Pathology Pt 2 Flashcards
Hemodynamically significant stenosis of the SMA is diagnosed when the peak systolic velocity is greater than? A. 1.0 m/s B. 1.75 m/s C. 2.0 m/s D. 2.75 m/s
D
Hemodynamically significant stenosis of the SMA is diagnosed with the PSV greater than 2.75 m/s.
What is the most common location of an intracranial aneurysm? A. internal carotid artery siphon B. middle cerebral artery C. anterior communication artery D. posterior communicating artery
C
The anterior communication artery is the most common location for a berry or saccular intracranial aneurysm.
An acute occlusion occurs in the common iliac artery on the left side. Which of the following vessels will also have absent flow?
A. external iliac artery only
B. common femoral artery and saphenous artery
C. internal iliac artery and gonadal artery
D. common femoral, external iliac and internal iliac artery
D
The external iliac and internal iliac arteries are branches of the common iliac artery. The external iliac artery becomes the common femoral artery once it crosses beneath the inguinal artery.
Which of the following patients would benefit from a Percutaneous Transluminal Angioplasty?
A. patient with chronic iliac DVT
B. patient with recurrent pulmonary embolism
C. patient with 80% stenosis in proximal SFA
D. patient with left ICA occlusion
C
Percutaneous Transluminal Angioplasty is used to open areas of stenosis in an artery. This intervention cannot be performed on a fully occluded vessel.
What is the purpose of performing periorbital Doppler?
A. detect severe distal ECA disease
B. detect flow reversal in the frontal artery signifying ICA disease
C. to evaluate the ophthalmic artery using Doppler
D. evaluate the integrity of the retina
B
Periorbital Doppler is used to assess flow direction in the frontal artery. If flow is moving away from the transducer, ipsilateral ICA disease is present. TRANSorbital Doppler is performed to evaluate the ophthalmic artery.
Which of the following procedures can be performed on a patient in renal failure? A. Duplex ultrasound B. MRA exam with contrast C. CT scan with contrast D. Angiography
A
Renal disease or failure is a contraindication for the use of radiology imaging contrast.
Significant atherosclerotic disease found in which artery could lead to male impotence? A. common iliac or internal iliac B. common iliac or external iliac C. common femoral or profunda femoral D. external iliac or common femoral
A
Disease in the common iliac and internal iliac artery can lead to ischemia of the penile tissues.
Which of the following is a long term treatment for DVT? A. venous ligation B. Lovenox C. Warfarin D. Heparin
C
Treatment for Acute DVT:
Subcutaneous shot of Lovenox immediately.
Heparin administered for 5-10 days to stop the progression of the clot, but does not have a clot lysing properties to decrease the clot that has already formed.
After Heparin dosage completed and recanalization has occurred. Warfarin is administered to prevent future clot formation. First DVT occurrence - Warfarin prescribed for 3 months
Recurrent DVT - Warfarin prescribed for 6+ months
Which of the following is a symptom related to giant cell arteritis? A. asymmetric brachial blood pressures B. jaw claudication C. headaches and neck pain D. more than one of the above
D
Temporal arteritis is associated with headaches and tenderness over the artery. Asymmetric brachial blood pressures are seen in patients with arteritis in extremities. Other symptoms include pain and/or stiffness in the neck, jaw claudication, and visual disturbances.
Which of the following causes flow reversal in venous perforators?
A. superficial thrombosis
B. deep vein thrombosis
C. compression stockings
D. combination of superficial and deep thrombosis
B
DVT in the deep system forces any remaining flow into areas of lower pressure, the perforators. Flow exits the deep system through the perforators to try to “escape” into the patent superficial system.
Which of the following is not an expected characteristic of flow proximal to an ICA occlusion? A. increased diastolic flow B. triphasic C. increased diastolic flow reversal D. increased resistance
A
The occlusion causes increased resistance in the flow proximally. There will be a loss of diastolic flow and reversal of diastolic flow causing a biphasic or triphasic waveform.
Which of the following is a sonographic finding of acute DVT?
A. incomplete compressibility of the vein
B. engorged vein with increased echogenicity in the lumen
C. valvular insufficiency
D. flattened, collapsed vessel with increased echogenicity of the wall
B
Chronic thrombus will demonstrate as echogenic material lining a partially collapsed vein. Acute thrombus causes the vein to grow in size and appear engorged with blood/debris.
A patient presents for a lower extremity arterial exam with mild bilateral leg pain. The 2D evaluation demonstrates minimal diffuse atherosclerosis bilaterally. The Doppler waveforms from the arteries of both legs demonstrate biphasic waveforms with increased acceleration time. Which of the following could explain these findings? A. bilateral popliteal entrapment B. cardiac ejection fraction 85% C. cardiac ejection fraction 30% D. systemic hypertension
C
Bilateral decrease in lower extremity velocities can indicate a cardiac issue, especially in the absence of aortic or bilateral iliac disease. Popliteal entrapment syndrome is a functional issue where the artery becomes compressed with contraction of the calf muscles, usually seen in runners. Symptoms of this disorder would be related to activity and would not normally produce constant mild pain. An exercise arterial exam would be necessary to diagnose this issue.
What critical finding is associated with calf paresthesia, localized muscle weakness, pain when stretching calf muscles, and drop foot? A. popliteal entrapment B. anterior compartment syndrome C. peripheral arterial disease D. post-phlebitic syndrome
B
Acute compartment syndrome is a medical emergency. It is usually caused by a severe injury and without intervention, it can lead to permanent muscle damage. Symptoms of compartment syndrome include paresthesia, localized muscle weakness, pain when stretching calf muscles, and drop foot.
The ______ on the foot is used as the dye injection site for ascending venography, while the _______ is used as the dye injection site for lower extremity arteriography.
A. dorsal vein, common femoral artery
B. dorsal vein, common femoral artery
C. common femoral vein, common femoral artery
D. tibial vein, superficial femoral artery
A
The dorsal vein on the foot us used as the dye injection site for ascending venography. Contrast material ascends through patent veins of the extremity. The common femoral artery is used as the dye injection site for lower extremity angiography. Contrast fills the arteries as blood moves distally into the leg.
Warfarin is administered to a patient:
A. to assist in clot lysis and recanalization
B. to prevent thrombus propagation
C. to increase platelet aggregation
D. to assist in atheroma lysis and recanalization
B
Warfarin is administered to a patient to prevent thrombus propagation and reduce platelet aggregation. Streptokinase is used for clot lysis in phlegmasia patients. Increased platelet aggregation would cause clot propagation.
\_\_\_\_\_\_\_\_ uses a balloon tipped catheter to compress the atheroma and expand the vessel lumen. A. an angioplasty procedure B. an endarterectomy procedure C. a valvulotome procedure D. an atherectomy procedure
A
Atherectomy uses a catheter with a rotating head and suction capabilities to break up the plaque and remove it from the artery. Angioplasty uses a balloon tipped catheter to compress the atheroma and expand the vessel lumen. An endarterectomy refers to when the carotid artery is lacerated, and the atheroma formation is scraped for removal. A valvulotome procedure is used to remove valves from inside a vein.
A patient complains of bilateral pain and color changes in the legs. When he lies down, both legs become pale. When he sits up on the edge of the bed, both legs become reddened. These clinical findings are most suggestive of: A. significant aortic stenosis B. deep venous reflux C. significant venous obstruction D. normal arterial flow
A
Pallor and dependent rubor are indications of significant arterial disease. The bilateral presentation indicates the obstruction is blocking flow to both legs = aorta.
Which of the following is associated with CREST syndrome? A. superficial phlebitis B. secondary Raynaud phenomenon C. primary Raynaud disease D. aortic aneurysm
B
In contrast to Raynaud disease, Raynaud phenomenon presents concurrently with CREAST syndrome, in which tissue necrosis results from spastic and occlusive disease. CREST syndrome involves symptoms of generalized calcinosis, Raynaud phenomenon, esophageal dysfunction, scleroderma, and telangiectasia.
A patient is referred for an arterial duplex exam for leg pain. The chart describes brown discoloration of the calves and prominent pedal pulses. Which of the following is an expected finding on today's exam? A. medial calcification B. normal arterial flow C. popliteal aneurysm D. Raynaud syndrome
B
Brawny discoloration of the calf is usually a sign of venous disease. Prominent pedal pulses indicate strong arterial flow in the tibial arteries. The patient will most likely demonstrate normal arterial flow.
Arterial claudication occurs: A. while the legs are in the dependent position B. distal to the obstruction C. while the patient is resting D. proximal to the obstruction
B
Arterial claudication occurs distal to the hemodynamically significant obstruction.
Which of the following abnormalities would be best evaluated by asking the patient to hyperextend the leg and point the toes? A. popliteal entrapment B. May Thurner syndrome C. Paget-Schreotter syndrome D. Raynaud syndrome
A
Popliteal entrapment occurs when the artery is compressed with contraction of the calf muscle. When the patient hyperextends the leg and points the toes, the calf muscle will contract. PPG or PW Doppler can be used to assess changes in flow during the maneuver.
Venous ulcers are normally located on the \_\_\_\_\_\_\_\_, while arterial ulcers are normally found on the \_\_\_\_\_\_\_\_. A. calf, thigh B. heel, toes C. distal calf, toes and heel D. toes and heel, distal calf
C
Venous ulcers are normally located on the distal calf, while arterial ulcers are normally found on the toes and heel.
When scanning a patient with a history of renal cell carcinoma, you identify a hypoechoic mass within the IVC lumen near the renal veins. What is the best way to determine if this is tumor invasion or thrombus formation?
A. evaluate the iliac veins for thrombus
B. evaluate the aorta for tumor invasion.
C. roll the patient into the decubitus position to evaluate the possible mobility of the mass.
D. apply color doppler to assess internal vascularity of the mass.
D
The mass should be evaluated for internal vascularity that would indicate tumor invasion. If there is not internal vascularity, the obstruction is most likely a thrombus. The iliac veins should be evaluated if the mass causes IVC obstruction, but the question refers to mass characterization.
All of the following correctly describe compartment syndrome, except:
A. all forms of compartment syndrome are considered an emergency
B. can occur in the leg or arm
C. most commonly occurs due to trauma
D. prevents blood flow in and out of surrounding tissues
A
You are performing a renal artery Doppler exam for renal stenosis. The mid aortic peak velocity is 70cm/s. The RRA peak velocity is 140cm/s and the LRA peak velocity is 240cm/s. What is the RAR for the right kidney? A. 0.3 B. 3.4 C. 2 D. 0.5
C
RRA 140cm/s / aorta 70cm/s = 2; LRA 240cm/s / aorta 70cm/s = 3.4
Which of the following would lead to overestimation of stenosis in the internal carotid artery?
A. reduced systemic blood pressure
B. significant aortic valve stenosis
C. tandem stenosis
D. compensatory flow due to stenosis on the other side
D
Overestimation of stenosis in the ICA can be seen with:
Systemic HTN
Compensatory flow due to stenosis on the other side
Short area of focal stenosis
Smaller vessel size
Elevated heart rate
Measuring a compensatory heart beat with arrhythmias
Which of the following describes chronic lower extremity DVT? A. echogenic vein walls B. varicocele formation C. vein is completely non-compressible D. pulsatile flow pattern
A
Chronic thrombus formation can cause the vein walls to appear thickened and echogenic. It can also lead to partial compressibility on the vein and continuous flow in the vessel.
A patient presents with a script that requests an aortic Doppler evaluation due to Leriche syndrome. What are you looking for on the exam?
A. the formation of multiple aneurysms of the aortic segments
B. extensive diffuse atherosclerotic disease causing obstruction of the distal aorta
C. monophasic flow in all segments of the aorta due to coarctation of the aorta in the chest
D. agenesis of the anterior branches of the aorta
B
Leriche syndrome refers to extensive diffuse atherosclerotic disease causing obstruction of the distal aorta and bilateral lower extremity symptoms.
Treatment for internal carotid artery occlusion includes which of the following? A. stent placement B. endarterectomy C. angioplasty D. none of the above
D
Occlusions in the carotid arteries are usually not invasively or surgically treated. There is limited benefit to attempting to revascularize the vessel and the risk of stroke/death is quite significant. Critical stenosis can be treated, occlusions cannot!
What is the most common cardiac disorder associated with arterial embolism? A. cardiomyopathy B. Marfan syndrome C. atrial fibrillation D. myocardial infarction
C
80-90% of arterial emboli are from a cardiac source. Atrial fibrillation can lead to clot formation in the left atrium. If the clot breaks of, it can travel anywhere in the systemic arterial system. If the foramen ovale is patent, the clot could also travel into the right heart and the pulmonary arteries.
Which of the following is a congenital vascular abnormality that commonly causes decreased ankle pressures bilaterally? A. coarctation of the aorta B. thoracic outlet syndrome C. congestive heart failure D. Budd Chiari syndrome
A
Coarctation causes a ridge of tissue that blocks flow, usually in the descending aorta. This causes monophasic flow with increased antegrade diastolic flow. Brachial pressures will be normal but the bilateral ankle pressures will be decreased.
The most common reason for underestimation of arterial stenosis is:
A. insonation of a vein and artery simultaneously
B. insonation of a vein instead of an artery
C. improper sample volume angle
D. improper sample volume location
D
The most common reason for underestimation of arterial stenosis is improper sample volume location. Anytime stenosis is suspected, the cursor should be walked through the area of stenosis to locate the area of highest velocity. Lack of proper sample placement can cause you to miss the area of highest velocity and therefore underestimate the stenosis.
Most lower extremity thrombosis begins in the \_\_\_\_\_\_\_\_\_\_. A. soleal sinuses B. tibial veins C. femoral vein in the adductor canal D. peroneal vein
A
Most lower extremity thrombosis begins in the soleal sinuses and propagates into the PTA and/or peroneal veins.
A patient presents with a history of right hip and thigh pain with numbness when he walks. Sometimes he walks only a short distance before the pain starts and sometimes he can walk for 20-30 minutes before the pain starts. There are no symptoms in his lower leg. The pain is reduced by sitting down. These findings are most suggestive of? A. peripheral arterial disease B. Raynaud's disease C. chronic venous disease D. neurogenic cause
D
The leg pain is not consistent and reproducible which are key components of claudication related to vascular disease.
Which of the following will be administered to a patient with extensive DVT to cause lysis of the clot? A. Heparin or Coumadin B. Streptokinase C. Heparin D. Coumadin
B
Heparin, Coumadin and Warfarin are medications that reduce the viscosity of blood to prevent propagation of the clot but they have no clot lysing properties. Streptokinase and Urokinase are used to dissolve the thrombus in cases with significant thrombosis of the venous system.
The type of plaque that carries the greatest risk of embolization is \_\_\_\_\_\_\_\_\_. A. soft B. complex C. calcific D. soft and complex
A
Soft plaque has the greatest risk of embolization due to its composition and decreased adhesive levels. Complex and calcific plaque have become increasingly fibrous and more easily adheres to the vessel wall.
Carotid body tumors are more common in:
A. men and people with Buerger disease
B. women and people living at sea level
C. men and people with Ehler-Danlos syndrome
D. women and people living at high altitudes
D
CBT is more common in females. Living at higher altitudes means less oxygen in the air. Chronic hypoxia leads to an overactive and enlarged CBT.
A patient presents for a carotid ultrasound. The chart state there is a history of myocardial infarction and a left ventricular assist device is present. Which of the following describes the expected flow pattern in the normal common carotid artery?
A. antegrade flow in systole and retrograde flow in diastole
B. high-velocity flow with accelerated upstroke
C. triphasic waveform with increased systolic velocity
D. low-velocity flow with delayed upstroke and loss of pulsatility
D
Left Ventricular Assist Device (LVAD) causes CCA Doppler waveforms with low-velocity flow, delayed upstroke and loss of pulsatility. Carotid Doppler waveform morphology is highly variable among patients with LVADs and is very dependent on pump settings. It is very important to document the presence of a left ventricular assist device or intra-aortic balloon pump on the preliminary report. The waveform contour cannot be evaluated in the patients.
Amaurosis fugax in the right eye indicates potential disease in what vessel? A. right ICA B. left ICA C. right ECA D. left ECA
A
Amaurosis fugax refers to an intermittent black shade covering the eye and can indicate a blockage in the orbital supply. The eyes are supplied with blood by branches of the distal ICA. The affected eye will be on the same side as the disease in the ICA.
Post-phlebitic Syndrome:
A. refers to valve damage in the veins after thrombus formation
B. will usually resolve within 2 weeks after treatment for DVT
C. refers to black discoloration of the toes caused by embolism from a AAA
D. will usually resolve within 6-8 weeks after treatment for DVT
A
Post-phlebitic Syndrome refers to valve damage in the veins after thrombus formation.
Blue Toe Syndrome can be a complication of which of the following? A. abdominal aortic aneurysm B. deep venous thrombosis C. thoracic outlet syndrome D. Raynaud phenomenon
A
Blue Toe Syndrome is caused by emboli reaching the small digital arteries and causing obstruction/ischemia. The ischemic toe tissue becomes discolored and cyanotic in appearance. AAA formation usually leads to thrombus accumulation in the affected area of the vessel. This thrombus poses a risk of emboli formation and distal ischemia.
An abnormal renal-aortic ratio would be a ratio \_\_\_\_\_\_\_. A. <3.5 B. >1.8 C. <1.8 D. >3.5
D
The renal aortic ratio is calculated by dividing the peak renal artery velocity by the peak velocity in the aorta. A value <3.5 indicates a normal exam.
A patient presents with gangrene of the foot and toes. The most likely cause of these symptoms is:
A. extensive deep and superficial vein thrombosis
B. chronic occlusion of the popliteal artery
C. coarctation of the aorta
D. a 5cm aortic aneurysm with mural thrombus
A
Venous gangrene usually involves the foot and all toes, while arterial gangrene usually involves one or two toes.
Which of the following terms would be used to describe flow identified just proximal to a 95% ICA stenosis? A. tardus parvus B. damped C. laminar D. low resistance
B
Pre-stenotic Zone: Increased resistance and resistive index, flow velocity may be dampened with loss of diastolic flow, short acceleration time.
The Bernoulli principle explains the:
A. increase in pressure seen with increased blood flow velocity
B. decrease in pressure seen with decreased blood flow velocity
C. decrease in pressure seen with increased blood flow velocity
D. decrease in resistance seen with increased blood flow velocity
C
The Bernoulli principle explains the decrease in pressure seen with increased blood flow velocity.
A patient presents with intermittent left lower leg swelling for several months. The popliteal vein demonstrates a collapsed appearance with echogenic, thickened walls. These findings are most consistent with: A. proximal venous stenosis B. chronic popliteal DVT C. vasculitis of the popliteal vein D. acute femoral DVT
B
Chronic DVT will become echogenic as it becomes more fibrous while attached to the vein wall. The fibrous material limits the pliability of the walls leading to a semi-collapsed appearance. Acute femoral DVT would cause a dilated popliteal vein.
Lower extremity ulcers are most commonly caused by \_\_\_\_\_\_\_\_. A. chronic arterial disease B. chronic venous disease C. acute venous disease D. recurrent cellulitis
B
Lower extremity ulcers are most commonly caused by chronic venous disease (75%).
\_\_\_\_\_\_\_\_\_ is the "gold standard" exam technique for diagnosis of venous disease in the lower extremities. A. arteriography B. venography C. Doppler ultrasound D. MR Angiography (MRA)
C
Doppler ultrasound has surpassed venography as the gold standard for evaluation of the veins in the lower extremities.
Which renal arteries are evaluated with Doppler in an ultrasound exam that is used to perform a direct evaluation for renal artery stenosis?
A. main renal artery, segmental and arcuate arteries
B. aorta
C. segmental and arcuate arteries
D. main renal artery
D
A direct evaluation uses Doppler to evaluate the velocity in the main renal artery segments. The indirect evaluation uses Doppler to evaluate the flow in the segmental/parenchymal arteries. The RI and AT values are assessed and the shape of the waveform is considered in the diagnosis (not peak velocity). The indirect evaluation looks for signs of stenosis in the main renal artery by looking at the flow in the organ distally.
Patients with lower extremity venous insufficiency may describe pain:
A. that is relieved by walking
B. that is relieved by lying down
C. that is relieved by elevating the legs
D. that is relieved by placing legs in a dependent position
C
The dependent position helps blood to reach the lower legs more quickly. Walking and elevating the legs would increase the flow toward the heart and reduce blood pooling in the calves. With venous insufficiency venous system. This can lead to increased pooling in the lower leg with swelling and pain.
Pulsus bisferiens in the carotid arteries is a sign of: A. mitral stenosis B. mitral regurgitation C. aortic regurgitation D. pulmonary regurgitation
C
Blood moves back through the aortic valve into the left ventricle during diastole. It is usually caused by diseased valve, congenital defects and chamber or aortic dilatation. Significant regurgitation results in volume overload in the chamber receiving the retrograde blood flow. With aortic regurgitation, volume overload occurs in the left ventricle. Pulsus bisferiens can occur in the carotid arteries. The waveforms will demonstrate double systolic peaks. Severe regurgitation is associated with diastolic flow reversal in the carotid arteries (Water Hammer Pulse).
A patient presents with a script for a “vascular ultrasound” due to a history of Paget Schroetter syndrome. What type of exam should be performed for this patient?
A. lower extremity venous Doppler exam
B. upper extremity venous Doppler exam
C. arterial PPG of the toes
D. segmental pressures on the lower extremities
B
Paget Schroetter Syndrome refers to the formation of upper extremity DVT due to excessive motion. It is usually associated with thoracic outlet syndrome.
Which of the following treatments would not be recommended for chronic peripheral arterial disease? A. Angioplasty B. Thrombolytic therapy C. Coumadin therapy D. Bypass graft
B
Thrombolytic therapy is used to treat DVT or acute arterial occlusion by thrombus.
Congestive heart failure is more commonly seen with __________, while distal ischemia is more commonly seen with ___________.
A. AV malformation, AV fistula
B. distal AV fistula, proximal AV fistula
C. AV fistula, hemodialysis
D. proximal AV fistula, distal AV fistual
D
Congestive heart failure is more commonly seen with a proximal AVF, while distal ischemia is more commonly seen with distal AVF.
If the left proximal CCA demonstrates a PSV of 35cm/s and the right proximal CCA demonstrates a PSV of 115cm/s, which of the following could explain the findings? A. congestive heart failure B. decreased hematocrit C. left ICA occlusion D. aortic valve stenosis
C
If a single CCA demonstrates elevated velocity = tortuosity on that side or compensatory flow due to obstruction in the other carotid system. If the left ICA is occluded, flow in the CCA will be low velocity with a quick upstroke and little to no diastolic flow. The right CCA velocity can increase as it tries to provide the additional cerebrovascular flow needed. The left vertebral artery may also demonstrate elevated velocity as it tries to compensate for the ipsilateral ICA occlusion. The other choices would cause bilateral hemodynamic changes.
Which of the following is related to the appearance of Rouleaux formation on the image? A. intracranial collateral flow B. thoracic outlet syndrome C. DVT D. Raynaud Syndrome
C
Proximal to a DVT the flow may be very slow and visible on 2D imaging, the RBCs appear lined up or stacked in rolls similar to coin rolls from your bank which is called the Rouleaux Formation.
Aneurysm formation affects the __________, while atherosclerotic disease affects the __________.
A. intimal layer of the vessel wall, media and adventitia layers of the vessel wall
B. extracranial arteries, intracranial arteries
C. media and adventitia layers of the vessel wall, intimal layer of the vessel wall
D. proximal arteries, distal arteries
C
Aneurysm formation is caused by a breakdown of the media and adventitia layers of the vessel wall. Atherosclerotic disease causes formation of plaque within the intimal layer of the vessel wall. Both disorders can be found in any artery in the body.
Which cardiac abnormality usually has NO effect in the peak systolic velocities in the carotid arteries? A. cardiomyopathy B. mitral valve regurgitation C. coronary artery disease D. aortic valve stenosis
B
Cardiac structure and function should be considered on all vascular evaluations. Changes in cardiac function can effect the velocities in the arterial system and change the flow characteristics of the venous system. Mitral regurgitation does NOT affect the systolic velocities in the arterial system. Aortic stenosis, mitral stenosis, CHF, diastolic dysfunction, dilated cardiomyopathy and CAD can reduce the PSV in the arterial system. Systemic HTN, aortic regurgitation, hypertrophic cardiomyopathy and compensatory heart beats with arrhythmias can falsely elevate the PSV.
A patient presents with leg pain 2 days after a coronary artery catheterization. All of the following are an important part of the physical evaluation of the patient, except:
A. evaluation of the lower leg for loss of hair, dry skin and thick toenails
B. evaluation of the groin for a bruit
C. evaluation of the leg for signs of pallor
D. evaluation of the toes for blue discoloration
A
Loss of hair, dry skin and thick toenails are symptoms of chronic disease that would not really be important to the acute onset of the new symptoms. Angiography procedures have a risk of related pseudoaneurysm, AV fistula (bruit), distal embolization (blue toes) and acute occlusion from the puncture.
Lymphedema is commonly related to: A. peripheral arterial disease B. a pulmonary embolism C. Leriche syndrome D. a history of radiation therapy or cancer
D
Lymphedema occurs due to an obstructed lymphatic system. It can be caused by many things, but is commonly seen with infection, injury, trauma, or cancer that affects the lymphatic system. Radiation therapy or removal of lymph nodes related to cancer can also cause lymphedema.
Which of the following is not an expected finding with a positive evaluation for thoracic outlet syndrome?
A. low amplitude PPG digit tracings on the affected side with arm adduction
B. decreased flow velocity in the distal arm on the affected side with arm adduction
C. decreased blood pressure on the affected side with Adson’s maneuver
D. decreased resistance in the proximal subclavian artery on the affected side with arm abduction
D
Due to compression of the distal subclavian with TOS, the flow in the proximal subclavian artery will demonstrate increased resistance.
An aortic aneurysm is diagnosed when the diameter of the aorta exceeds \_\_\_\_\_\_\_ and a popliteal aneurysm is diagnosed when the diameter of the popliteal artery exceeds \_\_\_\_\_\_\_\_. A. 3.5cm, 2cm B. 3.5cm, 1 cm C. 3cm, 3cm D. 3cm, 1cm
D
An aortic aneurysm is diagnosed when the diameter of the aorta exceeds 3cm and a popliteal aneurysm is diagnosed when the diameter of the popliteal artery exceeds 1cm.
Bilateral bruits are detected in the proximal neck. This finding is most suggestive of: A. CHF B. Subclavian steal C. Polycythemia vera D. Aortic valve stenosis
D
Bilateral carotid bruits and changes in both carotid flow patterns can be related to aortic stenosis. If the aortic valve is stenotic causing increased flow velocity and turbulence, flow in both carotids will reflect this change and may demonstrate bilateral bruits. CHF would lead to decreased flow through both carotids but a bruit would most likely NOT be identified due to slow moving flow.
Which of the following portions of the leg would be swollen with chronic insufficiency? A. calf only B. ankle and calf, but not the foot C. foot and ankle, but not the calf D. calf, foot, ankle
B
Swelling of the feet normally does not occur with venous disease (systemic or cardiac disease, yes)
Which of the following is a potential symptom caused by a subclavian steal?
A. HTN
B. syncope
C. unilateral amaurosis fugax
D. syncope and unilateral amaurosis fugax
B
Vertebrobasilar disease is associated with syncope. Amaurosis fugax is a visual disturbance than can be related to ICA stenosis. HTN is a risk factor for developing vascular disease.
Aspirin would be the preferred treatment for which of the following patients? A. 60% ICA stenosis B. presence of significant venous reflux C. compartment syndrome D. total occlusion of an ICA
A
Aspirin prevents platelet aggregation in the arteries which reduces the ability of plaque to form. Patients with mild to moderate carotid stenosis can benefit from an aspirin each day.
A 60yr old male presents for a carotid ultrasound due to two recent episodes of syncope. He also has a history of CHF. Which of the following statements describes the Doppler waveforms you expect to see on this exam?
A. bilateral CCA waveforms will demonstrate decreased resistance and velocity
B. bilateral CCA waveforms will demonstrate increased resistance and velocity
C. the right CCA waveform will be damped and the left CCA waveform will be increased in velocity and resistance
D. the left CCA waveform will be damped and the right CCA waveform will be increased in velocity and resistance
A
CHF = congestive heart failure
Any abnormality that causes a decrease in cardiac output will result in damped CCA waveforms bilaterally. Severe aortic valve stenosis can also lead to damped CCA blood flow bilaterally.
A patient presents for a carotid Doppler exam due to left sided amaurosis fugax. These findings are most suggestive of stenosis in: A. left ICA B. right ICA C. right vertebral artery D. left vertebral artery
A
Visual symptoms occur on the same side as the stenosis because the ophthalmic artery is a branch of the distal ICA.
Bilateral homonymous hemianopia is most commonly seen with: A. internal carotid artery stenosis B. subclavian vein thrombosis C. vertebrobasilar disease D. abdominal aortic aneurysm
C
Bilateral visual symptoms are most commonly related to verterbrobasilar disease and reduced flow to the occipital lobes of the brain. Unilateral visual symptoms are most commonly related to ICA disease and decreased flow to the ophthalmic artery.
Proximal to a DVT in the femoral vein, the flow appears very slow and visible on 2D imaging. The red blood cells appear lined up or stacked in rolls. What is this phenomenon called? A. Rouleaux Formation B. May-Thurner Syndrome C. Phlegmasia cerulea dolens D. Raynaud phenomenon
A
Proximal to a DVT in the superficial femoral vein, the flow appears very slow and visible on 2D imaging. The red blood cells appear lined up or stacked in rolls. This phenomenon is called Rouleaux formation.
A patient presents 3 days after left hip surgery for a DVT evaluation. There is severe edema from the hip to the ankle and the leg has a mild cyanotic appearance. You identify acute thrombus from the common femoral vein through the calf veins. The great saphenous vein is also occluded by thrombus. What is the diagnosis for this condition? A. Phlegmasia Alba Dolens B. Acute arterial occlusion C. Phegmasia Cerulea Dolens D. Budd Chiari syndrome
C
Phlegmasia Cerulea Dolens refers to extensive DVT occluding deep system and superficial system. Arterial inflow is significantly affected. Severe limb edema and mottled skin are noted with cyanosis due to high concentration of deoxygenated blood. Tip for remembering the difference between Cerulea Dolens and Alba Dolens, “C”erulea causes “C”yanosis of the leg, while Alba Dolens results in pallor.
Which of the following will result in a low resistance external carotid artery waveform with increased antegrade flow in diastole?
A. contralateral subclavian stenosis
B. ipsilateral mid common carotid artery stenosis
C. contralateral internal carotid artery occlusion
D. temporal arteritis
B
The ECA normally demonstrates a high resistance flow pattern with minimal antegrade diastolic flow. Stenosis proximal to the ECA (in the CCA) or in the proximal ECA will cause lower resistance ECA flow with increased antegrade flow in diastole. If the ipsilateral ICA is occluded, these same changes will occur.
If you detect flow toward the transducer in the right ACA while using the temporal window,
A. there is probably a left MCA occlusion
B. there is probably an occlusion of the right ICA
C. the flow direction is normal
D. there is probably an occlusion of the left ICA
B
If flow direction is reversed in one of the anterior cerebral arteries, the change can be caused by cross-over collateralization. An ICA occlusion should be suspected on the same side.
Patients with lower extremity arterial disease may describe pain
A. that is relieved by walking
B. that is relieved by elevating the legs
C. that is relieved by placing legs in a dependent position
D. that is relieved by lying down
C
The dependent position helps blood to reach the lower legs more quickly. Walking and elevating the legs would increase the pain. Lying down would provide minimal relief due to the loss of gravity’s assistance with the flow.
