Vascular Registry

Front 1

Name the renal arteries in order from Aorta to the edge of the parenchyma.

Back 1

Main renal artery -> segmentals -> interlobars -> arcuates -> interlobulars

Front 2

A patient has a PE and a test is being performed to determine the source of the PE. Which test is it? CT, MR, Nuc Med, Duplex US

Back 2

Duplex US

Front 3

A patient has an above-the-knee amputation. What is the most likely cause of death in the next 5 years?

Back 3

Sepsis from gangrene

Front 4

You measure the celiac artery velocity pre-prandial. How does the velocity compare post-prandial?

Back 4

Should remain the same

Front 5

MCA: depth, direction, mean velocity, window

Back 5

3 - 6 cm; toward txr; 55 +/- 12 cm/s; transtemporal

Front 6

ACA: depth, direction, mean velocity, window

Back 6

6 - 8 cm; away from txr; 50 +/- 11 cm/s; transtemporal

Front 7

PCA: depth, direction, mean velocity, window

Back 7

6 - 7 cm; P1 = toward, P2 = away; 39 +/- 10 cm/s; transtemporal

Front 8

terminal ICA: depth, direction, mean velocity, window

Back 8

5.5 - 6.5 cm; bidirectional; 55 +/- 12 cm/s (per Rumwell) or 39 +/- 9 cm/s (per Daigle); transtemporal

Front 9

Ophthalmic: depth, direction, mean velocity, window

Back 9

4 - 6 cm; toward; 21 +/- 5 cm/s; transorbital

Front 10

ICA siphon: depth, direction, mean velocity, window

Back 10

6 - 8 cm; supraclinoid (C2) = away & 41 +/- 14, genu (C3) = bidirectional, parasellar (C4) = toward & 47 +/- 11; transorbital

Front 11

Vertebrals: depth, direction, mean velocity, window

Back 11

6 - 9 cm; away; 38 +/- 10 cm/s; transforamenal

Front 12

Basilar: depth, direction, mean velocity, window

Back 12

8 - 12 cm; away; 41 +/- 10 cm/s; transforamenal

Front 13

ICA: depth, direction, mean velocity, window

Back 13

3.5 - 7 cm; away; 37 +/- 9 cm/s; submandibular

Front 14

Name the artery that becomes the common femoral artery at the inguinal canal

Back 14

External iliac artery

Front 15

Name the artery that the superficial femoral artery becomes at the adductor canal.

Back 15

Popliteal artery

Front 16

The common femoral artery bifurcates into what two major arteries?

Back 16

Superficial femoral artery, Deep femoral artery (profunda femoris)

Front 17

A common collateral artery branching at the adductor canal is

Back 17

Genicular branches

Front 18

Of the trifurcation vessels branching from the popliteal artery the first one to take off is

Back 18

ATA

Front 19

The posterior tibial and the peroneal artery branch from the

Back 19

Tibioperoneal trunk

Front 20

The dorsalis pedis is a continuation of this artery

Back 20

ATA

Front 21

What artery may be palpated posterior to the medial malleolus?

Back 21

PTA

Front 22

What affect does diabetes mellitus have on the arterial wall?

Back 22

The walls become hardened (less compliant) and have a greater tendency toward atherosclerosis.(Medial calcinosis)

Front 23

Describe a mycotic aneurysm

Back 23

a localized dilation in the wall of a blood vessel caused by the growth of a fungus. It usually occurs as a complication of bacterial endocarditis.

Front 24

What makes a pseudoaneurysm different from an aneurysm?

Back 24

An aneurysm is a dilatation of all 3 layers of the arterial wall; a pseudoaneurysm is essentially a pulsating hematoma wherein a hole in the arterial wall permits blood to escape under pressure into an area contained by the adjacent tissue.

Front 25

What is the characteristic flow pattern in the neck of the pseudoaneurysm?

Back 25

To/Fro flow; at systole blood flows from the artery into the lumen of the pseudoaneurysm, at diastole blood flows from the pseudoaneurysm back to the artery.

Front 26

What is the characteristic flow pattern in the lumen of the pseudoaneurysm?

Back 26

Yin/Yang; represents a swirling of the blood leaked from the artery into the contained area of the pseudoaneurysm

Front 27

What is the potential risk of pseudoaneurysms?

Back 27

Rupture; if the pseudoaneurysm ruptures, then the leak from the artery is no longer contained and large amounts of blood could extravasate.

Front 28

List two methods of treating pseudoaneurysms

Back 28

Ultrasound guided manual compression, ultrasound guided thrombin injection

Front 29

Define compartment syndrome

Back 29

Swelling within the osteofascial compartments of the leg or arm cause intercompartmental pressures to increase to the point where they exceed capillary perfusion pressure, therby decreasing vascular perfusion and compromising nutritive blood flow to the tissue.

Front 30

What are the sonographic signs of compartment syndrome?

Back 30

Calf muscles may look misshapen, evidence of hematoma may be seen.

Front 31

How is compartment syndrome treated?

Back 31

Fasciotomy

Front 32

Describe coarctation of the aorta

Back 32

Congenital narrowing or stricture of the thoracic aorta that may affect the abdominal aorta as well. May have hypertension due to decreased kidney perfusion or manifestations of lower extremity ischemia.

Front 33

Identify the muscle/s involved in popliteal entrapment syndrome

Back 33

Medial head of the gastrocnemius muscle or fibrous bands

Front 34

Who is generally affected by popliteal artery entrapment syndrome?

Back 34

Young men

Front 35

What is the primary symptom of popliteal artery entrapment syndrome?

Back 35

Symptomatic arterial occlusion or intermittent claudication

Front 36

Define gangrene

Back 36

Tissue death caused by deficient or absent blood supply

Front 37

Define ischemic rest pain

Back 37

A more severe symptom of diminished blood flow to the most distal portion of the extremity; usually occurs when the limb is not in a dependent position and the patient’s blood pressure is decreased; symptoms occur in the forefoot, heel, and toes, but not in the calf

Front 38

The toe pressure threshold for predicting healing of the foot is

Back 38

> 30 mmHg.

Front 39

List the five P's of acute arterial disease

Back 39

Pain, Pallor, Pulselessness, Paresthesia, Paralysis.

Front 40

Define pallor

Back 40

Pale skin resulting from a deficient blood supply

Front 41

Define Paresthesia

Back 41

Tingling, numbness, or lack of feeling

Front 42

Define the pulse ratings

Back 42

0 = None, 1 = Weak, 2= Good, 3 = Strong, 4 = Bounding (Aneurysmal)

Front 43

Identify four areas of the lower extremities where pulse pressures may be evaluated

Back 43

Femoral artery, Popliteal artery, Dorsalis pedis, Posterior tibial arteries

Front 44

What is the formula for PI – pulsatility index?

Back 44

(Peak-to-Peak Frequency) / Mean Frequency

Front 45

What is the formula for AT -acceleration time?

Back 45

(Initial peak time) – (Time at onset of systole)

Front 46

What is the recommended cuff size for taking arterial pressures?

Back 46

1.2 X the diameter of the limb

Front 47

List the diagnostic criteria for segmental pressure exam interpretation.

Back 47

Normal: > 1.0

Single level disease: > 0.5

Multi-level disease: < 0.5

Rest pain: < 0.35

Front 48

What is the threshold for abnormal TBI -toe brachial index?

Back 48

< 0.6

Front 49

What is the typical size of a toe pressure cuff?

Back 49

2.5 – 3 cm cuff

Front 50

Describe the procedure for reactive hyperemia

Back 50

Alternate method to exercise for stressing the peripheral circulation. May be indicated when the patient cannot walk long enough. Thigh cuffs (19 X 40 cm) are inflated to Suprasystolic pressure levels (20 – 30 mmHg above the higher brachial blood pressure) and maintained for 3 – 5 minutes. This produces ischemia and ultimately vasodilation distal to the cuff. Upon release of cuff occlusion, the changes in ankle pressures are similar to those observed after exercise. There may be a transient pressure decrease in the range of 17% - 34% in normal limbs after reactive hyperemia.

Front 51

Define pneumoplethysmography

Back 51

Air, volume, or true Plethysmography. The more arterial blood flow present moving underneath the air-filled cuff bladder, the greater the analog waveform excursion. When there is a decrease in arterial flow underneath the cuff due to obstructive disease, the waveform changes appearance.

Front 52

Define Photoplethysmography

Back 52

Detects cutaneous blood flow and records pulsations rather than recording volume changes. Not true Plethysmography. Rapid changes in blood content of the skin are recorded as pulsatile waveforms with each heartbeat. Infrared light is sent into the underlying tissue with an LED, and the adjacent photodetector (photocell) receives the backscattered infrared light and measures this reflection of light. As light is directed into the skin, the tissue and the blood in the cutaneous vessels attenuates a portion of it. Provides qualitative not quantitative flow information.

Front 53

What pressure are the cuffs inflated to obtain pulse volume recordings?

Back 53

10 – 65 mmHg

Front 54

Describe “blue toe syndrome”

Back 54

May be caused by ulcerated &/or atherosclerotic lesions, emboli, the inflammatory process of arteritis (thrombosis), and some angiographic procedures resulting in lack of flow at distal arterial endpoints, resulting in a cyanotic toe.

Front 55

Describe the affect of a proximal stenosis on a distal stenosis

Back 55

Causes pressure and flow volume to decrease further than with a single stenosis. This could lead to an overestimation of vascular consequence of the distal stenosis and an underestimation of the effect of the proximal stenosis.

Front 56

What is the most common site of lower extremity aneurysms?

Back 56

Popliteal artery

Front 57

What muscle lies lateral to the external iliac artery?

Back 57

Psoas major muscle (or iliopsoas)

Front 58

Define claudication

Back 58

Pain in muscles occurring during exercise but subsiding with rest. Discomfort is usually predictable, occurring with the same amount of work and disappearing within minutes of activity cessation. Results from inadequate blood supply to the exercising muscle, which may be caused by arterial spasm, atherosclerosis, arteriosclerosis, or an occlusion.

Front 59

Describe Buerger's disease including who it primarily affects

Back 59

The most common form of arteritis. Also known as thromboangiitis obliterans. Associated with heavy cigarette smoking and men < 40. Patchy areas of ulceration or gangrene.

Front 60

Describe an AVF – arterial venous fistula

Back 60

Congenital or traumatic abnormal connection between high-pressure arterial system & low-pressure venous system; causes marked anatomic & hemodynamic changes

Front 61

What is the formula for calculating an ABI?

Back 61

(Ankle systolic pressure) / (higher of the two brachial systolic pressures)

Front 62

What is the pressure gradient considered abnormal for segmental pressure exams of the lower extremities?

Back 62

> 30 mmHg between two consecutive levels

Front 63

Describe atherectomy

Back 63

An alternative to percutaneous transluminal angioplasty that cuts through or pulverizes the plaque with a rotational device at the end of the catheter.

Front 64

Describe endarterectomy

Back 64

The surgical removal of atherosclerotic material, and usually a portion of the intimal lining, from the arterial lumen.

Front 65

Describe angioplasty

Back 65

Used to dilate the precise segment of a vessel that contains a focal atherosclerotic lesion using a balloon-tipped catheter to push plaque against the walls of the vessel under fluoroscopic guidance.

Front 66

Describe the difference between the vasospastic disorders, primary Raynaud’s Syndrome (Raynaud’s disease) and secondary Raynaud’s Syndrome (Raynaud’s phenomenon):

Back 66

Vasospastic disorders occur due to a severe narrowing of the arterial lumen, usually without occlusion. Primary Raynaud’s is intermittent digital ischemia caused by digital arterial spasm. It may be hereditary, is usually bilateral, and the patient commonly presents with a long-term history of symptoms without progression or evidence of underlying cause. Secondary Raynaud’s is normal vasoconstrictive responses of the arterioles superimposed on a fixed arterial obstruction. Ischemia is constantly present. May be the first manifestation of a collagen disorder, Buerger’s disease, anatomic abnormality, or other underlying cause.

Front 67

Identify the four structures the subclavian artery, subclavian vein, brachial plexus pass through that will sometimes cause an impingement known as thoracic outlet syndrome

Back 67

Cervical rib, costoclavicular, anterior scalene muscle, middle scalene muscle

Front 68

Describe Adson maneuver

Back 68

Exaggerated military stance (shoulders back) with head turned sharply toward and then away from the arm being tested.

Front 69

Describe the costoclavicular maneuver

Back 69

Exaggerated military stance (shoulder blades pinched); depressing and retracting the shoulders as if standing at attention, extending the humerus and abducting it 30°, and hyperextending the neck and head.

Front 70

Describe the hyperabduction maneuver

Back 70

Patient’s arm is moved passively through a 180° semi-circle through the frontal plane to overhead

Front 71

T/F: When using Velcro to secure the PPG transducer, it should be wrapped as tightly as possible

Back 71

False

Front 72

Normal finger pressures should be ______ of the normal ipsilateral brachial systolic pressure.

Back 72

> 80 - 90%

Front 73

A normal finger/brachial index is

Back 73

0.8 - 0.9

Front 74

A pressure gradient of ____ between fingers is indicative of disease

Back 74

15 mmHg

Front 75

List three common symptoms of thoracic outlet syndrome

Back 75

Numbness or tingling of arm, pain or aching of shoulder and forearm, exercise and upward arm positions can increase discomfort and exacerbate symptoms.

Front 76

TOS is difficult to diagnose with ultrasound because 95% of the time the pain is

Back 76

of neurogenic origin

Front 77

The PPG waveform significantly increases/decreases (circle one) in an abnormal response to a maneuver in testing for TOS.

Back 77

Decreases

Front 78

As many as ____ of individuals demonstrate arterial compression during TOS maneuvers.

Back 78

25% to 30%

Front 79

A peaked pulse PVR waveform is indicative of

Back 79

Primary or secondary Raynaud’s

Front 80

The____ artery supplies blood to the superficial palmar arch.

Back 80

ulnar artery

Front 81

The ____ artery supplies blood to the deep palmar arch

Back 81

radial artery

Front 82

____ branches connect the deep palmar arch to the superficial palmar arch.

Back 82

Radial and ulnar

Front 83

Venous reflux testing using PPG is set in AC / DC (circle one) mode.

Back 83

DC

Front 84

T/F: The PPG sensor should be placed directly over an artery in testing for venous reflux.

Back 84

F

Front 85

Describe the patient position for venous reflux testing using PPG sensors.

Back 85

The patient is seated with legs dangling (non-weight bearing)

Front 86

The normal refill time in venous reflux testing is

Back 86

>/= 20 seconds

Front 87

An abnormal refill time before and after the application of a tourniquet suggests deep/superficial (circle one) venous insufficiency.

Back 87

Deep

Front 88

If the refill time returns to normal after the application of a tourniquet suggests deep/superficial (circle one) venous insufficiency.

Back 88

Superficial

Front 89

Identify two causes of erectile dysfunction that may be diagnosed by either duplex scanning or physiologic testing.

Back 89

Cavernosal venous leak, arterial insufficiency

Front 90

The dense fibrous sheath that encapsulates the sinusoidal tissue of the corpora cavernosa is called

Back 90

tunica albuginea

Front 91

T/F: The PPG sensor should be placed directly over an artery in testing for venous reflux.

Back 91

F

Front 92

Describe the patient position for venous reflux testing using PPG sensors.

Back 92

The patient is seated with legs dangling (non-weight bearing)

Front 93

The corpus spongiosum is located on the dorsal/ventral (circle one) side of the penis.

Back 93

Ventral

Front 94

The normal refill time in venous reflux testing is

Back 94

>/= 20 seconds

Front 95

In what compartment is the urethra located?

Back 95

Corpora spongiosum

Front 96

Describe the location of the helicine arteries in the penis.

Back 96

Corpus cavernosa.

Front 97

An abnormal refill time before and after the application of a tourniquet suggests deep/superficial (circle one) venous insufficiency.

Back 97

Deep

Front 98

If the refill time returns to normal after the application of a tourniquet suggests deep/superficial (circle one) venous insufficiency.

Back 98

Superficial

Front 99

Identify two causes of erectile dysfunction that may be diagnosed by either duplex scanning or physiologic testing.

Back 99

Cavernosal venous leak, arterial insufficiency

Front 100

The dense fibrous sheath that encapsulates the sinusoidal tissue of the corpora cavernosa is called

Back 100

tunica albuginea

Front 101

The corpus spongiosum is located on the dorsal/ventral (circle one) side of the penis.

Back 101

Ventral

Front 102

In what compartment is the urethra located?

Back 102

Corpora spongiosum

Front 103

Describe the location of the helicine arteries in the penis.

Back 103

Corpus cavernosa.

Front 104

Describe venous leak (venous incompetence) in regard to erectile dysfunction

Back 104

An insufficient veno-occlusive mechanism

Front 105

List two drugs commonly used to induce an erection for Doppler evaluation

Back 105

Papaverine, prostaglandin E

Front 106

Normal velocities of the cavernosal artreries are greater than

Back 106

30 cm/sec

Front 107

Normal blood flow at full tumescence of the cavernosal arteries is high/low (circle one) resistive.

Back 107

High

Front 108

A discrepancy in maximum velocities of the cavernosal arteries ____ between left and right indicates some degree of arterial insufficiency

Back 108

greater than 10 cm/sec

Front 109

A Doppler finding suggestive of penile venous incompetence is flow in the

Back 109

Deep dorsal vein.

Front 110

High diastolic flow ____ in the cavernosal artery may indicate a venous leak through ____

Back 110

> 5 cm/sec ; Deep dorsal vein

Front 111

Describe an aorto-aortic stent graft

Back 111

Tubular, single body device that fixes to athe aortic wall proximally, and to the aneurysm sac distally

Front 112

Describe an aorto-iliac stent graft, with femoro-femoral graft:

Back 112

A graft between the aorta and one of the iliac arteries with another graft between the two femoral arteries; bypasses the contralateral iliac artery.

Front 113

Describe an aorto-femoral stent graft with femoro-femoral graft:

Back 113

A graft between the aorta and a femoral artery with another graft between the two femoral arteries

Front 114

A patient with an aorto-femoral stent graft on the right and femoro-femoral graft. How blood get to the pelvic area?

Back 114

Collateral blood flow

Front 115

Define allograft

Back 115

Transplant of tissues, organs, or cells between two members of the same species but with different genotypes.

Front 116

Typically a renal allograft is placed (retroperitoneal, extraperitoneal). Circle one.

Back 116

Extraperitoneal

Front 117

Describe three ways the renal allograft artery is attached.

Back 117

a. End-to-side with external iliac artery
b. End-to-end with the internal iliac artery
c. Donor Aortic patch to side of external iliac artery

Front 118

List the three most important manifestations of renal allograft failure.

Back 118

a. Increased renal transplant size
b. Increased cortical echogenicity
c. Hypoechoic regions in the parenchyma
{Prominent Pyramids}

Front 119

List three waveform changes associated with renal allograft failure

Back 119

a. High-resistive; pulsatile
b. Spectral broadening
c. Tardus Parvus waveform in the parenchyma

Front 120

Duplex is used post-op of a hepatic allograft to document patency of six vessels. What are they?

Back 120

Portal vein, splenic vein, SMA, hepatic veins, IVC, hepatic artery

Front 121

Identify three sonographic signs of hepatic allograft failure

Back 121

a. High-resistive or no flow or tardus parvus in the hepatic artery (stenosis/occlusion); collateral formation at porta hepatis; areas of infarct
b. Portal vein thrombosis
c. Hepatic vein stenosis; absence of flow or monophasic waveform

Front 122

The Soleal veins drain into the

Back 122

Posterior tibial veins and the Peroneal veins.

Front 123

The longest vein in the body is the

Back 123

Great saphenous vein.

Front 124

Veins that connect the superficial veins to the deep veins are called

Back 124

perforators

Front 125

Blood flow in perforating veins flow from

Back 125

superficial veins to deep veins

Front 126

The communication between the posterior arch vein and the posterior tibial vein is through the

Back 126

Cockett’s perforators

Front 127

What is the Soleal sinus?

Back 127

A dilated channel of the lower calf muscles that allows venous blood to accumulate and then drain into the PTVs and Per vv.

Front 128

Blood flows from the soleal veins to the

Back 128

Posterior tibial or Peroneal veins

Front 129

What is the vein that is formed by the confluence of the axillary and cephalic veins?

Back 129

Subclavian vein

Front 130

The renal veins drain into the

Back 130

IVC

Front 131

What is the function of a venous valve?

Back 131

To keep blood flowing in only one direction

Front 132

List eight veins that typically do not have valves.

Back 132

(1) Soleal sinuses, (2) External iliac, (3) Internal iliac, (4) Common iliac, (5) IVC, (6) Subclavian, (7) Innominates, (8) SVC.

Front 133

What is transmural pressure?

Back 133

Difference between pressures within (intraluminal) & outside (interstitial) the veins; determines the cross-sectional shape of veins.

Front 134

Increased transmural pressure will make the vein appear more ____ in cross-section.

Back 134

circular and large

Front 135

The ____ veins empty during the relaxation phase.

Back 135

superficial

Front 136

Normal blood flow in the perforating veins is: (circle one)
a. superficial to deep b. deep to superficial

Back 136

a

Front 137

Inspiration increases or decreases (circle one) pressure in the abdominal cavity and increases or decreases (circle one) in the thoracic cavity

Back 137

increases; decreases

Front 138

List four of the most common clinical findings of DVT

Back 138

Swelling, Pain, Redness (erythema), Warmth.

Front 139

According to Wells scoring for the probability of DVT, a score of ____ indicates a high probability.

Back 139

> 3

Front 140

List five clinical signs of chronic venous insufficiency

Back 140

Swelling, Heaviness, Discoloration, Ulcerations, Varicosities.

Front 141

List the three components of Virchow's triad

Back 141

Trauma (endothelial damage), Venous stasis, Hypercoagulability.

Front 142

List one example of each of the three states of Virchow’s triad

Back 142

Intrinsic trauma, Pregnancy, Cancer.

Front 143

Describe Paget-Schroetter syndrome:

Back 143

Thrombosis of the subclavian or axillary vein secondary to intense, repetitive activity. Aka: stress or effort thrombosis; the venous component of TOS. Frequently associated with upper extremity repetitive motions.

Front 144

Describe May-Thurner syndrome

Back 144

Compression of left common iliac vein by right common iliac artery as artery crosses over it. In some cases artery causes enough compression to thicken vein wall and alter flow to the point of thrombosis.

Front 145

Describe a pulmonary embolism (PE):

Back 145

Part or all of a thrombus breaks loose and travels into the pulmonary circulation.

Front 146

What contributes to brawny discoloration of the skin?

Back 146

Fluid, RBCs, and fibrinogen leak into the surround tissue as a result of increased venous pressure. The breakdown of RBCs creates hemosiderin deposits.

Front 147

List the signs of post thrombotic syndrome

Back 147

Chronic swelling, brawny discoloration, and ulcer formation in the gaiter zone.

Front 148

Describe Klippel-Trenaunay syndrome

Back 148

Hypoplastic or absent deep veins (i.e., absent iliacs with varicosities of superficial system resulting in an enlarged limb.

Front 149

What is the term that is used to describe blood flow away from the liver?

Back 149

Hepatofugal

Front 150

Describe the difference between primary and secondary varicose veins.

Back 150

1° = result of congenital absence of > 1 valve; unrelated to DVT. 2° = caused by obstructive conditions of deep system, e.g., previous DVT, pregnancy, or obesity.

Front 151

Describe lipodermatosclerosis

Back 151

Thickening and hardening of the skin; can be found in patients with CVI. High venous pressure allows RBCs and fluid to leak into tissue, leading to chronic inflammation. When the skin and fat under the skin are inflamed for years, tissue becomes hard. Over time the tissue becomes depressed, changing the contour of the ankle are in a manner referred to as “bottle-neck deficiency”.

Front 152

Describe phlegmasia alba dolens including the cause

Back 152

A limb-threatening condition resulting from arterial spasms that occur 2° to extensive, acute iliofemoral vein thrombosis. Limb is very swollen, pale (whiteness / pallor), and painful.

Front 153

Describe phlegmasia cerulean dolens including the cause:

Back 153

A limb-threatening complication of acute iliofemoral vein thrombosis. Severely reduced venous outflow causes a marked reduction in arterial inflow. Tissue hypoxia can develop, leading to venous gangrene. Limb is very swollen, dark blue (cyanotic), and painful.

Front 154

Describe an arterial ulcer

Back 154

Little bleeding; located on toes or bony prominences; shiny skin; thickened toe nails; regular shape; severe pain

Front 155

Describe a venous ulcer

Back 155

Mild to severe pain; shallow irregular shape; located in medial gaitor area; oozes fluid; brawny discoloration; irregular shape

Front 156

Describe neurogenic ulcers

Back 156

Also known as diabetic ulcers, are ulcers that occur most commonly on the bottom of the foot. People with diabetes are predisposed to peripheral neuropathy, which involves a decreased or total lack of sensation in the feet. Feet are naturally stressed from walking, and someone who has decreased sensation will not necessarily feel that they have an area of skin breakdown occurring. Coupled with this lack or absence of sensation is a decrease in circulation to the feet as well. Wounds that do not get proper blood flow are not only slower to heal but also at an increased risk for infection. A small cut, scrape, or irritated area in a diabetic can turn into an ulcer for these reasons. It is common for these types of ulcers to keep coming back in diabetics.
A neurogenic ulcer begins with thickening and a callus on an area of pressure, followed by skin breakdown (an ulcer).

Front 157

Discuss and differentiate the different types of edema.

Back 157

Pitting edema = accumulation of fluid in the subcutaneous tissue. When manual pressure is applied on the tissue, some fluid is displaced causing a depression in the skin surface. May be 2° to fluid retention, an electrolyte imbalance, renal dysfunction, CHF or other causes of elevated venous pressure. Non-pitting edema = tissue is so engorged with fluid that it cannot be displaced with manual pressure. Lymphedema is a non-pitting edema resulting from an obstruction in the lymphatic system.

Front 158

Define / describe impedance plethysmography IPG

Back 158

Can detect thrombi in iliac, femoral, and popliteal veins. As blood volume in calf increases in response to cuff, resistance decreases and thus current to the sensors increases. Once cuff is released, resistance increases and current decreases. The blood in the calf should go from maximum venous capacitance back to baseline within 3 seconds.

Front 159

Describe strain gauge plethysmography SPG

Back 159

Can detect obstruction in large veins above the knee (e.g., femoral). A Hg-in-Silastic strain gauge measures changes in leg circumference as blood fills the leg 2° to cuff obstruction. Once the maximum venous capacitance is reached and the cuff is released, the circumference should return to baseline within 3 seconds.

Front 160

What is the major difference between IPG and SPG as far as what is being measured in the calf?

Back 160

In IPG the blood volume is being measured via increased resistance. In SPG, the leg circumference is being measured as it increases when filling.

Front 161

In cases of DVT there is reduced maximum venous capacitance (MVC) because?

Back 161

Blood volume in limb can’t increase from baseline, since limb can’t be properly emptied before test due to obstruction.

Front 162

In cases of DVT there is reduced maximum venous outflow (MVO) because?

Back 162

Once cuff is released, blood can’t efficiently empty from leg due to obstruction.

Front 163

Venous testing requires the use of [direct or alternating] (circle one) current.

Back 163

Direct

Front 164

Venous outflow is determined by how much volume decreases in

Back 164

3 seconds

Front 165

Describe photoplethysmography (PPG).

Back 165

Documents capillary blood volume and evaluates the presence and severity of venous insufficiency. Determines changes in blood content of skin by a photosensor that transmits light into the subcutaneous tissues. Since blood attenuates light in proportion to its content in the tissue, the difference between the transmitted and reflected signal can be converted into a waveform.

Front 166

The PPG sensor should be placed directly over an artery in testing for venous reflux. True/False

Back 166

False

Front 167

Describe the patient position for venous reflux testing using PPG sensors

Back 167

The patient is seated with legs dangling (non-weight bearing).

Front 168

Normal refill time for VRT testing is

Back 168

> 20 seconds.

Front 169

If the VRT test is abnormal without a tourniquet and normal with a tourniquet applied above the knee this indicates

Back 169

reflux in the Great saphenous vein

Front 170

If the VRT test is abnormal with and without a tourniquet this indicates

Back 170

insufficiency of the deep system

Front 171

Describe the principle of air plethysmography

Back 171

Measures volume changes in the extremity and evaluates the efficiency of the venous calf pump. Also can determine the presence or absence of venous insufficiency and quantify venous reflux. This is accomplished by measuring, via pressure transducers, the venous volume and filling time as the patient stands from supine, does 1 toe-up (ejection volume), and then does 10 to-ups (residual volume).

Front 172

Describe the limitations of CW Doppler in evaluating for DVT

Back 172

Difficult to differentiate if abnormal flow is due to DVT or extrinsic compression; paired deep veins in calf make diagnosis of isolated calf-vein thrombosis difficult; PAD decreases venous filling; COPD elevates central venous pressure; improper angle / pressure alters interpretation; can’t differentiate partial from total thrombosis; collateral development may give false-negative; bifid system may give false-negative; requires very experienced sonographer.

Front 173

The patient position for lower extremity venous Duplex examinations is

Back 173

reversed Trendelenburg with patient turned toward the symptomatic side with the hip externally rotated and the hip and knee flexed slightly

Front 174

Performing Duplex Doppler imaging of a lower extremity vein, in what view should the Doppler signal be obtained? Transverse or Longitudinal (circle one)

Back 174

Long

Front 175

List four things the Doppler signals are used to evaluate in lower extremity venous Doppler examinations

Back 175

Spontaneity, phasicity, augmentation with distal compression, augmentation with proximal release

Front 176

Baker's cysts are usually found (medial/lateral)

Back 176

Medial

Front 177

Describe the development of DVT and the location where it most commonly develops

Back 177

Intraluminal thrombi, predominately composed of RBCs trapped in a fibrin web, frequently originate at the cusps of the venous valves or in the soleal sinuses due to stagnation. As the clot propagates, flow becomes restricted, venous pressure increases, the vein walls stretch, and the venous valves can be damaged.

Front 178

Describe the process of hemosiderin deposition

Back 178

Fluid, RBCs, and fibrinogen leak into surrounding tissue due to increased venous pressure. The breakdown of RBCs creates hemosiderin deposits that cause brawny discoloration.

Front 179

Describe primary varicose veins

Back 179

Varicose veins in the absence of coexisting deep vein thrombosis

Front 180

Describe secondary varicose veins

Back 180

Sequela to deep vein thrombosis

Front 181

Describe recurrent varicose veins

Back 181

Varicose veins that reappear after venous ablation therapy

Front 182

List three common symptoms of pulmonary embolism

Back 182

Shortness of breath / difficulty breathing, chest pains, coughing (esp. with blood)

Front 183

Define venous insufficiency

Back 183

A condition in which the veins have problems sending blood from the legs back to the heart. Caused by problems in one or more deep leg veins. Normally, valves keep blood flowing back to heart so it doesn’t collect in one place. But if valves are either damaged or missing, veins remain filled with blood, especially when standing. May also be caused by a blockage in a vein from a clot (DVT). CVI is a long-term condition that occurs because of partial vein blockage or blood leakage around the vein valves

Front 184

List four clinical signs/symptoms of venous insufficiency

Back 184

Edema (pitting), Dilated veins, Leg pain, Skin changes in ankle area (Coloration / Thickening)

Front 185

Define stasis dermatitis

Back 185

Inflammatory skin condition that develops 2° to fluid build-up, or blood pooling (stasis), just under the skin due to problematic circulation. The extra fluid that builds up in the body makes it hard for blood to feed cells & get rid of waste products. Tissue becomes poorly nourished and fragile. Common at the ankles due to less supportive tissue. The rash associated with stasis dermatitis can have the following characteristics: Thin, inflamed, tissue-like skin; Itching; Tingling; hemosiderin deposits; dry, scaly patches of skin; hyperpigmentation; thickening of skin; slow to heal venous ulcers.

Front 186

Describe how collateral flow will affect the Doppler signal

Back 186

Continuous flow seen in presence of acute DVT or when collateral flow is not adequate. May show bi-directional flow.

Front 187

List four characteristics of acute thrombus

Back 187

Incomplete compressibility of veins, low-level echoes within lumen, vessel is dilated compared to accompanying artery, thrombus is poorly attached to wall & may have a spongy texture

Front 188

List four characteristics of chronic thrombus

Back 188

More echogenic, visible collateralization or recanalization, synechia, vessel is not dilated

Front 189

Describe the nuclear medicine study called VQ (ventilation quotient) scan

Back 189

Screening test for detection of perfusion defects of lungs, most commonly attributed to a PE. Radioactive contrast medium injected into arm & images of lung perfusion taken from various angles. Other disorders can also cause perfusion defects.

Front 190

The basilic vein lies medial or lateral to the brachial veins? (Circle one)

Back 190

Medial

Front 191

Are the following superficial or deep: Basilic; Brachial; Axillary; Cephalic; Subclavian; Innominate; Radial; Ulnar; Medial cubital

Back 191

S; D; D; S; D; D; D; D; S

Front 192

What two things should be done to evaluate the subclavian vein in place of compression by the transducer?

Back 192

Have patient take in quick deep breath through pursed lips; augment with distal compression (may be reduce or not evident)

Front 193

What is the typical flow characteristic of the subclavian vein?

Back 193

Pulsatile due to proximity to the heart; augmentation with distal compression may normally be reduced or not evident.

Front 194

The outflow vein of a patent dialysis access graft will exhibit the following 5 changes

Back 194

Increased flow velocity and volume flow, pulsatile flow, no response to distal compression, incompressible vessel, collateral channels evident

Front 195

How would you describe the walls of the portal vein?

Back 195

Hyperechoic

Front 196

How would you describe the waveform appearance of the normal portal vein?

Back 196

Minimally phasic, almost continuous; in the adult patient, flow is essentially not affected by normal respiration.

Front 197

What is the normal response to deep inspiration for the abdominal and pelvic veins?

Back 197

They should dilate

Front 198

What is the appearance of Rouleau flow?

Back 198

RBCs look like rolls of coins; very sluggish flow; B-mode appearance = heterogeneous material moving with respirations & augmentation; suggests slow flow due to proximal obstruction, increased proximal venous pressure, or other processes (increase in plasma immunoglobulin).

Front 199

Describe portal hypertension

Back 199

Increased BP in portal vein from increased resistance to blood flow which can result from pathology of portal vein, small intrahepatic portal vein radicles, hepatic parenchyma, or hepatic veins. Pathology varies and includes cirrhosis, cancer, pancreatitis, thrombosis, & trauma; portosystemic venous collaterals may develop; can result in hepatofugal flow.

Front 200

Describe Budd-Chiari syndrome

Back 200

Results from hepatic vein occlusion. Abnormal clinical findings include hepatomegaly, abdominal pain, sudden onset of ascites. Causes are many and vary with regard to the primary site of obstruction (hepatic vein level, sinusoids, or IVC).

Front 201

What does a positive D-dimer test indicate?

Back 201

Lysis (breakdown) of thrombus.

Front 202

Describe and compare ascending and descending venography.

Back 202

Ascending = used to evaluate acute DVT, congenital venous disease, &/or anomalies, and in the evaluation of chronic venous changes; contrast agent is injected into a vein on the dorsum of the foot. Descending = used primarily to detect and quantify reversed flow from incompetent venous valves; contrast agent is injected into CFV.

Front 203

Name two contraindications to venography

Back 203

Severe allergies to iodine, severe peripheral vascular occlusive disease.

Front 204

Describe the typical treatment for acute DVT

Back 204

Medical therapy: 10,000 units of heparin followed by continuous IV infusion for 5 – 10 days. Surgical and endovascular therapy: IVC filters.

Front 205

Name two types of vena cava filters

Back 205

Greenfield, bird’s nest filter

Front 206

Name three methods of treating venous ulcers

Back 206

Medicated wrap/dressing (e.g., Unna boot, Profore dressings), Hyperbaric oxygen therapy, Ligation of incompetent perforators.

Front 207

Name three methods of treating varicose veins

Back 207

Saphenous vein removal or phlebectomy (local excision of varicosities), Sclerotherapy, Venous ablation.

Front 208

What percentage of blood in the common carotid artery flows into the internal carotid artery?

Back 208

70-80%

Front 209

What is the first major branch of the internal carotid artery?

Back 209

Ophthalmic artery

Front 210

What are the two major terminal branches of the internal carotid artery?

Back 210

Middle cerebral artery, anterior cerebral artery

Front 211

What is the artery that takes blood to the brain, eyes, forehead, and nose?

Back 211

Internal carotid artery

Front 212

Is the internal carotid artery high resistive or low resistive? (circle correct answer)

Back 212

Low resistive

Front 213

What is the first branch of the external carotid artery?

Back 213

Superior thyroid artery

Front 214

What is the best way to differentiate between the internal and external carotid artery?

Back 214

The extracranial portion of the external carotid artery has branches and the internal does not.

Front 215

Often the vertebral arteries are asymmetrical in size (diameter). Which side is usually the larger diameter?

Back 215

Left

Front 216

What artery supplies blood to the posterior structures of the cranial cavity?

Back 216

Basilar

Front 217

What is the most important collateral structure in the cerebrovascular system?

Back 217

Circle of Willis

Front 218

The branches of this artery join with the supraorbital artery to form a collateral pathway

Back 218

Superficial temporal artery

Front 219

The nasal artery is a branch of the ____________, which becomes the _____________ and connects to the external carotid artery by way of the _______________.

Back 219

Frontal artery, angular artery, facial artery

Front 220

Define the term listed below including type of cells and function: Intimal layer

Back 220

single layer of endothelial cells with a base membrane and connective tissue.

Front 221

Define the term listed below including type of cells and function: Medial layer

Back 221

thick layer of smooth muscles and collagenous fiber that is usually arranged in a circular fashion

Front 222

Define the term listed below including type of cells and function: Adventitia layer

Back 222

thin fibrous layer of connective tissue and some smooth muscle fibers. This layer contains the vasa vasorum

Front 223

Define the term listed below including type of cells and function: Vasovasorum

Back 223

supplies blood to the adventitia layer

Front 224

The anterior circulation of the brain is fed by what two major branches of the circle of Willis?

Back 224

Anterior cerebral artery, middle cerebral artery

Front 225

The posterior circulation of the brain is fed by what major branch of the circle of Willis?

Back 225

Posterior cerebral artery

Front 226

Define Transient ischemic attack TIA

Back 226

symptoms last from a few minutes to few hours but resolve by 24 hours.

Front 227

Define Reversal ischemic neurological deficit RIND

Back 227

symptoms lasts longer than a TIA, but resolve in time.

Front 228

Define Stroke-CVA

Back 228

permanent neurologic deficits

Front 229

Define Vertebrobasilar insufficiency VBI

Back 229

causes bilateral symptoms of visual disturbance or paresthesia, and/ or vertigo, ataxia, drop attacks

Front 230

What type of stroke that is considered stable. Acute stroke, stroke in evolution, completed stroke. (circle one)

Back 230

Completed stroke

Front 231

Identify four risk factors associated with cerebrovascular disease

Back 231

Diabetes mellitus, hypertension, smoking, hyperlipidemia

Front 232

Define Ataxia

Back 232

defective muscular coordination especially that manifested when voluntary muscular movements are attempted.

Front 233

Define Syncope

Back 233

a brief loss of consciousness caused by reduction in cerebral blood flow

Front 234

Define Diplopia

Back 234

two images of an object seen at the same time

Front 235

Define Aphasia

Back 235

impairment of speech due to cerebral dysfunction

Front 236

Define Dysphasia

Back 236

lack of coordination of speech and failure to arrange words in an understandable way

Front 237

Define Dysphagia

Back 237

difficulty swallowing

Front 238

Define Amaurosis fugax

Back 238

temporary blindness (partial or total) because of transient ischemia of the retinal arteries.

Front 239

Define Bruit

Back 239

auscultory sound produced by turbulent or disturbed blood flow

Front 240

Define Dysarthria

Back 240

a speech disorder in which the pronunciation is unclear although linguistic and meaning are normal.

Front 241

Define Hemianopia

Back 241

blindness in one-half of the visual field, one or both eyes

Front 242

Define Hemiparesis

Back 242

muscular weakness affecting one side of the body

Front 243

Define Hemiplegia

Back 243

paralysis of one side of the body

Front 244

Define Monocular

Back 244

pertaining to one eye

Front 245

Define Paraplegia

Back 245

paralysis of the lower extremities, may include bowel and bladder.

Front 246

Identify the layer(s) that make up the capillaries

Back 246

Intimal layer only

Front 247

Arterial velocities of very young patients are usually higher or lower (circle one) than elderly patients

Back 247

Higher

Front 248

What is the most common type of stroke? Ischemic or hemorrhagic (circle one)

Back 248

ischemic

Front 249

The biggest risk factor for stroke is

Back 249

hypertension

Front 250

Describe neointimal hyperplasia

Back 250

Vascular smooth muscle cells accumulate in the intima and secrete matrix proteins. The migration of these cells from one tissue compartment to another followed by proliferation in the intima are required for intimal thickening. May cause restenosis

Front 251

Define atherosclerosis

Back 251

Disease of the arterial intima characterized by intimal proliferation (hyperplasia), deposition of fatty substances and luminal reduction

Front 252

Define Stenosis

Back 252

narrowing usually caused by atherosclerosis

Front 253

Define Fatty streak

Back 253

thin layer of lipid material on intimal layer

Front 254

Identify each symptom as either an indication for VB vertebro-basilar disease or CAR for Carotid artery system disease.
Ataxia; Diplopia; Aphasia;
Syncope; Dysphasia; Dysphagia;
Amaurosis fugax; Dysarthria; Hemianopia;
Hemiparesis; Hemiplegia; Monocular

Back 254

Ataxia, VB; Diplopia, VB; Aphasia, CAR; Syncope, VB; Dysphasia, CAR; Dysphagia, VB; Amaurosis fugax, CAR; Dysarthria, CAR/VB; Hemianopia, CAR; Hemiparesis, CAR; Hemiplegia, CAR; Monocular, CAR.

Front 255

Define Fibrous plaque

Back 255

accumulation of lipids that is covered by more lipid material, collagen, and elastic fiber deposits.

Front 256

Define Complicated plaque

Back 256

fibrous plaque that contains fibrous tissue, more collagen, calcium, and cellular debris.

Front 257

Define Ulcerative lesion

Back 257

there is a break in the fibrous cap allowing blood to flow into the ulcer creating a place for thrombus to form and debris to form an emboli.

Front 258

Define Intraplaque hemorrhage

Back 258

sonolucent area within the plaque. This type of plaque is at a higher risk of rupture.

Front 259

Define Thrombosis

Back 259

coagulated blood held together with fibrin material

Front 260

A common sonographic sign of temporal arteritis is

Back 260

Homogeneously circumferentially thickened artery wall

Front 261

What is the location of a carotid body tumor?

Back 261

Between the internal and external carotid arteries

Front 262

Carotid body tumors are vascular or nonvascular (circle one) masses?

Back 262

Vascular

Front 263

What is the artery that usually supplies blood to a carotid body tumor?

Back 263

External carotid artery

Front 264

Define carotid dissection

Back 264

Defines the entry of blood into the wall of the artery separating the layers of the wall and creating a false lumen through which blood flows

Front 265

Fibromuscular dysplasia affects primarily what size of arteries? Which Sex? What age group?

Back 265

Medium, women, 25 – 50 year olds

Front 266

What condition/disease is associated with the “string of pearls” sign?

Back 266

Fibromuscular dysplasia

Front 267

What is at risk for development 6 to 24 months after an endarterectomy, graft, or stent procedure?

Back 267

Hyperplasia

Front 268

List three complications of plaque ulceration

Back 268

Emboli, thrombus, intraplaque hemorrhage

Front 269

Radiography uses what type of waves?

Back 269

X-rays

Front 270

Magnetic Resonance uses what type of waves?

Back 270

Radio waves

Front 271

Nuclear Medicine uses what type of waves?

Back 271

Gamma Rays

Front 272

A bruit is usually no longer heard with stenosis greater than

Back 272

90%

Front 273

What is the difference in appearance between a waveform obtained with a CW Doppler transducer and a waveform obtained with a PW Doppler transducer?

Back 273

There is not an apparent frequency window with CW Doppler waveform.

Front 274

Describe spectral broadening

Back 274

Loss of a frequency window obtained with a PW Doppler transducer demonstrating multiple frequencies / velocities. Turbulence

Front 275

Describe the waveform characteristics seen distal to a tight stenosis

Back 275

Dampened flow – decreased velocities, rounded waveforms, turbulence, higher diastolic flow.

Front 276

What are some methods to differentiate between a tight stenosis or an occlusion

Back 276

Increased the PRF to check for extremely high velocities, decrease the PRF to check for very low velocities for color and PW Doppler, use power Doppler, B-Flow if available, or dynamic flow if available.

Front 277

Describe the expected waveform appearance in an CCA when there is an ipsilateral ICA occlusion

Back 277

Loss of diastolic flow or very high resistive

Front 278

In general an unusually high resistant waveform means stenosis __________ and a tardis parvis appearing waveform means a stenosis ___________

Back 278

Distal, proximal

Front 279

Diminished flow in bilateral carotid arteries indicate

Back 279

Low cardiac output

Front 280

Diminished flow unilaterally indicate

Back 280

Proximal ipsilateral disease, proximal CCA or innominate

Front 281

A young person has elevated velocities, the reason for this might be

Back 281

Increased cardiac output

Front 282

Reversed diastolic flow bilaterally may be due to

Back 282

Aortic regurgitation or insufficiency

Front 283

What vessels may demonstrate compensatory flow in presence of an ICA occlusion.

Back 283

ECA, contralateral ICA, vertebrals (either side)

Front 284

A totally occluded CCA will cause which ipsilateral artery to have reversed flow?

Back 284

External carotid artery

Front 285

Define crosstalk as it applies to a spectral Doppler waveform

Back 285

Mirror imaging of the spectral waveform caused by strong reflectors or too much PW gain

Front 286

Intraoperative duplex monitoring can detect

Back 286

Stricture of the suture line, intimal flaps, areas of platelet aggregation, or residual plaque.

Front 287

Name three cerebral arteries seen through the transtemporal window , state the corresponding flow direction and insonation depth.

Back 287

MCA , toward, 30 - 60mm
ACA, away, 60 – 80 mm
PCA, P1, toward, 60 – 70
PCA, P2, away, 60 – 70
ICAt, bidirectional, 55-65

Front 288

Name the window used to insonate the intradural vertebral artery

Back 288

Suboccipital, or transforamenal – same place, different name

Front 289

State the flow direction and the reference depth of the intradural vertebral artery.

Back 289

Away, 60 – 90mm

Front 290

Name the window used to insonate the ophthalmic artery

Back 290

Transorbital

Front 291

State the flow direction and the reference depth of the ophthalmic artery

Back 291

Toward, 40 – 60mm

Front 292

Name the cerebral artery with the highest expected velocity

Back 292

MCA

Front 293

While looking for vasospasm intracranially the MCA is serially evaluated for flow velocities. What are the normal velocities? ___________ What is the normal hemispheric ratio? __________.

Back 293

<120 cm/sec, <3

Front 294

Identify two conditions monitored using TCD intraoperatively

Back 294

Significant decrease in MCA flow velocities during cross-clamping, signals from microemboli.

Front 295

The angle of the Doppler beam to the vessel in handheld TCD is assumed to be ____________ degrees

Back 295

xxxx

Front 296

Name three possible locations where a stenosis may be found causing a subclavian steal

Back 296

Lt subclavian artery, Rt subclavian artery, Innominate artery

Front 297

What is the difference in bilateral brachial blood pressures to cause suspicion of a subclavian steal?

Back 297

15 – 20 mmHg

Front 298

A subclavian steal is suspected on the side of the higher, lower (circle one) pressure.

Back 298

lower

Front 299

What is Milroy's disease?

Back 299

Hereditary lymphedema

Front 300

How long does recanalization of a DVT take?

Back 300

3 - 6 months

Front 301

What is Homan's sign?

Back 301

pain with dorsiflexion

Front 302

What is Neuhoff's sign?

Back 302

Pain 6 - 7" above Achilles tendon with palpitation of PTA

Front 303

What is Treuseu's sign?

Back 303

Clots forming in relation to hypercoagulability brought on by certain cancers

Front 304

What is lymphedema praecox?

Back 304

Meige's lymphedema - a type of hereditary lymphedema

Front 305

How long does it take for a DVT to organize & begin to adhere?

Back 305

6 - 12 hours

Front 306

On what basis is a diagnosis of superficial thrombophlebitis made?

Back 306

Physical exam (palpable cord, red, swollen)