Pathology Pt 2 Flashcards
1
Q
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
A
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.
2
Q
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
A
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.
3
Q
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
A
A
FeedBack:Disease in the common iliac and internal iliac artery can lead to ischemia of the penile tissues.
4
Q
Numbness and tingling in the extremities is summarized by what term listed below?
A. Paralysis
B. Paresis
C. Paresthesia
D. Pallor
A
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.
5
Q
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
A
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.
6
Q
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
A
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.
7
Q
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.
A
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.
8
Q
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
A
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.
9
Q
Which of the following is associated with CREST syndrome?
A. Secondary Raynaud phenomenon
B. Superficial phlebitis
C. Primary Raynaud disease
D. Aortic aneurysm
A
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.
10
Q
Which of the following vessels supplies blood to a carotid body tumor?
A. ICA
B. subclavian
C. ECA
D. MCA
A
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.
11
Q
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
A
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.
12
Q
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
A
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.
13
Q
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
A
A
FeedBack:Arterial claudication occurs distal to the hemodynamically significant obstruction.
14
Q
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
A
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.
15
Q
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
A
B
FeedBack:Pre-Stenotic Zone: Increased resistance and resistive index, Flow velocity may be dampened with loss of diastolic flow, Short acceleration time
16
Q
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
A
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.
17
Q
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
A
C
FeedBack:FMD usually occurs in the mid or distal segment of the ICA, while atherosclerosis most commonly affects the proximal ICA.
18
Q
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
A
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.
19
Q
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
A
B
FeedBack:Raynaud, TOS, Buerger disease and atherosclerosis can all lead to abnormally low digit pressures and abnormal PPG tracing.
20
Q
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
A
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.
21
Q
What is the most common symptom of peripheral arterial disease?
A. claudication
B. rest pain
C. decreased pedal pulses
D. ulceration
A
A
FeedBack:Claudication is the most common symptom of peripheral arterial disease.
22
Q
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
A
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.
23
Q
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
A
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.
24
Q
The Scimitar sign is associated with:
A. Median arcuate ligament syndrome
B. Adventitial cysts
C. Bovine arch
D. Femoral to Femoral bypass graft
A
: 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).
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
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.
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
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.
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
C
FeedBack:Venous gangrene usually involves the foot and all toes, while arterial gangrene usually involves one or two toes.
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.
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)
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
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.
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
A
FeedBack:IVC thrombosis would cause flow abnormalities in both extremities. Internal iliac thrombosis will not affect the venous outflow of the legs.
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
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.
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
B
FeedBack:Venous gangrene usually involves the foot and all toes, while arterial gangrene usually involves one or two toes.
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.
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.
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
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.
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
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.
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
C
FeedBack:Venous flow proximal to an AV fistula becomes pulsatile due to the inflow of arterial flow distally.
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
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.
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.
D
FeedBack:The greater saphenous vein and associated tributaries are most commonly associated with varicosity formation.
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
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.
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
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.
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
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
42
The most common cause of hemodialysis graft failure is ________________.
A. thrombus formation
B. acute rejection
C. arterial stenosis
D. anastomosis rupture
A
FeedBack:The most common cause of hemodialysis graft failure is thrombus formation.
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
B
FeedBack:Swelling of the feet normally does not occur with venous disease (systemic or cardiac disease, yes)
44
Which of the following is not considered a risk factor for peripheral arterial disease?
A. Smoking
B. Systemic HTN
C. Pregnancy
D. Diabetes
C
FeedBack:Pregnancy can lead to an increase in venous blood volume and stasis but has no effect on the formation of arterial disease.
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
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.
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
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.
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
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.
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
A
FeedBack:Caput medusa refers to dilated, tortuous vessels around the umbilicus caused by portal HTN.
49
The most common complication of lower extremity DVT is:
A. phlegmasia cerulea dolens
B. phlegmasia cerulea alba
C. pulmonary embolism
D. valvular incompetence
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.
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
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.
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"
C
FeedBack:Recent swelling of the leg is an acute symptom.
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
B
FeedBack:Diabetic patients suffer from medial calcification of the blood vessel walls. This leads to increased resistance in the vessels and decreased flow.
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
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.
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
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
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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
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
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
```
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
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.
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
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.
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
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.
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
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.
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
C
FeedBack:Hemophilia refers to a condition causing abnormally thin blood and would be a contraindication to clot formation.
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
A
FeedBack:Venous ulcers are normally located on the distal calf, while arterial ulcers are normally found on the toes and heel.
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
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
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
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.
71
Arterial flow proximal to an AV fistula will be ________________.
A. phasic
B. high resistance
C. low resistance
D. laminar
C
FeedBack:Arterial flow proximal to an AV fistula will be low resistance.
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
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.
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
C
FeedBack:The double peaked PPG tracing is indicative of vasospasm seen with Raynaud syndrome.
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
C
FeedBack:Congestive heart failure is more commonly seen with a proximal AVF, while distal ischemia is more commonly seen with distal AVF.
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
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,
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
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.
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
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.
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
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.
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
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.
80
Which of the following is not a symptom of peripheral arterial stenosis?
A. pallor
B. pain
C. paresthesia
D. prominent pedal pulses
D
FeedBack:In patients with peripheral arterial stenosis the pedal pulses are usually diminished or absent.
81
Incompetent venous valves will lead to all of the following, except:
A. systemic hypertension
B. venous hypertension
C. edema
D. dilated superficial veins
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.
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
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
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
B
FeedBack:The most common site for atherosclerosis formation in the lower extremity is in the SFA in the adductor canal.
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
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.
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
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.
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
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.
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
B
FeedBack:The distal SFA in the adductor canal is the most common site of atherosclerosis formation in the legs.
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
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.
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
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.
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.
D
FeedBack:The leg pain is not consistent and reproducible which are key components of claudication related to vascular disease.
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.
A
FeedBack:Post-phlebitic Syndrome refers to valve damage in the veins after thrombus formation.
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
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.
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
B
FeedBack:The Bernoulli principle explains the decrease in pressure seen with increased blood flow velocity.
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.
D
FeedBack:Significant ischemic disease in the leg will lead to pallor upon elevation and rubor with dependency.
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
C
FeedBack:An increase in aortic sac diameter of 0.5cm or greater indicates a possible endoleak
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
D
FeedBack:Anemia causes thinned blood.
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
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.
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
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.
99
Lower extremity ulcers are most commonly caused by __________________.
A. chronic venous disease
B. acute venous disease
C. chronic arterial disease
D. recurrent cellulitis
A
FeedBack:Lower extremity ulcers are most commonly caused by chronic venous disease. (75%)
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
A
FeedBack:The anterior communicating artery is the most common location for a berry or saccular intracranial aneurysm.
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
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
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
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.
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
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.
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
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.
111
All of the following are risk factors for venous disease except:
A. Excessive standing
B. Excessive sitting
C. Polycythemia vera
D. Hyperlipidemia
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.
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
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.
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
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.
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
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.
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
D
116
Which of the following is not a common symptom of chronic venous disease?
A. pitting edema
B. brawny discoloration
C. varicosities
D. pallor
D
FeedBack:Pallor is most commonly a sign of arterial disease.
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
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
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
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.
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.
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.
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
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.
