US Guided Proc, Prep and Reporting

Question 1

A 76 yr old female with diabetes, HTN and COPD is sent to the vascular lab for a six month follow up on a carotid stenosis. What is the best patient position to use for the exam

Answer 1

semi erect with or without a pillow

Question 2

A recent CT scan demonstrates an acute infarct in the parietal lobe and a new blockage in the proximal left MCA. What is the most likely source for the embolism

Answer 2

plaque broke away from the sclerotic aortic valve

Question 3

Which exam would be improved by the administration of simethicone prior to the ultrasound evaluation

Answer 3

renal artery duplex

Question 4

What lab values may be elevated with renal artery stenosis

Answer 4

serum BUN and creatine

Question 5

A patient presents for a TCD exam due to an abnormal CT scan of the brain. The report states there is a recent cerebellar infarct. What vessels should you pay special attention to during the TCD exam

Answer 5

vertebral and basilar arteries

Question 6

A patient presents with dysphagia and hoarseness. The referring physician suspects Ortner syndrome. What type of exam will you be performing

Answer 6

upper extremity arterial duplex exam

Question 7

In some patients the right subclavian artery can be a direct branch of the aorta distal to the left subclavian origin. It is called __________. The artery usually originates from a dilated segment of the proximal descending aorta called the _________

Answer 7

retroesophageal subclavian artery or aberrant right subclavian artery, kommerell diverticulum

Question 8

D-dimer levels are most accurate for predicting

Answer 8

the absence of DVT

Question 9

A patient presents with an order for a lower extremity venous doppler exam to rule out venous insufficiency. This patient should be evaluated in the ______ position in order to ________

Answer 9

standing, increase hydrostatic pressure

Question 10

When preparing for a patient with suspected thoracic outlet syndrome, what other information should you review for pertinent information

Answer 10

chest x-ray

Question 11

The right frontal lobe is supplied with blood by the

Answer 11

right ACA and MCA

Question 12

A patient presents for a TCD exam due to an abnormal report from a CT of the brain. The report states that there is an acute infarct in the right frontal lobe. A significant stenosis in which arteries would be the most likely cause for these findings

Answer 12

right ACA or right MCA

Question 13

If the velocities in both carotid arteries are increased since last year’s exam with no visible change in plaque formation, what should you review in the patient chart as a possible explanation

Answer 13

lab values for decreased hematocrit levels

Question 14

Bilateral increased velocities in the CCA and ICA with no evidence of stenosis is usually related to

Answer 14

increased cardiac output

Question 15

When evaluating a pregnant patient for DVT, the patient should be placed in the ________ position

Answer 15

left oblique or decubitus

Question 16

A patient presents for a carotid ultrasound. The exam demonstrates significant atheroma formation and string flow in the proximal right ICA. What signs or symptoms listed in the patient chart would be related to the findings

Answer 16

left arm and leg paresthesia

Question 17

A patient presents for a TCD exam with a recent diagnosis of subdural hematoma. What is the physician looking for on the TCD exam

Answer 17

vasospasm

Question 18

If a patient complains of a single 12hr episode of right arm paresthesia and paralysis, what will you report on your technologist worksheet

Answer 18

history of transient ischemic attack

Question 19

What transducer would be preferred for a lower extremity DVT evaluation on an average sized patient

Answer 19

5-7MHz linear

Question 20

_________ transducers are used for evaluation of the superficial system for insufficiency or vein mapping

Answer 20

7-10MHz

Question 21

Why should a venous insufficiency exam be performed with the patient in the standing position

Answer 21

to evaluate the veins with the added effect of hydrostatic pressure

Question 22

When evaluating a suspected stenosis in the lower extremity arterial system, the peak systolic velocity is documented on the waveforms obtained. What other two factors should be reported to determine the severity of the stenosis

Answer 22

velocity ratio and diastolic flow direction

Question 23

What correctly describes how to prepare for an intra-operative vascular ultrasound

Answer 23

cover a high frequency transducer with a sterile sheath that contains gel

Question 24

A patient is undergoing balloon angioplasty of the left common femoral artery. The physician just completed the first expansion of the balloon and asks you to check the flow with doppler. Where is the preferred location to evaluate flow

Answer 24

dorsalis pedis or posterior tibial artery

Question 25

Endovenous heat-induced thrombosis (EHIT) is a complication of

Answer 25

radiofrequency ablation

Question 26

A patient is scheduled for a stab phlebectomy. What is being treated for this patient

Answer 26

varicose veins

Question 27

What statement best describes the doppler tracing found in the stalk of a pseudoaneurysm

Answer 27

high resistance to and fro flow

Question 28

At _______ post-injection, _______ should be performed to determine the success of a thrombin injection for pseudoaneurysm treatment

Answer 28

20 minutes, color doppler and ABI evaluation

Question 29

What is a contraindication for endovenous laser ablation of the great saphenous vein

Answer 29

chronic obstruction of the femoral vein

Question 30

Residual hyperechoic plaque in the lumen that has an abrupt edge

Answer 30

shelf lesion

Question 31

Hypoechoic/anechoic material adjacent to vessel wall that causes increased flow velocity

Answer 31

platelet aggregate

Question 32

_________ refers to the injection of a solution into spider veins to cause them to atrophy and requires aseptic technique

Answer 32

sclerotherapy

Question 33

What requires the use of sterile technique

Answer 33

radiofrequency venous ablation

Question 34

The terminal tip of the venous catheter is positioned in which central vein

Answer 34

distal 1/3 of the SVC (atriocaval junction)

Question 35

In most cases, a peripherally inserted central catheter (PICC) line is inserted in the basilic vein and advanced until the tip reaches

Answer 35

artiocaval junction

Question 36

What is true regarding the initial post-op examination of a TIPS placement

Answer 36

it helps to establish baseline velocities for upcoming follow up exams

Question 37

Why is the distance from the most proximal point of the contracted GSV to the saphenofemoral junction measured in a post-ablation exam

Answer 37

to document the lack of thrombus propagation into the deep system

Question 38

A patient presents for a follow up for the TIPS located between the right portal vein and right hepatic vein. The chart indicates an abnormal bruit and stenosis is suspected. Where should you look first for the stenosis because it is the most common site of stenosis in a TIPS

Answer 38

hepatic vein anastomosis

Question 39

A patient presents for follow up after a mesenteric stent placement procedure for a 75% SMA stenosis. What describes the findings in the SMA that indicate a successful procedure

Answer 39

increased resistance and decreased diastolic flow

Question 40

At the start of an endovenous ablation procedure for the GSV, the catheter is inserted _______ and advanced to a position _________ before activating the device

Answer 40

into the distal GSV, 2cm distal to the SFJ

Question 41

When evaluating the left arm for potential placement of a central venous catheter, you identify multiple small venous collaterals surrounding the subclavian vein, what should you do next

Answer 41

evaluate the venous system in the right arm

Question 42

If the GSV is being used to create an in situ vein graft _________

Answer 42

all perforator veins must be marked on the vein mapping so they can be closed

Question 43

What correctly describes sclerotherapy procedures

Answer 43

physicians may inject saline into the superficial veins of the extremity in order to cause the vessel to contract and cause fibrosis, which in turn reduces varicosity size

Question 44

The anatomical snuff box is also called the

Answer 44

radial fossa

Question 45

A “snuffbox” fistula connects what two vessels

Answer 45

radial artery connects to the cephalic vein in the radial fossa

Question 46

After an endarterectomy or carotid stent placement, the first follow up exam should be performed

Answer 46

within one month after the procedure

Question 47

What is the primary reason why dialysis grafts are commonly placed at the antecubital fossa or wrist, and not the shoulder

Answer 47

the closer the AV fistula to the heart, the greater the risk for developing heart failure

Question 48

Retained valve cusps are a complication of

Answer 48

in situ saphenous graft

Question 49

The most common cause of hemodialysis graft failure is

Answer 49

thrombus formation

Question 50

A peak systolic velocity greater than _______ is consistent with >75% stenosis in a dacron bypass graft

Answer 50

400cm/s

Question 51

What correctly describes a reversed vein graft

Answer 51

stenosis at the proximal anastomosis is a common complication

Question 52

A patient presents for an evaluation of a lower extremity synthetic bypass graft for suspected stenosis. What area of the graft should be evaluated first because it is the most common location of graft stenosis

Answer 52

at the anastomosis sites

Question 53

You are performing a follow up exam on a synthetic fem-pop graft that is 2 weeks post-op. The native arteries and graft appear normal on the 2D and color doppler evaluation. These same segments are evaluated using PW doppler and monophasic waveforms with mild diastolic flow throughout the cardiac cycle are demonstrated. What is most likely the reason for the discrepancy in findings

Answer 53

reactive hyperemia