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106 Cards in this Set

  • Front
  • Back
cerebrovascular fiibromuscular dysplasia occurs mostly in who?
In females
(Resembels a string of beads)
Describe how atherosclerosis works?
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)
With a left arm blood pressure that is 40mmHg lower than the right can be the result of what?
A Thoracic outlet entrapment, subclavian steal, Coractation of the aortic arch, and Innominate artery occlusion. (It is not an innominate occlusion)
What can you expect a with subclavian artery stenosis on the right side?
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)
What type of anatomic lesions can produce a vertebral steal?
An innominate artery occlusion, a left subclavian artery orgin stenosis. (Answer is A&B)
A hypertensive, diabetic 65-year oldmale, presents for cerebrovascular testing because of an asymptomatic bruit on the right side. What could be potential sources?
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)
A disease that affects primarily the intima and may extend into the media is what?
Aneurysmal disease
After carotid bifurcation disease, what is the next most common source of stroke symptoms?
Cardiac-source embolization
What is the strongest risk factor for stroke?
Hypertension can lead to small vessel rupture, hemmorhage.
In the cerebrovascular system, atherosclerosis occurs most commonly where?
The origin of the internal carotid artery
What is the most prevelant type of stroke?
Ischemic
Where are carotid body tumors located?
Betwen the ICA nd the ECA.
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?
It does not result from severe stenosis or occlusion of the proximal vertebral artery
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?
Carotid dissection
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?
Neointimal Hyperplasia
What does the term hemiparesis mean?
Weakness of one side
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
Diameter % stenosis calculated by dividing the minimal diameter by the diameter of the un-stenosed distal ICA
All of the following may represent symptoms from the brain stem or posterios circulation EXCEPT what? Dizziness, Vertigo, Ectasia, Syncope, Amaurosis Fugax
Amaurosis Fugax
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
False, Diplopia
What is a symptom of vertebrobasilar insufficiency is what?
Diplopia
On opthalmologic exam, a bright yellow spot is noticed with a branch artery, this is Hollenhorst plague. True or False
True
A patient complains of temporary shading of one eye, what is this symptom called?
Amaurosis Fugax
What is the incidence of new strokes per year?
500,000
What does the abbreviation TIA stand for?
Transient Ischemic Attack
A TIA of the right hemisphere of the brain will likely affect what?
The left side of the body
Amaurosis fugax related to an ICA lesion will cause what?
Temporary blindness or shading of the ipsilateral eye
How long deos a TIA last?
It usually resolves within 24 hours
Simultaneous bilateral ocular symptoms in the patient with suspected cerebrovascular disease generally originates from where?
There vertebrovascular arteries
Which of the following is a vertebrovascular symptom? Aphasia, Vertigo, Amaurosis fugax, right anterior hemisphere TIA, or Unilateral paresis?
Vertigo
Which of the following is an anterior circulation symptom? Ataxia, Drop attack, Syncope, Binocular visual disturbance, or facial asymmetry?
Facial asymmetry
Define RIND?
A neurologic ischemic deficit that resolves completely after 24 hours
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?
A stroke
Amaurosis fugax can be interpreted as what?
A TIA
Dyphasia, difficulty swallowing, is a symptom associated with what?
Vertebrovascular insufficency
What is a binocular disturbance that disrupts vision in half the visual field of both eyes?
Homonymous hemianopia
What does parasthesia refer to?
Tingling sensation
A patient describes a 30 minute episode of garbled speech. What is this called?
Dysphasia (longer more persistent is Aphasia)
A right handed patient describes a 30 minute episode of garbled speech. Which area of circultation is affected?
The right hemisphere (Affects the patients stronger side)
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?
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
What side does a subclavian steal usually affect?
The left
What does a hemispheric stroke usually affect?
The middle cerebral artery distribution and the contralateral side of the body
Stenosis of what vessel presens the hitghest risk for a TIA?
The internal carotid artery
What is a decreased pulse at mid neck suggestive of?
CCA stenosis if the contralateral pulse is normal
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?
The absence of a bruit rules out significant stenosis is false, it does not rule out stenosis
Bruits heard bilaterally, loudest low ib the neck is most likely caused by what?
Aortic valve stenosis
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?
Innominate occlusion
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?
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
During ordinary ausculation of a carotid bifurcation, the detection of a bruit that extends into diastole
Is highly significant
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?
Critical preocclusive stenosis of the ICA
Why are brachial pressures taken bilaterally when evaluation a patient for cerebrovascular disease?
To make sure they are equal
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?
The beam is Not continuously transmitted, it is pulsed
Loss of the spectral window with pulsed Doppler ultrasound occurs with what?
Flow turbulence, Increased gain, the sample volume is too close to the arterial wall, incorrect sample volume angle, stenosis
A goblet like configuration of the internal and external branches curving around a highly vascularized mass suggests what?
Carotid body tumor
Duplex imaging, the best arterial wall image quality is obtained when the beam is at what angle?
90
Transcranial Doppler findings consistent with vasospasm following subarachnoid hemorrhage would include what?
Greatly increased mean velocities in the middle cerebral artery
TCD, the normal direction of flow in the vertebral artery is what?
Away from the beam - retrograde
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,
Temporal arteritis
Doppler beam is considered optimal for standardization of duplex carotid studies is what?
60
The usual instrumentation for handheld TCD includes a probe with an operating freq of what?
2MHz
TCD, the normal direction of flow in the anterior cerebral artery is what?
Away from the beam - retrograde
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?
Significant stenosis of the MCA
TCD, the angle of the beam relative to flow is assumed to be what?
0
TCD, insonating the left anterior cerebral artery. The flow is toward the beam. This suggests what?
Ipsilateral carotid obstruction, with right to left collateralization
Name 2 things that will alter the frequency shift of the ICA doppler signal?
Tapering of the vessel from the bulb to the distal visualized segment and Increasing the transmitted frequency
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?
Elevation of systolic freq with poststenotic turbulence
What is the best way to prepare a transducer for intraoperative use?
Place it in a sterile bag with acoustic gel
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?
Increasing the beam angle to 70
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
It allows more precise range gating than pulse
What is the chief limitation of continuous doppler?
Depth information is not possible; precise location of flow pattern can not be determined
TCD, the normal direction of flow in the MCA is what?
Toward the beam, Antigrade
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?
A,B,&C- Desired beam width, The average and extreme depths of carotid vessels in most subjects to be studied, desired axial resolution
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?
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
Using temporal window for TCD, you find a strong signal with considerable diastolic flow at a depth of 50mm, this is most likely what?
The MCA
To optimize carotid vessel image data, lateral resolution should be what?
As small as possible to resolve side by side lesions
The TCD window used for assesing the MCA is what?
Temporal window
A carotid bruit can be detected with color flow and spectral analysis as what?
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
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
retrograde flow in the distal ICA
TCD window used for assesing the ophthalmic artery and carotid siphon is what?
Orbital
The doppler diagnostic criterion that is most important for calling >80% stenosis is what?
EDV
An arterial stenosis that is 75% by cross sectional area reduction corresponds to a diameter reduction of what?
50%
An arterial stenosis that is 80% by diameter reduction corresponds to a cross sectional area reduction of? 96%, 88%, 70%, 60%, 45%
96%
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
creating aliasing and overestimation of velocities
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?
Basilar
The characteristics of flow in the different carotid artery segments are what?
High resistance in the ECA, low resistance in the ICA, and Mixed in the CCA
How is the doppler sample volume usually adjusted?
Small, to sample flow only from the center
How should the angle correct cursor be adjusted for velocity estimates?
Parallel with the arterial walls
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?
depth on the Y axis
You preform precussion maneuvers on the superficial temporal artery and see oscillations on the spectral display, what artery is being insonated?
The ECA
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
Increase color flow PRF
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
Greatly increased end diastolic velocities in CCA spectral display
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?
Genicular to arcuate branches
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?
The ECA has branches near the bifurcation and the ICA does not
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
Even double projection arteriography may fail to fully determine diameter stenosis, especially in the event of vessel overlap
Major complications of cerebrovascular angiography occurs in approx?
1% of patients
What information can not be determined by cerebrovascular angiography?
The degree of narrowing of ICA by cross sectional area
What is the most common arterial puncture site for all forms of angiography?
Common Femoral artery
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.
it is often nondiagnostic
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
Unlimited repeatability
an emergency room patient with stroke symptoms, the inital diagnostic exam of choice would likely be what?
CT
How does a Magnetic resonance angiography (MRA) function?
By precessing radiofrequency pulses created by tissue and blood flow
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
All but B - It requires the use of ionizing radiation
Are endarterectomy procedures used for obstructed lower extremity arteries?
No normall the are bypassed
The NASCET trial indicated that the best treatment for carotid stenosis in the symptomatic patient is what?
Carotid endarterectomy for stenoses greater than 70% in diameter
What is the most common medical treatment for acute ischemic stroke?
rtPA
When is Hypertension associated with hyperperfusion syndrome
After carotid endarterectomy
What does Raynold # > 2000 mean?
Tirbulent flow