Vascular review chapters 7-10

Question 1

When evaluating an endarterectomy site within 48 hours of the surgical procedure, one should be mindful of preventing infection by using all of the following EXCEPT:
A. Using sterile gel
B. Leaving the sterile dressing in place
C. Using sterile pads
D. Using sterile transducer cover

Answer 1

B

Question 2

Which of the following is a major feature that should be present for a diagnosis of a dissection?
A. A color pattern clearly showing two flow directions in the true lumen
B. Identifiable thrombus within false lumen
C. Atherosclerosis along the posterior wall
D. A Hyperechoic (white/bright) line in the lumen of the artery

Answer 2

D

Question 3

During duplex evaluation of a patient post-CEA, residual plaque is noted T the distal end of the surgical site, creating an abrupt edge of the arterial wall. What is this defect commonly called?

Answer 3

Shelf lesion

Question 4

When might the velocity criteria established for native (non operated) carotid arteries NOT be valid in post-CEA ICA?

Answer 4

CEA with patch closure

Question 5

Which of the following is not a common problem leading to stenosis at the level of the arteriotomy performed during endarterectomy?
A. Use of a patch
B. Narrowing due to sutures
C. Retained plaque
D. Hyperplastic response

Answer 5

A

Question 6

Which of the following will not result in symmetrical changes in the Doppler spectra?
A. Aortic valve or root stenosis
B. Brain death
C. Subclavian steal
D. Intra-aortic balloon pump

Answer 6

C

Question 7

What is the distinguishing flow pattern in the neck of a pseudo aneurysm?

Answer 7

To and fro pattern alternating

Question 8

As plaque develops and fills the carotid bulb, what change can be expected in the Doppler waveform at this level?

Answer 8

Disappearance of normal flow separation

Question 9

How should the patients head be positioned in order to expedite a carotid vertebral duplex examination?

Answer 9

Head rotated 45 degrees away from side being examined with a pillow under the shoulders

Question 10

In a normal hemodynamically low- resistance system or vessel, such as the internal carotid and vertebral arteries, what will a change to high-resistance pattern suggest?

Answer 10

Distal stenosis or occlusion

Question 11

A pulsatile mass at the base of the neck may be indicative (and often mistaken) for an aneurysm, which it is most likely tortuousity of which of the following?
A. Proximal subclvin artery
B proximal vertebral artery
C. Proximal common carotid
D. Proximal internal jugular vein

Answer 11

C

Question 12

Because of limitations in evaluating the vessels following an endarterectomy, what becomes more important to evaluate?

Answer 12

Quality of flow in the distal ICA

Question 13

What is the most common technique used to identify the vertebral artery?

Answer 13

View the common carotid artery and angle the transducer slightly posterior

Question 14

What is reactive hypermedia, a provocative maneuver used during the duplex evaluation of the extracranial cerebrovascular system, used to demonstrate?

Answer 14

A change from latent or partial to complete subclavian steal

Question 15

Where does a typical carotid endarterectomy procedure involving a longitudinal arteriotomy begin and end?

Answer 15

A normal distal portion of ICA into the CCA

Question 16

Which of the following describes a vessel diameter measuring >200% of the diameter of a normal section of the ICA or >150% of the CCA?
A. True aneurysm of the carotid vessels
B. Large carotid bulb
C. Normal carotid bulb
D. Pseudoaneurysm

Answer 16

A

Question 17

A patient presents to the vascular lab for a carotid-vertebral duplex exam. Upon questioning. The patient reveals a 2 week history of intermittent blindness in the right eye. The symptoms resolve within a few seconds. What would these symptoms indicate?

Answer 17

TIA

Question 18

What does a perivascular fluid collection above the irregular buckling of a patch indicate?

Answer 18

Active infection

Question 19

Which malformation may be associated with neck-swelling post-CEA?
A. Pseudoaneurysm
B. Hematoma
C. Infection
D. All of the above

Answer 19

D

Question 20

When qualifying the appearance of plaque by ultrasound, the use of which of the following terms is discouraged owing to poor reliability?
A. Homogeneous/heterogeneous
B. Smooth/irregular
C. Ulcerated
D. Calcified

Answer 20

C

Question 21

When performing a Doppler on a tortuous internal carotid artery, how should the cursor be aligned if a velocity measurement must be made on a curved segment of the artery?

Answer 21

Set the angle cursor so the middle of the cursor is parallel to the walls and center stream

Question 22

What is stenosis at the CEA site usually considered to result from more than 24 months after an endarterectomy?

Answer 22

Neointimal hyperplasia

Question 23

Why is it important to throughly evaluate the vessel wall of the artery where a perforation led to a Pseudoaneurysm?

Answer 23

Thrombosis is likely to occur in that are

Question 24

Which transducer is most commonly used to perform a duplex evaluation of the extracranial cerebrovascular system?

Answer 24

12-3 MHz linear array

Question 25

What is the secondary goal of examination of the extracranial carotid artery system by duplex ultrasound?

Answer 25

Document progression of the disease

Question 26

Which of the following is not a characteristic of the flow in a secondary lumen created by a tear or dissection?
A. Same direction of flow in the true lumen
B. Reverse direction of flow, exiting the false lumen through a secondary proximal tear
C. An alternate antegrade/retrograde flow pattern in and out of the false lumen
D. High velocities as would be seen in stenosis

Answer 26

D

Question 27

In a patient with hypertension, incidental diagnosis of fibromuacular dysplasia in the carotid artery should lead to follow up evaluation of which vessel?

Answer 27

The renal arteries

Question 28

What is a likely source of the symptoms in patients under 50 years of age presenting to the vascular lab with symptoms of stroke (without typical risk factors)?

Answer 28

Dissection if one of the carotid vessels

Question 29

Why does the aversion technique for carotid endarterectomy not require a patch?

Answer 29

The sutures are at the widened area of the bulb

Question 30

Which condition consists of a repetitive pattern of narrowing and small dilatation in an internal carotid artery, giving the appearance of a “string of beads”?

Answer 30

Fibromuscular dysplasia