Pathology Pt 2

Question 1

Which of the following is least likely to be associated with the acute onset of 3 blue toes?

A. DVT formation in the popliteal and calf veins
B. popliteal aneurysm
C. recent angiography procedure
D. abdominal aortic aneurysm

Answer 1

A

FeedBack:Blue toe syndrome occurs due to distal embolism from a recent invasive procedure, atherosclerotic plaque or thrombus in the aorta or lower extremity artery.

Question 2

Longitudinal images are presented of the anterior abdomen just superior to the umbilicus. What is the most common cause of the abnormality seen on the images?

A. portal HTN
B. polycythemia vera
C. malignant HTN
D. pulmonary HTN

Answer 2

A

FeedBack:A patent umbilical vein is identified on the images. Severe portal HTN will cause the umbilical vein to recanalize, allowing retrograde filling to occur within the vessel.

Question 3

Significant atherosclerotic disease found in which artery could lead to male impotence?

A. common iliac or internal iliac
B. common iliac or external iliac
C. common femoral or profunda femoral
D. external iliac or common femoral

Answer 3

A

FeedBack:Disease in the common iliac and internal iliac artery can lead to ischemia of the penile tissues.

Question 4

Numbness and tingling in the extremities is summarized by what term listed below?

A. Paralysis
B. Paresis
C. Paresthesia
D. Pallor

Answer 4

C

FeedBack:Paresis refers to the partial loss of movement and feeling of an extremity/body part. Paralysis refers to the complete loss of movement and feeling of an extremity of body part. Pallor refers to a pale white color of the skin.

Question 5

All of the following correctly describe compartment syndrome, except:

A. all forms of compartment syndrome are considered an emergency
B. most commonly occurs due to trauma
C. can occur in the leg or arm
D. prevents blood flow in and out of surrounding tissues

Answer 5

A

FeedBack:Acute compartment syndrome is an emergency, but chronic compartment syndrome is not an emergency. The acute onset of compartment syndrome is usually associated with trauma and a broken leg or arm. Increased pressure in the osteofascial compartment will prevent blood flow in and out of surrounding tissues. This can cause permanent muscle and nerve damage.

Question 6

Which of the following describes chronic lower extremity DVT?

A. pulsatile flow pattern
B. echogenic vein walls
C. vein is completely non-compressible
D. varicocele formation

Answer 6

B

FeedBack:Chronic thrombus formation can cause the vein walls to appear thickened and echogenic. It can also lead to partial compressibility of the vein and continuous flow in the vessel.

Question 7

A patient presents with a prior history of popliteal DVT and a recent history of intermittent mild leg pain with increasing appearance of small varicosities on the calf. Which statement below best describes his condition?

A. The patient is suffering from secondary varicose vein formation.
B. There is most likely a clot in the gastrocnemius veins of the calf.
C. The patient most likely has a recurrent acute DVT.
D. There is most likely a Baker’s cyst in the popliteal fossa causing extrinsic compression.

Answer 7

A

FeedBack:Primary varicosities form due to abnormal valves in the superficial venous system. Secondary varicosities form if there is an associated problem in the deep system, such as previous DVT.

Question 8

Proximal to a DVT in the femoral vein, the flow appears very slow and visible on 2D imaging. The red blood cells appear lined up or stacked in rolls. What is this phenomenon called?

A. May-Thurner Syndrome
B. Rouleaux Formation
C. Phlegmasia cerulea dolens
D. Raynaud phenomenon

Answer 8

B

FeedBack:Proximal to a DVT in the superficial femoral vein, the flow appears very slow and visible on 2D imaging. The red blood cells appear lined up or stacked in rolls. This phenomenon is called Rouleaux formation.

Question 9

Which of the following is associated with CREST syndrome?

A. Secondary Raynaud phenomenon
B. Superficial phlebitis
C. Primary Raynaud disease
D. Aortic aneurysm

Answer 9

A

FeedBack:In contrast to Raynaud disease, Raynaud phenomenon presents concurrently with CREST syndrome, in which tissue necrosis results from spastic and occlusive disease. CREST syndrome involves symptoms of generalized calcinosis, Raynaud phenomenon, esophageal dysfunction, scleroderma, and telangiectasia.

Question 10

Which of the following vessels supplies blood to a carotid body tumor?

A. ICA
B. subclavian
C. ECA
D. MCA

Answer 10

A

FeedBack:Coarctation causes a ridge of tissue that blocks flow, usually in the descending aorta. This causes monophasic flow with increased antegrade diastolic flow. Brachial pressures will be normal but the bilateral ankle pressures will be decreased.

Question 11

A 55yr old with a history of alcoholism, jaundice and cirrhosis is referred for a liver Doppler exam. All of the following are commonly associated findings, except

A. portal thrombosis
B. dilated umbilical vein
C. dilated coronary vein
D. decreased resistance in the hepatic artery

Answer 11

D

FeedBack:Resistance in the hepatic artery will increase with the increase in resistance to flow in the cirrhotic liver tissue. The coronary vein (AKA left gastric vein) and the umbilical vein will dilate with significant portal HTN.

Question 12

All of the following correctly describes Buerger disease, except?

A. commonly associated with collagen disease
B. associated with males that are heavy smokers
C. also known as thromboangiitis obliterans
D. most commonly presents as multiple painless, wet, oozing ulcers of the feet and ankles

Answer 12

D

FeedBack:Buerger Disease/Thromboangiitis Obliterans is an occlusive disease of SMALL to MEDIUM size arteries caused by inflammation of arterial wall and surrounding connective tissue. It is always associated with heavy smoking. It is most common in men, age 20-30 years. Collagen disease, such as lupus, is usually associated with Buerger disease. The disease first affects the plantar or palmar arteries then moves centrally. Common symptoms include ischemic rest pain and distal dry, painful ulcers. Evaluation can be performed by Duplex and PPG techniques.

Question 13

Arterial claudication occurs:

A. distal to the obstruction
B. while the patient is resting
C. while the legs are in the dependent position
D. proximal to the obstruction

Answer 13

A

FeedBack:Arterial claudication occurs distal to the hemodynamically significant obstruction.

Question 14

Which of the following is a congenital vascular abnormality that commonly causes decreased ankle pressures bilaterally?

A. Coarctation of the aorta
B. Budd Chiari Syndrome
C. Thoracic Outlet Syndrome
D. CHF

Answer 14

A

FeedBack:Coarctation causes a ridge of tissue that blocks flow, usually in the descending aorta. This causes monophasic flow with increased antegrade diastolic flow. Brachial pressures will be normal but the bilateral ankle pressures will be decreased.

Question 15

Which of the following terms would be used to describe flow identified just proximal to a 95% ICA stenosis?

A. laminar
B. damped
C. low resistance
D. tardus parvus

Answer 15

B

FeedBack:Pre-Stenotic Zone: Increased resistance and resistive index, Flow velocity may be dampened with loss of diastolic flow, Short acceleration time

Question 16

If the left proximal CCA demonstrates a PSV of 35cm/s and the right proximal CCA demonstrates a PSV of 115cm/s, which of the following could explain the findings?

A. aortic valve stenosis
B. decreased hematocrit levels
C. congestive heart failure
D. left ICA occlusion

Answer 16

D

FeedBack:If a single CCA demonstrates elevated velocity = tortuosity on that side or compensatory flow due to obstruction in the other carotid system. If the left ICA is occluded, flow in the CCA will be low velocity with a quick upstroke and little to no diastolic flow. The right CCA velocity can increase as it tries to provide the additional cerebrovascular flow needed. The left vertebral artery may also demonstrate elevated velocity as it tries to compensate for the ipsilateral ICA occlusion. The other choices would cause bilateral hemodynamic changes.

Question 17

Fibromuscular dysplasia most commonly affects which portion of the carotid arteries?

A. CCA bifurcation
B. bulb and proximal ICA
C. mid segment of the ICA
D. proximal ECA

Answer 17

C

FeedBack:FMD usually occurs in the mid or distal segment of the ICA, while atherosclerosis most commonly affects the proximal ICA.

Question 18

You perform a bilateral venous Doppler due to bilateral swelling and pain in the legs. Both common femoral vein waveforms look like the tracing on the image. Which of the following is least likely to cause the flow changes?

Image of spectral Doppler is of pulsatile venous flow

A. congestive heart failure
B. severe tricuspid regurgitation
C. venous hypertension
D. IVC obstruction

Answer 18

D

FeedBack:Cardiac pulsatility in the lower extremity veins can be related to venous HTN. This is caused by CHF, renal dysfunction and severe tricuspid regurgitation.

Question 19

Which of the following is least likely to cause a decrease in digit pressures of the upper extremity?

A. Buerger disease
B. SVC syndrome
C. Raynaud disease
D. Thoracic outlet syndrome

Answer 19

B

FeedBack:Raynaud, TOS, Buerger disease and atherosclerosis can all lead to abnormally low digit pressures and abnormal PPG tracing.

Question 20

Patients with lower extremity arterial disease may describe pain

A. that is relieved by lying down
B. that is relieved by elevating the legs
C. that is relieved by walking
D. that is relieved by placing legs in a dependent position

Answer 20

D

FeedBack:The dependent position helps blood to reach the lower legs more quickly. Walking and elevating the legs would increase the pain. Lying down would provide minimal relief due to the loss of gravity’s assistance with the flow.

Question 21

What is the most common symptom of peripheral arterial disease?

A. claudication
B. rest pain
C. decreased pedal pulses
D. ulceration

Answer 21

A

FeedBack:Claudication is the most common symptom of peripheral arterial disease.

Question 22

If the tibioperoneal trunk is occluded, flow in which calf vessel(s) will not be decreased?

A. anterior tibial artery
B. posterior tibial artery
C. peroneal artery
D. posterior tibial artery and peroneal artery

Answer 22

A

FeedBack:The popliteal artery bifurcates into the anterior tibial artery and tibioperoneal trunk just outside the popliteal artery. Slight distal to that bifurcation the trunk splits into the posterior tibial artery and peroneal artery.

Question 23

Blue Toe Syndrome can be a complication of which of the following?

A. Abdominal aortic aneurysm
B. Deep venous thrombosis
C. Thoracic outlet syndrome
D. Raynaud Phenomenon

Answer 23

A

FeedBack:Blue toe syndrome is caused by emboli reaching the small digital arteries and causing obstruction/ischemia. The ischemic toe tissue becomes discolored and cyanotic in appearance. AAA formation usually leads to thrombus accumulation in the affected area of the vessel. This thrombus poses a risk of emboli formation and distal ischemia.

Question 24

The Scimitar sign is associated with:

A. Median arcuate ligament syndrome
B. Adventitial cysts
C. Bovine arch
D. Femoral to Femoral bypass graft

Answer 24

: B

FeedBack:The Scimitar sign is associated with adentitial cyst formation. The arterial lumen is compressed by the cyst and is said to look like a scimitar (type of curved sword).

Question 25

Which of the following describes the path of an embolus?

A. a small piece of soft plaque breaks off from the carotid bulb and floats toward the brain
B. a small piece of thrombus breaks off from a thrombus in the left ventricle and floats toward the lungs
C. a small piece of soft plaque breaks off from the carotid bulb and floats toward the lungs
D. a small piece of thrombus breaks off from a thrombus in the right ventricle and floats toward the brain

Answer 25

A

FeedBack:An embolus is a floating piece of debris, air bubble, thrombus or plaque that moves distally until it lodges in a small vessel. Thrombus in the right ventricle will be sent to pulmonary artery and the lungs = pulmonary embolism. Thrombus in the left ventricle can be sent to the brain through the aorta = stroke. An embolus in the carotid system will go to the brain.

Question 26

Paresthesia is defined as:

A. dizziness related to change in patient position
B. loss of vision in one eye for a short period of time
C. loss of ability to move an extremity or other body part
D. an abnormal skin sensation, such as numbness or tingling

Answer 26

D

FeedBack:Paralysis is defined as loss of ability to move an extremity or other body part. Paresthesia refers to an abnormal skin sensation, such as numbness or tingling.

Question 27

A patient presents with gangrene of the foot and toes. The most likely cause of these symptoms is:

A. a 5cm aortic aneurysm with mural thrombus
B. chronic occlusion of the popliteal artery
C. extensive deep and superficial vein thrombosis
D. coarctation of the aorta

Answer 27

C

FeedBack:Venous gangrene usually involves the foot and all toes, while arterial gangrene usually involves one or two toes.

Question 28

Which of the following statements regarding venous ulceration is false?

A. Venous ulcerations are most commonly located on the medial calf/ankle area.
B. Venous ulcerations are usually very painful.
C. Venous ulcerations are usually wet and oozy.
D. Most venous ulcers can be treated and resolved.

Answer 28

B

FeedBack:Venous ulcerations are not reported as causing pain in majority of cases. Arterial ulcerations are very painful due to tissue ischemia and necrosis. Most venous ulcerations can heal once the venous insufficiency issue has been corrected. (stockings, laser, surgery etc)

Question 29

Which of the following risk factors has the highest incidence of lower extremity thrombus formation?

A. Diabetes
B. Polycythemia vera
C. Rotator cuff repair
D. Recent hip surgery

Answer 29

D

FeedBack:Patients who have undergone any type of lower extremity surgery are at the greatest risk of DVT. Usually these patients are confined to a bed for several days/weeks which leads to stasis. There are significant limitations with using blood thinners immediately following surgery because it would prevent the healing of the surgery and could lead to hemorrhage.

Question 30

A patient presents with a swollen left leg from hip to ankle and the right leg is normal. A US exam shows compressible vessels bilaterally. Doppler demonstrates normal flow in right, leg but there is loss of phasicity of flow and decreased augmentation of the left common femoral vein and proximal femoral vein. Which of the following is/are a potential diagnosis?

A. left ovarian mass and left external iliac thrombosis
B. right external iliac thrombosis and IVC thrombosis
C. bilateral external iliac and internal iliac thrombosis
D. IVC thrombosis
E. bilateral external iliac thrombosis

Answer 30

A

FeedBack:IVC thrombosis would cause flow abnormalities in both extremities. Internal iliac thrombosis will not affect the venous outflow of the legs.

Question 31

Adventitial cysts:

A. are more common in women
B. most commonly affect the popliteal artery
C. are a normal variant that can be seen in up to 10% of patients
D. are usually treated with bypass graft placement

Answer 31

B

FeedBack:Adventitial cysts are a rare condition that involves the collection of mucinous material within the adventitial wall layer of the affected vessel. They predominantly affect the peripheral arteries with the popliteal artery most commonly affected. The cysts are most common in young to middle-aged men. The can be treated by ultrasound guided cyst aspiration.

Question 32

Venous gangrene usually involves ____________________________, while arterial gangrene usually involves________________________.

A. the foot but no toes, the toes but not the foot
B. all the toes and foot, just one or two toes
C. right foot, left foot
D. just one or two toes, all the toes and foot

Answer 32

B

FeedBack:Venous gangrene usually involves the foot and all toes, while arterial gangrene usually involves one or two toes.

Question 33

A venous insufficiency exam is performed for a patient with multiple varicosities. The deep system is found to be competent, but there is insufficiency present in the great saphenous vein. Which of the following statements regarding the findings is true?

A. There are secondary varicosities present but compression stockings are not an option for treatment for this patient.
B. There are primary varicosities present.
C. There are secondary varicosities present.
D. Compression stockings are not an option for treatment for this patient.

Answer 33

B

FeedBack:Varicosities with superficial venous insufficiency related to deep venous system disease = secondary varicosities Varicosities with incompetent valves causing superficial venous insufficiency and normal deep system = primary varicosities Compression stockings are usually the first step in treatment for all varicosities.

Question 34

A 54yr old male presents with a moderately swollen right leg, from the upper thigh down to the ankle. He states that the leg started to swell 3 days ago. He first noticed it when he returned home from the airport following a recent vacation to Indonesia. What is the most likely cause of his symptoms?

A. Acute DVT in the femoral vein
B. Acute DVT in the popliteal vein
C. Superficial phlebitis in the great saphenous vein caused by infection
D. Chronic DVT in the femoral vein with onset of cellulitis

Answer 34

A

FeedBack:Superficial phlebitis would not lead to moderate leg swelling. Chronic DVT would not create an acute symptom. His recent history of a long flight to Indonesia increases his risk for Acute DVT formation due to stasis. Acute DVT in the popliteal vein would cause swelling of the lower leg only.

Question 35

Which of the following can cause overestimation of stenosis in the carotid artery?

A. polycythemia vera
B. congestive heart failure
C. aortic regurgitation
D. compensatory flow

Answer 35

D

FeedBack:When there is a significant stenosis or an occlusion in one carotid system, the carotid system on the other side can aid in feeding both sides of the brain. Flow velocities in the contralateral carotid system will be elevated. For example, if there is a left CCA occlusion, the velocities in the right CCA, ECA and ICA can increase with compensatory flow. If there is also a carotid stenosis on the right side, the stenosis can be overestimated using velocity criteria because the velocities are falsely elevated due to compensatory flow.

Question 36

Venous flow proximal to an AV fistula becomes ________________ due to the inflow of arterial flow distally

A. phasic
B. high resistance
C. pulsatile
D. continuous

Answer 36

C

FeedBack:Venous flow proximal to an AV fistula becomes pulsatile due to the inflow of arterial flow distally.

Question 37

You are performing a venous Doppler exam due to the recent onset of swelling in the left calf. The mid left femoral vein appears to be occluded by hypoechoic, non-compressible thrombus. The popliteal vein is completely compressible. Which of the following Doppler waveform characteristics is expected from the popliteal vein?

A. normal response to distal augmentation of calf muscle
B. decreased response to distal augmentation of calf muscle
C. loss of respiratory phasicity
D. increased pulsatility

Answer 37

C

FeedBack:The flow response to the distal augmentation would most likely be decreased but NEVER augment a patient’s calf when an acute DVT is diagnosed. The best answer is loss of respiratory phasicity because continuous flow is expected with the proximal obstruction.

Question 38

A varicose vein is usually:

A. a dilated vessel of the perforator system.
B. a dilated lesser saphenous vein.
C. a dilated tributary of the deep system.
D. a dilated tributary of the greater saphenous vein.

Answer 38

D

FeedBack:The greater saphenous vein and associated tributaries are most commonly associated with varicosity formation.

Question 39

If there is a 75% stenosis of the distal superficial femoral artery, which of the following arteries will demonstrate a monophasic waveform?

A. peroneal and posterior tibial
B. posterior and anterior tibial
C. anterior tibial only
D. posterior tibial, peroneal and anterior tibial

Answer 39

D

FeedBack:A 75% stenosis in the SFA will cause a significant loss of flow distally. The resistance in the distal vessels will drop and the waveforms will become monophasic.

Question 40

An aortic dissection most commonly originates:

A. in the infrarenal descending aorta
B. in the descending thoracic aorta, just distal to the origin of the left subclavian artery
C. in the aortic root
D. in the ascending aorta

Answer 40

B

FeedBack:Aortic dissection most commonly occurs in the descending thoracic aorta, just distal to the origin of the left subclavian artery. The ascending aorta and arch are the second most common sites for dissection.

Question 41

Which of the following would lead to overestimation of stenosis in the internal carotid artery?

A. Tandem stenosis
B. Reduced systemic blood pressure
C. Compensatory flow due to stenosis on other side
D. Significant aortic valve stenosis

Answer 41

C

FeedBack:Overestimation of stenosis in the ICA can be seen with:
Systemic HTN
Compensatory flow due to stenosis on other side
Short area of focal stenosis
Smaller vessel size
Elevated heart rate
Measuring a compensatory heart beat with arrhythmias

Question 42

The most common cause of hemodialysis graft failure is ________________.

A. thrombus formation
B. acute rejection
C. arterial stenosis
D. anastomosis rupture

Answer 42

A

FeedBack:The most common cause of hemodialysis graft failure is thrombus formation.

Question 43

Which of the following portions of the leg would be swollen with chronic insufficiency?

A. calf only
B. ankle and calf, but not the foot
C. foot and ankle, but not the calf
D. calf, foot, ankle

Answer 43

B

FeedBack:Swelling of the feet normally does not occur with venous disease (systemic or cardiac disease, yes)

Question 44

Which of the following is not considered a risk factor for peripheral arterial disease?

A. Smoking
B. Systemic HTN
C. Pregnancy
D. Diabetes

Answer 44

C

FeedBack:Pregnancy can lead to an increase in venous blood volume and stasis but has no effect on the formation of arterial disease.

Question 45

Which of the following will result in a low resistance ECA waveform with increased antegrade flow in diastole?

A. contralateral ICA occlusion
B. temporal arteritis
C. contralateral subclavian stenosis
D. ipsilateral mid CCA stenosis

Answer 45

D

FeedBack:The ECA normally demonstrates a high resistance flow pattern with minimal antegrade diastolic flow. Stenosis proximal to the ECA (in the CCA) or in the proximal ECA will cause lower resistance ECA flow with increased antegrade flow in diastole. If the ipsilateral ICA is occluded, these same changes will occur.

Question 46

Instep claudication is a symptom that is most commonly related to:

A. Thoracic outlet syndrome
B. Thromboangiitis Obliterans
C. Peripheral arterial disease
D. Raynaud’s syndrome

Answer 46

B

FeedBack:TAO refers to occlusive disease of SMALL to MEDIUM size arteries caused by inflammation of arterial wall. The disorder is always assoc. w/ heavy smoking and commonly presents with instep claudication.

Question 47

A damped waveform with low velocity turbulent systolic flow will be found:

A. at the stenosis site
B. distal to a significant stenosis
C. proximal to a significant stenosis
D. in a normal PTA tracing

Answer 47

B

FeedBack:Distal to the site of stenosis, the blood flow will be lower velocity than at the stenosis. Turbulence will also cause spectral broadening.

Question 48

What is caput medusa?

A. tortuous vessels around the umbilicus caused by portal HTN
B. lower extremity varicosities on the anterior thigh
C. formation of gastroesophageal varices caused by portal HTN
D. lower extremity varicosities on the anterior knee

Answer 48

A

FeedBack:Caput medusa refers to dilated, tortuous vessels around the umbilicus caused by portal HTN.

Question 49

The most common complication of lower extremity DVT is:

A. phlegmasia cerulea dolens
B. phlegmasia cerulea alba
C. pulmonary embolism
D. valvular incompetence

Answer 49

D

FeedBack:The presence of DVT damages venous valvular structure and motion. Pulmonary embolism is the most critical complication of a DVT.
Phlegmasia alba dolens is an extensive iliofemoral thrombosis, usually due to stasis of uterine blood with recent pelvic surgery or pregnancy. It presents as painful swelling and pallor of the entire leg (milk leg).
Phlegmasia cerulea dolens is an uncommon severe form of DVT which results from extensive thrombotic occlusion of the veins of an extremity. It presents as painful “blue” swollen leg. Milk leg becomes Blue leg if untreated.

Question 50

A patient presents with intermittent left lower leg swelling for several months. The popliteal vein demonstrates a collapsed appearance with echogenic, thickened walls. What is most likely diagnosis for this patient?

A. proximal venous stenosis
B. vasculitis of the popliteal vein
C. acute femoral DVT
D. chronic popliteal DVT

Answer 50

D

FeedBack:Chronic DVT will become echogenic as it becomes more fibrous while attached to the vein wall. The fibrous material limits the pliability of the walls leading to a semi-collapsed appearance.

Question 51

All of the following are symptoms of a patient with chronic venous disease, except:

A. Varicose veins
B. Spider veins
C. Recent onset of limb swelling
D. Discoloration of the “gaiter zone”

Answer 51

C

FeedBack:Recent swelling of the leg is an acute symptom.

Question 52

Patients with this risk factor have a greater incidence of atherosclerotic disease in walls of the vessels in the calf.

A. Systemic HTN
B. Diabetes
C. Raynaud syndrome
D. Buerger disease

Answer 52

B

FeedBack:Diabetic patients suffer from medial calcification of the blood vessel walls. This leads to increased resistance in the vessels and decreased flow.

Question 53

Which of the following has the lowest risk of DVT?

A. 3rd trimester pregnancy
B. Recent motor vehicle accident
C. Diabetes
D. Pelvic Mass

Answer 53

C

FeedBack:A pelvic mass and 3rd trimester pregnancy can cause extrinsic compression on a deep vein in the pelvis (iliac or IVC). This can reduce venous outflow in the extremity that can lead to DVT formation. Trauma to an extremity increases the risk of DVT formation.

Question 54

Which of the following symptoms is the most commonly seen with peripheral arterial disease?

A. Phlegmasia dolens
B. Dry ulcerations
C. Absent pedal pulses
D. Claudication

Answer 54

D

FeedBack:Claudication is defined as pain in muscles that subsides w/ rest. The pain will be predictable and reproducible at the same level of exercise. EX: Calf cramping occur every time the patient walks for 5 minutes

Question 55

An occlusion of the proximal left subclavian artery will lead to abnormal flow changes in all of the following, except:

A. left innominate artery
B. left vertebral artery
C. left brachial artery
D. left ulnar artery

Answer 55

A

FeedBack:There is no left innominate artery. An occlusion of the proximal left subclavian artery will lead to abnormal flow changes in those vessels distal to the occlusion. The axillary, brachial and forearm arteries will demonstrate abnormal flow patterns. The vertebral artery is a branch of the left subclavian artery and will also demonstrate abnormal flow.

Question 56

The bilateral proximal common carotid arteries demonstrate normal velocity and systolic upstroke. Diastolic flow reversal is present and continues throughout diastole. Which of the following correctly describes the findings?

A. aortic valve stenosis should be suspected
B. mid CCA occlusion should be suspected
C. significant aortic valve regurgitation should be suspected
D. proximal ICA occlusion should be suspected

Answer 56

C

FeedBack:Significant aortic valve regurgitation will cause flow to move from the ascending aorta/arch into the left ventricle during diastole. This can cause flow reversal that lasts throughout diastole in the branches of the arch. Both CCA can be affected. If there was an ICA occlusion, the CCA velocity would be reduced with minimal diastolic flow reversal in early diastole.

Question 57

Bilateral leg and foot edema are present. What is the most common cause for this?

A. Chronic insufficiency in the superficial system
B. Chronic insufficiency in deep system
C. Lymphedema
D. Congestive heart failure

Answer 57

D

FeedBack:Cardiac and systemic problems lead to bilateral swelling of the lower extremities, including the feet. Lymphedema can cause bilateral leg and foot swelling, but it is less common than CHF. Chronic venous disease does not normally cause swelling of the feet and is most commonly unilateral.

Question 58

Ten days post right hip replacement surgery, the patient presents with recent onset of right calf and thigh swelling. Which of the following should be considered a potential finding on the ultrasound exam?

A. AV malformation
B. Popliteal entrapment syndrome
C. Internal iliac vein thrombosis
D. AV fistula

Answer 58

D

FeedBack:Internal iliac vein thrombus would not lead to the leg swelling described. This vessel drains the pelvic organs and merges with the external iliac vein to form the common iliac vein. An AV malformation is a congenital disorder and would not be related to the onset of symptoms after surgery. Popliteal entrapment syndrome occurs with compression of the popliteal artery by the medial head of the gastrocnemius muscle. An AV fistula refers to a connection of an artery or vein due to trauma or invasive procedure.

Question 59

Which of the following correctly describes Hollenhorst plaques?

A. Heavily calcified plaque that forms in the distal aorta
B. Heavily calcified plaque that forms in the aortic arch
C. Usually seen on optometry exams
D. Most patients experience intermittent periods of unilateral blindness

Answer 59

C

FeedBack:Hollenhorst plaques are cholesterol emboli that originate from atherosclerotic lesions in the ipsilateral carotid artery or aorta and lodge in the small branches of the retinal artery. They are usually identified by an optometrist on a standard vision exam because the patient is asymptomatic.

Question 60

A 56yr old female presents with mild calf pain that is caused by dorsiflexion of the foot. The symptoms began after she returned from vacation in France. Yesterday she noticed a sudden red color change and edema, localized to lower leg. What is the most likely finding on the US exam?

A. cellulitis
B. acute DVT
C. chronic insufficiency
D. pseudoaneurysm

Answer 60

B

FeedBack:The patient noticed the problem after a vacation in France = long airplane ride = venous stasis. The sudden onset of additional symptoms indicates propagation of a clot in the calf.

Question 61

Which of the following would lead to underestimation of stenosis in the internal carotid artery?

A. Elevated heart rate
B. Compensatory flow due to stenosis on other side
C. Significant aortic valve stenosis
D. Short area of focal stenosis

Answer 61

C

FeedBack:Underestimation of stenosis in the ICA can be seen with:
Reduced systemic blood pressure
Proximal stenosis - such as significant aortic valve stenosis
Long area of focal stenosis
Tandem stenosis or eccentric stenosis
Critical stenosis (string flow)
Reduced cardiac output - CHF, coronary artery disease, dilated cardiomyopathy

Question 62

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

A. rubor
B. cyanosis
C. pallor
D. brawny

Answer 62

C

FeedBack:
Six "P"s of Acute Arterial Occlusion: 
1.	Pain 
2.	Pallor 
3.	Pulselessness 
4.	Paresthesia 
5.	Paralysis 
6. Polar Sensation (Cold) 
***Caused by embolism, thrombus formation or trauma

Question 63

Why would exposure to cold increase symptoms of lower extremity arterial stenosis?

A. blood becomes less viscous with cold exposure
B. increased resistance due to vasodilation
C. increased resistance due to vasoconstriction and blood becomes less viscous with cold exposure
D. increased resistance due to vasoconstriction

Answer 63

D

FeedBack:Cold exposure can cause the smaller vessels on the hand/foot to constrict which increases resistance to flow. This effect could further exacerbate symptoms of ischemia in the extremity.

Question 64

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 great saphenous vein is also occluded by thrombus. What is the diagnosis for this condition?

A. Phlegmasia Alba Dolens
B. Phlegmasia Cerulea Dolens
C. Acute arterial occlusion
D. Budd Chiari syndrome

Answer 64

B

FeedBack:Phlegmasia Cerulea Dolens refers to extensive DVT occluding deep system and superficial system. Arterial inflow is significantly affected. Severe limb edema and mottled skin are noted with cyanosis due to high concentration of deoxygenated blood. Tip for remembering the difference between Cerulea Dolens and Alba Dolens, “C”erulea causes “C”yanosis of the leg, while Alba Dolens results in pallor.

Question 65

A bilateral decrease in the femoral pulses can be related to:

A. aortic coarctation
B. DVT formation
C. occlusion of the deep femoral artery
D. occlusion of the popliteal artery

Answer 65

A

FeedBack:Aortic coarctation refers to the overgrowth of normal tissue in the aorta causing obstruction. It most commonly occurs in the arch just distal to the origin of the left subclavian artery. If the coarctation occurs distal to the origin of the left subclavian artery, both arms will demonstrate normal systolic BP and the legs will demonstrate significantly lower pressures. If the coarctation occurs proximal to the origin of the left subclavian artery, the right arm will demonstrate a much higher pressure than the left arm and the legs.

Question 66

If the tibioperoneal trunk is occluded, which calf vessel(s) will not demonstrate absent or monophasic flow?

A. posterior tibial artery and peroneal artery
B. dorsalis pedis and peroneal artery
C. anterior tibial and dorsalis pedis artery
D. anterior tibial artery and peroneal artery

Answer 66

C

FeedBack:The dorsalis pedis artery is the distal branch of the anterior tibial artery. The ATA branches from the popliteal artery leaving the tibioperoneal trunk to course into the calf to split into the PTA and peroneal vessels.

Question 67

All of the following conditions are risk factors related to increased incidence of upper extremity DVT, except?

A. central venous catheter for chemotherapy
B. recent shoulder surgery
C. hemophilia
D. polycythemia vera

Answer 67

C

FeedBack:Hemophilia refers to a condition causing abnormally thin blood and would be a contraindication to clot formation.

Question 68

Venous ulcers are normally located on the _______________, while arterial ulcers are normally found on the ____________.

A. distal calf, toes and heel
B. heel, toes
C. toes and heel, distal calf
D. calf, thigh

Answer 68

A

FeedBack:Venous ulcers are normally located on the distal calf, while arterial ulcers are normally found on the toes and heel.

Question 69

Secondary Raynaud phenomenon:

A. occurs in patients with severe venous disease
B. is a functional vasospastic disorder which occurs in patients with an unobstructed vascular system
C. is a functional vasospastic disorder that occurs due to kidney disease
D. occurs in patients with an obstructed vascular system

Answer 69

D

FeedBack:
Primary - NL vascular system, intermittent bilateral digital arterial spasm, excellent prognosis; Raynaud syndrome or disease
Secondary - ABNL obstructed system with vasoconstriction causes constant ischemia, may be unilateral; Raynaud phenomenon

Question 70

All of the following findings are commonly identified with a left subclavian steal, except:

A. increased resistance in the left axillary artery
B. increased flow volume and velocity in the right vertebral artery
C. flow reversal in the left vertebral artery
D. right vertebral artery increases in size

Answer 70

A

FeedBack:If the left subclavian artery is obstructed, flow will move from the right vertebral into the left vertebral artery. Flow in the right vertebral artery will increase with increased velocity as it tries to meet the increased demands. This usually causes the artery to dilate. Flow in the left vertebral artery is reversed and the flow enters the left subclavian artery distal to the obstruction. The flow in arteries of the left arm will demonstrate reduced resistance and a monophasic flow pattern.

Question 71

Arterial flow proximal to an AV fistula will be ________________.

A. phasic
B. high resistance
C. low resistance
D. laminar

Answer 71

C

FeedBack:Arterial flow proximal to an AV fistula will be low resistance.

Question 72

Which of the following vessels will be abnormally dilated with significant portal HTN?

A. main portal vein and hepatic veins
B. hepatic veins only
C. left gastric vein and hepatic veins
D. main portal vein and left gastric vein

Answer 72

D

FeedBack:The left gastric vein (AKA coronary vein) dilates with significant portal HTN It normally drains into the splenic vein near the portal confluence and is best evaluated in sagittal plane near porta hepatis. A dilated, patent umbilical vein is also a sign of significant portal HTN. It is best evaluated in the sagittal plane to the left of midline at the level of the ligamentum teres. It acts as a reservoir for portal blood with nowhere to go.

Question 73

A double peaked waveform obtained during PPG evaluation of the digits of the left hand is indicative of:

A. Subclavian stenosis
B. palmar arch stenosis
C. Raynaud syndrome
D. Thoracic outlet syndrome

Answer 73

C

FeedBack:The double peaked PPG tracing is indicative of vasospasm seen with Raynaud syndrome.

Question 74

Congestive heart failure is more commonly seen with ____________________, while distal ischemia is more commonly seen with _________________.

A. AV malformation, AV fistula
B. distal AV fistula, proximal AV fistula
C. proximal AV fistula, distal AV fistula
D. AV fistula, hemodialysis fistula

Answer 74

C

FeedBack:Congestive heart failure is more commonly seen with a proximal AVF, while distal ischemia is more commonly seen with distal AVF.

Question 75

Which of the following are collagen disorders that have increased risk for arterial dissection?

A. Shone’s complex and Blue Toe syndrome
B. Paget Schroetter syndrome and Raynaud syndrome
C. Marfan syndrome and Ehler-Danlos syndrome
D. Marfan syndrome and Polycythemia vera

Answer 75

C

FeedBack:Marfan syndrome and Ehler-Danlos syndrome are collagen disorders that can lead to the formation of arterial aneurysm or dissection. Shone’s complex is a group of cardiac defects and defects of the aortic arch and valve. Blue Toe syndrome is caused by emboli from an AAA with mural thrombus, Paget Schroetter syndrome affects the upper extremity veins. Raynaud syndrome is a collagen disorder that reduces flow to the hands/feet. Polycythemia vera is a rare cancer that causes blood thickening,

Question 76

All of the following describe an AV malformation, except:

A. dilated venous collaterals adjacent to the AVM
B. low resistance arterial inflow
C. direct connection between a single artery and vein
D. pulsatile venous outflow

Answer 76

C

FeedBack:An AVM is a congenital malformation with multiple connections between the arterioles and venules without a capillary bed in between. Venous collaterals will develop and dilate over time. The arterial inflow and venous outflow will demonstrate the same hemodynamic characteristics of an AVF, low resistance arterial inflow and pulsatile, turbulent venous outflow.

Question 77

Thromboangiitis obliterans involves inflammation of:

A. all vessel walls and surrounding connective tissue
B. all vessel walls with no effect on connective tissue
C. intimal wall layer
D. intimal and media wall

Answer 77

A

FeedBack:Thromboangiitis refers to diffuse inflammation of the intimal wall layer. Thromboangiitis obliterans refers to inflammation of all vessel walls and surrounding connective tissue.

Question 78

A patient presents with splenomegaly and multiple, small, tortuous vessels are visualized in the porta hepatis area of the liver. These vessels most likely represent:

A. Dilated extrahepatic biliary system
B. Cavernous transformation
C. Duplicated hepatic artery
D. Portal aneurysm

Answer 78

B

FeedBack:Cavernous transformation of the vessels at the porta hepatis refers to the formation of varices from the increased portal pressure with portal HTN. Accessory veins dilate at the porta hepatis due to the backlog of blood flow. These vessels are small and tortuous. Splenomegaly is another sign of portal HTN and a backlog in the blood flow in the portal system.

Question 79

Which of the following symptoms would be associated with steal syndrome of a hemodialysis graft?

A. hand pain that increases with exercise
B. spontaneous bruising of the neck, arm and hand
C. hand pain that is reduced or eliminated during dialysis
D. shoulder swelling

Answer 79

A

FeedBack:Steal Syndrome most commonly occurs in a radiocephalic graft. The ulnar artery flow will be antegrade and the radial artery flow will be retrograde. Blood travels from the ulnar artery into the hand and moves through the palmar arch to exit the hand in the radial artery. Symptoms include pain, polar sensation, paresthesia, Finger/Brachial Index <0.8, cyanotic finger tips, and diminished radial pulse on palpation. Symptoms can increase with use of the arm (exercise) and during dialysis.

Question 80

Which of the following is not a symptom of peripheral arterial stenosis?

A. pallor
B. pain
C. paresthesia
D. prominent pedal pulses

Answer 80

D

FeedBack:In patients with peripheral arterial stenosis the pedal pulses are usually diminished or absent.

Question 81

Incompetent venous valves will lead to all of the following, except:

A. systemic hypertension
B. venous hypertension
C. edema
D. dilated superficial veins

Answer 81

A

FeedBack:Incompetent venous valves will cause a back log of blood in the legs and elevated pressure in the veins. Edema will develop and the superficial system will dilate because flow cannot easily enter the deep system.

Question 82

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:

A. normal variant in patients over 70yrs of age
B. Juxtarenal dissection
C. Type B dissection
D. Type A dissection

Answer 82

C

FeedBack:
Stanford Classification:
Type A: dissections that involve the ascending aorta and arch
Type B: dissections that involve the aorta from the left subclavian artery to the iliac bifurcation

Question 83

Which of the following is the most common site for atherosclerosis formation in the lower extremity?

A. CFA bifurcation
B. SFA in Adductor canal
C. Calf trifurcation
D. Popliteal artery

Answer 83

B

FeedBack:The most common site for atherosclerosis formation in the lower extremity is in the SFA in the adductor canal.

Question 84

Upper extremity DVT is increasing in incidence due to:

A. Increased applications of shoulder surgery techniques
B. Decreased reliance on Coumadin as an acceptable blood thinner
C. Increased use of central venous catheters
D. Increased use of urinary catheters

Answer 84

C

FeedBack:The increased use of central venous catheters has led to an increased incidence upper extremity DVT. The puncture of the vein wall leads to blood cell accumulation on the rough surface. The catheter causes flow turbulence that can lead to stasis.

Question 85

Why does blood move into smaller collateral vessels when a larger vessel is occluded?

A. the resistance to flow in the smaller collateral is higher than the resistance in the occluded vessel
B. the resistance to flow in the smaller collateral is lower than the resistance in the occluded vessel
C. to compensate for loss of blood flow proximal to the obstruction
D. because of the significant drop in venous pressure

Answer 85

B

FeedBack:Collateral flow around an occlusion develops to compensate for the reduction in flow to the distal tissues. When the native artery is patent, the resistance to flow is greater in the smaller arteries. When the larger artery is occluded, the resistance to flow in the smaller collateral is lower than the resistance in the occluded vessel. Blood flow moves into the vessel with the least resistance.

Question 86

Which of the following conditions can cause cardiac pulsatility to occur in the leg veins?

A. Tachycardia
B. Bradycardia
C. Congestive heart failure
D. DVT

Answer 86

C

FeedBack:As the heart moves in the chest it causes the ripple effect in the venous system. Normally, the upper IVC and Hepatic veins demonstrate this ripple effect as flow reversal during cardiac systole. The “ripples” of cardiac pressure/motion usually dissipate as they reach the mid abdomen area. In patients with CHF, the venous blood volume is increased throughout the system. The cardiac pulsatility will extend further into the lower extremities due to the increased blood volume.

Question 87

Which of the following is the second most common site for atherosclerosis formation in the lower extremity?

A. popliteal trifurcation
B. origin of the common iliacs
C. Distal SFA in Adductor canal
D. CCA bifurcation

Answer 87

B

FeedBack:The distal SFA in the adductor canal is the most common site of atherosclerosis formation in the legs.

Question 88

When compared to the normal left CCA, the right CCA demonstrates reduced velocity, slower upstroke and holodiastolic flow. Which of the following is the most likely cause?

A. congestive heart failure
B. stenosis proximal to the point of insonation
C. decreased hematocrit levels
D. elevated hematocrit levels

Answer 88

B

FeedBack:If a single CCA demonstrates reduced velocity, slower upstroke and holodiastolic flow = stenosis proximal to the point of insonation. The vessel demonstrates the characteristics of flow distal to a stenosis. The other choices would cause hemodynamic changes in both carotid arteries.

Question 89

Patients with venous disease may describe leg pain that is:

A. relieved by elevating the legs
B. relieved by placing the legs in a dependent position
C. relieved by resting/sitting
D. very painful and accompanied by paresthesia

Answer 89

A

FeedBack:Venous disease symptoms will be relieved by elevating the legs to “empty” the calves. Arterial disease symptoms will be relieved by standing still or placing the legs in a dependent position.

Question 90

A patient presents with a history of right hip and thigh pain with numbness when he walks. Sometimes he walks only a short distance before the pain starts and sometimes he can walk for 20-30 minutes before the pain starts. There are no symptoms in his lower leg. The pain is reduced by sitting down. What is the most likely cause for the symptoms?

A. chronic venous disease
B. peripheral arterial disease
C. Raynaud’s disease
D. The vascular system is most likely unrelated to the symptoms.

Answer 90

D

FeedBack:The leg pain is not consistent and reproducible which are key components of claudication related to vascular disease.

Question 91

Post-phlebitic Syndrome:

A. refers to valve damage in the veins after thrombus formation
B. refers to black discoloration of the toes caused by embolism from a AAA.
C. will usually resolve within 2 weeks after treatment for DVT.
D. will usually resolve within 6-8 weeks after treatment for DVT.

Answer 91

A

FeedBack:Post-phlebitic Syndrome refers to valve damage in the veins after thrombus formation.

Question 92

If significant disease is identified on the Doppler evaluation, but 4 minutes of exercise has little effect on the ankle pressures:

A. there are collateral pathways present
B. service should be scheduled for the ultrasound unit
C. digital pressures must be recorded to diagnose disease in this patient
D. post-occlusive reactive hyperemia should be performed

Answer 92

A

FeedBack:If significant disease identified on the Doppler evaluation, but exercise has little effect on the ankle pressures, collateral pathways are present that are maintaining the required flow volume. Digit pressures would also be normal due to the collateral flow. Post-occlusive reactive hyperemia is reserved for those patients that cannot exercise. If it was performed, it would provide the same results as exercise.

Question 93

The Bernoulli principle explains the:

A. increase in pressure seen with increased blood flow velocity
B. decrease in pressure seen with increased blood flow velocity
C. decrease in resistance seen with increased blood flow velocity
D. decrease in pressure seen with decreased blood flow velocity

Answer 93

B

FeedBack:The Bernoulli principle explains the decrease in pressure seen with increased blood flow velocity.

Question 94

Which of the following statements is true regarding the signs and symptoms of lower extremity arterial disease?

A. Significant ischemic disease in the leg will lead to pallor with dependency.
B. Significant ischemic disease in the leg will lead to rubor with elevation.
C. Significant ischemic disease in the leg will lead to cyanosis upon elevation.
D. Significant ischemic disease in the leg will lead to pallor upon elevation and rubor with dependency.

Answer 94

D

FeedBack:Significant ischemic disease in the leg will lead to pallor upon elevation and rubor with dependency.

Question 95

When evaluating a patient with an aortic endograft, what is the minimum increase in aortic sac size that indicates a possible endoleak?

A. 0.2cm
B. 0.9cm
C. 0.5cm
D. 1.5cm

Answer 95

C

FeedBack:An increase in aortic sac diameter of 0.5cm or greater indicates a possible endoleak

Question 96

All of the following are risk factors for developing a thrombus in a deep vein, except?

A. Polycythemia vera
B. Oral contraceptive pills (OCP)
C. Obesity
D. Anemia

Answer 96

D

FeedBack:Anemia causes thinned blood.

Question 97

All of the following are sonographic findings of chronic DVT, except:

A. Incomplete compressibility of the vein
B. Engorged vein with increased echogenicity in the lumen
C. Flattened, collapsed vessel with increased echogenicity of the wall
D. Valvular insufficiency

Answer 97

B

FeedBack:Chronic thrombus will demonstrate as echogenic material lining a partially collapsed vein. Acute thrombus causes the vein to grow in size and appear engorged with blood/debris.

Question 98

A 65yr old female presents with left leg swelling for over one year. Mild brown discoloration is present in the distal calf and ankle area. What is the most likely diagnosis found on an ultrasound exam?

A. Chronic Insufficiency
B. Superficial Phlebitis
C. Cellulitis
D. Acute DVT

Answer 98

A

FeedBack:Chronic swelling and brown discoloration are characteristics of venous stasis. This is most commonly associated with chronic insufficiency. Acute DVT would result in acute swelling with a red discoloration.

Question 99

Lower extremity ulcers are most commonly caused by __________________.

A. chronic venous disease
B. acute venous disease
C. chronic arterial disease
D. recurrent cellulitis

Answer 99

A

FeedBack:Lower extremity ulcers are most commonly caused by chronic venous disease. (75%)

Question 100

Carotid body tumors are more common in:

A. men and people with Buerger disease
B. women and people living at sea level
C. women and people living at high altitudes
D. men and people with Ehler-Danlos syndrome

Answer 100

C

FeedBack:CBT is more common in females. Living at higher altitudes means less oxygen in the air. Chronic hypoxia leads to an overactive and enlarged CBT.

Question 101

Patients with lower extremity venous insufficiency may describe pain

A. that is relieved by elevating the legs
B. that is relieved by placing legs in a dependent position
C. that is relieved by lying down
D. that is relieved by walking

Answer 101

A

FeedBack:The dependent position helps blood to reach the lower legs more quickly. Walking and elevating the legs would increase the flow toward the heart. Walking will increase the arterial flow to into an already inefficient venous system. This can lead to increased pooling in the lower leg.

Question 102

Aside from the carotid artery, what other vessels are commonly affected by fibromuscular dysplasia (FMD)?

A. small arteries of the foot and ankle
B. jugular veins
C. renal and mesenteric arteries
D. small arteries of the hand and wrist

Answer 102

C

FeedBack:If FMD is identified in the carotid arteries, the renal and mesenteric arteries should also be evaluated for FMD. Stenosis caused by atherosclerosis usually affects the origin of the artery, while FMD usually causes stenosis in the mid/distal artery.

Question 103

Which of the following is a sonographic sign of acute DVT?

A. partial compressibility
B. continuous flow pattern on Doppler
C. vein engorged with thrombus
D. hyperechoic material adhered to the vein wall

Answer 103

C

FeedBack:Acute DVT will cause the vein to increase in size as it fills with thrombus. Chronic DVT usually causes a partial obstruction as the thrombus atrophies becoming denser. Acute thrombus formation usually appears hypoechoic while chronic thrombosis usually appears more echogenic.

Question 104

Which of the following is a sign of a normally functioning hemodialysis graft?

A. presence of a water hammer pulse
B. pain or pallor in the hand
C. palpable thrill over the graft
D. absence of a palpable thrill over the graft

Answer 104

C

FeedBack:A normal AVG should demonstrate a palpable thrill as blood flow moves through it. Absence of the thrill or a water hammer pulse is indicative of an occluded graft. If the graft becomes stenosed or occluded, the distal forearm and hand could become ischemic.

Question 105

Which of the following correctly describes myointimal hyperplasia in an arterial bypass graft?

A. Caused by the healing process at the anastomosis sites
B. Not identified on ultrasound until greater than 3 years post-op
C. Most commonly occurs in an in situ vein graft at sites of valve removal
D. Easily differentiated from atheroma formation

Answer 105

A

FeedBack:Myointimal hyperplasia is a common cause of stenosis at the anastomosis sites of a graft. Native tissues proliferate during the healing process after graft placement. It can be identified anytime from 1 month to 2 years post-op. Difficult to differentiate from soft atheroma formation.

Question 106

Which of the following vessels is the most common location of a saccular intracranial aneurysm?

A. Anterior communicating artery
B. Middle cerebral artery
C. Internal carotid artery siphon
D. Posterior communicating artery

Answer 106

A

FeedBack:The anterior communicating artery is the most common location for a berry or saccular intracranial aneurysm.

Question 107

All of the following correctly describe Hypothenar Hammer Syndrome, except:

A. Positive Tinel sign
B. Ulnar artery is commonly affected by occlusion or stenosis
C. Associated with Raynaud syndrome
D. Negative Allen test

Answer 107

D

FeedBack:Hypothenar Hammer Syndrome can be caused by repetitive compression or blunt trauma. The ulnar artery is commonly affected because it crosses over the hook of hamate bone. It is associated with Raynaud syndrome and most commonly causes ischemia of fourth and fifth fingers.
Positive Tinel sign = distal paresthesia induced by compression of the affected portion of the entrapped ulnar nerve
Positive Allen test = demonstrates occlusion of the distal ulnar artery
Ultrasound may also demonstrate irregular contour or aneurysm of the ulnar artery

Question 108

Which of the following describes Takayasu Arteritis?

A. most commonly affects the ascending aorta
B. most commonly found in patients that smoke
C. more common in males
D. strongly associated with stasis dermatitis

Answer 108

A

FeedBack:Takayasu Arteritis presents as hypertrophic area(s) of inflamed tissue found in the aorta and its branches. It is commonly associated with supravalvular aortic stenosis and aortic coarctation. It can also affect the renal and subclavian arteries. Most commonly seen in young females.

Question 109

Which of the following would cause flow in the left ECA to reverse direction during systole?

A. right CCA occlusion
B. left vertebral artery occlusion
C. left CCA occlusion
D. left proximal ICA occlusion

Answer 109

C

FeedBack:Ipsilateral CCA occlusion can cause ECA flow reversal so that it can supply the ICA with flow. The left ECA will reverse to fill the left ICA with blood because the CCA is occluded.

Question 110

Which of the following causes flow reversal in venous perforators?

A. superficial thrombosis
B. deep vein thrombosis
C. compression stockings
D. combination of superficial and deep thrombosis

Answer 110

B

FeedBack:DVT in the deep system forces any remaining flow into areas of lower pressure, the perforators. Flow exits the deep system through the perforators to try to “escape” into the patent superficial system.

Question 111

All of the following are risk factors for venous disease except:

A. Excessive standing
B. Excessive sitting
C. Polycythemia vera
D. Hyperlipidemia

Answer 111

D

FeedBack:Hyperlipidemia refers to high cholesterol which is a risk factor for arterial disease. Excessive sitting or standing can lead to venous stasis and thrombus formation. Polycythemia vera causes thickening of the blood which can lead to venous stasis and thrombus formation.

Question 112

An acute occlusion occurs in the common iliac artery on the left side. Which of the following vessels will also have absent flow?

A. external iliac artery only
B. common femoral artery and saphenous artery
C. internal iliac artery and gonadal artery
D. common femoral, external iliac and internal iliac artery

Answer 112

D

FeedBack:The external iliac and internal iliac arteries are branches of the common iliac artery. The external iliac artery becomes the common femoral artery once it crosses beneath the inguinal artery.

Question 113

Aneurysm formation affects the ____________________________, while atherosclerotic disease affects the _______________________.

A. proximal arteries, distal arteries
B. extracranial arteries, intracranial arteries
C. media and adventitia layers of the vessel wall, intimal layer of the vessel wall
D. intimal layer of the vessel wall, media and adventitia layers of the vessel wall

Answer 113

C

FeedBack:Aneurysm formation is caused by a breakdown of the media and adventitia layers of the vessel wall. Atherosclerotic disease causes formation of plaque within the intimal layer of the vessel wall. Both disorders can be found in any artery in the body.

Question 114

128. ____________________ cause primary varicose veins, while ___________________ cause secondary varicose veins.

A. elevated deep venous pressures, incompetent valves
B. elevated deep venous pressures, elevated arterial pressures
C. incompetent valves, incompetent perforators
D. incompetent valves, elevated deep venous pressures

Answer 114

D

FeedBack:Incompetent valves cause primary varicose veins, while elevated deep venous pressures in a diseased deep system (hx of DVT or abnormal valves) cause secondary varicose veins. Primary varicose veins are much more common than secondary.

Question 115

Elevated venous pressure in the lower extremities will cause:

A. dilated superficial veins
B. edema
C. heavy feeling in the legs
D. all of the above

Answer 115

D

Question 116

Which of the following is not a common symptom of chronic venous disease?

A. pitting edema
B. brawny discoloration
C. varicosities
D. pallor

Answer 116

D

FeedBack:Pallor is most commonly a sign of arterial disease.

Question 117

Which of the following is related to the appearance of Rouleaux formation on the image?

A. Raynaud Syndrome
B. DVT
C. Thoracic outlet syndrome
D. Intracranial collateral flow

Answer 117

B

FeedBack:Proximal to a DVT the flow may be very slow and visible on 2D imaging; the RBCs appear lined up or stacked in rolls similar to coin rolls from your bank which is called the Rouleaux Formation

Question 118

Which of the following vessels would most likely be occluded in a patient with Phlegmasia Alba Dolens?

A. deep veins, superficial veins and common femoral artery
B. femoral vein, deep calf veins, popliteal vein
C. saphenous veins only
D. common femoral artery

Answer 118

B

FeedBack:Phlegmasia Alba Dolens refers to a condition where all deep venous vessels are occluded in the extremity causing reduced arterial inflow. The superficial veins are usually patent. The leg has a milky white appearance due to severe outflow obstruction and markedly reducing arterial inflow. Leads to ischemia in entire extremity with severe pain.

Question 119

Which of the following statements is false regarding venous insufficiency?

A. Insufficiency will occur even with patient standing quietly.
B. The valsalva maneuver will increase venous flow reversal in the legs.
C. In cases of severe insufficiency, exercise will help to decrease venous pooling in the lower legs.
D. Distal and proximal augmentation techniques provide useful Doppler information regarding the presence/absence of insufficiency.

Answer 119

C

FeedBack:Increased arterial inflow with limited venous outflow causes pooling in legs even with calf muscle pump function. The problem is not with the calf pump, gravity and incompetent valves cause the pump to be inefficient.

Question 120

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. What is the most likely cause of these color changes?

A. significant venous obstruction
B. normal arterial flow
C. significant aortic stenosis
D. deep venous reflux

Answer 120

C

FeedBack:Pallor and dependent rubor are indications of significant arterial disease. The bilateral presentation indicates the obstruction is blocking flow to both legs = aorta.