Vascular Registry

Front 1

If the true lumen is measured at 8mm and the residual lumen is measured at 2 mm, what is the diameter reduction?

Back 1

75% residual/time-100x100%

Front 2

From an infrarenal abdominal aneursym, what is the most frequent complication from the disease?

Back 2

Rupture

Front 3

T or F. A 50% area reduction is equal to a 75% diameter reduction

Back 3

False

Front 4

The SVC is formed by the confluence of which 2 vessels?

Back 4

Bilateral innominate veins

Front 5

A physician asks you to record only the flow velocities in the dialysis graft. What is the significance of a PSV of 85cm/sec in the case?

Back 5

Patient has arterial inflow problem

Front 6

You detect antegrade flow in the ipsilateral ACA. What is the significance of the finding?

Back 6

Crossover collateralization

Front 7

Venous hypertension most often results from

Back 7

Deep venous reflux

Front 8

If PSVs are greater than or equal to 400cm/sec in the SFA, the probable area reduction is:

Back 8

greater than or equal to 75%

Front 9

A carotid duplex exam reports an ICA plaque to be a 60-79% diameter stenosis as indicated by the performing lab duplex criteria. Angiography reports this lesion to be a 90% stenosis. All of the following might cause discrepancy except:

Back 9

Correcting to 45 degrees when true incident was 60 degrees; angiographic suit reports its stenosis values as % area reduction

Front 10

The most common sequelae of DVT is:

Back 10

Valvular destruction

Front 11

What is the role in venous evaluations?

Back 11

To detect the presence/absence of venous insufficiency

Front 12

What is the classification of ABI? (normal, mild PAD, Moderate PAD, Severe PAD)

Back 12

greater than 1.0=normal

greater than 9.0-1.0=Asymptomatic obstructive disease

0.5-0.9=Claudication

less than 0.5=rest pain; sever arterial disease

*Thigh pressures indices are greater than 1.2 , while 0.8-1.2 suggests aortoiliac disease and <0.8 indicates that proximal occlusion is likely.

Front 13

A disadvantage of indirect arterial testing over direct duplex scanning methods is:

Back 13

Cannot distinguish stenosis from occlusion.

Front 14

Low-resistance flow patterns are expected in all of the following arteries except:

Back 14

Pre-prandial SMA

CHIVRS

Front 15

Which of the following pathway for arterial flow is correct?

Back 15

EIA, CFA, FA

Front 16

Turbulent flow occurs in all instances except:

Back 16

At a site 2 cm proximal to severe stenosis of 50% or greater.

Turbulent flow is in the carotid bulb; after a sever stenosis; or placement of the sample volume near the arterial wall.

Front 17

Which of the following is not typical in a patient with portal vein HTN?

Back 17

Nephromegaly

Front 18

A type of plethysmography that is concerned with the simultaneous measurement of pulse arrival times and pressures between the patient's right and left side is:

Back 18

OPG-K (OPG-Karchner)

Front 19

It is often reported that the high thigh pressure should be at least 20-30 mmHg higher than the brachial pressure. Which statement below best describes the reason for this?

Back 19

Thigh cuff is bigger than the arm cuff; arm cuff is bigger than the thigh cuff; the pressure in the CFA is greater than the pressure in the brachial artery; there are 2 arteries (SFA, PFA) under the thigh cuff and 1 (brachial artery) under the arm.

Front 20

A lab reports that its carotid exam is 95% accurate in the identification of carotid stenosis with specificity of 85%. Which of the following statements are true?

Back 20

Sensitivity is greater than specificity; NPV is higher than PPV.

Front 21

What is the significance of finding PSVs of 80cm/sec in the aorta and 240cm/sec in the left renal artery?

Back 21

Within normal limits

Front 22

Which of the following Doppler parameters is most effective at differentiating a 60-70% ICA stenosis from an 80-99% stenosis?

Back 22

Diastolic velocity

Front 23

A patient with a new CVA with right-sided hemiparesis undergoes carotid duplex evaluation. High quality images are obtained and reveal the following:

Sys dia ICA/CCA flow %stenosis

R ICA 175cm/s 55cm/s 2.6 laminar 20%

L ICA 350cm/s 160cm/s 4.8 turbulent 90%

Which is the most likely correct answer?

Back 23

Patient has falsely elevated right ICA stenosis

Front 24

The principle site of peripheral resistance in the vascular bed is:

Back 24

The arterioles

Front 25

The most common site for the development of stenotic lesions in bypass grafts is:

Back 25

Distal anastomosis

Front 26

A 69 year old present with a 1 year history of uncontrollable HTN. Duplex findings include elevated, low resistance PSVs (160-180cm/sec) throughout the RRA with out post-stenotic turbulence, as well as cystic right kidney, absence of flow in the left renal artery, and a small left kidney with PSVs of 8cm/sec. What is the most likely explanation for the elevated velocities in the RRA?

Back 26

Contralateral renal artery occlusion.

Front 27

As you evaluate flow patterns in a patient you document a PSV of 104 cm/sec at the distal aorta, 218 cm/sec at the take-off of the left CIA and 226 cm/sec at the right proximal CIA. What would your preliminary report include?

Back 27

Patient has >50% diameter reduction of the CIAs bilaterally.

Front 28

Patient has CHF. How might CHF be associated with dialysis access?

Back 28

You suspect the access is too close to the heart and a large amount of blood is being shunted into the venous circulation, stressing the heart.

Front 29

The most common cause of edema involving one leg only is:

Back 29

Chronic venous disease

Front 30

Which of the following procedures does not provide information on the status of the microcirculation?

Back 30

segmental pressures

Front 31

A carotid bruit is heard because:

Back 31

Audible turbulence localized at the carotid bifurcation.

Front 32

T or F. In the event of occlusive diseases in the ICA proximal to the carotid siphon, the ECA provides collateral circulation through the ophthamalmic artery via the distal branches of the superficial temporal artery.

Back 32

True

Front 33

It is often reported that the high thigh pressure should be at least 20-30mmHg higher than the brachial pressure. Which statement below best describes the reason for this?

Back 33

None of these: Thigh cuff is bigger than the arm cuff; arm cuff is bigger than the thigh cuff; the pressure in the CFA is greater than the pressure in the brachial artery; there are 2 arteries (SFA, PFA) under the thigh cuff and 1 (brachial) under the arm cuff.

Front 34

All of the follow statements about interpreting flow in a native artery of the upper extremity are true except:

Back 34

The stenosis profile is not evident in upper extremity disease.

The true statements are: PSVs can vary widely secondary to changes in temperature; there is no criteria consistent with a >50% diameter reduction; absence of Doppler signals is most likely consistent with an occlusion; distal emboli may be associated with a subclavian aneurysm.

Front 35

If the lower extremity and upper extremity superficial veins are not suitable as an arterial conduit for coronary artery bypass surgery, which vessel will most likely be considered for this procedure?

Back 35

Radial artery

Front 36

What would the report include if the aortic PSV was 70cm/sec and the RRA (right renal artery) had peak velocities of 280cm/sec?

Back 36

> or equal to 60% diameter reduction of the right renal artery

Front 37

The gastrocnemius vein terminates at the:

Back 37

Posterior tibial viens

Front 38

You are concerned when you see a well-defined area of very low-level echoes within the aneurysmal sac. Although you are unable to detect flow in that area with color flow Doppler, you suspect something is going on. What is the best description?

Back 38

Endotension: not a true leak but defined as continued expansion greater than 5mm.

Front 39

Of the statements below, the one that is true is:

Back 39

The adventitial layer of the artery is stronger and thicker than that of the vein.

Front 40

If sensitivity: 98%, specificity: 93%, PPV: 97%, and NPV: 91%, what is the accuracy?

Back 40

96%

Front 41

An ICA duplex waveform demonstrating a normal spectral window, a systolic velocity of 150cm/sec, a diastolic velocity of 20cm/s and an ICA/CCA ratio of 1.0 would signify:

Back 41

Elevated CCA flow

Front 42

A drop in pressure from above the knee to below the cuffs indicates:

Back 42

Popliteal artery obstruction

Front 43

A 74 year old female is undergoing a carotid duplex study because of a pulsatile mass in her neck. Which of the following is the most likely explanation for a pulsatile mass in the cervical carotid artery?

Back 43

Tortous CCA

Front 44

Superficial thrombophlebitis treatment is:

Back 44

7-10 days of IV heprin, aspirin, and heat to the infected area

Front 45

The Internal Jugular Vein carries blood into which vessel?

Back 45

Innominate vein

Front 46

The venous Doppler examination is:

Back 46

Compares the response of one side of the body with the response of the other side; highly accurate in the detection of the calf vein thrombosis.

Front 47

The preliminary report to the surgeon would most likely be based on which of the following pieces of information?

(narrowing of the vessel; flow is decreased)

Back 47

Rapid production of smooth muscle cells

Front 48

What flow changes would you expect to see if TIPSS procedure is successful?

Back 48

Pressure in the portal vein would decrease

Front 49

Where is contrast agent injected for a venogram? (Ascending)

Back 49

Superficial vein on dorsum of foot

Front 50

What is the Virchow's triad? Name them.

Back 50

Trauma, stasis, hypercoagulability

Front 51

What would you call a bruit if you palpated it?

Back 51

thrill

Front 52

The principle control mechanisms affecting blood volume changes are:

Back 52

Cardiac output and peripheral resistance

Front 53

The wavelength in a material having a wave velocity of 1500m/s employing a transducer frequency of 5 MHz is:

Back 53

0.3 mm

Front 54

With a hemodynamically significant, short segment stenosis, one would expect:

Back 54

An increase PSV and a increase in EDV

Front 55

Aliasing will not occur as long as the Doppler shifted frequency is:

Back 55

Equal to 1/2 PRF and < 1/2 PRF

Front 56

Which of the following statements is true about this image (no flow in distal ICA with calcification) from a previously healthy 54 year old with no history of vascular disease?

Back 56

Thrombosis of the ICA= B-mode findings

Front 57

Starting a OPG-Gee the brachial pressures on the patient are 160/90 on the right and 158/88 on the left. As you follow normal testing protocol, you instill a local anesthetic to the eyes and apply 500 mmHg pressure to the eye cups. You immediately document pulsations on the recording. What is the next step?

Back 57

Cannot complete due to HTN

Front 58

All the following information accurately describes MCA findings except:

Back 58

Signal is obtained at 60-70 mm

True statements: antegrade flow is expected; velocity: 55+- 12cm/sec; probe is angled anterior and superior; Bi-directional flow at its origin is an important landmark

Front 59

Ms. Lewis is being evaluated for acute left hemiplegia and aphasia. Flow in the right CCA is: biphasic, high resistance. This flow pattern mostly likely suggests:

Back 59

If unilateral, distal occlusion

Front 60

Patient with brawny, brownish discoloration of the lower extremity presents with complaints of increased swelling of lower extremity. Which of the following findings would be least likely?

Back 60

An initial VRT of 34sec with a VRT of 26sec with tourniquet.

Front 61

Patient is having a carotid duplex for a 2nd opinion. Her original study was consistent with a high-grade stenosis of left carotid artery. This waveform (spectral broading with velocities at <450cm/sec) is consistent with all the following except:

Back 61

Results anything Doppler angle is <60 degrees

Front 62

Inverse damping factor

Back 62

The ratio of the distal pulsatility index to the proximal pulsatility index of an arterial segment. Indicates the degree to which the wave is dampened as it moves through an arterial segment.

SFA occlusion or severe stenosis when inverse femoral popliteal damping factor is less than 0.9. Normal=0.9-1.1

Front 63

Which of the following is not a method for restricting the dynamic range of the signal?

Back 63

Relaxion

Front 64

The brawny brownish discoloration of patient's legs is related to alterations in blood flow that can result from all the following conditions except:

Back 64

decrease venous pressure

Front 65

The circle of Willis is compose of all the following arteries except:

Back 65

Anterior choroidal artery

Front 66

Occlusion of the MCA may cause abnormalities on all of the following except:

Back 66

Carotid imaging

Front 67

T or F. Emboli monitoring with TCD should be performed at least 15 minutes in order to properly calculate the EPH.

Back 67

True

Front 68

When listening to the posterior tibial vein with a CW pencil probe, the examiner hears brisk cephalad-directional flow upon release of calf compression. This is consistent with:

Back 68

Acute DVT

Front 69

A transducer made up of concentric rings cut from the same slab of piezoelectric material describes:

Back 69

Annular array transducers

Front 70

Axial resolution is determined chiefly by the

Back 70

Pulse duration

Front 71

Lateral resolution is determined by the:

Back 71

beam width

Front 72

Which intensity value is the highest?

Back 72

SPTP

Front 73

What are the sites of highest to lowest systolic pressures when a 12 cm is on a typical normal patient

Back 73

Thigh, ankle, arm

Front 74

After aortoiliac endarterectomy, a 55 year old patient complaining of that he has become impotent, whereas prior to operation, he had no such problem. A penile blood pressure measured to be 100mmHg, with an arm pressure of 120mmHg is documented. which is the correct statement?

Back 74

Neurogenic impotence

Front 75

The units used to quantify the rate of attenuation are:

Back 75

decibels/cm

Front 76

Flow in the carotid siphon exhibits which of the following:

Back 76

bi-directional flow

Front 77

End diastolic ratios are more sensitive in detecting:

Back 77

high degrees of stenosis

Front 78

Flow resistance decreases with an increase in which of the following?

Back 78

Vessel length, vessel diameter, and blood viscosity

Front 79

According the Reynold's the development of turbulent flow depends mainly on:

Back 79

Velocity and vessel size

Front 80

The deep and superficial venous systems are connected at all of the following sites except:

Back 80

Distal thigh: gastrofemoral junction.

True junctions: The groin: saphenofemoral junction; the popliteal fossa: saphenofemoral junction; the ankle perforators.

Front 81

ABI: which statement is correct:

Right left

Arm: 140 141

High thigh: 188 181

Low thigh: 177 170

Calf: 133 160

Ankle: 93 143

Back 81

Right leg multilevel disease

Front 82

The PVR tracing is: (rounded at the peak and rounded diacrotic notch)

Back 82

Normal, with a diacrotic notch in late diastole

Front 83

The Doppler signal demonstrates: (phasic flow below the baseline with an augmented flow also below the baseline.)

Back 83

Normal phasic venous flow pattern

Front 84

A hydrophone is used to measure:

Back 84

Intensity

Front 85

What is the normal flow characteristics of a portal vein?

Back 85

Hepatopetal, minimally phasic and almost continuous

Front 86

A carotid waveform is aliasing. All of the following may resolve this problem except:

Back 86

Switching to a higher frequency

Front 87

Which of the following is not a diagnostic test that has been used to diagnose DVT?

Back 87

non-imaging PW probe

Front 88

A 68 year old male diabetic patient complains of left lower extremity numbness. The patient denies claudication. Triphasic Doppler signals are recorded bilaterally. Pressures were: right brachial: 140; Left bracial: 137; Right ankle 120; left ankle: 206; right big toe: 140; left big toe: 120. Which statement is most correct?

Back 88

Normal except non-obstructive diabetic medial calcification.

Front 89

Definition of Accuracy

Back 89

Detecting disease when disease is present and excluding disease when the circulation is considered normal.

Front 90

The term genicular refers to:

Back 90

The Knee

Front 91

What is true regarding venous circulation?

Back 91

Veins contain valves

Front 92

The CFV lie_____ to the CFA, while CFV bifurcation lies ______ to the CFA bifurcation.

Back 92

Medial and inferior

Front 93

Flow patterns of tibial arteries (normal/abnormal)

Back 93

Waveforms are consistent with a low flow state; flow is monophasic; waveforms are severely dampened.

Front 94

With the 3 cuff method, how should the thigh pressure compare to the brachial pressures?

Back 94

Thigh pressures are expected to be similar to the brachial pressures in the absence of aortoiliac occlusive disease.

Front 95

A 35 year old male who complains of severe pain in his feet at night. Which is the most significant of his risk factors?

Back 95

smokes 3ppd

Front 96

Ms. Peters, presents to the clinic with bluish discoloration of her right big toe. all pulses are palpable. Denies any history of pain in her legs with activity or pain that wakes her up at night. Has no risk factors associated with arterial disease. What do you suspect is the most likely cause of her problem?

Back 96

Aneurysmal disease

Front 97

Energy losses associated with a stenosis are greatest:

Back 97

When multiple lesions are in a series

Front 98

Ms. Morris presents to your vascular lab for arterial testing because she has pain in her legs when she walks. If she has vascular disease, what is the most likely cause?

Back 98

Atherosclerosis

Front 99

A patient presents with left lower extremity claudication. The right waveforms were normal but the left had rounded, broad plethysmographic waveforms at the thigh level, which were similar to the calf and ankle levels. Doppler pressures are brachial: 150; left thigh: 100; calf: 90; ankle: 90. These findings suggest:

Back 99

Suspected left ileo-femoral arterial obstructive disease

Front 100

A proplerly set up longitudinal color flow image of a normal CCA is displayed to show the flow in the proximal portion of the vessel in the red. Which of the following is true?

Back 100

Darker red seen at the edges and lighter in the middle

Front 101

Which of the following 2 Doppler shifts will alias if the PRF is 5 KHz. A 3KHz and/or 5KHz Doppler shift?

Back 101

Both 3KHz and 5KHz

Front 102

As you evaluate the plethysmographic waveforms form a patient who complains of bilateral hip/thigh pain with activity. You notice that there is no notch (reflection) on the downslope of the waveforms bilaterally. What is the significance of that observation?

Back 102

Is likely based on the result of collateral arterial branches

Front 103

If patient cannot walk on treadmill, protocol is to complete reactive hyperemia. All the following are true:

Back 103

Provides an alternative method for stressing peripheral circulation; both large thigh cuffs are inflated to 30mmHg above the higher brachial pressure; Normal limbs may show a temporary drop of < or = 34%; Multilevel disease is considered with a >50% drop in pressure

Front 104

A 71 year old male presents for post operative evaluation of his right femoral-posterior tibial reverse saphenous vein bypass graft. At rest ABI is 0.92. The biphasic Doppler velocities are 85 cm/sec in the native CFA, 100 cm/sec in the proximal anastomosis, and 50 cm/sec at the knee level, with a range of 48-52 cm/sec at the distal anastomosis and native PTA. No post-stenotic turblence is observed. What is the most likely cause of the decrease in velocites?

Back 104

Increase in graft diameter

Front 105

An embolic episode involving the ophthalmic artery (amaurosis fugax) or its branches can result in:

Back 105

Transient blindness of the ipsilateral eye

Front 106

"End point detectors"

Back 106

Photoplethysmography; stethoscope; volume plethysmography; CW Doppler

Front 107

If the PSV in the region of stenosis is measured at 224cm/sec, what would the prestenotic PSVs have to be for this stenosis to be considered > or = 75% diameter reduction?

Back 107

56 cm/sec

224 x .75= 0.56

Front 108

Mr. Richards has ABIs of 0.8 bilaterally using bother the PTA and DPA jwith a PBI of 0.38. What is your impression?

Back 108

Has impotence due to vascular disease of his aorticiliac arteries.

Front 109

A 63 year old non-diabetic male complains of bilateral claudication and is sent to you for arterial testing:

right left

Arm: 120 180

High thigh: 100 180

Low thigh: 96 108

Below knee: 106 104

PTA: 90 50

DPA: 100 40

Which statement is correct?

Back 109

Severe nature of the disease on the left is consistent with impending gangrene.

Front 110

MCA- window, depth, direction, velocity, angle

Back 110

Transtemporal, 30-60, Antegrade, 55+- 12, Anterior superior

Front 111

T ICA-window, depth, direction, velocity, angle

Back 111

Transtemporal, 55-65, bi-directional, 55+-12, Anterior superior

Front 112

ACA- window, depth, direction, velocity, angle

Back 112

Transtemporal, 60-80, retrograde, 50+-11, anterior superior

Front 113

PCA- window, depth, direction, velocity, angle

Back 113

Transtemporal, 60-70, antegrade, 39+-10, posterior/ laterally

Front 114

Carotid Siphiod- window, depth, direction, velocity, angle

Back 114

Transoribital, 60-80, Para-antegrade, Supra-retrograde, Geno-bi-directional, 47+-14, varies.

Front 115

Ophthalmic-window, depth, direction, velocity, angle

Back 115

Transorbital, 40-60, antegrade, 21+-5, medial

Front 116

Vertebral arteries- window, depth, direction, velocity, angle

Back 116

Transforamental/subocciptal, 60-90, retrograde, 38+-10, right or left midline

Front 117

Basilar arteries-window, depth, direction, velocity, angle

Back 117

Transforamental/subocciptal, 80-120, retrograde, 41+-10, midline

Front 118

Persistance

Back 118

frame to frame averaging or "smoothing" of an image

Front 119

VRT of <20 sec that normalizes to >20sec with an above the knee tourniquet.

Back 119

GSV reflux

Front 120

Does APG measure volume changes indirectly or directly?

Back 120

Indirectly

Front 121

Venous flow in a vasconstricted state- increases or decreases?

Back 121

decreases

Front 122

Portal vein is hepatopetal or hepatofugal in direction of flow?

Back 122

Hepatopetal- carries approximately 80% of blood flow to the liver.

Front 123

Does venous flow in the portal vein change with inspiration?

Back 123

NO

Front 124

What veins carry blood from the liver into the IVC?

Back 124

Hepatic veins

Front 125

Corresponding veins

Back 125

Venae Comitantes

Front 126

What is May-Thurner Syndrome?

Back 126

Left CIV passes under the right CIA causing compression.

Front 127

What 2 veins form the IVC?

Back 127

The confluence of bilateral CIV.

Front 128

Perforators carry blood from______ to ______ system.

Back 128

superficial to deep system

Front 129

Brachial veins are formed by_______

Back 129

Confluence of the radial and ulnar veins.

Front 130

Axillary veins are formed by __________________

Back 130

Brachial and basilic veins.

Front 131

Subclavian veins are formed by ______________

Back 131

Axillary and cephalic veins

Front 132

Innominate (brachiocephalic) veins are formed by ________________

Back 132

Subclavian and internal jugular vein.

Front 133

The Superior Vena Cava is formed by ____________

Back 133

Right and Left innominate veins carries blood to the right atrium

Front 134

When standing, what is the hydrostatic pressure at the ankle, heart, and at a raised arm?

Back 134

100 mmHg, 0 mmHg, -50 mmHg

Front 135

How does the valsalva maneuver affect venous flow?

Back 135

Causes all venous flow to halt.

Front 136

Venous ulcers are usually located in what location? What do they look like? Painful?

Back 136

Near the medial malleolus, shallow, mild compared to arterial ulcers.

Front 137

Arterial ulcers are usually located in what location? Skin changes? Appearance? Pain?

Back 137

Boney area or toes; dryness, scaly, loss of hair, thickened toenails; deep punched out appearance; severe pain.

Front 138

What is Budd-Chiari Syndrome?

Back 138

obstruction to hepatic venous outflow causing extreme blood retention of the liver. Collateral pathways develop quickly with an acute event. Potential reversed Portal venous flow.

Front 139

Paget-Schroetter disease

Back 139

Effort induced thrombosis after vigorous activity; mostly in young males

Front 140

Hollenhorst's plaque

Back 140

A cholestrol embolus that is seen in a blood vessel of the retina

Front 141

You are performing a Doppler exam on a patient with suspected renovascular HTN. Which diagnostic parameter is the best indicator o renovascular disease?

Back 141

Renal/Aortic ratio; <3.5

Front 142

Monckenberg's Sclerosis

Back 142

Rigidity of arterial walls. (Calcification)

Front 143

Takayasu's Disease

Back 143

Chronic inflammation of the aorta. Pulselessness disease

Front 144

What are the smallest veins?

Back 144

Venules

Front 145

What are the largest veins?

Back 145

Vena Cava

Front 146

In a supine patient, is there arterial pressure? venous? hydrostatic?

Back 146

Yes, Yes, No

Front 147

Poiseuille's equation

Back 147

Q=(P1-P2) 3.14 r^4/8nL

Front 148

Autoregulation

Back 148

The ability of most vascular beds to maintain a constant level of blood flow over a wide range of perfusion pressures

Front 149

Inertia

Back 149

objects to maintain their status quo maintain flow.

Front 150

Stroke volume

Back 150

The amount of blood ejected

Front 151

hydrostatic pressure

Back 151

equivalent to the weight of the column of blood

Front 152

Vasospasm readings are most accurate in the______

Back 152

MCA; Severe vasospasm=> 200cm/sec

Front 153

Transmural pressure

Back 153

The difference between intraluminal pressure pushing the vein open and the external tissue pressure attempting to compress the vein.

Front 154

Which site is the absence of spontaneous flow a normal variant?

Back 154

Posterior tibial vein

Front 155

What is the most common place for arterial aneurysms?

Back 155

infrarenal aorta