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461 Cards in this Set
- Front
- Back
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What are the 3 layers of blood vessels?
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1. Intima- inner
2. Media- middle 3. Adventitia- outer |
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Which vessel layer is thicker in arteries?
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Media
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What describes flow of blood from lt ventricle through body and back to rt atrium?
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Systemic
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What describes flow of blood from rt ventricle through lungs and back to lt atrium?
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Pulmonary
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What vessels transport blood to tissues?
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Arteries
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Which vessel layer is thinner in arteries?
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Adventitia
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What vessels regulate flow from arteries to capillaries?
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Arterioles
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With vasoconstriction, flow into capillaries increases/decreases?
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Decreases
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With vasodilation, flow into capillaries increases/decreases?
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Increases
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What vessels have the highest resistance in the circulatory system?
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Arterioles
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What vessels conduct exchange of nutrients and waste between blood and tissue?
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Capillaries
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What vessels connect arterioles and venules?
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Capillaries
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What vessels drain blood from capillaries into veins?
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Venules
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What vessels transport blood from tissues back to the heart?
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Veins
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What supplies blood vessels themselves?
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Vasa vasorum
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Blood flow and blood pressure are directly/inversely related?
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Directly
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Blood flows towards areas with higher/lower pressure?
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Lower
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What 3 factors affect BP?
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1. Cardiac output
2. Blood volume 3. Peripheral resistance |
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What is the formula for cardiac output?
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Stroke volume x heart rate
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What is the typical cardiac output?
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5.25 L/min
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What is the normal blood volume?
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5 L
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Blood volume increases/decreases with hemorrhage?
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Decreases
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Blood volume increases/decreases with salt intake?
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Increases
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What are 3 factors of resistance?
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1. Viscosity
2. Vessel radius 3. Vessel length |
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What describes the "thickness" of blood?
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Viscosity
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Viscosity increases/decreases with increased RBC's?
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Increases
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Viscosity increases/decreases with anemia or hemorrhage?
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Decreases
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When vessel radius decreases, vessel pressure increases/decreases?
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Increases
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When vessel length increases, vessel pressure increases/decreases?
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Increases
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What law describes how much fluid is moving through a vessel?
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Poiseuille's Law
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A Reynold's number higher than ___ indicates turbulent flow?
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2000
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What describes the inverse relationship between pressure and velocity?
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Bernoulli Equation
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What type of flow is found in ICA, renal, vertebral, hepatic, splenic, and celiac arteries?
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Low-resistance
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What type of flow is found in ECA, aorta, iliacs, subclavian, and extremity arteries?
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High-resistance
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What type of flow is found in high resistance vascular beds, distal to stenosis, or proximal to significant stenosis?
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Diastolic flow reversal
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With vasoconstriction, pulsatility increases/decreases in small and medium sized arteries?
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Increases
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With vasodilation, pulsatility increases/decreases in small and medium sized arteries?
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Decreases
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Name 5 major branches of the abdominal aorta, from prox to distal.
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1. Celiac axis
2. SMA 3. Renal arteries 4. IMA 5. Common iliac arteries |
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What are the 3 branches of the celiac axis?
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1. Left gastric
2. Splenic 3. Common hepatic |
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What are the 2 branches of the common hepatic artery?
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1. Proper hepatic
2. GDA |
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What artery feeds the small intestine, ascending colon, cecum, and part of the transverse colon?
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SMA
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What artery feeds most of the coolon and the rectum?
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IMA
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Veins are anterior/posterior to arteries above the umbilicus?
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Anterior
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Veins are anterior/posterior to arteries below the umbilicus?
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Posterior
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What is it when the aorta isn't aneurysmal, but doesn't taper normally?
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Ectasia
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Hardening and thickening of intimal wall
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Atherosclerosis
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Where are 2 common sites for atherosclerosis in the abdomen?
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1. Origin of renal arteries
2. Iliac bifurcation |
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Atherosclerosis is more common in men/women?
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Men
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What is narrowing of the aorta?
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Coarctation
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What are 2 clinical findings of coarctation?
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1. HTN
2. Lower extremity ischemia (decreased pulses) |
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What are 4 types of aneurysms?
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1. Fusiform
2. Saccular 3. Dissecting 4. Pseudoaneurysm |
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Chance of dissection is increased with what syndrome?
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Marfan's syndrome
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What are 3 types of grafts are seen in the aorta?
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1. Aortic end-to-end
2. Aortoiliac 3. Aorto-bifemoral graft |
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Where does the IVC originate?
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From the iliac veins at the 5th lumbar vertebra
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What are the 3 main branches of the IVC?
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1. Common iliac
2. Renal 3. Hepatic |
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T/F: The IVC and its main branches have valves
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False
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Intrathoracic pressure increases/decreases with inspiration?
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Decreases
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Intraabdominal pressure increases/decreases wiht inspiration?
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Increases
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Flow in legs increases/decreases with inspiration?
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Decreases or stops
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What is the main cause of IVC enlargement?
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Faulty tricuspid valve (reflux of blood through right atrium)
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What is the most common mural tumor in the venous system?
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Leiomyosarcoma
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What is normal portal venous pressure?
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0-5 mmHg
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What is abnormal values for portal venous pressure?
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10-12 mmHg
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What type of portal hypertension is found "before" liver?
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Prehepatic
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Name 6 causes of prehepatic portal hypertension?
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1. Congenital atresia of PV
2. PV thrombosis 3. SV thrombosis 4. Compression of PV by mass 5. Splenomegaly 6. AVM |
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What type of portal HTN is found within the liver?
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Intrahepatic
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Name 6 causes of intrahepatic portal HTN?
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1. Cirrhosis
2. Schistosomiasis (parasite) 3. Chronic hepatitis 4. Fatty liver 5. Diffuse metastatic disease |
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Name 3 causes of suprahepatic portal HTN
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1. Chronic heart failure
2. Budd-Chiari 3. IVC occlusion |
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What are 6 common types of varices seen with portal HTN?
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1. Splenic (MPV and SV)
2. Subcapsular liver (Intrahepatic PV's) 3. Esophageal (Gastric V's) 4. Hemorrhoids (SMV) 5. Recanalized paraumbilical (MPV) 6. Ascites/pleural effusion (chronically increased pressure) |
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What is normal velocity in a TIPS?
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125-200 cm/s
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With a TIPS, flow in the LPV and anterior RPV should be hepatopetal/hepatofugal?
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Hepatofugal
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What are 3 common complications with a TIPS?
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1. Stent occlusion
2. Stent stenosis 3. HV stenosis |
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What type of AVM will have a tangle of small vessels?
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Congenital
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What are 2 main causes of renal artery stenosis?
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1. Atherosclerosis
2. FMD |
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Where are 3 sites common sites of stenosis with renal transplants?
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1. Anastomosis
2. Distal donor artery 3. Recipient artery |
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A renal artery aneurysm larger than ___ requires surgery.
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2.5 cm
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What is normal PSV in the renal arteries?
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100-200 cm/s
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Renal artery PSV greater than ___ indicates > 60% stenosis.
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180 cm/s
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RAR greater than ___ indicates > 60% stenosis.
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3.5
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Acceleration time greater than ___ indicates a significant renal artery stenosis.
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70 ms
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External iliac artery becomes common femoral at what ligament?
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Inguinal
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Femoral artery becomes popliteal artery where?
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Hunter's (abductor) canal
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Anterior tibial artery runs along what membrane?
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Interosseous
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Anterior tibial artery becomes what in the foot?
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Dorsalis pedis
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What two arteries make up the plantar arch?
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Deep plantar and Lateral plantar
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What arteries supply the toes?
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Plantar arch and Dorsal metatarsal arteries
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In the lower extremity, where are the most common sites for aneurysm?
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SFA and popliteal artery
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Happens when pop artery becomes entrapped by gastrocnemius due to abnormal insertion of the muscle
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Entrapment syndrome
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A collection of symptoms produced by and obstruction of a portion of blood supply and increased pressure
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Compartment syndrome
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What syndrome is caused by increased amount of blood and serous fluid?
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Compartment syndrome
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What is an inflammation of veins or arteries, AKA Buerger's disease?
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Thromboangitis Obliterans (TAO)
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What is inflammation of veins or arteries that starts in the plantar or palmar vessels and proceeds centrally, preventing collaterals from forming?
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TAO
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What is pain produced by exercise?
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Claudication
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What is severe pain in the foot produced by TAO?
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Instep claudication
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What are the three most common sites of claudication?
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1) Buttocks
2) Thighs 3) Calves |
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Claudication in the buttocks indicates disease where?
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Aortoiliac
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Claudication in the thighs indicates disease where?
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Iliacs or common femoral
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Claudication in the calves indicates disease where?
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Femoropopliteal
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Vessels distal to stenosis will have increased/decreased pressure?
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Decreased
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During segmental pressure exam, the width of the cuffs should be ____ greater than diameter of the limb
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20-25%
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With segmental pressures, decreased pressure in a segment means there is disease proximal/distal
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Proximal
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What is used to confirm abnormally high ABI's resulting from vessel calcification?
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Toe pressures
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Why is it important to do segmental pressures with PVR?
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PVR could be normal if there are collaterals
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What are 3 methods of PVR?
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1. Air cuff
2. Strain gauged 3. PPG |
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What is a mercury filled tube that expands and contracts with tissue and is a form of PVR?
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Strain gauged
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What is a photocell w/ infrared light that is attached to the great toe and is a form of PVR?
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PPG
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PVR amplitude at thigh should be greater than ___ mm?
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15
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PVR amplitude at the calf should be greater than ___ mm?
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20
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What do you do if a patient has claudication and has normal ABI's?
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Have patient exercise
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Pressure in the high thigh should be ___ mmHg greater than brachial pressure
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30
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What is normal values for ABI's?
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> .96
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What ABI indicates ischemia?
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< .20
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Where does subclavian artery become axillary artery?
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At level of 1st rib
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Radial artery branches into what?
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Superficial palmar arch
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Ulnar artery branches into what?
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Deep palmar arch
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What syndrome occurs when an extra rib or scalene muscle compresses the distal subclavian or proximal axillary arteries?
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Thoracic outlet syndrome
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With subclavian steal, retrograde flow is present in the ipsilateral/contralateral vertebral artery?
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Ipsilateral
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With subclavian steal, difference in arm pressure is ___ mmHg?
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15-20
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What is giant cell arteritis that affects the aortic arch and its branches?
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Takayasu disease
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What is constriction of blood flow caused by cold or extreme emotional conditions?
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Raynaud syndrome
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What is the most common type of dialysis graft?
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Brachial artery to axillary vein
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With dialysis grafts, disease occurs mostly at the venous/arterial side
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Venous side
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PSV of greater than ___ cm/s indicates 75% diameter reduction in dialysis graft
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400
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What is the PSV normally in well-functioning dialysis grafts?
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100-200 cm/s
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Name 7 types of bypass grafts
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1. Aorto-bifemoral
2. Aortofemoral 3. Femoropopliteal 4. Axillofemoral 5. Axillofemoral/femorofemoral 6. Femorotibial 7. Femorofemoral |
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What are 2 types of autologous vein grafts?
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1. Reversed vein graft
2. In situ vein graft |
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What vessel is used for autologous vein grafts?
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GSV
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What are 3 causes of acute graft failure?
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1. Pseudoaneurysm
2. Surgical dissection of intima 3. Retained valve |
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What is the main reason for long term graft failure?
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Atherosclerosis
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With bypass grafts, inflow/outflow ratio >2 indicates ___ stenosis
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50-75%
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With bypass grafts, inflow/outflow ratio > 3 indicates ___ stenosis
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75%
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If overall graft velocity is less than ___ cm/s, there is high suspicion for thrombosis
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40
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With in situ grafts, the proximal segment is larger/smaller than the distal segment
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Larger
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With reversed vein grafts, the proximal segment is larger/smaller than the distal segment
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Smaller
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T/F: Retrograde flow at the distal anastomosis of a graft is normal
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True
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With inspiration, intrathoracic pressure increases/decreases?
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Decreases
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|
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With inspiration, intraabominal pressure increases/decreases?
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Increases
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With inspiration, flow in the lower extremity veins increases/decreases?
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Decreases
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How many valves are in each leg?
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100-200
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T/F: The soleal sinuses contain valves?
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False
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What are the risk factors for DVT (Virchow triad)?
|
1. Stasis
2. Trauma 3. Hypercoagulability (pregnancy, cancer, birth control, etc.) |
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What are two common complications of DVT?
|
1. Incompetence
2. PE |
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T/F: There is a greater risk for PE when DVT is above the knee
|
True
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What is it called when there is calf pain when the foot is dorsiflexed?
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Homan's sign
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What are 2 common anticoagulants used to treat DVT?
|
1. Coumadin
2. Heparin |
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What is put in the IVC to prevent DVT?
|
Greenfield filter
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What are 4 unusual forms of DVT?
|
1. Phlegmasia alba dolens
2. Phlegmasia cerulea dolens 3. May-Thurner syndrome 4. Klippel-Trenaunay-Weber syndrome |
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AKA "milk leg", ileofemoral thrombosis, increased frequency in postpartum period
|
Phlegmasia alba dolens
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Swollen, painful, blue leg; ileofemoral and GSV thrombosis, most severe form of DVT
|
Phlegmasia cerulea dolens
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When left CIV courses posterior to right CIA
|
May-Thurner syndrome
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|
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Congenital absence or atresia of deep veins
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Klippel-Trenaunay-Weber syndrome
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|
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What is the main cause of venous insufficiency?
|
Damage to valves due to DVT
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Type of varicose veins due to hereditary weakness or absence of valves; aggravated by pregnancy or obesity
|
Primary
|
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Type of varicose veins due to disease in deep system
|
Secondary
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|
Infection of soft tissues; hot, red skin
|
Cellulitus
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Loss of phasic venous flow indicates obstruction prox/distal to that segment
|
Proximal
|
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Forward flow during valsalva indicates what?
|
Pelvic thrombus
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|
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Pulsatile venous flow indicates what?
|
CHF or pulmonary HTN
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|
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What are the superficial veins in the arm?
|
Basilic and cephalic
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What veins join to make the axillary vein?
|
Brachials and basilic
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What 2 veins join to make the braciocephalic vein?
|
Subclavian and IJV
|
|
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What vein drains the interior of the skull, face, and neck?
|
IJV
|
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What vein drains the superficial head, face, and neck?
|
EJV
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What 2 veins join to make the superior vena cava?
|
Right and left brachiocephalic
|
|
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What veins do the vertebral veins drain into?
|
Brachiocephalic
|
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T/F: Upper extremity DVT is more serious than lower extremity DVT
|
False
|
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|
The internal pedundal artery branches from what?
|
Internal iliac
|
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What three arteries branch off of the internal pedundal artery before it becomes the penile artery?
|
1. Urethral
2. Bulbar 3. Perineal |
|
|
What arteries branch off of the penile artery?
|
1. Right and left cavernosal
2. Right and left dorsal |
|
|
What arteries supply the corpus cavernosum and communicate with the sinusoidal spaces?
|
Cavernosal
|
|
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What arteries supply the skin and glands of the penis?
|
Dorsal
|
|
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What artery supplies the corpus spongiosum and urethral tissue?
|
Urethral
|
|
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What artery supplies the urethral bulb and bulbourethral gland?
|
Bulbar
|
|
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What veins drain the corpus cavernosum?
|
Emissary and circumflex
|
|
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What veins drain the corpus spongiosum and empty into the internal pedundal vein?
|
Urethral
|
|
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What vein drains skin and subcutaneous tissue of the penis?
|
Superficial dorsal vein
|
|
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Explain how an erection is produced
|
Arterial beds relax allowing blood to fill sinusoids-- this causes increased pressure on veins, preventing venous drainage
|
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What is caused when plaque or scar tissue develops on the tunica albuginea and causes a curvature in the penis during an erection?
|
Peyronie disease
|
|
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What are arterial causes of ED?
|
Disease in the cavernosal, penile, or internal pedundal arteries
|
|
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What are venous causes of ED?
|
Veins may not become sufficiently compressed
|
|
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How can an AVM cause ED?
|
Allows blood to leave corpus cavernosum before sufficient pressure is achieved
|
|
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What veins are usually involved with varicoceles?
|
Pampiniform plexus and cremasteric plexus
|
|
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T/F: Varicoceles are more common on the right side
|
False
|
|
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T/F: Varicoceles increase the temperature in the scrotum and lowers sperm count
|
True
|
|
|
PSV of less than ___ cm/s when penis is flaccid indicates arterial insufficiency
|
10
|
|
|
Diameter of penile arteries should increase more than ___ percent with injection of prostaglandin
|
75
|
|
|
Flow in penile arteries preinjection are high resistance/low resistance?
|
High resistance
|
|
|
Flow in penile arteries postinjection are high/low resistance?
|
Low resistance
|
|
|
EDV in penile arteries postinjection, should be less than ___ cm/s
|
5
|
|
|
What are normal values for PBI's? (Penile-brachial index)
|
.65 to .70
|
|
|
Where is the speech area of cortex located?
|
Temporal lobe of dominant hemisphere
|
|
|
What vessel is usually affected by a hemisperic stroke?
|
MCA
|
|
|
If a right-sided stroke occurs, which side of the body will be affected?
|
Left side
|
|
|
Stenosis of which vessel carries the greatest risk for TIA?
|
ICA
|
|
|
Decreased pulse mid-neck suggests stenosis of which vessel if the contralateral pulse is normal?
|
CCA
|
|
|
What do low bilateral neck bruits indicate?
|
Aortic valve stenosis
|
|
|
T/F: Bruits extending into diastole are highly significant?
|
True
|
|
|
With TCD, vertebral flow is toward/away from transducer?
|
Away from
|
|
|
What frequency is normally used for TCD?
|
2 MHz
|
|
|
With TCD, ACA flow is toward/away from transducer?
|
Away from
|
|
|
With TCD, MCA flow is toward/away from transducer?
|
Toward
|
|
|
Left ACA flow toward transducer indicates what?
|
Left carotid obstruction with right-to-left collateralization
|
|
|
Major complications of cerebrovascular angiography occurs in ___ percent of patients?
|
1%
|
|
|
What are 4 complications of cerebrovascular angiography?
|
1. Death
2. Stroke 3. Renal failure 4. Occlusion at access site |
|
|
Where is the most common puncture site for angiography?
|
CFA
|
|
|
Patient in ER with stroke symptoms will usually have US/CT first?
|
CT
|
|
|
T/F: Endarterectomy is not used for lower extremity arteries?
|
False
|
|
|
What is the most common medical treatment for TIA?
|
rtPA (Recombinant Tissue Plasminogen Activator)
|
|
|
T/F: Muscle contraction causes increased pressure in secondary varicose veins
|
True
|
|
|
T/F: Diabetes and smoking are common risk factors for DVT
|
False
|
|
|
T/F: Obesity is not a common cause of lymphedema
|
True
|
|
|
The gastrocnemial veins empty into which vein?
|
Popliteal
|
|
|
The soleal veins empty into which veins?
|
Posterior tibials and peroneals
|
|
|
What percentage of calf vein thrombus propogates proximally?
|
15-20%
|
|
|
T/F: Venous ulcers are usually painful
|
False
|
|
|
What type of boots are used to treat venous ulcers?
|
Unna boots
|
|
|
T/F: With CW, cessation of flow with proximal compression, resuming on release is normal?
|
True
|
|
|
What test uses tourniquets and changes in patient position?
|
Trendelenburg test
|
|
|
T/F: PPG is very effective in detecting DVT
|
False
|
|
|
What are the two most common patient positions when scanning LE veins?
|
Semi-fowler and reverse Trendelenburg
|
|
|
T/F: Reflux greater than .5 seconds indicates venous insufficiency?
|
True
|
|
|
A large, dark area on the medial popliteal space with no associated blood flow indicates what?
|
Baker's cyst
|
|
|
T/F: Nonspontaneous flow in calf veins is normal in a cold patient?
|
True
|
|
|
What is descending venography used to diagnose?
|
Venous insufficiency
|
|
|
Where is the usual puncture site for contrast venography in ruling out DVT?
|
Dorsal vein in the foot
|
|
|
Where is the usual puncture site for contrast venography in ruling out venous insufficiency?
|
CFV
|
|
|
What is the patient position for contrast venography?
|
On exam table tilted 60 degrees upright
|
|
|
How does acute DVT appear on contrast venography?
|
Railroad tracks
|
|
|
What is a radioisotope test that is reported in high, medium, or low probability?
|
V/Q scan
|
|
|
T/F: Heparin can cause thrombocytopenia?
|
True
|
|
|
T/F: Partial thromboplastin time decreases with heparin shot?
|
False
|
|
|
What drug is a patient placed on after receiving Heparin?
|
Sodium Warfarin
|
|
|
What are 4 complications of IVC interruption?
|
1. Decreased cardiac output
2. Edema 3. Ulcers 4. Claudication |
|
|
What drug is the initial treatment for PE?
|
Heparin
|
|
|
What percent of infrarenal AAA's are degenerative in origin?
|
90%
|
|
|
What is the source of 80-90% of upper and lower extremity emboli?
|
The heart
|
|
|
T/F: Buerger's disease is most common in elderly females
|
False
|
|
|
Where is the most common site for atherosclerosis in the leg?
|
Hunter's canal
|
|
|
Diabetics are ___ times more likely to have claudication?
|
4
|
|
|
Elevation ___ and dependent ___ are signs of advanced LE ischemia?
|
Pallor, rubor
|
|
|
What is pain with horizontal position that is relieved by standing or dangling foot?
|
Ischemic rest pain
|
|
|
T/F: Acute arterial occlusion is associated with claudication?
|
False
|
|
|
T/F: The dorsum of the foot is a common site for auscultation of bruits?
|
False
|
|
|
Vibration felt while palpating pulses
|
Thrill
|
|
|
Red skin color
|
Rubor
|
|
|
Where are arterial ulcers usually found?
|
Toes and distal foot
|
|
|
T/F: Delayed capillary blush is a sign of advanced ischemia?
|
True
|
|
|
T/F: Pitting edema is usually associated with arterial disease
|
False- assoc. with CHF, venous disease, and lymphedema
|
|
|
T/F: The peroneals are commonly palpated
|
False
|
|
|
What is the most common cause of unilateral claudication in young people?
|
Popliteal entrapment
|
|
|
What is the formula for pulsatility index?
|
(PSV-EDV)/mean
|
|
|
T/F: Increased resistance causes increased pulse amplitude?
|
True
|
|
|
T/F: Hyperemia in obstructed limbs is shorter than in normal limbs
|
False
|
|
|
What are typical ABI's in claudicating patients?
|
0.5 - 0.9
|
|
|
T/F: ABI's are calculated by dividing the ankle pressure by the lower brachial pressure
|
False
|
|
|
What test uses a pressure transducer that monitors pressure over a limb?
|
Arterial pneumoplethysmography
|
|
|
T/F: The higher ankle pressure is used for ABI's?
|
True
|
|
|
What type of output is typically used for arterial volume recording?
|
A/C coupled
|
|
|
What is the usual pressure for arterial volume recording?
|
65 mmHg
|
|
|
T/F: Diastolic flow reversal is commonly seen in vasodilated limbs
|
False
|
|
|
What percent increase indicates a normal response to reactive hyperemia testing?
|
100%
|
|
|
What is the first branch off the ECA?
|
Superior thyroid
|
|
|
What branches off of the subclavian artery and is AKA internal thoracic?
|
Internal mammary
|
|
|
What artery is the terminal branch of the facial artery?
|
Angular artery
|
|
|
Where does the CCA bifurcate?
|
Upper thyroid cartilage
|
|
|
What is the first branch of the ICA?
|
Opthalmic
|
|
|
What is the terminal branch of the maxillary artery?
|
Infraorbital artery
|
|
|
What are the three branches of the opthalmic artery?
|
1. Nasal
2. Frontal 3. Supraorbital |
|
|
What vessels will be seen 60-65 mm deep from the temporal window and have bidirectional flow?
|
ACA and MCA
|
|
|
What is the most common anomaly of the Circle of Willis?
|
Absence or hypoplasia of one or both communicating arteries
|
|
|
T/F: Helical flow at the carotid bulb is normal
|
True
|
|
|
What is the most common variation of the aortic arch?
|
Common origin of brachiocephalic and left CCA
|
|
|
Where is Hunter's perforator located?
|
Mid thigh
|
|
|
Where is Dodd's perforator located?
|
Just above knee
|
|
|
Where is Boyd's perforator located?
|
At the medial knee
|
|
|
Where is Cockett's perforator located?
|
Mid/distal calf
|
|
|
T/F: The left CIV crosses posterior to the left CIA and distal aorta bifurcation
|
False- it crosses posterior to the right CIA
|
|
|
T/F: The brachiocephalic vein is located only on the right side
|
False
|
|
|
What is a continuation of the anterior tibial artery?
|
Dorsalis pedis
|
|
|
T/F: The profunda femoris artery is posteromedial to the SFA?
|
False
|
|
|
What artery courses medial to the psoas muscle?
|
External iliac
|
|
|
T/F: The left renal vein is inferior to the left renal artery
|
True
|
|
|
What vessel is also known as the hypogastric artery?
|
Internal iliac artery
|
|
|
What is the left branch of the celiac axis?
|
Splenic artery
|
|
|
What type of cells make up the intimal lining of vessels?
|
Endothelial
|
|
|
T/F: Capillaries only have one vessel layer- intima
|
True
|
|
|
What 2 vessel layers make up venules?
|
Adventitia and intima
|
|
|
What is the strongest risk for stroke?
|
HTN
|
|
|
Which side of the body is subclavian steal most common?
|
Left
|
|
|
What is commonly seen with CEA and is proliferation of smooth muscle cells?
|
Neointimal hyperplasia
|
|
|
What is the term for weakness on one side of the body?
|
Hemiparesis
|
|
|
How is the percent of stenosis calculated under NASCET criteria?
|
Minimum diameter/Diameter of unstenosed distal ICA
|
|
|
What is transient blindness in one eye?
|
Amaurosis fugax
|
|
|
What is loss of one half of the visual field in both eyes?
|
Homonymous hemaniopia
|
|
|
What is a bright yellow spot seen in an artery on an opthalmogic exam?
|
Hollenhorst plaque
|
|
|
How many new strokes occur per year?
|
500,000
|
|
|
What vessels are usually associated with bilateral occular symptoms?
|
Vertebrobasilar
|
|
|
What is a spinning, off-balance feeling?
|
Vertigo
|
|
|
What is a tingling sensation?
|
Paresthesia
|
|
|
What is garbled speech, not to be confused with difficult swallowing?
|
Dysphasia
|
|
|
T/F: Bruit indicates critical pre-occlusive disease
|
False
|
|
|
T/F: Stenting of the ICA is more risky than that of the CCA
|
False
|
|
|
What degree of carotid stenosis usually requires endarterectomy?
|
70% or greater
|
|
|
What is a serious complication after endarterectomy?
|
Hyperfusion
|
|
|
T/F: There will be swelling of the feet if DVT is present
|
False
|
|
|
What causes unilateral leg swelling with an achy, heavy feeling?
|
Postphlebotic syndrome
|
|
|
In terms of pressure, what occurs with postphlebotic syndrome after exercise?
|
Prolonged return to pre-exercise pressure
|
|
|
What is a parasite that can cause lymphedema?
|
Filaria nematode
|
|
|
What typically causes bilateral LE edema and nephrotic syndrome?
|
IVC thrombus
|
|
|
Where is the "gaiter zone" located?
|
Near medial aspect of ankle
|
|
|
Where do most venous ulcers occur?
|
Gaiter zone (medial ankle)
|
|
|
T/F: With chronic venous obstruction, pressure dramatically increases with ambulation
|
True
|
|
|
With PPG, normal venous refill time should be ___ seconds?
|
20
|
|
|
What percent of patients die from AAA rupture?
|
80%
|
|
|
Pressure is higher/lower distal to stenosis?
|
Lower
|
|
|
T/F: Peripheral resistance is lower in lower extremity arteries
|
False
|
|
|
What is chest pain that radiates to the left arm or jaw?
|
Angina
|
|
|
What are typical leg pressures in a patient with ischemic rest pain?
|
Less than 60 mmHg
|
|
|
What are typical ABI's in a patient with ischemic rest pain?
|
Less than .30
|
|
|
T/F: There should be no change in ankle pressures with exercise
|
True
|
|
|
What is overgrowth of smooth muscle cells, typically seen in females?
|
Fibromuscular dysplasia
|
|
|
What is the formula for resistive index?
|
(PSV-EDV)/PSV
|
|
|
T/F: With CW doppler, increased angle of incidence = decreased frequency shift
|
True
|
|
|
What is a characteristic of a PTFE (Gore-Tex) graft?
|
"Double line" appearance
|
|
|
With a 50 % stenosis, PSV in the stenosis is ___ percent higher than prestenotic velocity
|
100
|
|
|
With reversed vein grafts proximal velocity is increased/decreased compared to distal velocity?
|
Increased
|
|
|
T/F: Volume flow rate in reversed vein grafts should be the same throughout
|
True
|
|
|
T/F: There is a decrease in vasodilation with occlusive arterial disease
|
False- increase due to body trying to compensate
|
|
|
What are normal values in TcPO2 assessment?
|
60-80 mmHg
|
|
|
T/F: Transient pressure decrease of 20% is an abnormal ankle pressure response to reactive hyperemia
|
False
|
|
|
A clenched fist will increase/decrease the pulsatility index in the brachial artery
|
Increase
|
|
|
T/F: Finger pressures increase in a patient with Raynaud's after cold water immersion
|
False
|
|
|
What uses a mask to subtract unnecessary information from the final arteriogram?
|
Digital subtraction arteriography
|
|
|
T/F: Patient cooperation does not matter with DSA
|
False
|
|
|
Inflow, outflow, and runoff refer to what, respectively?
|
Aortoiliac, femoropopliteal, and trifurcation arteries
|
|
|
Arteriography would be contraindicated in a patient with what?
|
Renal failure
|
|
|
T/F: Patency rates for angioplasty of infrainguinal arteries is better than patency rates for iliac arteries
|
False
|
|
|
What is the "kissing stent" technique useful for?
|
Bifurcations
|
|
|
What type of revascularization surgery requires the use of a valvulatome?
|
In-situ saphenous graft
|
|
|
What upper extremity vein is commonly used for an arterial bypass in the leg?
|
Cephalic vein
|
|
|
What type of bypass would be recommended for a patient with an occluded iliac artery?
|
Femorofemoral
|
|
|
What is the five-year risk for rupture of an AAA measuring 4 cm?
|
Less than 10%
|
|
|
What is the most effective lytic treatment for acute arterial thrombosis?
|
Urokinase or streptokinase
|
|
|
What is the best diagnostic indicator of renovascular disease?
|
Renal/aortic ratio
|
|
|
What vessel is most commonly compromised by compression of the median arcuate ligament of the diaphragm?
|
Celiac artery
|
|
|
T/F: Decreased flow resistance in parenchymal arteries is a common feature of renal allograft rejection
|
False
|
|
|
T/F: An enlarged coronary vein is a likely result of increased portal vein pressure
|
True
|
|
|
What is the most common cause of portal hypertension in the US?
|
Cirrhosis
|
|
|
What do the splanchnic arteries refer to?
|
Arteries that feed the gut (SMA, IMA, Celiac)
|
|
|
T/F: Patients with SMA obstruction have preprandial pain that is relieved by eating
|
False
|
|
|
What will a subclavian vein doppler signal do with inspiration?
|
Augment
|
|
|
Pulsatile portal vein flow is usually characteristic of what?
|
Portal hypertension
|
|
|
T/F: Portal vein flow is usually phasic with respiration
|
True
|
|
|
What is the best way to show vein-wall coaptation of the subclavian vein?
|
Deep breath in or sniff test
|
|
|
T/F: A subclavian vein waveform is usually pulsatile
|
True
|
|
|
T/F: The incidence of pseudoaneurysms is decreasing
|
False
|
|
|
T/F: Penile pressure can decrease after treadmill testing
|
True
|
|
|
T/F: Lack of diastolic flow in a transplanted kidney is normal
|
False
|
|
|
What is a normal PBI (Penile-Brachial Index)
|
> .75
|
|
|
An abnormal flow rate for a radial artery/cephalic vein dialysis fistula is less than ___ ml/min
|
200
|
|
|
What is the name for a radial artery/cephalic vein dialysis graft?
|
Cimeno-Brescia graft
|
|
|
In flaccid penis, PSV < ___ cm/s indicates arterial insufficiency
|
10
|
|
|
If high resistance flow in penis after prostaglandin injection persists, what is indicated?
|
Significant venous leakage
|
|
|
Normal PSV in postinjection penis should be what?
|
= or > 25 cm/s
|
|
|
Increase venous flow in postinjection penis indicates what?
|
Venous leak
|
|
|
What are normal PBI values?
|
> .65 - .70
|
|
|
If difference in penile-brachial pressures is = or > ___ mmHg, there is suspicion for vasculogenic impotence
|
60
|
|
|
What are the 4 ICA segments?
|
1. Cervical
2. Petrous 3. Cavernous ("siphon") 4. Supraclinoid |
|
|
What is the longest ICA segment?
|
Cervical
|
|
|
What are the 4 branches of the opthalmic artery?
|
1. Central retinal
2. Supraorbital 3. Frontal 4. Nasal/Angular |
|
|
What vessel supplies the globe and is connected to the ECA via the superficial temporal artery?
|
Supraorbital
|
|
|
What artery supplies the mid-portion of the forehead and joins the ECA via the superficial temporal artery?
|
Frontal
|
|
|
What artery supplies the eye?
|
Central retinal
|
|
|
What artery branches off the frontal artery to supply the nose?
|
Nasal
|
|
|
What artery courses down the lateral border of the nose?
|
Angular
|
|
|
What are the 8 ECA branches?
|
1. Ascending pharyngeal
2. Superior thyroid 3. Lingual 4. Posterior auricular 5. Internal maxillary 6. Superficial temporal 7. Transverse facial 8. Occiptal |
|
|
Which vertebral artery is usually smaller?
|
Right
|
|
|
What connects the anterior and posterior circulation of the brain?
|
Circle of Willis
|
|
|
What artery supplies 20-30% of the blood to the brain?
|
Anterior cerebral
|
|
|
What artery supplies 70-80% of blood to the brain?
|
Middle cerebral
|
|
|
What are the 7 vessels of the Circle of Willis?
|
1. Anterior cerebral
2. Middle cerebral 3. Posterior cerebral 4. Basilar 5. Distal ICA 6. Anterior communicating 7. Posterior communicating |
|
|
What precentage of blood is sent to the brain via the ICA's?
|
75%
|
|
|
What percentage of blood is sent to the brain via the vertebral arteries?
|
25%
|
|
|
What arteries make up the anterior circulation of the brain?
|
Carotids and their branches
|
|
|
What arteries make up the posterior circulation of the brain?
|
Vertebrobasilar and their branches
|
|
|
Thin layer of lipid material in the intima of an artery
|
Fatty streak
|
|
|
Accumulation of lipids covered by additional lipid deposits, collagen, and elastic fibers
|
Fibrous plaque
|
|
|
Plaque containing fibrous tissue, calcium, and cellular debris
|
Complicated plaque
|
|
|
Plaque with deterioration of fibrous cap
|
Ulcerative plaque
|
|
|
Sonolucent area within plaque
|
Intraplaque hemorrhage
|
|
|
Foreign substance or piece of thrombus that moves through circ system and becomes lodged in a distal blood vessel
|
Embolus
|
|
|
Diffuse, concentric thickening of arterial walls
|
Arteritis
|
|
|
Stroke causing permanent damage- occurs due to ischemia or hemorrhage
|
CVA
|
|
|
Event that reverses withing 24 hours or less
|
TIA
|
|
|
What usually causes a TIA?
|
Embolization from the heart or carotids
|
|
|
TIA that lasts longer than 24 hours but less than 72 hours?
|
RIND
|
|
|
What does RIND stand for?
|
Reversible Ischemic Neurologic Deficit
|
|
|
Transient unilateral blindness
|
Amaurosis fugax
|
|
|
What eye does amaurosis fugax occur in if an embolus is from carotid?
|
Ipsilateral eye
|
|
|
Paralysis or weakness on one side
|
Hemiparesis
|
|
|
Numbness or tingling on one side
|
Paresthesia
|
|
|
Difficulty speaking
|
Dysphasia
|
|
|
Blindness on one half of the visual field
|
Hemianopia
|
|
|
Bilateral blindness on one half of the visual field
|
Homonymous hemianopia
|
|
|
Difficulty maintaining equilibrium or spinning feeling
|
Vertigo
|
|
|
Loss of muscle coordination, gait disturbance, or imbalance
|
Ataxia
|
|
|
Pain or difficulty swallowing
|
Dysphagia
|
|
|
Impairment of the voice
|
Dysphonia
|
|
|
Abnormal articulation or pronunciation
|
Dysarthria
|
|
|
Double vision
|
Diplopia
|
|
|
Rapid involuntary movement of the eyeball
|
Nystagmus
|
|
|
Drooping of upper eyelid, sinking in of the orbit, and constriction of the pupil
|
Horner syndrome
|
|
|
Uses eye cups and vacuums to deform the shape of the eye
|
OPG-Gee
|
|
|
With OPG-Gee, if brachial pressures are <140, a ___ mmHg vacuum is used
|
300
|
|
|
With OPG-Gee, if brachial pressures are >140, a ___ mmHg vacuum is used
|
500
|
|
|
What arteries are evaluated with periorbital doppler?
|
Terminal branches of ICA
|
|
|
What arteries are compressed when performing periorbital doppler?
|
1. Facial
2. Superficial temporal 3. Infraorbital 4. CCA |
|
|
What are 6 uses for TCD?
|
1. Detects intracranial stenoses, occlusions, and aneurysms
2. Monitors vasospasm 3. Confirms brain deaths 4. Intraoperative monitoring during CEA 5. Evaluates AVM's 6. Evaluates collateralization |
|
|
4 windows for TCD
|
1. Transtemporal
2. Suboccipital 3. Submandibular 4. Transorbital |
|
|
Transtemporal window: MCA depth/direction
|
30- 60 mm; Antegrade
|
|
|
Transtemporal window: ACA depth/direction
|
60-80 mm; Retrograde
|
|
|
Transtemporal window: Terminal ICA depth/direction
|
65-75 mm; Bi-directional
|
|
|
Transtemporal window: PCA (ipsilateral) depth/direction
|
60-70 mm; Antegrade
|
|
|
Transtemporal window: PCA (contralateral) depth/direction
|
60-70 mm; Retrograde
|
|
|
Transorbital window: Opthalmic depth/direction
|
40-60 mm; Antegrade
|
|
|
3 segments of carotid siphon
|
1. Genu
2. Parasellar 3. Supraclinoid |
|
|
Suboccipital window: Basilar depth/direction
|
80-120 mm; Retrograde
|
|
|
Suboccipital window: Vertebral depth/direction
|
60-90 mm; Retrograde
|
|
|
T/F: ACA has high velocity, turbulent flow
|
True
|
|
|
Flow direction in genu portion of carotid siphon
|
Bidirectional
|
|
|
Flow direction in parasellar portion of carotid siphon
|
Antegrade
|
|
|
Flow direction in supraclinoid portion of carotid siphon
|
Retrograde
|
|
|
Antegrade flow in ipsilateral ACA indicates what?
|
Crossover collateralization
|
|
|
Retrograde flow in ipsilateral opthalmic artery indicates what?
|
External-to-Internal collateralization
|
|
|
With external-to-internal collateralization, flow in opthalmic artery ___ with compression of ECA branches
|
Decreases, stops, or reverses
|
|
|
When velocities in ipsilateral PCA exceed those the ipsilateral MCA, what is indicated?
|
Posterior-to-anterior collateralization
|
|
|
(STOP protocol) PSV <170 cm/s indicates what?
|
Normality; annual follow-up needed
|
|
|
(STOP protocol) PSV 170-199 cm/s indicates what?
|
Conditional; follow-up in 6 months
|
|
|
(STOP protocol) PSV >200 cm/s indicates what?
|
Abnormal; follow-up in 2-4 weeks
|
|
|
Velocities in artery supplying AVM are increased/decreased
|
Increased
|
|
|
Velocities in arteries adjacent to AVM are increased/decreased
|
Decreased
|
|
|
Velocity >___ cm/s indicates vasospasm
|
200
|
|
|
ICA: PSV <125 cm/s
|
Normal
|
|
|
ICA: PSV >125 cm/s, EDV <140 cm/s
|
50-79% stenosis
|
|
|
ICA: PSV >125 cm/s, EDV >140 cm/s
|
80-99% stenosis
|
|
|
APG measures how many seconds of outflow?
|
3 seconds
|
|
|
Reference test considered to be "the truth"
|
Gold standard
|
|
|
Ability to document normal when G.S. documents normal
|
Specificity
|
|
|
Ability to detect disease when disease is present
|
Sensitivity
|
|
|
Percent of positive tests that accurately predict abnormality
|
Positive predictive value
|
|
|
Percent of negative tests that accurately predict normality
|
Negative predictive value
|
|
|
# correct tests/total # of tests
|
Accuracy
|
|
|
Percent of correct diagnoses
|
Accuracy
|
|
|
True negatives/(True negatives+False positives)
|
Specificity
|
|
|
True positives/(True positives+False negatives)
|
Sensitivity
|
|
|
True positives/(True positives+False positives)
|
Positive predictive value
|
|
|
True negatives/(True negatives+False negatives)
|
Negative predictive value
|
|
|
To-and-fro waveform in distal ICA suggests what?
|
Brain death
|
|
|
Kappa value: 0 indicates what?
|
No relationship
|
|
|
Kappa value: 1 indicates what?
|
Complete agreement between 2 variables
|
|
|
W/ liver transplants, where is the arterial anastomosis?
|
Several cm prox to hepatic hilum
|
