Anatomy Pt 2 Flashcards
What blood vessel is used to cause the variations in diastolic flow on the ECA tracing? A. common carotid artery B. supraorbital artery C. superficial temporal artery D. superficial thyroidal artery
C
The temporal tap is performed by lightly tapping the temporal artery located at the soft spot on the anterior aspect of the temporal bone. The temporal artery is a branch of the ECA and the vibrations from the tapping will be seen within the ECA waveform. The ICA does not communicate with the temporal artery and no response will be identified from the tapping maneuver. This technique is used to differentiate the ECA from the ICA.
Which of the following occurs during calf muscle relaxation?
A. blood flows through the perforators from the superficial to the deep veins
B. The gastrocnemius veins fill with blood from the popliteal vein
C. blood flows through the perforators from the deep to the superficial veins
D. the superficial veins fill with blood
A
When the muscle contracts, flow moves from the deep calf veins into the popliteal and femoral vein. As the muscle relaxes, blood is essentially sucked through the perforators from the superficial system into the deep system to refill the vessels.
How can the P1 and P2 segments of the posterior cerebral artery be differentiated on a transtemporal evaluation during a TCD exam?
A. P1 demonstrates flow moving away from the transducer and P2 demonstrates flow moving toward from the transducer
B. P1 demonstrates monophasic flow and P2 demonstrates biphasic flow
C. P1 demonstrates flow moving toward the transducer and P2 demonstrates flow moving away from the transducer
D. P1 demonstrates laminar flow and P2 demonstrates turbulent flow
C
The PCA has a curved course within the cranium. The P1 segment courses toward the midline outer aspect of the brain and demonstrates flow moving toward the transducer when evaluating by the transtemporal window. The PCA curves and the P2 segment extends toward the posterior lateral aspect of the cranium and demonstrates flow moving away from the transducer when evaluated by the transtemporal window. Keep in mind, when the PCA is evaluated in the suboccipital window, P1 flow is away from the transducer and P2 flow is toward the transducer.
Which of the following cannot be characterized as concomitant veins? A. peroneal veins B. soleal veins C. posterior tibial veins D. gastrocnemius veins
B
Concomitant veins - refers to a pair of veins that are coursing on both sides of a single artery. Radial, ulnar, PTV, ATV, peroneal and gastrocnemius veins are examples of concomitant veins. The soleal veins/sinuses have no accompanying artery.
Which of the following correctly describes normal flow in the hepatic vessels?
A. the portal veins demonstrate hepatofugal flow
B. the hepatic artery demonstrates hepatofugal flow
C. the hepatic veins demonstrate hepatopetal flow
D. the hepatic artery demonstrates hepatopetal flow
D
Hepatofugal flow is flow that is moving out of the liver.
Hepatopetal flow is flow that is moving toward/into the liver.
The normal HA and PV demonstrate hepatopetal flow. The hepatic veins demonstrate heptatofugal flow.
Which of the following normally demonstrates a low resistance Doppler flow profile?
A. external carotid artery
B. hepatic artery and renal artery
C. renal artery and internal iliac artery
D. external carotid artery, renal and hepatic arteries
B
All vessels that feed organs will have low resistance vascular beds which lead to a low resistance waveform.
Which of the following describes how to correctly measure the AP diameter of iliac artery?
A. transverse view, outer wall to inner wall
B. transverse view, outer wall to outer wall
C. longitudinal view, outer wall to inner wall
D. longitudinal view, outer wall to outer wall
D
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.
The lateral plantar arch artery originates at the \_\_\_\_\_\_\_\_\_. A. peroneal artery B. popliteal artery C. anterior tibial artery D. posterior tibial artery
D
The lateral plantar arch originates at the PTA.
The great saphenous vein is attached to the \_\_\_\_\_\_\_ aspect of the common femoral vein. A. posterior B. anterior C. medial D. lateral
C
the great saphenous vein is attached to the medial aspect of the CFV.
Which calf vessel can be identified between the medial malleolus and the distal portion of the Achilles tendon? A. ATA and ATVs B. PTA and PTVs C. GSV D. SSV
B
the PTA and PTVs can be identified between the medial malleolus and the distal portion of the Achilles tendon.
What are the direct branches of the popliteal artery? A. ATA and Tibioperoneal trunk B. PTA and ATA C. peroneal and PTA D. PTA and Tibioperoneal trunk
A
The ATA branches off the popliteal artery first, to leave the tibioperoneal trunk that splits into the peroneal
During inspiration the flow in the veins of the lower extremities \_\_\_\_\_\_\_\_\_. A. increases B. decreases C. remains unchanged D. reverses direction
B
During inspiration the pressure within the chest cavity decreases allowing venous flow from the upper extremities to increase. During expiration, the pressure within the chest cavity increases causing the venous flow from the upper extremities to decrease. THE OPPOSITE IS TRUE WITH THE FLOW FROM THE LOWER EXTREMITIES.
During inspiration the pressure within the abdominal cavity increases causing venous flow from the lower extremities to decrease. During expiration, the pressure within the abdominal cavity decreases allowing the venous flow from the lower extremities to increase.
The profunda artery courses \_\_\_\_\_\_\_\_\_ to the superficial femoral artery. A. posterior lateral B. anterior medial C. posterior medial D. anterior lateral
A
The deep femoral artery courses posterior and lateral to the superficial femoral artery.
Which of the following anatomic variants of ICA anatomy is most often associated with symptoms of cerebral ischemia? A. coiling B. tortuosity C. duplication D. kinking
D
kinking - vessel takes a sharp turn of 90 degrees or less, mimics stenosis and is related to plaque/stenosis formation. It is the anatomic variant most commonly associated with symptoms of ischemia.
Coiling - vessel forms a circle during its course.
Tortuosity - vessel forms an S-shaped curve
You are evaluating the subclavian artery and its branches. How can you differentiate the vertebral artery from the thyrocervical and costocervical trunks?
A. the trunk arteries have many branches and lower end diastolic flow velocities
B. the vertebral artery demonstrates flow moving away from the transducer and the trunk arteries demonstrate flow toward the transducer
C. the vertebral artery has many branches and lower end diastolic flow velocities.
D. the vertebral artery demonstrates flow moving toward the transducer and the trunk arteries demonstrate flow moving away from the transducer
A
Thyrocervical and costocervical trunk arteries can be differentiated from the vertebral arteries by their many branches and lower end-diastolic flow velocities. Flow direction should not be used to identify these vessels because of the many variables in evaluation technique and potential flow abnormalities (like a subclavian steal).
The external iliac artery:
A. begins at the level of the inguinal ligament
B. courses along the medial side of the psoas muscle
C. courses medially through adductor hiatus
D. supplies the pelvic organs
B
The external iliac artery travels laterally to the inguinal ligament and becomes the common femoral artery as it crosses under the ligament. It also courses along the medial side of the psoas muscle to supply the lower extremities with blood.
Normally, what changes occur in the waveform of the SMA postpradially?
A. resistance decreases
B. resistance increases
C. diastolic flow decreases
D. resistance and diastolic flow decreases
A
When digestion starts, the digestive organs require an increase in blood flow. The resistance in the SMA blood flow will decrease and diastolic flow will increase. When distal resistance to flow decreases, more blood flow occurs in diastole. If stenosis is present, there will be an increase in systolic velocity (>2.75m/s) with no change in the resistance to the flow.
Where will you place the transducer to evaluate flow in the posterior tibial artery?
A. posterior to the medial malleolus
B. anterior to the medial malleolus
C. on the foot, between the 1st and 2nd digit
D. posterior to the lateral malleolus
A
To evaluate flow in the PTA, the transducer is placed posterior to the medial malleolus. The PTA courses between the medial malleolus and the Achilles tendon.
What Sonographic landmark is used to identify the distal end of the common iliac artery?
A. the bifurcation into the external and internal iliac artery
B. the saphenofemoral junction
C. head of the quadricep muscle
D. the inguinal ligament
A
The common iliac artery ends at the bifurcation into the external and internal iliac arteries. The inguinal ligament is an anatomic landmark for the external iliac artery, but it cannot normally be visualized when evaluation the extremity arteries.
Which vessel courses posterior to the anterior scalene muscle? A. brachial artery B. axillary artery C. aorta D. subclavian artery
D
The subclavian artery courses posterior to the anterior scalene muscle.
The most common normal variant in the external/internal carotid artery anatomy is:
A. the ECA lies posterior and lateral to the ICA
B. the ECA lies posterior and medial to the ICA
C. the ECA is absent and the ICA has branches that feed the extracranial structures
D. the ECA branches directly from the ICA at the level of the angle of the mandible
A
In most patients the ECA is the anterior medial branch of the CCA. There are several normal variants in ECA/ICA position, with the most common being the ECA lies posterior and lateral to the ICA.
The dorsalis pedis artery is a branch of: A. the PTA B. the peroneal artery C. the gastrocnemius artery D. the ATA
D
The DPA is a distal branch of the ATA.
Which of the following normally demonstrates a higher resistance Doppler flow profile?
A external carotid artery
B. post-prandial superior mesenteric artery
C. renal artery
D. hepatic artery
A
The post-prandial SMA will be lower resistance with increased diastolic flow. The MCA, renal and hepatic arteries will also have low resistance flow with increased diastolic flow.
Which of the following system adjustments would increase the size of the spectral window?
A. tortuous vessel
B. changing from a 2mm to 4mm sample size
C. decreasing rejection
D. changing from a 4mm to 2mm sample size
D
Smaller sample sizes will evaluate fewer red blood cells and demonstrate a narrower range of frequency shifts. Reducing the sample size will display a larger spectral window beneath a narrow range of frequency shifts.
The diameter of a normal portal vein should not exceed: A. 12mm B. 11mm C. 10mm D. 13mm
D
The diameter of the portal vein should not exceed 13mm.
Vasocontriction will cause ______, while vasodilation will cause _______.
A. increased flow volume, decreased flow volume
B. increased heart rate, increased blood pressure
C. increased flow rate, decreased flow rate
D. increased resistance to flow, decreased resistance to flow
D
Vasoconstriction in the arterioles will cause increased resistance to flow in the feeding vessels, while vasodilation will cause reduced resistance.
The supraorbital artery originates from the ophthalmic artery and joins what branch of the ECA? A. superficial temporal artery B. posterior auricular artery C. vertebral artery D. lingual artery
A
The supraorbital artery originates from the ophthalmic artery and joins the superficial temporal artery (branch of the ECA). The arrangement allows for collateral flow to occur on the same side of the body if the ICA is obstructed.
Exercise causes ______ which leads to _____ in the lower extremities.
A. vasocontriction, decreased resistance
B. vasodilation, increased resistance
C. vasodilation, decreased resistance
D. vasoconstriction, increased resistance
C
Vasodilation and resistance drops to encourage more flow distally, as the muscles require more oxygen.
When scanning the internal carotid, which way would you angle your probe to locate the external carotid artery in most patients? A. lateral and/or anterior B. superior and/or lateral C. medial and/or anterior D. 40 degrees medially
C
When scanning the internal carotid artery, you angle your probe medial and anterior to locate the external carotid artery in most patients.
Which of the following veins normally do not demonstrate spontaneous flow on Doppler evaluation?
A. posterior tibial and popliteal veins
B. peroneal and femoral veins
C. posterior tibial, peroneal and great saphenous vein
D. All lower extremity veins should normally demonstrate spontaneous flow on Doppler evaluation. Loss of spontaneity indicates flow stasis.
C
Calf veins and superficial veins do not normally demonstrate flow without augmentation. (Lack spontaneity) Normally the flow is very low velocity and not easily detected without augmentation.
Where do the plantar arteries originate?
A. from the ATA anterior to the medial malleolus
B. from the peroneal artery just past the Achilles tendon attachment at the heel
C. from the ATA posterior tp the medial malleolus.
D. from the PTA posterior to the medial malleolus
D
The plantar arteries originate from the PTA posterior to the medial malleolus.
Increased pressure in the venous system results in: A. an increased risk of stroke B. edema C. decreased arterial pressure D. Baker cyst formation
B
Increased pressure in the venous system results in edema as fluid is forced into surrounding tissues.
What is the proper patient position and respiration for assessing the portal vein diameter?
A. supine with quiet respiration
B. right lateral decubitus position with deep inspiration
C. supine with inspiration and the Valsalva strain
D. left lateral decubitus position with deep inspiration
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.
Vasodilation:
A. can cause a monophasic waveform to become triphasic
B. usually occurs in response to cold stimuli
C. can cause a triphasic waveform to become biphasic
D. usually occurs with stress or anxiety
C
Vasodilation causes reduced resistance to flow to meet the tissue demands. Exercise will cause vasodilation and a triphasic waveform can become biphasic with the reduced resistance to flow.
A weak pulse on the PTA will be described as \_\_\_\_\_\_, while a bounding pulse in the ATA will be described as \_\_\_\_\_\_. A. 4+, 0 B. 1+, 4+ C. 2+, 6+ D. 0, 2+
B
Pulses are described as 0 none, 1+ weak, 2+ good, 3+ strong, 4+ bounding.
Which of the following is the best patient position for performing a transcranial Doppler exam to obtain a waveform from the basilar artery?
A. seated on a stool, with their back to the Sonographer and the machine
B. left lateral decubitus with left hand placed under the head for support
C. supine with chin in neutral position
D. seated on a stool, facing the Sonographer and the machine
B
The patient need to be able to hold their head steady for the exam. Lying down with the head supported will provide the best position for the exam. Placing the hand under the head will also help to raise it from the stretcher to maintain a straight neck.
What is the most common normal variant in renal artery anatomy?
A. right renal artery courses anterior to the IVC
B. duplicated renal arteries
C. absence of the left renal artery
D. absence of the right renal artery
B
1/3 patients have duplicated renal artery (most common anatomic variant).
Which arteries supply the forearm and hand with blood?
A. 2 Radial and 2 Ulnar Arteries
B. 1 Radial Artery and 1 Ulnar Artery
C. 1 Cephalic Artery and 1 Basilic Artery
D. 2 Radial and 1 Ulnar arteries
B
2D transverse views of the lower extremity veins are preferred for: A. PW Doppler evaluation B. demonstrating the extent of thrombus C. evaluating compressibility D. color Doppler evaluation
C
Sagittal views are preferred for evaluating the extent of thrombus formation, demonstrating color and PW Doppler exams. Transverse views are used to obtain 2D images or clips of vein compression.
Which of the following describes the recommended protocol for an accurate evaluation of the lower extremity arteries?
A. Rotate the leg internally and bend the knee slightly
B. Place the patient in the Trendelenburg position
C. Flex the foot and rotate the ankle when performing Doppler evaluation of the distal posterior tibial and dorsalis pedis arteries
D. Patients with hip pain can be placed in an oblique or prone position to obtain the Doppler samples from the popliteal artery
D
Patients should be placed in the supine position for a routine examination. Rotate the leg externally and bend the knee slightly for Doppler evaluation. The foot and ankle should always be in the neutral position when performing a Doppler evaluation of the distal PTA and DPA. Patients with hip pain can be placed in an oblique or prone position to obtain the Doppler samples from the popliteal artery.
Which of the following is a potential collateral pathway for extracranial to intracranial blood flow?
A. Ascending pharyngeal branches connect to small branches of the lingual artery
B. Ascending pharyngeal branches connect to small branches of the superior thyroidal artery
C. Facial and maxillary artery branches connect to small branches of the orbital artery
D. Superficial temporal artery branches connect to small branches of the ascending pharyngeal artery
C
ECA branches provide collateral pathways when stenosis is present in the intracranial system Superficial temporal artery branches connect to small branches of the ophthalmic artery.
Facial and maxillary artery branches connect to small branches of the orbital artery.
Ascending pharyngeal branches connect to small branches of the vertebral artery. The other answer choices given describe connection of two vessels in the extracranial system.
Put the following terms in order from largest to smallest in size. Capillary, aorta, femoral artery, arteriole, tibial artery.
D
From largest to smallest: aorta, femoral artery, tibial artery, arteriole, capillary. Capillaries are the smallest blood vessels in the body.
The preferred imaging plane to measure the AP dimension of the aorta is: A. coronal B. transverse C. sagittal D. radial
C
The sagittal plane is the preferred imaging plane to measure the AP dimension of the aorta.
Which of the following are branches of the distal ICA?
A. supraorbital artery and PCA
B. MCA, ACA and posterior communicating artery
C. MCA and anterior communicating artery
D. MCA, ACA and PCA
B
Ophthalmic artery is the first branch from siphon area inside the cranium and branches into nasal, frontal & supraorbital arteries. The anterior choroidal artery and posterior communicating artery are the other two main intracranial branches of the distal ICA before it terminates at the bifurcation into the ACA and MCA once it reaches the circle of willis.
A common anatomic variant of the mesenteric arterial anatomy is:
A. the celiac artery and SMA originate from the posterior aorta
B. the celiac axis and SMA share a common trunk
C. the SMA and IMA share a common trunk
D. the celiac artery is absent and the liver, stomach and spleen are supplied with blood from the inferior mesenteric artery
B
A common anatomic variant of the mesenteric arterial anatomy is the celiac axis and SMA share a common trunk. Other known variants include the hepatic artery originates from the SMA or the hepatic artery originates directly from the aorta.
In most patients the right common carotid artery:
A. bifurcates at a lower level in the neck than the left CCA
B. bifurcates at the level of the clavicle
C. originates directly from the aortic arch
D. is nearly twice the diameter of the left CCA
A
Right CCA originates from the innominate artery. Left CCA originates from the aortic arch (second branch from the arch). In most patients the right CCA bifurcates at a lower level than the left CCA.
Which of the following describes the normal response to a Doppler evaluation for erectile dysfunction?
A. Normally the PSV and EDV of the arteries will increase post injection and dorsal venous flow will become pulsatile.
B. Normally the velocity of the cavernosal arteries will not change post injection but the dorsal venous flow ill become pulsatile.
C. Normally the PSV and EDV of the cavernosal arteries will decrease post injection but dorsal venous flow will remain unchanged.
D. Normally the PSV and EDV of the cavernosal arteries will increase post injection, but dorsal venous flow will remain unchanged.
D
Normally the PSV and EDV of the cavernosal arteries will increase post injection, but dorsal venous flow will remain unchanged. Abnormal inflow will cause the velocity in the cavernosal arteries to be less than 30cm/s. Increased venous outflow can also be responsible for impotence.
During a color evaluation of the common femoral vein, the patient is asked to perform the Valsalva maneuver. The cephalic flow indicated by the blue color in the CFV immediately disappears until the patient releases their muscles. The blue color returns and completely fills the vessel. What do these color Doppler findings indicate?
A. The response described is a normal result for the CFV.
B. Superficial venous insufficiency is present.
C. There is most likely a occlusive DVT in the superficial femoral vein causing the venous turbulence proximally.
D. A significant level of insufficiency is present and should be further evaluated with PW or CW Doppler techniques.
A
When the Valsalva maneuver is applied, flow within the lower extremities should decrease significantly and/or stop completely. The loss of color flow during the Valsalva maneuver is a normal response of cessation of flow.
Which of the following is part of the superficial venous system of the lower extremity? A. gastrocnemius veins B. peroneal veins C. sural sinuses D. vein of Giacomini
D
The vein of Giacomini is a superficial communicator vein connecting the GSV and SSV. The gastrocnemius veins and sural sinus are located deep in the calf muscle. The peroneal veins are deep veins of the calf.
The most common congenital anomaly of the Circle of Willis:
A. the absence of one or both of the MCAs
B. the duplication of one or both of the MCAs
C. the absence of one or more communicating arteries
D. the duplication of one or more communicating arteries
C
The most common congenital anomaly of the Circle of Willis is the absence of one or more communicating arteries.
What vein contains blood with a very high oxygen content? A. pulmonary veins B. IVC C. portal veins D. hepatic veins
A
The pulmonary veins are the only veins in the body that carry highly oxygenated blood. These veins drain the blood from the lungs into the left ventricle/aorta. All other veins carry blood that have depleted levels of oxygen because the organs that they are draining require the oxygen to function.
Which of the following is correct regarding the brachiocephalic veins?
A. Right and left brachiocephalic veins merge to form the superior vena cava
B. Cardiac pulsatility is an abnormal Doppler finding in the brachiocephalic veins
C. Formed by the junction of the external jugular and subclavian veins
D. Right and left brachiocephalic veins course anterior and medial to the right and left brachiocephalic arteries
A
The brachiocephalic veins are formed by the junction of the internal jugular and subclavian veins. Right and left brachiocephalic veins merge to form the superior vena cava. There is no brachiocephalic artery on the left side. Cardiac pulsatility is a normal Doppler finding in the brachiocephalic veins due to their proximity to the heart.
