Vascular Ultrasound 1

Front 1

cerebrovascular fiibromuscular dysplasia occurs mostly in who?

Back 1

In females
(Resembels a string of beads)

Front 2

Describe how atherosclerosis works?

Back 2

Starts as a breakdown of the intima, they usually develop at bifurcations, It is a generalized disease, and It may begin in adolescence. (It is not a red blood disease)

Front 3

With a left arm blood pressure that is 40mmHg lower than the right can be the result of what?

Back 3

A Thoracic outlet entrapment, subclavian steal, Coractation of the aortic arch, and Innominate artery occlusion. (It is not an innominate occlusion)

Front 4

What can you expect a with subclavian artery stenosis on the right side?

Back 4

The flow in the right vertebral artery may be reversed, the patient may have right arm claudication, the arm pressure may be reduced, the right axillary dopplar signal will be monophasic, (Answer is none of the above)

Front 5

What type of anatomic lesions can produce a vertebral steal?

Back 5

An innominate artery occlusion, a left subclavian artery orgin stenosis. (Answer is A&B)

Front 6

A hypertensive, diabetic 65-year oldmale, presents for cerebrovascular testing because of an asymptomatic bruit on the right side. What could be potential sources?

Back 6

Astenosis of the external carotid artery, a stenosis of a subclaivian artery, and a dissection of the CCA. (An occlusion can not cause a bruit)

Front 7

A disease that affects primarily the intima and may extend into the media is what?

Back 7

Aneurysmal disease

Front 8

After carotid bifurcation disease, what is the next most common source of stroke symptoms?

Back 8

Cardiac-source embolization

Front 9

What is the strongest risk factor for stroke?

Back 9

Hypertension can lead to small vessel rupture, hemmorhage.

Front 10

In the cerebrovascular system, atherosclerosis occurs most commonly where?

Back 10

The origin of the internal carotid artery

Front 11

What is the most prevelant type of stroke?

Back 11

Ischemic

Front 12

Where are carotid body tumors located?

Back 12

Betwen the ICA nd the ECA.

Front 13

Which of the following statements is FALSE about a subclaivian steal? It occurs most commonly on the left side, most patients are asymptomatic, it results from severe stenosis or occlusion of the proximal vertebral artery, lower blood pressure is seen in the affected arm, or all of them are false?

Back 13

It does not result from severe stenosis or occlusion of the proximal vertebral artery

Front 14

24 year old patient with a history of automobile accidents arrives in the ICU with symptoms of acute right-side weakness and aphasia. What is the most likely etiology of these symptoms?

Back 14

Carotid dissection

Front 15

A patient undergoes carotid endarterectomy and six months later angiography is preformed because of symptoms referable to the other side. The angiogram reveals that the operated carotid is significantly narrowed. What is the most likely cause?

Back 15

Neointimal Hyperplasia

Front 16

What does the term hemiparesis mean?

Back 16

Weakness of one side

Front 17

The NASCET (North American Symptomatic Carotid Endarterectomy Trial) used which of the following arteriographic criteria to classify ICA disease? Area and diameter stenosis calculatged by dividing the minimal area and diameter at the ICA by the area and diameter at the CCA, Area % stenosis calculated by dividing the minimal area by the original area at the site of stenosis, Diameter % stenosis calculated by dividing the minimal area by the original area at the site of stenosis, Diameter % stenosis calculated by dividing the minimal diameter by the original diameter at the site of stenosis, Diameter % stenosis calculated by dividing the minimal diameter by the diameter of the un-stenosed distal ICA, or Area % stenosis calculated by dividing the minimal area by the normal area of the distal ICA

Back 17

Diameter % stenosis calculated by dividing the minimal diameter by the diameter of the un-stenosed distal ICA

Front 18

All of the following may represent symptoms from the brain stem or posterios circulation EXCEPT what? Dizziness, Vertigo, Ectasia, Syncope, Amaurosis Fugax

Back 18

Amaurosis Fugax

Front 19

Is the following true or false. Apatient with a 10min episode of loss of vision. He closed each eye and the reduction in the right half of his visual field was bilaterally. This is amaurosis fugax

Back 19

False, Diplopia

Front 20

What is a symptom of vertebrobasilar insufficiency is what?

Back 20

Diplopia

Front 21

On opthalmologic exam, a bright yellow spot is noticed with a branch artery, this is Hollenhorst plague. True or False

Back 21

True

Front 22

A patient complains of temporary shading of one eye, what is this symptom called?

Back 22

Amaurosis Fugax

Front 23

What is the incidence of new strokes per year?

Back 23

500,000

Front 24

What does the abbreviation TIA stand for?

Back 24

Transient Ischemic Attack

Front 25

A TIA of the right hemisphere of the brain will likely affect what?

Back 25

The left side of the body

Front 26

Amaurosis fugax related to an ICA lesion will cause what?

Back 26

Temporary blindness or shading of the ipsilateral eye

Front 27

How long deos a TIA last?

Back 27

It usually resolves within 24 hours

Front 28

Simultaneous bilateral ocular symptoms in the patient with suspected cerebrovascular disease generally originates from where?

Back 28

There vertebrovascular arteries

Front 29

Which of the following is a vertebrovascular symptom? Aphasia, Vertigo, Amaurosis fugax, right anterior hemisphere TIA, or Unilateral paresis?

Back 29

Vertigo

Front 30

Which of the following is an anterior circulation symptom? Ataxia, Drop attack, Syncope, Binocular visual disturbance, or facial asymmetry?

Back 30

Facial asymmetry

Front 31

Define RIND?

Back 31

A neurologic ischemic deficit that resolves completely after 24 hours

Front 32

Two days ago a 56 yr old patient reports loss of vision in her left eye with total resolution in 10 minutes. Yesterday morning she developed weakness/numbness in her right hand with a 90% recovery, and normal sensation. What is clinically described as?

Back 32

A stroke

Front 33

Amaurosis fugax can be interpreted as what?

Back 33

A TIA

Front 34

Dyphasia, difficulty swallowing, is a symptom associated with what?

Back 34

Vertebrovascular insufficency

Front 35

What is a binocular disturbance that disrupts vision in half the visual field of both eyes?

Back 35

Homonymous hemianopia

Front 36

What does parasthesia refer to?

Back 36

Tingling sensation

Front 37

A patient describes a 30 minute episode of garbled speech. What is this called?

Back 37

Dysphasia (longer more persistent is Aphasia)

Front 38

A right handed patient describes a 30 minute episode of garbled speech. Which area of circultation is affected?

Back 38

The right hemisphere (Affects the patients stronger side)

Front 39

Which of the following statements is true regarding a subclaviain steal? Resulting strokes are usually disabling, it is usually a harmless phenomenon, it is caused by arterial obstruction proximal to the origin of the vertebral artery, it is caused by arterial obstruction, A & C, A & D, B & C, or B & D?

Back 39

B and C, It is usually a harmless hemodynamic phenomenon, and it is caused by arterial obstruction proximal to the origin of the vertebral artery

Front 40

What side does a subclavian steal usually affect?

Back 40

The left

Front 41

What does a hemispheric stroke usually affect?

Back 41

The middle cerebral artery distribution and the contralateral side of the body

Front 42

Stenosis of what vessel presens the hitghest risk for a TIA?

Back 42

The internal carotid artery

Front 43

What is a decreased pulse at mid neck suggestive of?

Back 43

CCA stenosis if the contralateral pulse is normal

Front 44

Which of the following statements is not true regarding a carotid bruit? Sever stenosis may cause a bruit, the absence of a bruit rules out significant stenosis, the presence of a bruit is significant, a cervical bruit might arise from stenosis of the ECA, or a bruit extending into diastole suggests sever stenosis?

Back 44

The absence of a bruit rules out significant stenosis is false, it does not rule out stenosis

Front 45

Bruits heard bilaterally, loudest low ib the neck is most likely caused by what?

Back 45

Aortic valve stenosis

Front 46

A stronger pulse palpated ion the right neck than on the left, this could result from all of the following Except which? Tortuous CCA, Carotid anurysm on the right, Tech error, Left carotid obstruction, or innominate occlusion?

Back 46

Innominate occlusion

Front 47

Which of the following statements is true regarding the clinical detection of a bruit? A bruit is always an indication of disease, it means that turbulent flow exists, it may be indicative of valvular dysfunction in the heart, it may be a normal finding in parts of some vessels and during periods of enhanced flow, a bruit is present in >90% of vessels with disease. B,C,&D, or A,B,&E?

Back 47

B,C,&D It means that turbulent flow exists, it may be indicative of valvular dysfunction in the heart, and it may be a normal finding in parts of some vessels during periods of enhanced flow

Front 48

During ordinary ausculation of a carotid bifurcation, the detection of a bruit that extends into diastole

Back 48

Is highly significant

Front 49

Which of the following is Least likely to cause a bruit in the neck? Severe stenosis of the ICA, Severe stenosis of the ECA, Hyperdynamic carotid flows, Cardiac valvular disease, or Critical preocclusive stenosis of the ICA?

Back 49

Critical preocclusive stenosis of the ICA

Front 50

Why are brachial pressures taken bilaterally when evaluation a patient for cerebrovascular disease?

Back 50

To make sure they are equal

Front 51

All of the following statements apply to pulsed wave Doppler Except which? Aliasing occurs when the freq shift exceeds 1/2 the system sampling rate, one transducer is used for both transmission and reception, The beam is continuously transmitted with intermittent reception according to vessel depth, a sample volume is used to determine the depth of interest, or all of them are correct?

Back 51

The beam is Not continuously transmitted, it is pulsed

Front 52

Loss of the spectral window with pulsed Doppler ultrasound occurs with what?

Back 52

Flow turbulence, Increased gain, the sample volume is too close to the arterial wall, incorrect sample volume angle, stenosis

Front 53

A goblet like configuration of the internal and external branches curving around a highly vascularized mass suggests what?

Back 53

Carotid body tumor

Front 54

Duplex imaging, the best arterial wall image quality is obtained when the beam is at what angle?

Back 54

90

Front 55

Transcranial Doppler findings consistent with vasospasm following subarachnoid hemorrhage would include what?

Back 55

Greatly increased mean velocities in the middle cerebral artery

Front 56

TCD, the normal direction of flow in the vertebral artery is what?

Back 56

Away from the beam - retrograde

Front 57

Which of the following os Not a condition which TCD might be useful? Vasospasm following subarachnoid hemorrhage, determination of brain death, cerebral artery monotoring during surgery, carotid siphon stenosis, or temporal arteritis,

Back 57

Temporal arteritis

Front 58

Doppler beam is considered optimal for standardization of duplex carotid studies is what?

Back 58

60

Front 59

The usual instrumentation for handheld TCD includes a probe with an operating freq of what?

Back 59

2MHz

Front 60

TCD, the normal direction of flow in the anterior cerebral artery is what?

Back 60

Away from the beam - retrograde

Front 61

A localized increase in mean velocity from 50 to 150 cm/sec at a depth of 50 mm with the TCD placed in the temporal window probably indicates what?

Back 61

Significant stenosis of the MCA

Front 62

TCD, the angle of the beam relative to flow is assumed to be what?

Back 62

0

Front 63

TCD, insonating the left anterior cerebral artery. The flow is toward the beam. This suggests what?

Back 63

Ipsilateral carotid obstruction, with right to left collateralization

Front 64

Name 2 things that will alter the frequency shift of the ICA doppler signal?

Back 64

Tapering of the vessel from the bulb to the distal visualized segment and Increasing the transmitted frequency

Front 65

Which one of the following criteria for stenosis would be anticipated in the presence of a 50-60% diameter stenosis of the ICA? Poststenotic turbulence only, Blunting of the systolic waveform with absence of diagnostic freq at the site of max freq shift change, Elevation of both systolic and diastolic freq components with no demonstrable poststenotic turbulence, Elevation of systolic and diastolic freq components with no demonstrable poststenotic turbulence, or an Elevation of systolic frequency with poststenotic turbulence?

Back 65

Elevation of systolic freq with poststenotic turbulence

Front 66

What is the best way to prepare a transducer for intraoperative use?

Back 66

Place it in a sterile bag with acoustic gel

Front 67

Pulse wave doppler, with spectral analysis to asses the ICA, which of the following operator error would most likely result in a falsely LOW freq shit? Overdriving the doppler signal gain, allowing the signal beam to overlap both an artery and a vein, changing to a higher freq transducer, leaving the wall filter on, or increasing the beam angle to 70?

Back 67

Increasing the beam angle to 70

Front 68

Of the chief advantages of continuous wave doppler, which of the following is FALSE? Aliasing can not occur; recording of extremely high freq shifts, It allows more precise range gating than pulse, The signal to noise ration is inherently greater than pulsed doppler systems due to it's continuous state, Continuouos dopplers are less expensive, The instrumentation is less comples than in pulsed

Back 68

It allows more precise range gating than pulse

Front 69

What is the chief limitation of continuous doppler?

Back 69

Depth information is not possible; precise location of flow pattern can not be determined

Front 70

TCD, the normal direction of flow in the MCA is what?

Back 70

Toward the beam, Antigrade

Front 71

Which of the following determinants dictates transducer freq selection for optimal carotid Bmode imaging? Desired beam width, The average and extreme depths of carotid vessels in most subjects to be studied, desired axial resolution, A,B,&C, or C,&D?

Back 71

A,B,&C- Desired beam width, The average and extreme depths of carotid vessels in most subjects to be studied, desired axial resolution

Front 72

Which of the following is true regarding axial resolution in carotid imaging? Differentiates soft plaque from blood, resolves two targets positioned one in front of another along the axis of the beam, improves the observers ability to estimate vessel thickness, determines the absolute depth of penetration of ultrasound beam at a given freq, A&D, B&C, or B&D?

Back 72

B&C -resolves two targets positioned one in front of another along the axis of the beam, improves the observers ability to estimate vessel thickness

Front 73

Using temporal window for TCD, you find a strong signal with considerable diastolic flow at a depth of 50mm, this is most likely what?

Back 73

The MCA

Front 74

To optimize carotid vessel image data, lateral resolution should be what?

Back 74

As small as possible to resolve side by side lesions

Front 75

The TCD window used for assesing the MCA is what?

Back 75

Temporal window

Front 76

A carotid bruit can be detected with color flow and spectral analysis as what?

Back 76

A mosiac of low red and blue freq's in color flow, in tissue lying outside or the lumen, and oscillatory waveforms above and below the baseline in the spectral waveform

Front 77

All of the following are consistent with total occlusion o fthe internal carotid atrery Except? Absence of flow in the ICA lumen, decreased velocity proximal to occlusion, retrograde flow in the distal ICA, increase in flow through collateral pathways, or an inability to be reconstructed surgically

Back 77

retrograde flow in the distal ICA

Front 78

TCD window used for assesing the ophthalmic artery and carotid siphon is what?

Back 78

Orbital

Front 79

The doppler diagnostic criterion that is most important for calling >80% stenosis is what?

Back 79

EDV

Front 80

An arterial stenosis that is 75% by cross sectional area reduction corresponds to a diameter reduction of what?

Back 80

50%

Front 81

An arterial stenosis that is 80% by diameter reduction corresponds to a cross sectional area reduction of? 96%, 88%, 70%, 60%, 45%

Back 81

96%

Front 82

A vascular lab calls a stenosis 60-70% by diameter based on its duplex assesment, but angiography the next day calls it 90% by diameter. All of the following are possible Except? The stenosis long and smooth changing its doppler character compared to that of a shorter lesion, only one plane of visulization was used for angiography, poor angle correction with the duplex, creating artificially low vvelocity estimates, acoustic shadowing prevented dopppler assesmentof the maximal narrowing, color flow PRF set too low, creating aliasing and overestimation of velocities

Back 82

creating aliasing and overestimation of velocities

Front 83

A print out from a TCD exam, one shows a spectral wave form labled "subocciptal window", and the depth is indicated to be 90mm. This is most likely what artery?

Back 83

Basilar

Front 84

The characteristics of flow in the different carotid artery segments are what?

Back 84

High resistance in the ECA, low resistance in the ICA, and Mixed in the CCA

Front 85

How is the doppler sample volume usually adjusted?

Back 85

Small, to sample flow only from the center

Front 86

How should the angle correct cursor be adjusted for velocity estimates?

Back 86

Parallel with the arterial walls

Front 87

The components of information on the spectral doppler display include all Except? Pixel brightness, Freq shift on Y axis, Time axis on X axis, depth on the Y axis, or all of them?

Back 87

depth on the Y axis

Front 88

You preform precussion maneuvers on the superficial temporal artery and see oscillations on the spectral display, what artery is being insonated?

Back 88

The ECA

Front 89

Which of the following is Not a useful color flow adjustment in an effort to detect slow flow in a possibly occluded ICA? Increase color flow gain, Increase color flow PRF, Decrease color flow PRF, Increase color flow wall filter, or Decrease beam angle relative to the vessel

Back 89

Increase color flow PRF

Front 90

Which of the following is Not a duplex indication of a totally occluded ICA? ICA lumen filled with heterogenous echoes, no doppler or color flow obtainable within the ICA lumen, Absence of diastolic flow in CCA spectral display, Greatly increased end diastolic velocities in CCA spectral display, or "Drumbeat" or "slapping" doppler signal at ICA origin

Back 90

Greatly increased end diastolic velocities in CCA spectral display

Front 91

Of the following, which is Not one of the main collateral pathways in ICA obstruction? Posterior to Anterior, Genicular to arcuate branches, Contralateral hemisphere, ECA branches to ophthalmic branches, or they are all good?

Back 91

Genicular to arcuate branches

Front 92

When visualizing the carotid bifurcation using duplex, MRI, or angiography, the best way to determine whether you are looking at the ICA is by the fact that what?

Back 92

The ECA has branches near the bifurcation and the ICA does not

Front 93

Conventional arteriography reveals 30% diameter stenosis in a symptomatic patient with severe stenosis by B mode and PSVs of 230 cm/sec in the proximal ICA. Which of the following statements is true? The high velocities were caused by carotid kinking, Even double projection arteriography may fail to fully determine diameter stenosis, especially in the event of vessel overlap, Arteriography may fail to reveal small "berry" aneurysms in the brain, B mode "plaquing" may have been background ultrasound noise, The ultrasound findings are not as important as the findings of an arch study

Back 93

Even double projection arteriography may fail to fully determine diameter stenosis, especially in the event of vessel overlap

Front 94

Major complications of cerebrovascular angiography occurs in approx?

Back 94

1% of patients

Front 95

What information can not be determined by cerebrovascular angiography?

Back 95

The degree of narrowing of ICA by cross sectional area

Front 96

What is the most common arterial puncture site for all forms of angiography?

Back 96

Common Femoral artery

Front 97

Angiography is generally considered only when the information is necessary for surgery or other urgent patient management because of all of these factors Except? It's expensive, It carries a risk of anaphylactic complications, it is often nondiagnostic, or it is an invasive procedure.

Back 97

it is often nondiagnostic

Front 98

Advantages of angiography over duplex carotid studies include all Except? Ability to visualize the intracranial collaterals, Superiority at calling ulceration, Ability to visualize the entire cerebral vasculature, Unlimited repeatability,or an Ability to determine siphon stenosis

Back 98

Unlimited repeatability

Front 99

an emergency room patient with stroke symptoms, the inital diagnostic exam of choice would likely be what?

Back 99

CT

Front 100

How does a Magnetic resonance angiography (MRA) function?

Back 100

By precessing radiofrequency pulses created by tissue and blood flow

Front 101

A pitfall of MRA is? Patients with cardiac pacemakers can not be studied, It requires the use of ionizing radiation, It tends to overestimate the degree of stenosis, and it requires a high degree of patient cooperation., A&B, A&C, all but A, All but B, All but C

Back 101

All but B - It requires the use of ionizing radiation

Front 102

Are endarterectomy procedures used for obstructed lower extremity arteries?

Back 102

No normall the are bypassed

Front 103

The NASCET trial indicated that the best treatment for carotid stenosis in the symptomatic patient is what?

Back 103

Carotid endarterectomy for stenoses greater than 70% in diameter

Front 104

What is the most common medical treatment for acute ischemic stroke?

Back 104

rtPA

Front 105

When is Hypertension associated with hyperperfusion syndrome

Back 105

After carotid endarterectomy

Front 106

What does Raynold # > 2000 mean?

Back 106

Tirbulent flow