Anatomy Pt 1 Flashcards
What is the proper caliper placement for assessing the portal vein diameter?
A. Inner wall to inner wall at the point the portal vein crosses the IVC
B. Inner wall to inner wall at the junction of the splenic vein and portal vein
C. Outer wall to outer wall at the point the portal vein crosses the IVC
D. Outer wall to outer wall at the junction of the splenic vein and portal vein
A
The portal vein should be assessed with the patient supine and with quiet respiration. The measurement should be obtained at the point the portal vein crosses the IVC.
The ECA is normally \_\_\_\_\_\_\_ to the ICA. A. Lateral B. Medial C. Superior D. Inferior
B
The ECA usually courses anteriorly and medially in the neck to feed structures including the face, tongue and scalp. The ICA usually courses posteriorly and laterally to enter the skull and feed the cerebral tissues.
Which of the following statements regarding a duplex exam of the upper extremity veins is false?
A. The cephalic vein is easily compressed with light probe pressure, which can be an exam limitation.
B. The subclavian and innominate veins normally demonstrate continuous flow.
C. Inspiration will cause an increase in flow within the larger upper extremity veins.
D. The internal jugular vein is usually part of the upper extremity evaluation.
B
Proper compression of the subclavian vein is normally inhibited by the clavicle. The subclavian and innominate veins usually demonstrate pulsatile, physic flow.
A mesenteric to aortic ratio is considered normal when it is \_\_\_\_\_\_. A. > 1.0 B. 1.0 or less C. > 3.0 D. < 3.0
B
The mesenteric velocity should be similar to the aortic velocity, which would yield a ratio of around 1.0. As the stenosis in the SMA increases, the velocity increases and the ratio increases. SMA/aortic ratio > 3.0 indicates significant stenosis.
Which of the following is an expected change in flow in the brachial artery that occurs when the patient clenches their fist during the Doppler exam?
A. Decreased resistive index
B. Increased pulsatility index
C. Triphasic to Monophasic waveform change
D. Increased diastolic flow
B
Clenching the fist causes an increase in distal resistance. The brachial artery will show increased pulsatility and resistance with decreased diastolic flow.
Respiration and \_\_\_\_\_\_\_\_\_ are responsible for venous blood flow. A. Vessel recoil B. Valsalva maneuvers C. The calf muscle pump D. The tunica media layer of the wall
C
Respiration and the calf muscle pump are responsible for moving venous blood through the body.
Which vessel wall layer is thicker in arteries than in veins? A. Tunica media B. Tunica externa C. Vasa vasorum D. Tunica intima
A
The muscular layer is thicker in the arteries to help maintain their shape and to handle the higher pressure blood flow within.
Which of the following structures is supplied by branches of the internal carotid artery?
A. Lateral nose only
B. Parietal lobe only
C. Eyes and lateral nose, but not the parietal lobe
D. Eyes, lateral nose and parietal lobe
D
Branches of the internal carotid artery supply the eyes, lateral nose and parietal lobe.
Which of the following is not normally a branch of the ophthalmic artery? A. Supraorbital artery B. Frontal artery C. Posterior auricular artery D. Nasal artery
C
The posterior auricular artery branches from the ECA and supplies the ear with oxygenated blood.
Which vein(s) originates at the ankle and courses along the medial border of the fibula to join the posterior tibial veins just distal to the popliteal fossa? A. Small saphenous vein (SSV) B. Peroneal veins (PER) C. Great saphenous vein (GSV) D. Deep femoral veins (DFV)
B
The peroneal vein originates at the ankle and courses along the medial border of the fibula to join the PTV just distal to the popliteal fossa.
Which of the following veins originates at the medial wrist and courses up the medial arm to join the axillary vein? A. Radial vein B. Basilic vein C. Ulnar vein D. Cephalic vein
B
The radial veins join the ulnar veins at the elbow to form the brachial vein(s). The cephalic vein originates near the base of the wrist and travels up the lateral side of the arm to empty into the subclavian vein.
Which of the following normal vessels will collapse when you ask the patient to sniff quickly with moderate exertion? A. Common femoral vein B. Basilic vein C. Subclavian vein D. Cephalic vein
C
The quick change in intrathoracic pressure with a sniff should cause the normal subclavian vein to collapse quickly due to the increased outflow into the innominate vein.
Which blood vessel courses anterior to the aorta and posterior to the SMA? A. Right renal vein B. Inferior mesenteric vein C. Superior mesenteric vein D. Left renal vein
D
The left renal vein courses from the left kidney across the abdomen between the aorta and SMA to reach the IVC.
An effective calf pump causes ___________ in the pressure in the deep veins of the calf.
A. An increase in cardiac output and an increase
B. A decrease
C. An increase
D. Little change
B
Effective calf pump reduces blood stasis/pooling, decreases venous volume and pressure in the calf veins. Ineffective calf pump leads to increased stasis, venous volume and pressure in the calf veins; reflux is a contributing factor.
An ineffective calf muscle pump causes:
A. The pressure in the deep veins to drop
B. Flow to move through the perforators into the deep system
C. The pressure in the superficial veins to drop
D. The pressure in the deep calf veins to increase
D
Effective calf pump reduces blood stasis/pooling, decreases venous volume and pressure in the calf veins. Ineffective calf pump leads to increased stasis, venous volume and pressure in the calf veins; reflux is a contributing factor.
Which of the following terms can be used to describe the normal Doppler waveform in the portal vein?
A. Continuous with mild pulsatility
B. Blunted with respiratory phasicity
C. Prominent respiratory phasicity and mild pulsatility
D. Continuous with minimal respiratory phasicity
D
Venous flow in the portal system normally demonstrates no cardiac pulsatility with minimal respiratory phasicity due to the increased thickness of the vessel walls and location in the abdomen.
What term refers to the capability of the vascular beds to alter the resistance to flow to maintain the levels of flow needed for normal function? A. Laminar flow B. Autoregulation C. Vasodilation D. Vasoconstriction
B
Vasoconstriction and vasodilation are ways the vascular beds auto regulate the flow.
Which of the following statements is true regarding the vertebral arteries?
A. The right vertebral artery is the first branch of the aortic arch
B. The right vertebral artery is normally smaller than the left
C. Vertebral artery flow is normally biphasic due to turbulence at their junction with the basilar artery.
D. The right and left vertebral arteries empty their blood into the right and left basilar arteries.
B
The right vertebral artery is normally smaller than the left vertebral artery.
The ICA terminates into which two branches of the Circle of Willis?
A. MCA and ACA
B. Vertebral and basilar arteries
C. MCA and posterior communicator arteries
D. PCA and ACA
A
Bilateral ICAs course superiorly to join the Circle of Willis on the lateral aspect of each side of the brain. In most patients, they terminate at the origination of the MCA and ACA. The PCoA is branch of the distal ICA.
Increased transducer pressure during a venous evaluation can have what negative effect on the exam? A. Demonstrate compression of a vein B. Increased beam intensity C. Non-visualization of normal veins D. Increase beam penetration
C
If the transducer pressure is too great, normal superficial veins could be compressed causing non-visualization. Beam intensity does not change with transducer pressure. Transducer compression should be performed to assess vein compression (not a negative effect).
The gastrocnemius veins empty into the \_\_\_\_\_\_\_\_\_. A. Distal SFV B. Distal profunda vein C. Popliteal vein D. Great saphenous vein
C
The gastrocnemius veins are part of the venous system of the calf muscles. Together with the soleal sinuses, they provide a venous reservoir for extremity blood.
Proximal augmentation during an extremity Doppler evaluation is used to assess: A. Arterial insufficiency B. For the presence of CHF C. Vein compressibility D. Venous insufficiency
D
Proximal augmentation and distal augmentation techniques are used to assess for venous insufficiency. Distal augmentation is also used in the DVT evaluation.
The posterior communicating arteries connect the: A. PCA and MCA B. ACA and PCA C. Basilar and PCA D. Vertebral and basilar
A
The posterior communicating arteries connect the ipsilateral PCA and MCA.
Once the pressure in the deep venous system consistently exceeds the pressure in the superficial system,
A. Perforators will exhibit stasis of flow and thrombus formation
B. Perforators will dilate and allow flow to only move into the deep system.
C. Perforators will constrict forcing flow reversal into the superficial system
D. Perforators will dilate leading to bi-directional flow
D
Once pressure in the deep venous system consistently exceeds the pressure in the superficial system, perforators will dilate leading to bi-directional flow.
Which of the following is a direct branch of the aortic arch? A. Right carotid B. Left vertebral C. Left carotid D. Right vertebral
C
The three main branches of the aortic arch are the innominate artery, left common carotid artery and left subclavian artery.
The normal flow profile within the aorta is termed: A. Phasic flow B. Plug flow C. Recoil flow D. Continuous flow
B
The layers of blood flow in the aorta move relatively the same speed and this is called plug flow. Laminar flow patterns occur in smaller vessels. The velocity of the layers of blood flow in these vessels vary slightly by decreasing as they near the vessel wall.
__________ receives the blood from the posterior tibial perforators and plays a major role in venous stasis of the lower extremity.
A. The lateral perforator
B. The anterior accessory saphenous vein
C. The posterior accessory saphenous vein
D. The posterior venous arch
D
Posterior arch vein extends superior from the ankle to the GSV in the mid-calf; plays a major role in venous stasis; connected to 3 ankle perforators called posterior tibial perforators (formerly Cockett’s Perforators).
The Supraorbital artery is a branch of the _________. Branches of the supraorbital artery connect with branches of the ___________, which is a branch of the ECA. This is a common collateral pathway from the ECA to the ICA.
A. ICA, facial artery
B. ICA, ophthalmic artery
C. Ophthalmic artery, maxillary artery
D. Ophthalmic artery, superficial temporal artery
D
The supraorbital artery is a branch of the ophthalmic artery. Branches for the supraorbital artery connect with branches of the superficial temporal artery, which is a branch of the ECA. This is a common collateral pathway from the ECA to the ICA.
Which of the following will increase spectral broadening on the image? A. Increased sample volume size B. Increased wall filter C. More laminar flow D. Increased PRF
A
Increasing sample volume size on pulse wave Doppler will allow for sampling of more blood cells moving at different velocities. The increase in the number of velocities displayed will cause fill in of the spectral window.
Which of the following veins are part of the superficial venous system in the lower extremity?
A. Small saphenous vein and peroneal veins
B. Posterior tibial vein
C. Great saphenous vein and femoral vein
D. Great and small saphenous veins
D
The great and small saphenous veins make up the superficial venous drainage system of the lower extremity.
Which of the following is NOT normally a part of a test for vasculogenic impotence?
A. Obtain Doppler samples of the cavernous arteries and veins in the penis
B. Obtain Doppler samples of the CFA, PTA and DPA.
C. Measure the length of the cavernous arteries
D. Obtain blood pressures in the arms and ankles
C
When performing a penile Doppler exam, obtain Doppler samples of the CFA, cavernous arteries and veins in the penis. Doppler sample will also be taken in the PTA and DPA while performing ankle pressures. The ABI should be evaluated to determine if PAD can be causing the erectile dysfunction. The diameter of the Caverness arteries should be measured.
Which of the following statements is true regarding the Tunica intima?
A. The vasa vasorum forms within the intimal layer.
B. An intimal dissection requires generation of a preliminary report and a stat review by a physician. 
C. The intimal layer of the artery will become less prominent with age and more difficult to visualize sonographically.
D. The Tunica intima is responsible for holding the vessel shape and allowing for wall flexibility.
B
An intimal dissection requires generation of a preliminary report and a stat review by a physician. It is considered a critical finding. The vasa vasorum surrounds the outer wall of the vessel to supply the walls with blood. The tunica media is responsible for holding the vessel shape and allowing for wall flexibility. The intimal layer of the artery will become more prominent with age and more easily visualized sonographically.
Which of the following characteristics is/are seen in a normal hepatic vein Doppler tracing?
A. Cardiac Pulsatility and respiratory phasicity
B. Respiratory Phasicity only
C. Monophasic flow and respiratory phasicity
D. Cardiac pulsatility only
A
Cardiac pulsatility is normally seen in the hepatic veins and upper abdominal portion of the IVC. The motion of the heart causes vibrations within the chest that are carried throughout the adjacent structures. The flexibility of the IVC and hepatic veins allow the vibrations to affect the flow inside causing pulsatility. As the diaphragm moves up and down with respiration, the intra-abdominal pressure is affected. Inspiration causes the diaphragm to move down which increases the intra-abdominal pressure. This causes flow in the abdomen and lower extremities to decrease or cease movement. The diaphragm moves upward with expiration and the intra-abdominal pressure decreases allowing flow to move toward the heart again.
Which of the following is considered an abnormality that causes turbulence in a vessel? A. Bifurcation B. Tortuosity C. Eccentric change in vessel course D. Myointimal hyperplasia
D
Abnormal causes of turbulence are acquired. Myointimal hyperplasia occurs with stent or bypass graft placement. Atherosclerosis formation or bypass graphs are acquired causes of turbulent flow in a vessel. The other choices offered are normal anatomic variants that can cause turbulence.
Which of the following terms would be used to describe abnormal venous flow in the deep veins of the thigh? A. Phasic B. Spontaneous C. Pulsatile D. Low velocity
C
The term pulsatile refers to arterial flow changes that occur with cardiac systole and diastole. Venous flow varies with respiration and normally has very low velocity. Spontaneous flow should also be present (without any augmentation maneuvers applied). If venous flow is pulsatile in the lower extremities, cardiac complications, like CHF or severe tricuspid regurgitation, should be suspected.
The \_\_\_\_\_\_\_\_\_\_ course(s) Between the tibial and fibular head to empty blood into the popliteal vein. A. Peroneal veins B. Small saphenous vein C. Anterior tibial veins D. Posterior tibial veins
C
ATVs course anterolaterally to the tibial bone across the interosseous membrane of the calf and through space between the tibial and fibular head to empty into the popliteal vein.
Where are the venous sinusoids in the lower extremity?
A. Between the soleal and gastrocnemius muscle
B. Within the adductor canal
C. Within the quadriceps
D. Popliteal fossa
A
The venous sinusoids serve as blood reservoirs in the calf and are an important part of the calf pump mechanism. They are located between the soleal and gastrocnemius muscle.
What two veins converge to form the superior vena cava? A. Right and left subclavian B. Axillary and cephalic C. Right subclavian and innominate D. Right and left innominate
D
The right and left innominate veins converge to form the superior vena cava.
The radial and ulnar veins merge to form the \_\_\_\_\_\_\_\_ at the \_\_\_\_\_\_\_\_\_\_\_\_\_ fossa. A. Axillary vein, antecubital B. Axillary vein, axillary C. Brachial vein, antecubital D. Brachial vein, popliteal
C
The radial and ulnar veins merge to form the brachial vein at the anti-cubital fossa.
Which of the following vessels supply the majority of blood to the cerebellum? A. Vertebral and basilar B. ICA and Vertebral C. ECA and Basilar D. ICA and ECA
A
The cerebellum is located in the posterior fossa of the skull. The vertebral arteries course between the vertebral pedicles to converge into the basilar artery. Branches from the vertebral and basilar arteries feed the cerebellum and portions of the brain stem.
Which of the following veins does not normally contain any functioning valves? A. Innominate vein B. Axillary vein C. Peroneal veins D. Small saphenous
A
Lower extremity veins that do not contain valves = IVC, iliac veins and soleal sinuses; upper extremity veins that do NOT contain valves = SVC and innominate veins.
Where should the Doppler sample be placed to obtain the highest velocity when evaluating laminar flow?
A. In the center of the vessel
B. Adjacent to the posterior wall
C. Adjacent to be anterior wall
D. Varies with the type of vessel evaluated
A
The Doppler sample should be placed in the center of the vessel to obtain the highest velocity when evaluating laminar flow.
The small saphenous vein:
A. Originates immediately posterior to the Achilles’ tendon attachment at the heel and it ascends along the midline aspect of the posterior calf
B. Originates posterior to the lateral malleolus and ascends along the midline aspect of the posterior calf
C. Originates posterior to the medial malleolus and it ascends along the midline aspect of the posterior calf
D.  originates anterior to the lateral malleolus and ascends along the midline aspect of the posterior calf
B
The small saphenous vein originates posterior to the lateral malleolus and ascends along the midline aspect of the posterior calf.
What is the primary factor that determines the resistance characteristics of the arterial signal displayed by pulse wave Doppler? A. Origin of blood B. Branch number C. Vessel course and location D. Part it is supplying
D
Example: renal artery is low resistance for a normal kidney. Organs need constant flow throughout the cardiac cycle. The femoral artery is high resistance for a normal leg. Extremities do not need constant flow throughout the cardiac cycle.
The great saphenous vein originates _____________
A. At the dorsum of the foot and courses anterior to the medial malleolus.
B.  at the great toe and courses along the ventral aspect of the foot to reach the medial ankle and extend up the leg.
C. At the dorsum of the foot and courses anterior to the lateral malleolus.
D. At the great toe and courses along the ventral aspect of the foot to reach the lateral ankle and extend up the leg.
A
The great saphenous vein originates at the dorsum of the foot and courses anterior to the medial malleolus.
All of the following are limitations of the 2D evaluation of the extremity veins, except:
A. Location of the subclavian vein
B. Increased transducer pressure
C. Increased amount of fibrous tissues and ligaments in the adductor canal
D. Inability to visualize the vessels immediately posterior to the inguinal ligament
D
The inguinal ligament is not normally visible on ultrasound evaluation and it does not cause non-visualization of adjacent anatomy. The adductor canal contains several ligaments and connective tissues that limit compression of the distal femoral vein. Increased transducer pressure can cause non-visualization of normal veins. The subclavian vein courses posterior to the clavicle, which limits manual compression.
Paired veins that accompany an artery of the same name are called: A. Venae comitantes B. Klippel Trenauney Weber syndrome C. Duplicated veins D. Posterior arch veins
A
Which of the following describes the probe placement for a Doppler evaluation of the frontal artery?
A. near the outer canthus of the eye
B. Just above the mid-point of the eyebrow
C. Approximately 2cm above the zygomatic arch
D. Near the inner canthus of the eye
D
Periorbital Doppler is a CW Doppler evaluation of the frontal artery (branch of the ophthalmic artery). An 8-10MHz pencil probe is placed near the inner canthus of the eye. Normal flow direction will be toward the probe.
The most cephalic branch of the abdominal aorta is: A. Common hepatic artery B. Celiac axis C. Splenic artery D. SMA
B
The celiac axis is the first abdominal branch of the aorta followed by the origin of the SMA approximately 2 cm more distal on the aorta. The renal arteries are the next distal branch followed by the IMA.
\_\_\_\_\_\_\_\_\_\_\_\_\_ drain(s) blood from the GSV in the proximal thigh into the proximal and mid femoral vein. A. Thigh perforators B. Posterior tibial perforators C. Posterior venous arch D. Paratibial perforators
A
Hunterian’s perforators drain blood from the GSV in the proximal/mid-thigh into the femoral vein. They are also referred to as proximal thigh perforators.
Which transcranial window is most commonly used to evaluate the carotid siphon and the ophthalmic artery? A. Temporal B. Submandibular C. Orbital D. Occipital
C
The orbital window is used to evaluate the carotid siphon and the ophthalmic artery.
Which of the following statements can be used to describe a normal renal artery waveform?
A. Low resistance with increased diastolic flow
B. Increased diastolic flow reversal
C. Biphasic with mild diastolic flow reversal
D. Pulsus alternans
A
Blood flow into organs is normally continuous throughout the cardiac cycle. The flow is described as low resistance or monophasic and demonstrates increased ante grade flow in diastole.
Which of the following describes how to correctly measure the width of the iliac artery?
A. Transverse view, outer wall to outer wall
B. Transverse view, outer wall to inner wall
C. Longitudinal view, outer wall to outer wall
D. Longitudinal view, outer wall to inner wall
A
When evaluating the diameter of the aorta and iliac arteries AP dimensions are obtained in longitudinal plane, from outer wall to outer wall of the vessel. Width dimensions are obtained in the transverse plane, from outer wall to outer wall of the vessel.
A normal peak velocity in the cavernosa arteries after a papaverine injection would be \_\_\_\_\_\_\_\_\_\_\_\_ A. At least 50 cm/s B. > 30 cm/s C. < 20 cm/s D. < 40 cm/s
B
A normal peak velocity in the cavernosa arteries after a papaverine injection would be > 30 cm/s. Reduced velocity indicates vasculogenic impotence.
Which of the following factors are related to potential hemodynamic changes within a vessel?
A. Vessel length and blood viscosity, but not vessel radius
B. Blood viscosity and vessel radius, but not vessel length
C. Vessel length and vessel radius, but not blood viscosity
D. Vessel length, vessel radius and blood viscosity
D
Changes in vessel length, vessel radius and blood viscosity are related to potential hemodynamic changes within a vessel.
The transducer is placed over the mid femoral vein while calf compression is performed. The Doppler waveform demonstrates spontaneous flow with an increase in a forward flow with the calf compression. Which of the following describes the findings?
A. The flow response is normal for the femoral vein.
B. Heart disease is most likely present which causes the abnormal flow response.
C. The popliteal and distal femoral veins have incompetent valves.
D. The popliteal vein has incompetent valves.
A
Normal response to distal augmentation is an increase in forward flow with the calf compression and NO flow reversal after the increase in flow.
