Pathology Flashcards
What is associated with spectral broadening
increased bandwidth
Bilateral tardus parvus waveforms in the carotid arteries can indicate
mitral stenosis
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
waveforms from the CCA will have 2 systolic peaks and the first one should be measured to determine the peak velocity
What can lead to systolic flow reversal in the hepatic veins
significant tricuspid regurgitation
An acute, occlusive thrombus is identified in the femoral vein in the adductor canal. What vein will demonstrate related blood stasis
small saphenous
A critical stenosis will have what effect on the ipsilateral MCA flow
decreased diastolic flow
If there is an occlusion at the proximal ICA, what will happen to the flow in the CCA
damped with increased resistance/decreased diastolic flow
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
significant stenosis is present in the basilar artery
What is the most common cause of upper extremity DVT in the normal ambulatory patient population
paget-schroetter syndrome
What correctly describes the standard protocol for performing cerebral angiography
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
If the external iliac is occluded, what vessels provide the potential for collateral flow to the extremity
inferior epigastric artery and deep circumflex artery
Significant valvular disease in the right heart usually leads to
pulsatile flow in the lower extremity veins
If there is a 75% stenosis of the distal axillary artery, which of the following arteries will demonstrate a triphasic waveform
subclavian
Hemodynamically significant stenosis of the celiac axis is diagnosed with the PSV greater than
2.0 m/s
The external carotid artery normally demonstrates a velocity below
150 cm/s
Why is the carotid compression technique performed
to evaluate the presence of intracranial collateral formation
What is part of the virchow’s triad
blood stasis, trauma, hypercoagulability/polycythemia vera
The most common location of valvular insufficiency is
GSV and CFV junction
How is hemispheric index calculated
using the MCA peak systolic velocity and dividing it by the distal ICA peak systolic velocity
Amaurosis fugax can be described as
TIA of the eye
The most accurate doppler predictor of ICA stenosis is
end diastolic velocity
What are symptoms of ICA/MCA disease
unilateral visual disturbances, receptive aphasia, expressive aphasia
An autosomal dominant disorder that affects the vasculature of multiple organs. It is characterized by multiple AVMs
hereditary hemorrhagic telangiectasia AKA osler-weber rendu syndrome
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
> 30%
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
string flow sign
_______ is a nonspecific sign of DVT. It is defined as pain experienced upon quick dorsiflexion of the foot
homan sign
Type of visual disturbance where half of the field of view is disrupted in the eye
homonymous hemianopia
Leak at the branch vessels
type 2 endoleak
Potential signs of an unstable AAA sac
echolucent areas within the sac, changes in aneurysm shape and/or sac size, increased pulsatility of the sac
TIA = stroke symptoms lasting ________
CVA= stroke symptoms lasting ________
24 hours or less,
more than 24 hours
What is not a complication of a liver transplant
cirrhosis
What vessel can provide a pathway for collateral flow from the vertebral system to the MCA on the same side of the body
posterior communicator arteries
What arteries are evaluated during a penile duplex exam for erectile dysfunction
cavernosal
If there is a 90% stenosis in the left carotid siphon the left iCA flow will be
high resistance
Wernicke aphasia (AKA receptive aphasia) is defined as
inability to understand speech, speak or follow directions
A bilateral visual symptom, such as diplopia, is commonly associated with disease in which artery
vertebral
If a left ICA occlusion is present, the ________ will demonstrate decreased or absent flow
left MCA
Elevated erythrocyte sedimentation rate and C-reactive protein (CRP) levels are associated with
giant cell arteritis
A patient presents with left arm paresthesia and intermittent blurring of vision in the right eye. These clinical findings are most consistent with
Rt ICA stenosis
What renal arteries are evaluated with doppler in an ultrasound exam that is used to perform an indirect evaluation for renal artery stenosis
segmental and parenchymal arteries
Broca aphasia (expressive aphasia) can be defined as
inability to speak but can understand and follow directions
What is the most common cause of cerebrovascular disease
atherosclerosis
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
phlegmasia cerulea dolens
Phlegmasia cerulea dolens causes
cyanosis
Phlegmasia alba dolens causes
pallor
Aside from the carotid artery, what other vessels are commonly affected by FMD
renal and mesenteric arteries
What structure compresses the artery in popliteal entrapment
medial head of the gastrocnemius muscle
Takayasu arteritis normally affects the
aorta, subclavian and renal arteries
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
buerger disease
Renal artery stenosis is considered hemodynamically significant when it is greater than
60%
What can be caused by congestive heart failure
decreased ankle pressures
_________ uses a catheter with a rotating head to break up the plaque and suction capabilities to remove it from the artery
an atherectomy procedure
_________ 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
lemierre syndrome
A patient presents for an exam due to a history of lemierre syndrome. What vessels should be evaluated for associated findings
bilateral internal jugular veins
Which of the following vessels can provide a collateral pathway to redistribute flow from one side of the brain to the other side
anterior communicator and basilar artery
What describes an abnormal response to proximal augmentation
flow reversal begins at the onset of the augmentation maneuver
According to the bernoulli principle, where will you find the lowest pressure in a vessel with stenosis
at the site of stenosis
What symptoms would be most suggestive of significant disease in the MCA
contralateral face and arm paresis
_________ feeds the portions of the brain responsible for the face and arm motion
MCA
What is the main risk factor for a stroke
systemic HTN
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
absence of the deep veins in the leg with multiple dilated varicosities present
When a hammer pulse is identified in the carotid arteries, what cardiac complication should be suspected
severe aortic regurgitation
Restenosis of a carotid stent most commonly occurs
at the stent attachment sites
If flow in the left ophthalmic artery is reversed in a transorbital evaluation, what is the expected flow pattern in the right ophthalmic artery
increased systolic and diastolic velocities
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
bilateral CCA waveforms will demonstrate decreased resistance and velocity
Stanford type A
dissection that involves the ascending aorta and arch
Stanford type B
dissection that involves the aorta from the left subclavian artery to the iliac bifurcation
DeBakey type 1
dissection that involves the ascending and descending aorta
DeBakey type 2
dissection that involves only the ascending aorta
DeBakey type 3
dissection that involves the descending aorta only, starting after the origin of the left subclavian artery
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
type b dissection, type 3 dissection
What terms would be used to describe flow identified just proximal to a 95% ICA stenosis
damped
The scimitar sign is associated with
adventitial cysts
________ refers to valve damage in the veins after thrombus formation
post-phlebitic syndrome
When evaluating a liver transplant, you must use angle correction during doppler evaluation of
hepatic arteries and portal veins
A patient presents for a carotid doppler exam due to bilateral diplopia and dizziness. These findings are most suggestive of stenosis in
vertebral arteries
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
chronic insufficiency
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
low velocity flow with delayed upstroke and loss of pulsatility
Thrombolytic therapy is used to treat ___________ and ___________
extensive acute DVT, acute arterial obstruction by thrombus
Dilated venous collaterals adjacent to the area of interest
AV malformation
Transorbital doppler is used to evaluate the
ophthalmic artery
Periorbital doppler is used to assess
flow direction in frontal artery
FMD most commonly affects which portion of the carotid arteries
mid or distal segment of the ICA
An acute occlusion occurs in the common iliac artery on the left side. What vessels will also have absent flow
common femoral, external and internal iliac artery
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
left ICA occlusion
__________ refers to the formation of upper extremity DVT due to excessive motion
paget schroetter
A 55yr old with a history of alcoholism, jaundice and cirrhosis is referred for a liver doppler exam. What is an expected abnormal finding
increased resistance in the hepatic artery
What is the most common indication for an upper extremity arterial duplex exam
evaluate hemodialysis graft performance
An aortic dissection most commonly origintes
in the ascending aorta
Venous gangrene usually involves _________ while arterial gangrene usually involves __________
the foot and all toes, one or two toes
Bilateral bruits are detected in the proximal neck. This finding is most suggestive of
aortic valve stenosis
Which of the following will be administered to a patient with extensive DVT to cause lysis of the clot
streptokinase
Varicosities with superficial venous insufficiency related to deep venous system disease are called
secondary varicosities
Varicosities with incompetent valves causing superficial venous insufficiency and normal deep system are called
primary varicosities
Congestive heart failure is more commonly seen with ______ while distal ischemia is more commonly seen with _________
proximal AV fistula, distal AV fistula
Aneurysm formation affects the ________, while atherosclerotic disease affects the _________
media and adventitia layers of the vessel wall, intimal layer of the vessel wall
What is a common infection that causes skin discoloration in patients with venous insufficiency
stasis dermatitis
What is caput medusa
tortuous vessels around the umbilicus caused by portal HTN
What is the most common site for atherosclerosis formation in the lower extremity
SFA in adductor canal
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
giant cell arteritis
_________ refers to diffuse inflammation of the intimal wall layer. _________ refers to inflammation of all vessel walls and surrounding connective tissue
thromboangitis, thromboangitis obliterans
Thromboangitis obliterans involves inflammation of
all vessel walls and surrounding connective tissue
Most lower extremity thrombosis begins in the
soleal sinuses
The carotid compression test is used to _______, while the carotid sinus massage is used to ________
evaluate the presence of collateral flow, reduce the heart rate
Arterial claudication occurs where
distal to the obstruction
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
dorsal vein, common femoral artery
What provides the greatest risk for peripheral arterial disease
hyperlipidemia
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 _________
decrease, increase
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
calculate the ICA/CCA systolic and diastolic velocity ratios
Paresthesia is defined as
an abnormal skin sensation, such as numbness or tingling
Blue toe syndrome can be a complication of
AAA
What is the most common cardiac disorder associated with arterial embolism
atrial fibrillation
What is the second most common site for atherosclerosis formation in the lower extremity
CFA bifurcation
The 6 Ps of acute arterial occlusion are
pain
pallor
pulselessness
paresthesia
paralysis
polar sensation
The most common color change demonstrated in a lower extremity with an acute arterial occlusion is
pallor
_______ cause primary varicose veins, while ________ cause secondary varicose veins
incompetent valves, elevated deep venous pressures
What vessels supply blood to a carotid body tumor
branches of ECA
What vessels will be abnormally dilated with significant portal HTN
main portal vein and left gastric vein
If you detect flow toward the transducer in the right ACA while using the temporal window, there is probably
an occlusion of the right ICA
What correctly describes hollenhorst plaques
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
What is the normal value for a transcutaneous oximetry exam
70-80mmHg
A bilateral decrease in the femoral pulses can be related to
aortic coarctation
What is the most common location of an intracranial aneurysm
anterior communicating artery
Carotid body tumors are more common in
women and people living at high altitudes
Treatment for ICA occlusions
nothing
What could cause flow in the left ECA to reverse direction during systole
left CCA occlusion
Posterior to anterior collateralization with a left ICA occlusion will cause
increased velocity in the left PCA P1 segment
A patient presents with a script that requests an aortic doppler evaluation due to leriche syndrome. What are you looking for on the exam
extensive diffuse atherosclerotic disease causing obstruction of the distal aorta
What is the minimum amount of diameter stenosis in the ICA that will demonstrate hemodynamic significance
50%
Hemodynamically significant stenosis of the SMA is diagnosed when the peak systolic is greater than
2.75 m/s
A patient presents with a script that states “2yr hx of budd chiari syndrome”. What are you looking for on the exam
atrophied liver with Non visualization of the hepatic veins
What is most suggestive of renal transplant rejection
oliguria
What is a long term treatment for DVT
warfarin
What condition would be treated with streptokinase
phlegmasia cerulea dolens
What lower extremity vessels would most likely be occluded in a patient with phlegmasia alba dolens
femoral vein, deep calf veins, popliteal vein
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
cardiac tamponade
What critical finding is associated with calf paresthesia, localized muscle weakness, pain when stretching calf muscles and drop foot
anterior compartment syndrome
Amaurosis fugax in the right eye indicates potential disease in what vessel
right ICA
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
right ICA
When a water hammer pulse is identified in the carotid arteries, what cardiac complication should be suspected
severe aortic regurgitation
A pulsatility index of >1.2 in the cerebral vessels indicates
vasospasm
The most accurate doppler predictor of ICA stenosis is
the EDV
What measurement is used to differentiate inflow from outflow disease in the lower extremity arteries
acceleration time
_________ refers to the injection of saline or other sclerosing agent that damages the vein and causes fibrosis to occur.
sclerotherapy
What can lead to systolic flow reversal in the hepatic veins
significant tricuspid regurgitation
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
critical stenosis in the distal right ICA
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
SVC syndrome
Hemodynamically significant stenosis of the celiac axis is diagnosed with the PSV greater than
2.0m/s
An acute, occlusive thrombus is identified in the femoral vein in the adductor canal. Which of the following veins will demonstrate related blood stasis
small saphenous
Which renal arteries are evaluated with doppler in an ultrasound exam that is used to perform an indirect evaluation for renal artery stenosis
segmental and parenchymal arteries
What vessels are evaluated in a doppler evaluation for erectile dysfunction
cavernous arteries and dorsal veins
_________ uses a catheter with a rotating head to break up the plaque and suction capabilities to remove it from the artery
an atherectomy procedure
What is an autosomal disorder that can lead to arteriovenous AVM or portovenous AVM in the liver
hereditary hemorrhagic telangiectasia
what indicates a significant SMA stenosis
dilated inferior mesenteric artery that is easily visualized sonographically
What is the minimum % area ICA stenosis that is considered hemodynamically significant and treatment is recommended
70%
Which vessel can provide a pathway for collateral flow from the vertebral system to the MCA on the same side of the body
posterior communicator arteries
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
carotid dissection
If the P1 segment of the PCA is occluded on the left side, how will flow reach the P2 segment of the PCA
flow reversal within the left posterior communicator artery
A patient presents for an exam due to a history of lemierre syndrome. What vessels should be evaluated for associated findings
bilateral internal jugular veins
What is the most common cause of upper extremity DVT in the normal ambulatory patient population
paget-schroetter syndrome
What is the most common cause of venous stasis ulcer formation on the distal medial calf
insufficiency in the posterior tibial perforators and the posterior arch vein
If an abnormal transcutaneous oximetry reading is obtained, what should you do next
move to sensor proximally
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
posterior accessory saphenous vein
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
significant stenosis is present in the basilar artery
_________ is a nonspecific sign of DVT. It is defined as pain experienced upon quick dorsiflexion of the foot
homan sign
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
triphasic flow with decreased velocity
Congenital malformations of arterial vasculature
PHACE syndrome
Compression of the carotid artery
eagle syndrome
Compression of ulnar artery
hypothenar hammer syndrome
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
significant aortic stenosis
What describes an AV malformation
dilated venous collaterals adjacent to the area of interest
What is associated with CREST syndrome
secondary raynaud phenomenon
Adventitial cysts most commonly affect the
popliteal artery
What will result in a low resistance external carotid artery waveform with increased antegrade flow in diastole
ipsilateral mid CCA stenosis
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
monophasic with increased diastolic flow
What causes flow reversal in venous perforators
DVT
_______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
ehler-danlos
NL vascular system, intermittent bilateral digital arterial spasm, excellent prognosis
primary raynaud phenomenon
ABNL obstructed system with vasoconstriction causes constant ischemia, may be unilateral
secondary raynaud phenomenon
_________ refers to extensive diffuse atherosclerotic disease causing obstruction of the distal aorta and bilateral lower extremity symptoms
leriche
