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143 Cards in this Set

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  • Back
The etiology of arterial abeyrysms includes all of the following except? Syphilitic, Degenerative, Inflammatory, Congenital, or Saccular
Saccular
More than 90% of inrarenal abdominal aneurysms are o what type?
Degenerative origin
What is a condition that causes nonatherosclerotic narrowing of brachiocephalic arteries in overwhelmingly female patients?
Takayasu's Disease
What is the most common source of lower or upper extrimity peripheral arterial embolus?
The heart
What are aneurysms most often caused by?
Congenital Arterial wall weakness
What is an occlusive disease of medium and small arteries in the distal upper and lower limbs of primarily young male, heavy smokers?
Thromboangitis obliterans
What is a condition that might result from reperfusion edema following bypass surgery, causing ischemia due to compression, and which might call for treatment by fasciotomy?
Compartment Syndrome (caused by increased pressure within a closed tissue space, leading to impared perfusion and ischemia)
The combination of neuropathy and peripherially distributed atherosclerosis makes the diabetic patient especially vunerable to what?
Foot lesions
What are the chances of a patient dying from a rupture of an abdominal aortic aneurysm?
80%
In the lower extremity circulation, where is the most common site of atherosclerosis?
The arterial segment begenning in the Hunter's Canal (Adductors canal)
Which of the following statements is true about popliteal aneurysms? The can cause symptoms by compressing contiguous structures, The pose significant risk of limb loss due to embolism or occlusion, They are found bilaterally in >10% of cases where they exist, Claudication is a rare symptom, A and D, or B-C-D?
B-C-D: They can cause symptoms by compressing contiguous structures, They pose a significant risk of limb loss dudue to embolism or occlusion, They are found bilaterally in >10% of cases where they exist
Which of the following statements is False regarding abdominal aortic aneurysms? AAA's are usually infrarenal, CT and MRI are common modalities for the diagnosis of AAA, Ultrasound is the most frequently used modalities for the diagnosis of AAA, Abdominal aneurysms pose a significant risk of rupture if >6 cm in diameter, Most prerupture AAAs are discovered because of abdominal symptoms or distal emboli
Most prerupture AAAs are discovered because of abdominal symptoms or distal emboli is false
What is the risk of claudication in diabetic patients?
Greater than 4 times the risk in the general poulation
Which of the following is not a risk factor in peripheral arterial occlusive disease? Hypolipidemia, Smoking, Hypertension, Diabetes, Hyperlipidemia
Hypolipidemia
What is the vascular disease that presents as back, abdominal, or flank pain?
Abdominal Aortic Aneurysm
Takayasu's arteries is most often found in whom?
Young Women
Common signs of advanced arterial insufficiency of the lower extremityinclude what?
Loss of hair growth over the dorsum of the toes and feet, Thickening of toenails, Dependent rubor
A common evaluation for advanced lower extremity ischemia involves raising the supine patients leg and then having the patient sit and dangle the leg. A positive result is described as what?
Elevation pallor, dependent rubor
Patients with symptoms of claudication complain of what?
Cramping pain in the calf, thigh, or buttocks with excercise and relieved with rest
Patients presenting with diagnosis of ischemis rest pain may comlain of what?
Foot pain in a horizontal position, relieved by standing or dangling the foot in a dependent position
Patients found to have ulcerating lesions or gangrene may which diseases?
Arterial insufficiency, neuropathy, vasospasm, venous disease
What are the most common presenting symptoms in acute arterial occlusion?
5-P's Paralysis, Pulselessness, Pallor, Paresthesias, Pain
Patients with advanced peripheral arterial vascular occlusive disease exibits what skin changes?
Shiny, scaly skin; Dependent Rubor; Pallor on elevation
pain that does not limit the patients ability to walk, with varying pain, resolved by sitting down. Is this a vascular disease?
These symptoms are not typical of vascular disease
A diabetic patient with redness of the skin in the foot and toe probably has what?
An infection
A pulsitile mass in the groin after catherization of a cardiac patient most likely will be what?
A pseudoaneurysm of the femoral artery
Early atherosclerosis of the lower extremities will be associated with what?
Claudication
Which sign or symptom is least likely to be associated with arterial embolization? Blue Toe, TIA, Popliteal aneurysm, Amaurosis fugax, Progressive claudication
Progressive claudication
What is rest pain characterized by?
Pain at night in the forefoot or foot that may go away with leg dependency
The symptom or sign most likely not to be associated with acute arterial occlusion is? Blue toe, Pain of sudden onset, Pale or white extremity, Claudication, Paresthesia
Claudication
What are ischenic ulcers?
Very painful and commonly located over the dorsum of the foot
Where are common sites for auscultation of bruits in the lower extremity circulation?
Abdomen, Groin, and the Popliteal space
What is a vibration noted while palpating pulses?
A thrill
What is rubor defined as?
Red skin color
Ulcers due to arterial insufficiency are found most often where?
On toes and the distal foot
Delayed return of the capillary blush after pressure on the pulp of the digit is a sign of what?
Advanced ischemia
What are signs of advanced ischemia in the lower extremity?
Slow venous filling after dropping the elevated extremity into a dependent position, Pallor on elevation, rubor on dependency, and ulceration at the dorsum of the foot
Pulse sites commonly palpated in the lower extremities include all except what? CFA, Popliteal, Posterios Tibial, Anterior Tibial, Peroneal
Peroneal is not a connon site of paplation
Does the absence of a bruit rule out significant stenosis?
No
Why is the Auscultation of the abdomen, aortoilliac, and CFA important?
Presence of a bruit may be the first indication of arterial disease
What are the sypmptoms of anterior tibial compartment syndrom?
Swelling and/or palpable tenderness, sensory defecit or paresthesias, Pain on passive strech of the muscle, and weakness of the muscles in the compartment
What does unilateral claudication on the calf and foot of a young individual suggest?
Popliteal artery entrapment
A patient complains of distal pallor or cyanosis induced by cold exposure or emotional stimuli. These symptoms are characteristic of what?
Raynauds phenomenon
What is the pulsitility index defined as?
Peak systolic to peak end diastolic velocity divided by mean velocity
What is always true of patients who suffer from intermittent claudication?
There is a pressure drop distal to the obstructed segment after excercise
Which of the following conditions will cause an increase in the pulse amplitude of the arterial pressure wave? An increase in peripherial resistance, a decrease in left ventricular function, vasodilation secondary to heating, young age, or mild atherosclerosis
An increase in preipherial resistance
Which one of the following changes occur in peripherial blood flow of limbs with obstructive aterial disease in response to laboratory induced ischemia or excercise? Flow increases more in obstructed limbs than in limbs with no obstruction, Hyperemia is prolonged in obstructed limbs in comparison to limbs with no obstruction, flow decreases in order to redistribute blood volume to the central circulation, Cardiac output is reduced, peripherial resistance is increased due to muscle contraction
Hypertension is prolonged in obstructed limbs in comparison to limbs with no onstruction
What are the ankle/arm indices in claudicating patients ?
In the range of .5 to .9
How is the ankle/arm index obtained?
By dividing the Ankle pressures by the higher brachial pressure
A velocity obtained in the mid SFA is 225 cm/sec, while a measurement just proximal to this site gives 90 cm/sec. What does this suggest?
>50% SFA stenosis
The right high-thigh pressure measurement is 108 mmHg, while the left high-thigh is 142 mmHg, Brachial is 122 mmHg. Which of the following is most likely: Right femoral obstruction, Left femoral obstruction, Aortoilliac obstruction, Left iliac artery obstruction, or Right popliteal artery obstruction.
Right femoral obstruction
What is the key technology in arterial pneumoplethysmography?
A pressure transducer monitoring cuff pressure over a limb
When assesing a digital aretry with doppler, patency of the palmar arch can be determined how?
By alternately compressing the radial and ulnar arteries while listening for changes in the digital artery signal
When is assesment of the palmar arch patency useful?
Before placement of an arteriovenous arm shunt, and to evaluate blood flow to the digital arteries
An analog doppler waveform of the subclaivian or axillary artery in a normal individual would typically resemble what?
A CFA or SFA waveform
A popliteal to dorsal pedal lesser saphenous reverse bypass graft has a peak systolic velocity of 28 cm/sec at the distal anastomosis. Which of the following is true? This velocity may be normal for this graft, The gradt is failing because the velocity is less than 45 cm/sec, The graft is failing because the graft velocity has increased from 24 cm/sec measured in a previous study, The graft is failing because the velocity has decreased from 32 cm/sec measured in a previous study, We must know the diastolic velocity before interpreting this velocity information
This velocity may be normal for this graft
What are the two flow characteristics that define arterial stenosis anywhere in the body include focal acceleration and what?
Velocities and Distal turbulence
Diastolic reversal of flow is most likely in what?
Extremities at rest
Why do doppler velocity waveforms from upper extremity vessels vary slightly from lower extremity waveforms?
Because the peripherial resistance is usually lower in the upper extremity
28 yr old male complains of excercise induced cramping of the right calf that occurs after walking 6 blocks and is relieved within 5 mins of rest. Bounding pedal pulses are noted and resting ankle pressures are normal. The symptoms are reproduced with excercise. The ankle pressure remains normal on the left but drops to 40mmHg on the right. What are these signs consistent with?
Popliteal entrapment
Your segmental pressure readings disclose a 36 mmHg decrease in pressure from the low thigh to the below the knee anterior tibial artery, and a 10mmHg decrease from low thigh to below knee posterior tibial artery. These findings localize obstruction to what?
The anterior tibial artery
Your segmental pressure readings indicate 126 mmHg at the high thigh, 144 at the low thigh, and 120 at below the knee. These findings might be the result of all the following except? SFA obstruction, Cuff artifact, poor cuff application, calcified arteries in a diabetic patient, or all are possible causes.
SFA obstruction
All of the following devices utilized in a standard fasion can measure ankle pressures except? Doppler, B-mode, Strain guage plethysmography, Photocell plethysmography, air plethysymography
B-mode
This CW doppler wavefor from a popliteal artery
Suggests interference from venous flow
Protocols for cardiac treadmill testing and claudication treadmill testing differ, what is the major difference?
The speed is varied during cardiac tests
A four level pressure cuff technique is used to asses arterial disease in the legs. Thigh high pressure is 140 mmHg, with an arm pressure of 160 mmHg, All of the following lesions can cause this Except what? Significant aortic stenosis, Common or External Iliac artery disease, SFA plus profunda artery occlusion, CFA, or Isolated profunda femoral artery disease
Isolated profunda femoral artery disease
While preforming a treadmill test, the patient complains of pain in the left arm and jaw, but denies any other pain. The examiner should consider this could possibly be what>?
Angina
During assesment of ankle pressures, all three vessels at the level of the ankle are used to measure pressures. The pressure in both the PTA and Peroneal is 40 mmHg and the DPA is 50mmHg. Which of the following is true? The PTA pressure should be used to calculate the ankle/brachial index, The DPA pressure should be used to calculate the ankle/brachial index, The PTA pressure should be used to calculate the ABI, There is disease in the Tibiopreoneal trunk, There is disease in or above the PTA.
The DPA pressure should be used to calculate the ankle/brachial index
What is the normal diameter for the abdominal aorta?
2-3 cm
A patient complains of rest pain, on physical exam, elevation pallor and dependent rubor are present. There are no palpable pulses in the leg. A pressure of 120mmHg is measure at the ankle. This preassure is?
Higher than expected
A patient with a history of rest pain. 100 foot calf and thigh claudication and an ulcer on the great toe of the ledt foot has a left ankle pressure of >300mmHg. What is this result?
Erroneous due to probable arterial calcification
A patient with mild claudication like symptoms has an ankle brachial index for the affected leg of 1.02 What is this finding?
An incomplete evaluation
After walking for 5 mins on the treadmill, a patient eexperiences desreases in ankle pressure of 40% on the right and 15% on the left. What is this finding?
Typical for patients with claudication
Left ankle/brachial index is what? RT arm 180/100 LT arm 120/60, RT PTA 100, LT PTA 90
.50 (90/180)
In consideration of the aforementioned pressure findings, which of the following statements is not true? The patient has RT LE arterial di=sease, The patient has LT LE arterial disease, The patient has renovascular hypertension, Arteriography would be reccomended if bypass surgery is contemplated
The patient has renovascular hypertension
What is the correct setting for arterial volume recording?
AC-coupled output
Doppler waveform abnormalities in the lower extremity arterial circulation distal to a hemodynamically significant stenosis include?
Absent flow reversal component, blunting of the peak velocity, and prolonged upslope and downslope
Parameteres usually assessed in excercise testing include all Except? Changes in Thigh to ankle index, Time requird for recovery, patient complaint of leg pain, length of time of excercise, magnitude of pressure drop
Changes in thigh to ankle index
Reasons to preform reactive hyperemia instead of treadmill testing include all Except? Patients inability to tolerate application of pressure cuffs, patients inability to stand or walk, patients poor cardiac status, patient has pulmonary problems, patient has very sever disease in one leg
Patients inability to tolerate application of the pressure cuff
A normal arterial volume waveform may have all except? Swift upstroke, Sharp peak, Rapid downslope bowed toward baseline, Dicrotic notch, Reverse flow component
Reverse flow component
What is the most widely used interpretive technique for analog Doppler waveform?
A qualitative approach or pattern recognition
Normal Doppler waveform morphology for a peripherial artery includes what?
A sharp upslope and downslope and a prominent reverse flow component
A normal resopnse of ankle pressure to excercise testing (such as treadmill) is?
No change
The amplitude of arterial volume recording waveforms
Is only marginally meaningful diagnostically
Possibel errors that can occur when recording a remoral arterial waveform using CW doppler include? Isonating an artery other than the intended one, recording two vessels simultaneously, Using an improper probe freq, B & C, All of the Above
All of them
The doppler beam may be attenuated if what?
The sound beam must pass through scar tissue a hematoma or excessive fat, The vessel has calcific plaque on the anterior wall
With sever LE arterial occlusive disease, the Doppler waveforms distaly will appear how?
Markedly dampened possibly making interpretation difficult for distal segments
Transcutaneous partial pressure of oxygen studies can be useful for all except? Determination of arterial level of obstruction, Determination of amputation level, Assessment of skin graft viability, Assessment of foot perfusion, Assessment of healing stump
Determination of arterial level of obstruction
What is the usual cuff pressure used in arterial colume recording?
65mmHg
This distal photoplethysmography waveform might suggest?
Secondary Raynauds disease
Distal to an aortoilliac occlusion, the CFA signal is typically what?
Low pitched and monophasic
Diastolic flow reversal may be absent where?
In vasodilated limbs
What is the most important reason doppler evaluations should be preformed with the patient in the basal state and warm temperatures?
The results are influenced by the patients peripheral resistance
Audible doppler venous signals typically are low freq and vary with respiration, wheras normal arterial signals in the legs and arms are what?
Relatively high freq with pulsatile components
If one is listening with a continuous wave doppler directly over a stenotic lesion the signal will have waht?
A high freq sound
Little or no increase of blood flow velocity in response to postocclusive reactive hyperemia. Using an inflated thigh cuff would most likely indicate what?
Significant obstructed disease
What is a normal postpcclusive reactive hyperemia velocity response?
A >100% increase in mean velocity
Monophasic PTA waveforms, despite mormal ankle/arm indices in the asymptomatic patient indicate what?
That the high pass filter may be set too high
In a patient who wakes up at night with pain in the foot and has to drop the foot by the side of the bed, the ankle/arm systolic pressure ratio will most likley be what?
Less than .50
In the presence of tibial artery calcification in the diabetic patient, the ankle arm index may be what?
In the normal range or abnormally decreased, yet falsely elevated
You are preforming CW dopppler on a patients lower extremity arteries, You obtain a signal at the proximal dorsalis pedis level. When you move proximally, the signal becomes higher in pitch. This could be all of the following except what? You have moved over a stenotic area, You have stod the probe up increasing the angle, You leaned the probe back decreasing the angle, you moved over a segment of artery which is going deeper, You are pushing too hard on the probe
You have stood the probe up increasing the angle of incidence is not a result
While monitoring of femorodistal bypass graft using duplex ultrasonography, the graft may be at risk of failure if what?
The graft velocity has dropped from 70 cm sec as measured 6 months earlier to 30 cm sec
True or false, Toe pressures are falsely elevated less frequently than tibial ankle pressures?
True
Systolic thigh pressures are 180 mmHg in both LE's; the systolic arm pressure is 170 mmHg on the right and 160 mmHg on the left. The patient complins of claudication. What is a possible diagnosis.
The patient may have aortoilliac occlusive disease
To minimize error during the measurement of the systolic pressures using a manometer having 2 mmHg marks, what should the deflation rate be?
Approx 2mmHg per heart beat
How can a PTFE graft be identified during ultrasound imaging?
A double line appearance of the graft walls
A patient has a 50% diameter stenosis in a LE vein graft.The systolic velocity at the stenosis will be 100% greater than what?
The prestenotic velocity followed by a drop in velocity
The velocities measured in a reversed saphenous vein byupass graft are usuallly what?
Higher proximally and lower distally
How should the volume of blood flow be in a reversed saphenous vein bypass graft?
The same throughout
In the presence of arterial obstructive disease and distal ischemia, what happens withh vasodilation and distal resistance?
Vasodilation increases and distal resistance decreases
A damped doppler velocity waveform of the subclavian artery isolates a significant lesion where?
Proximal to the point of insonation
What are normal values in TcPO2 assesment?
60-80 mmHg
When should evaluation of an abdominal aortic aneurysm be done?
Before breakfast / Fasting
What waveform would most likely be obtained with a CW doppler when there is a long SFA occlusion?
Triphasic at the CFA nad prox SFA with monophasic waveforms in the popliteal and tibeal artreries
In the calculation of ankle.brachial systolic pressure ratios, what arm pressure should be used as the denominator?
The higher of the right or left arm pressures
Claudication occurs with an ABI of what?
Between .5 and .9
Rest pain occurs with an ABI of what?
<.5
What is a normal ankle pressure response to reactive hyperemia?
Transient decrease of approx 20%
Pulse volume recording demonstrate a lack of dicrotic notch in the recordings at the thigh, decreased pulses at the upper calf, and flat tracings at the ankle. What is the most likely interpretation?
Mild iliofemoral stenosis, severe SFA stenosis or occlusion and severe infrapopliteal occlusive disease
In a study of the UE, pulse volume recording show lack of dicrotic notch at all levels of a patient with warm hands and fingers bilaterally. Why?
The patient is vasodilated
A clenched fist ill change what parameter in the brachial artery doppler waveform?
Increased pulsatility index
Which statement prob does not describe aspects of Raynauds disease?
Normal digital pressures when the hand is immersed in cold water
A 12 year old is noted by the pediatrician to have described femoral artery pulses and is referred to the lab for eval. Bilateral arm blood pressures are 210/100 and femoral artery pulses bilaterally are indeed diminished , as are the ankle pressures. Femoral artery doppler waveforms are abnormal. What diagnosis should be entertained
Coarctation of the aorta
Which ctatement is true regarding digital subtractioin arteriography?
A mask often without contrast is selected to be subtracted from the frames obtained during injection of the contrast solution
Which of the following is a significant problem with digital subtraction angiongraphy?
Patient cooperation
Which of the following is not correct regarding peripherial arterial angiography?
Arteriography is used for routine postoperative follow up
What is the usual site of puncture for a percutaneous LE angiography?
CFA
What do the common radiologic terms "inflow, outflow, and runoff" refer to?
Aortoilliac, femoropopliteal, and trifurcation arteries
Arteriography would be contraindicated or approached very cautiously in a patient with?
Renal failure
Which condition typically shows up on angiography as a string of beads?
Fibromuscular dysplasia
CT is useful in the LE primarily for detection of what?
Famoral or popliteal aneurysm
Regarding the use od magnetic resonance arteriography for evaluation of LE arteries, which is false
Mra cannot achieve the accuracy of conventional angiography
Compared to patency rates in the illiac arteries, patency rates for angiography of the infrarenal arteries are what?
Worse
What is the " Kissing stent" angioplasty stent useful for?
Bifurcations
What type of revascularization surgery requires the use of a valvulatome?
In situ saphenous graft
The UE vein most commonly used for an arterial bypass in the leg is what?
Cephalic vein
Which superficial vein is not commonly used as a bypass graft?
The superficial femoral vein
A patient has a 7 cm abdominal aortic aneurysm. The patient elects not to have an operation which of the following is false?
The risk of death from cardiac disease is greater than the risk of death from rupture of the aneurysm
A 64 year old male complains of half block left thigh and calf claudication without symptoms on the right. Physical examination reveals that the left femoral pulse is absent pulses on the right are normal without bruit. Treadmill testing results are abnormal on the left, normal on the right. Duplex reveals an occluded illiac artery on the left. This patient would be an ideal candidate for what?
Femorofemoral bypass
The five year risk for rupture of abdominal aortic aneurysms of 4cm is approx what?
<10%
Regarding lumbar sympathectomy, all are true except?
Potentiallu useful in claudication patients
What is the most effective lytic treatment for acute arterial thrombosis?
Urokinase or streptokinase
Your measurement of a patients abdominal aorta gives a diameter of 6.5cm. The probable management of this patient would involve what?
Elective repair