __________

A

the foot and all toes, one or two toes

91
Q

Bilateral bruits are detected in the proximal neck. This finding is most suggestive of

A

aortic valve stenosis

92
Q

Which of the following will be administered to a patient with extensive DVT to cause lysis of the clot

A

streptokinase

93
Q

Varicosities with superficial venous insufficiency related to deep venous system disease are called

A

secondary varicosities

94
Q

Varicosities with incompetent valves causing superficial venous insufficiency and normal deep system are called

A

primary varicosities

95
Q

Congestive heart failure is more commonly seen with ______ while distal ischemia is more commonly seen with _________

A

proximal AV fistula, distal AV fistula

96
Q

Aneurysm formation affects the ________, while atherosclerotic disease affects the _________

A

media and adventitia layers of the vessel wall, intimal layer of the vessel wall

97
Q

What is a common infection that causes skin discoloration in patients with venous insufficiency

A

stasis dermatitis

98
Q

What is caput medusa

A

tortuous vessels around the umbilicus caused by portal HTN

99
Q

What is the most common site for atherosclerosis formation in the lower extremity

A

SFA in adductor canal

100
Q

A 72 year old female presents for an upper extremity arterial doppler exam due to asymmetric brachial pressure. The right axillary artery demonstrates a circumferential halo of thickened vessel wall tissue and increased wall vascularity. These findings are most consistent with

A

giant cell arteritis

101
Q

_________ refers to diffuse inflammation of the intimal wall layer. _________ refers to inflammation of all vessel walls and surrounding connective tissue

A

thromboangitis, thromboangitis obliterans

102
Q

Thromboangitis obliterans involves inflammation of

A

all vessel walls and surrounding connective tissue

103
Q

Most lower extremity thrombosis begins in the

A

soleal sinuses

104
Q

The carotid compression test is used to _______, while the carotid sinus massage is used to ________

A

evaluate the presence of collateral flow, reduce the heart rate

105
Q

Arterial claudication occurs where

A

distal to the obstruction

106
Q

The ________ on foot used as the dye injection site for ascending venography, while the ______ is used as the dye injection site for lower extremity arteriography

A

dorsal vein, common femoral artery

107
Q

What provides the greatest risk for peripheral arterial disease

A

hyperlipidemia

108
Q

The resistive index of the renal parenchymal arteries in cases of main renal artery stenosis will ________ and the resistive index of the renal parenchymal arteries in cases of renal parenchymal disease will _________

A

decrease, increase

109
Q

A patient presents for a carotid ultrasound for pre op testing for an aortic valve replacement surgery. The echo report in their chart indicates the stenosis is severe. What is the best way to determine if carotid stenosis is present in this patient

A

calculate the ICA/CCA systolic and diastolic velocity ratios

110
Q

Paresthesia is defined as

A

an abnormal skin sensation, such as numbness or tingling

111
Q

Blue toe syndrome can be a complication of

A

AAA

112
Q

What is the most common cardiac disorder associated with arterial embolism

A

atrial fibrillation

113
Q

What is the second most common site for atherosclerosis formation in the lower extremity

A

CFA bifurcation

114
Q

The 6 Ps of acute arterial occlusion are

A

pain
pallor
pulselessness
paresthesia
paralysis
polar sensation

115
Q

The most common color change demonstrated in a lower extremity with an acute arterial occlusion is

A

pallor

116
Q

_______ cause primary varicose veins, while ________ cause secondary varicose veins

A

incompetent valves, elevated deep venous pressures

117
Q

What vessels supply blood to a carotid body tumor

A

branches of ECA

118
Q

What vessels will be abnormally dilated with significant portal HTN

A

main portal vein and left gastric vein

119
Q

If you detect flow toward the transducer in the right ACA while using the temporal window, there is probably

A

an occlusion of the right ICA

120
Q

What correctly describes hollenhorst plaques

A

cholesterol emboli that originate from atherosclerotic lesions in the ipsilateral carotid artery or aorta and lodge in the small branches of the retinal artery, usually seen on optometry exams

121
Q

What is the normal value for a transcutaneous oximetry exam

A

70-80mmHg

122
Q

A bilateral decrease in the femoral pulses can be related to

A

aortic coarctation

123
Q

What is the most common location of an intracranial aneurysm

A

anterior communicating artery

124
Q

Carotid body tumors are more common in

A

women and people living at high altitudes

125
Q

Treatment for ICA occlusions

A

nothing

126
Q

What could cause flow in the left ECA to reverse direction during systole

A

left CCA occlusion

127
Q

Posterior to anterior collateralization with a left ICA occlusion will cause

A

increased velocity in the left PCA P1 segment

128
Q

A patient presents with a script that requests an aortic doppler evaluation due to leriche syndrome. What are you looking for on the exam

A

extensive diffuse atherosclerotic disease causing obstruction of the distal aorta

129
Q

What is the minimum amount of diameter stenosis in the ICA that will demonstrate hemodynamic significance

A

50%

130
Q

Hemodynamically significant stenosis of the SMA is diagnosed when the peak systolic is greater than

A

2.75 m/s

131
Q

A patient presents with a script that states “2yr hx of budd chiari syndrome”. What are you looking for on the exam

A

atrophied liver with Non visualization of the hepatic veins

132
Q

What is most suggestive of renal transplant rejection

A

oliguria

133
Q

What is a long term treatment for DVT

A

warfarin

134
Q

What condition would be treated with streptokinase

A

phlegmasia cerulea dolens

135
Q

What lower extremity vessels would most likely be occluded in a patient with phlegmasia alba dolens

A

femoral vein, deep calf veins, popliteal vein

136
Q

A patient presents for a carotid ultrasound due to recent episodes of near syncope. Other symptoms include shortness of breath and pedal edema. Noticeable respiratory variation in the peak velocities of the carotid arteries is present. What cardiac complication should be suspected

A

cardiac tamponade

137
Q

What critical finding is associated with calf paresthesia, localized muscle weakness, pain when stretching calf muscles and drop foot

A

anterior compartment syndrome

138
Q

Amaurosis fugax in the right eye indicates potential disease in what vessel

A

right ICA

139
Q

A patient presents for a carotid doppler exam due to left arm and leg paresthesia. Which vessel should be closely evaluated for a potential vascular cause of symptoms

A

right ICA

140
Q

When a water hammer pulse is identified in the carotid arteries, what cardiac complication should be suspected

A

severe aortic regurgitation

141
Q

A pulsatility index of >1.2 in the cerebral vessels indicates

A

vasospasm

142
Q

The most accurate doppler predictor of ICA stenosis is

A

the EDV

143
Q

What measurement is used to differentiate inflow from outflow disease in the lower extremity arteries

A

acceleration time

144
Q

_________ refers to the injection of saline or other sclerosing agent that damages the vein and causes fibrosis to occur.

A

sclerotherapy

145
Q

What can lead to systolic flow reversal in the hepatic veins

A

significant tricuspid regurgitation

146
Q

You identify flow moving toward the transducer in the left ophthalmic artery and flow moving away from the transducer in the right ophthalmic artery. What does this mean

A

critical stenosis in the distal right ICA

147
Q

A patient presents with bilateral distention of the internal jugular veins and arm swelling. The lower extremities are normal on physical examination. These findings are most suggestive of

A

SVC syndrome

148
Q

Hemodynamically significant stenosis of the celiac axis is diagnosed with the PSV greater than

A

2.0m/s

149
Q

An acute, occlusive thrombus is identified in the femoral vein in the adductor canal. Which of the following veins will demonstrate related blood stasis

A

small saphenous

150
Q

Which renal arteries are evaluated with doppler in an ultrasound exam that is used to perform an indirect evaluation for renal artery stenosis

A

segmental and parenchymal arteries

151
Q

What vessels are evaluated in a doppler evaluation for erectile dysfunction

A

cavernous arteries and dorsal veins

152
Q

_________ uses a catheter with a rotating head to break up the plaque and suction capabilities to remove it from the artery

A

an atherectomy procedure

153
Q

What is an autosomal disorder that can lead to arteriovenous AVM or portovenous AVM in the liver

A

hereditary hemorrhagic telangiectasia

154
Q

what indicates a significant SMA stenosis

A

dilated inferior mesenteric artery that is easily visualized sonographically

155
Q

What is the minimum % area ICA stenosis that is considered hemodynamically significant and treatment is recommended

A

70%

156
Q

Which vessel can provide a pathway for collateral flow from the vertebral system to the MCA on the same side of the body

A

posterior communicator arteries

157
Q

A 32yr old construction worker fell 15ft at work. He was treated and released by the ER 36hrs prior. He now presents with acute hemiparesis and dysphasia. These clinical findings are most suggestive of

A

carotid dissection

158
Q

If the P1 segment of the PCA is occluded on the left side, how will flow reach the P2 segment of the PCA

A

flow reversal within the left posterior communicator artery

159
Q

A patient presents for an exam due to a history of lemierre syndrome. What vessels should be evaluated for associated findings

A

bilateral internal jugular veins

160
Q

What is the most common cause of upper extremity DVT in the normal ambulatory patient population

A

paget-schroetter syndrome

161
Q

What is the most common cause of venous stasis ulcer formation on the distal medial calf

A

insufficiency in the posterior tibial perforators and the posterior arch vein

162
Q

If an abnormal transcutaneous oximetry reading is obtained, what should you do next

A

move to sensor proximally

163
Q

A patient presents with a wet ulcer located on the medial calf just above the ankle. What vessel should be evaluated first as the most likely primary cause of the ulcer

A

posterior accessory saphenous vein

164
Q

While scanning through the suboccipital window with midline angulation, the mean flow velocity increases from 55cm/s to 145cm/s at 105mm in depth. What do these findings mean

A

significant stenosis is present in the basilar artery

165
Q

_________ is a nonspecific sign of DVT. It is defined as pain experienced upon quick dorsiflexion of the foot

A

homan sign

166
Q

When performing a carotid exam, the proximal ICA is limited in color and doppler evaluation by heavy calcification of the arterial wall. The mid ICA segment demonstrates biphasic flow with the main component of flow moving in a retrograde direction. Which of the following describes the CCA flow pattern that will be identified

A

triphasic flow with decreased velocity

167
Q

Congenital malformations of arterial vasculature

A

PHACE syndrome

168
Q

Compression of the carotid artery

A

eagle syndrome

169
Q

Compression of ulnar artery

A

hypothenar hammer syndrome

170
Q

A patient complains of bilateral pain and color changes in the legs. When he lies down, both legs become pale. When he sits up on the edge of the bed, both legs become reddened. These clinical findings are most suggestive of

A

significant aortic stenosis

171
Q

What describes an AV malformation

A

dilated venous collaterals adjacent to the area of interest

172
Q

What is associated with CREST syndrome

A

secondary raynaud phenomenon

173
Q

Adventitial cysts most commonly affect the

A

popliteal artery

174
Q

What will result in a low resistance external carotid artery waveform with increased antegrade flow in diastole

A

ipsilateral mid CCA stenosis

175
Q

An AV fistula is present connecting the femoral artery and vein at the right groin. The doppler evaluation of the common femoral artery will demonstrate what flow pattern

A

monophasic with increased diastolic flow

176
Q

What causes flow reversal in venous perforators

A

DVT

177
Q

_______is a genetic disorder that negatively affects collagen formation. The reduction in collagen will result in less rigid arteries and increased risk of aneurysm formation

A

ehler-danlos

178
Q

NL vascular system, intermittent bilateral digital arterial spasm, excellent prognosis

A

primary raynaud phenomenon

179
Q

ABNL obstructed system with vasoconstriction causes constant ischemia, may be unilateral

A

secondary raynaud phenomenon

180
Q

_________ refers to extensive diffuse atherosclerotic disease causing obstruction of the distal aorta and bilateral lower extremity symptoms

A

leriche

VASCULAR URR (6 decks)

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