US Guided Proc, Prep and Reporting Flashcards
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
semi erect with or without a pillow
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
plaque broke away from the sclerotic aortic valve
Which exam would be improved by the administration of simethicone prior to the ultrasound evaluation
renal artery duplex
What lab values may be elevated with renal artery stenosis
serum BUN and creatine
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
vertebral and basilar arteries
A patient presents with dysphagia and hoarseness. The referring physician suspects Ortner syndrome. What type of exam will you be performing
upper extremity arterial duplex exam
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 _________
retroesophageal subclavian artery or aberrant right subclavian artery, kommerell diverticulum
D-dimer levels are most accurate for predicting
the absence of DVT
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 ________
standing, increase hydrostatic pressure
When preparing for a patient with suspected thoracic outlet syndrome, what other information should you review for pertinent information
chest x-ray
The right frontal lobe is supplied with blood by the
right ACA and MCA
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
right ACA or right MCA
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
lab values for decreased hematocrit levels
Bilateral increased velocities in the CCA and ICA with no evidence of stenosis is usually related to
increased cardiac output
When evaluating a pregnant patient for DVT, the patient should be placed in the ________ position
left oblique or decubitus
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
left arm and leg paresthesia
A patient presents for a TCD exam with a recent diagnosis of subdural hematoma. What is the physician looking for on the TCD exam
vasospasm
If a patient complains of a single 12hr episode of right arm paresthesia and paralysis, what will you report on your technologist worksheet
history of transient ischemic attack
What transducer would be preferred for a lower extremity DVT evaluation on an average sized patient
5-7MHz linear
_________ transducers are used for evaluation of the superficial system for insufficiency or vein mapping
7-10MHz
Why should a venous insufficiency exam be performed with the patient in the standing position
to evaluate the veins with the added effect of hydrostatic pressure
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
velocity ratio and diastolic flow direction
What correctly describes how to prepare for an intra-operative vascular ultrasound
cover a high frequency transducer with a sterile sheath that contains gel
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
dorsalis pedis or posterior tibial artery
Endovenous heat-induced thrombosis (EHIT) is a complication of
radiofrequency ablation
A patient is scheduled for a stab phlebectomy. What is being treated for this patient
varicose veins
What statement best describes the doppler tracing found in the stalk of a pseudoaneurysm
high resistance to and fro flow
At _______ post-injection, _______ should be performed to determine the success of a thrombin injection for pseudoaneurysm treatment
20 minutes, color doppler and ABI evaluation
What is a contraindication for endovenous laser ablation of the great saphenous vein
chronic obstruction of the femoral vein
Residual hyperechoic plaque in the lumen that has an abrupt edge
shelf lesion
Hypoechoic/anechoic material adjacent to vessel wall that causes increased flow velocity
platelet aggregate
_________ refers to the injection of a solution into spider veins to cause them to atrophy and requires aseptic technique
sclerotherapy
What requires the use of sterile technique
radiofrequency venous ablation
The terminal tip of the venous catheter is positioned in which central vein
distal 1/3 of the SVC (atriocaval junction)
In most cases, a peripherally inserted central catheter (PICC) line is inserted in the basilic vein and advanced until the tip reaches
artiocaval junction
What is true regarding the initial post-op examination of a TIPS placement
it helps to establish baseline velocities for upcoming follow up exams
Why is the distance from the most proximal point of the contracted GSV to the saphenofemoral junction measured in a post-ablation exam
to document the lack of thrombus propagation into the deep system
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
hepatic vein anastomosis
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
increased resistance and decreased diastolic flow
At the start of an endovenous ablation procedure for the GSV, the catheter is inserted _______ and advanced to a position _________ before activating the device
into the distal GSV, 2cm distal to the SFJ
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
evaluate the venous system in the right arm
If the GSV is being used to create an in situ vein graft _________
all perforator veins must be marked on the vein mapping so they can be closed
What correctly describes sclerotherapy procedures
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
The anatomical snuff box is also called the
radial fossa
A “snuffbox” fistula connects what two vessels
radial artery connects to the cephalic vein in the radial fossa
After an endarterectomy or carotid stent placement, the first follow up exam should be performed
within one month after the procedure
What is the primary reason why dialysis grafts are commonly placed at the antecubital fossa or wrist, and not the shoulder
the closer the AV fistula to the heart, the greater the risk for developing heart failure
Retained valve cusps are a complication of
in situ saphenous graft
The most common cause of hemodialysis graft failure is
thrombus formation
A peak systolic velocity greater than _______ is consistent with >75% stenosis in a dacron bypass graft
400cm/s
What correctly describes a reversed vein graft
stenosis at the proximal anastomosis is a common complication
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
at the anastomosis sites
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
reactive hyperemia
