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Vascular Technology Review > Cerebrovascular Disease > Flashcards

Cerebrovascular Disease Flashcards

1
Q

Atherosclerosis is a disease that begins in the

a) adventitia
b) intima
c) inner media
d) outer media

A

b) intima

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2
Q

Which of the following is NOT considered a risk factor for atherosclerosis?

a) hypertension
b) female gender
c) diabetes
d) lipoprotein abnormalities
e) tobacco use

A

b) female gender

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3
Q

Which of the following is a complication of plaque ulceration?

a) thrombosis
b) intraplaque hemorrhage
c) embolization
d) all of the above
e) none of the above

A

d) all of the above

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4
Q

Cerebrovascular fibromuscular dysplasia occurs in

a) males
b) females
c) australians
d) infants
e) hypoglycemics

A

b) females

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5
Q

Which of the following is NOT true regarding atherosclerosis

a) atherosclerosis starts as a breakdown of the intima
b) atherosclerosis usually develops at bifurcations
c) atherosclerosis is a red blood cell disease
d) atherosclerosis is a generalized disease
e) intimal damage/repair may begin in adolescence

A

c) atherosclerosis is a red blood cell disease

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6
Q

A left arm blood pressure that is 40 mmHg lower than the right can be the result of any of the following EXCEPT

a) thoracic outlet entrapment
b) subclavian steal
c) coarctation of the aortic arch
d) axillary artery embolus
e) innominate artery occlusion

A

e) innominate artery occlusion

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7
Q

With a subclavian artery stenosis on the right side:

a) the flow in the right vertebral artery will be reversed
b) the patient will have right arm claudication
c) the arm pressure will be reduced
d) the right axillary Doppler signal will be monophasic
e) none of the above will necessarily be present

A

e) none of the above will necessarily be present

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8
Q

Which of the following anatomic lesions can produce a vertebral steal?
a) innominate artery occlusion
b) left subclavian artery origin stenosis
c) left vertebral artery stenosis
d) right common carotid artery occlusion
e) right axillary artery occlusion
f) D and E
G) A and B

A

G) A and B

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9
Q

A hypertensive, diabetic 65 year-old male presents for cerebrovascular testing because of an asymptomatic bruit on the right side. You are considering all of the following to be potential sources of the bruit EXCEPT?

a) stenosis of the external cartoid artery
b) stenosis of the subclavian artery
c) occlusion of the common carotid artery
d) dissection of the common cartoid artery
e) all of the above may produce a bruit

A

e) all of the above may produce a bruit

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10
Q

A disease that affects primarily the intima and may extend into the media is

a) buergers disease
b) aneurysmal disease
c) atherosclerosis
d) takayasu disease
e) diabetes

A

c) atherosclerosis

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11
Q

After carotid bifurcation disease, the next most common source of stroke symptoms is

a) cardiac-source embolization
b) paradoxical embolization from DVT via patent foramen ovale
c) spinal stenosis
d) subclavian stenosis
e) aortic dissection

A

a) cardiac-source embolization

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12
Q

The strongest risk factor for stroke is

a) poor diet
b) obesity
c) hypertension
d) hypocholesterolemia
e) alcohol abuse

A

c) hypertension

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13
Q

In the cerebrovascular system, atherosclerosis occurs most commonly in the

a) origin of internal carotid artery
b) intracranial internal carotid artery
c) left subclavian artery
d) innominate artery
e) proximal common carotid artery

A

a) origin of internal carotid artery

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14
Q

The most prevalent type of stroke is

a) aneurysmal
b) hemorrhagic
c) septic embolic
d) venous thrombotic
e) ischemic

A

e) ischemic

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15
Q

Where are carotid body tumors located

a) medial to the origin o the external carotid artery
b) within the internal jugular vein
c) between the internal and external carotid arteries
d) in the submandibular gland
e) in the intracranial internal carotid artery

A

c) between the internal and external carotid arteries

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16
Q

Which statements about subclavian steal is FALSE?

a) it occurs most commonly on the left side
b) most patients are asymptomatic
c) it results from severe stenosis or occlusion of the proximal vertebral artery
d) lower blood pressure is seen in the affected arm
e) all of these statements are false

A

c) it results from severe stenosis or occlusion of the proximal vertebral artery

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17
Q

A 24 year old patient with a history of recent automobile accident arrives in the ICU with symptoms of acute right-side weakness and asphia. The most likely etiology of these symptoms is

a) carotid dissection
b) cerebral aneurysm rupture
c) severe internal carotid artery stenosis
d) embolic activity from cardiac mural thrombus
e) thrombocytopenia

A

a) carotid dissection

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18
Q

A patient undergoes carotid endarterectomy. 6 months later angiography is performed because of symptoms referable to the other side. The angiogram reveals that the operated carotid is significantly narrowed. The most likely cause is:

a) atherosclerotic plaque recurrence
b) carotid dissection
c) embolic activity
d) extrinsic compression
e) neointimal hyperplasia

A

e) neointimal hyperplasia

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19
Q

The term hemiparesis means:

a) paralysis on one side
b) weakness of one side
c) numbness/ tingling on one side
d) spasm of voluntary muscle on one side
e) dizziness

A

b) weakness of one side

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20
Q

The NASCET (North American Symptomatic Carotid Endarterectomy Trial) used the following arterigraphic criterion/criteria to classify internal carotid artery disease:

a) area and diameter stenoses calculated by dividing the minimal area and diameter at the internal carotid artery by the area and diameter at the common carotid artery
b) Area percentage stenosis calculated by dividing the minimal area by the original area at the site of stenosis
c) diameter percentage stenosis calculated by dividing the minimal diameter by the original diameter at the site of stenosis
d) diameter percentage stenosis calculated by dividing the minimal diameter by the diameter of the un-stenosed distal internal carotid artery
e) Area percentage stenosis calculated by dividing the minimal area by the normal area of the distal internal carotid artery

A

d) diameter percentage stenosis calculated by dividing the minimal diameter by the diameter of the un-stenosed distal internal carotid artery

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21
Q

All of the following may represent symptoms form the brain stem or posterior circulation except:

a) dizziness
b) vertigo
c) ectasai
d) syncome
e) amaurosis fugax

A

e) amaurosis fugax

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22
Q

True or False?
A Patient relates a 10 minute episode of loss of vision. He closed each eye and the reduction in the right half of his visual field was present bilaterally. This patient is describing amaurosis fugax?

A

False- homonymous hemianopia

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23
Q

A symptom of vertebrobasilar insufficiency is

a) unilateral paresis
b) aphasia
c) amaurosis fugax
d) diplopia
e) none of the above

A

d) diplopia

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24
Q

True or False

On ophthalmologic examination, a bright yellow spot is noted within a branch artery. This is Hollenhorts plaque

A

True

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25
Q

A patient complains of a temporary shading of the vision of one eye. This symptom is called

a) subclavian steal syndrome
b) dysphasia
c) reversible ischemic neurologic event
d) amaurosis fugax
e) permanent ischemic neurologic event

A

d) amaurosis fugax

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26
Q

The incidence of stroke per year is

a) 150,000
b) 250,000
c) 500,000
d) 1,000,000
e) 2,600,000

A

c) 500,000

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27
Q

The abbreviation TIA stands for

a) terminal internal artery
b) temporary ischemic attack
c) transient ischemic attack
d) transient internal artery
e) temporary internal attack

A

c) transient ischemic attack

28
Q

A TIA of the right anterior hemisphere of the brain will likely affect:

a) the entire body
b) the left side of the body
c) the right side of the body
d) the right side of the face
e) the back of the head

A

b) the left side of the body

29
Q

Amaurosis fugax related to an internal carotid lesion will cause

a) permanent blindness of the contralateral eye
b) temporary blindness or shading of the ipsilateral eye
c) permanent blindness of the ipsilateral eye
d) temporary blindness or shading of the contralateral eye
e) temporary blindness or shading of both eyes

A

b) temporary blindness or shading of the ipsilateral eye

30
Q

A transient ischemic attack

a) resolves within 24 hours
b) does not resolve within 24 hours
c) resolves within 72 hours
d) resolves after 24 hours
e) resolves in one week

A

a) resolves within 24 hours

31
Q

Simultaneous bilateral ocular symptoms in the patient with suspected cerebrovascular disease generally originate from

a) the vertebrobasilar arteries
b) the ophthalmic arteries
c) both common carotid arteries
d) both internal carotid arteries
e) both external carotid arteries

A

a) the vertebrobasilar arteries

32
Q

Which of the following is a vertebrobasilar symptom

a) aphasia
b) vertigo
c) amaurosis fugax
d) right anterior hemisphere TIA
e) unilateral paresis

A

b) vertigo

33
Q

Which one of the following is an anterior circulation symptom

a) ataxia
b) drop attack
c) syncope
d) binocular visual disturbance
e) facial asymmetry

A

e) facial asymmetry

34
Q

Which one of the following accurately defines RIND, also called stroke with recovery

a) a reversible ischemic neurologic deficit that completely resolves within 24 hours
b) a neurologic deficit that does not resolve
c) a neurologic deficit that waxes and wanes
d) an irreversible neurologic deficit
e) a neurologic ischemic deficit that resolves completely after 24 hours

A

e) a neurologic ischemic deficit that resolves completely after 24 hours

35
Q

A 56 year old patient reports loss of vision in her left eye 2 days ago, with total resolution in 10 minutes. Yesterday morning she developed weakness and numbness in her right hand and was unable to hold her coffee cup. This afternoon her hand strength is about 90% normal, with normal sensation. Clinically she has

a) amaurosis fugax
b) transient ischemic attack
c) migraine
d) stroke
e) lacunar infarct

A

d) stroke

36
Q

Amaurosis fugax can be interpreted as a

a) stroke of the visual cortex
b) transient ischemic attack
c) stroke of the eye
d) transient ischemic attack of the frontal cortex
e) stroke of the parietal cortex

A

b) transient ischemic attack

37
Q

Dysphagia is a

a) hormone inbalance causing loss of appetite
b) psychological, not physiological, problem
c) left-hemisphere symptom (if patient is right-handed)
d) right- hemisphere symptom (if patient is right-handed)
e) symptom associated with vertebrobasilar insufficiency

A

e) symptom associated with vertebrobasilar insufficiency

38
Q

A binocular disturbance that disrupts vision of half the visual field of both eyes is called

a) hemiplegia
b) amaurosis duplex
c) dysphagia
d) homonymous hemianopia
e) hemiparesis

A

d) homonymous hemianopia

39
Q

Paresthesia refers to

a) dizziness
b) disturbance of speech
c) loss of function of a limb
d) weakness
e) tingling sensation

A

e) tingling sensation

40
Q

A patient describes a 30 minute episode of garbled speech. This is called

a) dysphasia
b) aphasia
c) paresthesia
d) dysphagia
e) syncope

A

a) dysphasia

41
Q

Which of the following is true regarding subclavian steal?

a) resulting strokes are usually severely disabling
b) it is usually a harmless hemodynamic phenonmenon
c) it is caused by arterial obstruction proximal to the origin of the vertebral artery
d) it is caused by arterial obstruction distal to the origin of the vertebral artery
e) a and c
f) a and d
g) b and c
h) b and d

A

g) b and c

42
Q

subclavian steal occurs

a) more often on the right side
b) more often on the left side
c) equally often on both sides
d) mainly in young, male smokers
e) mainly in females

A

b) more often on the left side

43
Q

A hemispheric stroke usually affects

a) the anterior cerebral artery disruption and the ipsilateral side of the body
b) the middle cerebellar artery disruption and the ipsilateral side of the body
c) the external carotid distribution, and may affect one or both sides of the body
d) the anterior cerebellar artery distribution and the contralateral side of the body
e) the middle cerebral artery distribution and the contralateral side of the body

A

e) the middle cerebral artery distribution and the contralateral side of the body

44
Q

stenosis of the following vessel presents the highest risk for a TIA:

a) left main coronary artery
b) common carotid artery
c) internal carotid artery
d) external carotid artery
e) middle cerebral artery

A

c) internal carotid artery

45
Q

A decreased pulse at mid neck is suggestive of

a) carotid aneurysm
b) common carotid stenosis if the contralateral pulse is normal
c) common cartoid stenosis if the contralateral pulse is decreased
d) internal carotid stenosis if the contralateral pule is normal
e) internal carotid stenosis if the contralateral pulse is also decreased

A

b) common carotid stenosis if the contralateral pulse is normal

46
Q

Which is NOT true regarding carotid bruit

a) severe stenosis may cause bruit
b) the absence of a bruit rules out significant stenosis
c) the presence of a bruit is significant
d) a cervical bruit might arise from stenosis of the external carotid artery
e) a bruit extending into diastole suggests severe stenosis

A

b) the absence of a bruit rules out significant stenosis

47
Q

Bruits heard bilaterally, loudest low in the neck, are most likely caused by:

a) aortic valve stenosis
b) innominate stenosis
c) bilateral subclavian stenosis
d) aortic arch occlusion
e) bilateral CCA obstruction

A

a) aortic valve stenosis

48
Q

A stronger pulse is palpated in the right neck than on the left. This could result from all of the following except

a) tortuous CCA
b) carotid aneurysm on the right
c) tech error
d) left carotid obstruction
e) innominate occlusion

A

e) innominate occlusion

49
Q

Which of the following is/are true regarding the clinical detection of a bruit?

a) a bruit is always an indication of disease
b) it means that turbulent flow exists
c) it may be indicative of valvular dysfunction in the heart
d) it may be a normal finding in parts of some vessels and during periods of enhanced flow
e) a bruit is present in >90% of vessels with disease
f) b,c and d
g) a, b and e

A

f) b,c and d

50
Q

During ordinary auscultation of a carotid bifurcation, the detection of a bruit that extends into diastole is

a) insignificant
b) marginally significant
c) moderately significant
d) highly significant
e) impossible

A

d) highly significant

51
Q

Which of these conditions is LEAST likely to cause a bruit in the neck?

a) severe stenosis of the internal carotid artery
b) severe stenosis of the external carotid artery
c) hyperdynamic carotid flows
d) cardiac valvular disease
e) critical preocclusive stenosis of the internal carotid artery

A

e) critical preocclusive stenosis of the internal carotid artery

52
Q

Why are brachial blood pressures obtained bilaterally when evaluating a patient for cerebrovascular disease?

a) the systolic components from each arm are averaged to determine the likelihood of cerebrovascular disease
b) It is necessary to know both brachial pressures to rule out the presence of hypoperfusion syndrome
c) the brachial blood pressures are compared to see if they are equal
d) both brachial blood pressures must be known to determine if hypertension is present
e) there is no value in obtaining bilateral brachial pressures if they are not compared to the ankle pressures

A

c) the brachial blood pressures are compared to see if they are equal

53
Q

All of the following statements apply to pulsed-wave Doppler except:

a) Aliasing occurs when the frequency shift exceeds 1/2 the pulse repetition frequency
b) One transducer is used for both transmission and reception
c) the beam is continuously transmitted with intermittent reception according to vessel depth
d) a sample volume is used to determine the depth of interest
e) all of theses statements are true

A

c) the beam is continuously transmitted with intermittent reception according to vessel depth

54
Q

Loss of the spectral window with pulsed Doppler ultrasound occurs with

a) flow turbulence
b) parabolic flow
c) laminar flow
d) all of the above
e) none of the above

A

a) flow turbulence

55
Q

A duplex image of the carotid bifurcation that demonstrates a goblet like configuration of the internal and external branches curving around a highly vascularized mass suggest

a) carotid aneurysm
b) severe ICA stenosis
c) myointimal hyperplasia
d) carotid body tumor
e) temporal arteritis

A

d) carotid body tumor

56
Q

In duplex imaging, the best arterial wall image quality is obtained when the beam is at the following angle to the artery walls

a) 90
b) 60
c) 0
d) oblique
e) obtuse

A

a) 90

57
Q

TCD findings consistent with vasospasm following subarachnoid hemorrhage would include

a) absence of diastolic flow in the middle cerebral artery
b) greatly diminished diastolic flow in the middle cerebral artery
c) retrograde flow in the middle cerebral artery
d) greatly increased mean velocities in the middle cerebral artery
e) this is not a condition for which TCD is a useful modality

A

d) greatly increased mean velocities in the middle cerebral artery

58
Q

In TCD, the normal direction of flow in the vertebral artery is

a) toward the beam
b) away from the beam
c) bidirectional
d) dependent on the cardiac cycle
e) not detectable with TCD

A

b) away from the beam

59
Q

Which of the following is not a condition for which TCD might be useful

a) vasospam following subarachnoid hemorrhage
b) determination of brain death
c) cerebral artery monitoring during surgery
d) carotid siphon stenosis
e) temporal arteritis

A

e) temporal arteritis

60
Q

The doppler beam angle considered optimal for standardization of duplex carotid studies is most vascular labs i s

a) 0
b) 20-40
c) 40-50
d) 60
e) any angle greater than 60

A

d) 60

61
Q

The usual instrumentation for handheld TCD includes a probe with an opening frequency of

a) 10 KHz
b) 2 MHz
c) 5 MHz
d) 7.5 MHz
e) 10 MHz

A

b) 2 MHz

62
Q

In TCD, the normal direction of flow in the anterior cerebral artery is

a) toward the beam
b) away from beam
c) bidirectional
d) dependent on the cardiac cycle
e) not detectable with TCD

A

b) away from beam

63
Q

A localized increase in mean velocity from 50 to 150 cm/sec at a depth of 50 mm with the TCD transducer placed in the temporal window probably indicates:

a) significant stenosis of the anterior cerebral
b) moderate generalized vasospasm
c) significant stenosis of the internal carotid at the siphon
d) significant vasospasm of the middle cerebral artery
e) significant stenosis of the middle cerebral artery

A

e) significant stenosis of the middle cerebral artery

64
Q

In handheld TCD, the angle of the beam relative to flow is assumed to be:

a) 0
b) 30
c) 45 exactly
d) 60
e) 90

A

a) 0

65
Q

You perform TCD, insonating the left anterior cerebral artery. The flow is toward the beam. This finding suggest:

a) Ipsilateral carotid obstruction, with right-to- left collateralization
b) contralateral carotid bifurcation obstruction, with left-to-right collateralization
c) ipsilateral carotid obstruction, with posterior-to-anterior collateralization
d) nothing of diagnostic significance

A

a) Ipsilateral carotid obstruction, with right-to- left collateralization

66
Q

Which of the following would alter the frequency shift of the internal carotid artery Doppler signal?

a) tapering of the vessel from the bulb to the distal visualized segment
b) increasing the transmitted frequency
c) readjusting the angle-correct cursor
d) lowering the system threshold sensitivity
e) A and B
f) C and D

A

e) A and B

Vascular Technology Review (2 decks)

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