Anatomy Pt 2 Flashcards
(130 cards)
1
Q
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
A
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.
2
Q
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
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.
3
Q
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
A
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.
4
Q
Which of the following cannot be characterized as concomitant veins? A. peroneal veins B. soleal veins C. posterior tibial veins D. gastrocnemius veins
A
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.
5
Q
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
A
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.
6
Q
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
A
B
All vessels that feed organs will have low resistance vascular beds which lead to a low resistance waveform.
7
Q
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
A
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.
8
Q
The lateral plantar arch artery originates at the \_\_\_\_\_\_\_\_\_. A. peroneal artery B. popliteal artery C. anterior tibial artery D. posterior tibial artery
A
D
The lateral plantar arch originates at the PTA.
9
Q
The great saphenous vein is attached to the \_\_\_\_\_\_\_ aspect of the common femoral vein. A. posterior B. anterior C. medial D. lateral
A
C
the great saphenous vein is attached to the medial aspect of the CFV.
10
Q
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
A
B
the PTA and PTVs can be identified between the medial malleolus and the distal portion of the Achilles tendon.
11
Q
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
A
The ATA branches off the popliteal artery first, to leave the tibioperoneal trunk that splits into the peroneal
12
Q
During inspiration the flow in the veins of the lower extremities \_\_\_\_\_\_\_\_\_. A. increases B. decreases C. remains unchanged D. reverses direction
A
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.
13
Q
The profunda artery courses \_\_\_\_\_\_\_\_\_ to the superficial femoral artery. A. posterior lateral B. anterior medial C. posterior medial D. anterior lateral
A
A
The deep femoral artery courses posterior and lateral to the superficial femoral artery.
14
Q
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
A
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
15
Q
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
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).
16
Q
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
A
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.
17
Q
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
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.
18
Q
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
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.
19
Q
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
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.
20
Q
Which vessel courses posterior to the anterior scalene muscle? A. brachial artery B. axillary artery C. aorta D. subclavian artery
A
D
The subclavian artery courses posterior to the anterior scalene muscle.
21
Q
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
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.
22
Q
The dorsalis pedis artery is a branch of: A. the PTA B. the peroneal artery C. the gastrocnemius artery D. the ATA
A
D
The DPA is a distal branch of the ATA.
23
Q
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
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.
24
Q
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
A
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.
25
```
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.
26
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.
27
```
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.
28
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.
29
```
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.
30
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.
31
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.
32
```
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.
33
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.
34
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.
35
```
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.
36
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.
37
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).
38
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
39
```
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.
40
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.
41
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.
42
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.
43
```
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.
44
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.
45
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.
46
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.
47
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.
48
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.
49
```
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.
50
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.
51
```
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.
52
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.
53
```
The pulsatility index (PI) in a normal aorta should be _____ the PI in the normal popliteal artery.
A. higher than
B. very similar to
C. PI not measured in extremity vessels
D. lower than
```
D
The pulsatility index (PI) in a normal aorta should be lower than the PI in the normal popliteal artery. The aorta flow is lower resistance than the popliteal artery, therefore there is a greater amount of pulsatility in the popliteal artery. The PI increases from the central arteries to the peripheral extremity arteries. A PI <5.0 in a lower extremity artery indicates proximal obstruction.
54
Which of the following is NOT normally performed after the injection of papaverine into the tissues proximal to the shaft of the penis:
A. Measure the diameter of the cavernous arteries
B. Doppler waveforms are obtained in the cavernous arteries and veins 1-2 minutes post-injection
C. Apply the 2.5 cm blood pressure cuff around the shaft of the penis
D. Repeat the ABI measurements
D
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 cavernous arteries should be measured. After the injection the penile artery diameters and velocities are repeated. The penile pressure is obtained using a 2.5cm cuff and the PBI is calculated. The ABI is performed before the injection to assess any PAD that may be present.
55
```
The profunda femoral artery supplies blood to which of the following structures?
A. Bicep muscle
B. Psoas muscle
C. Pelvic organs
D. Quadriceps muscle
```
D
The profunda artery branches from the common femoral artery and mainly supplies blood to the muscles/structures of the thigh and hip.
56
Which of the following veins courses anterior to the tibial bone in the calf?
A. great saphenous vein
B. great saphenous vein and anterior tibial vein
C. anterior tibial vein
D. peroneal vein
C
| The anterior tibial veins course anterior to the tibial bone in the calf.
57
The distal femoral artery becomes the popliteal artery:
A. at the level of the heads of the gastrocnemius muscles
B. at the level of the adductor canal
C. in the popliteal fossa
D. at the level of the medial quadricep tendon
B
| The distal femoral artery becomes the popliteal artery at the level of the adductor canal (Hunter's canal).
58
```
The normal brachial artery waveform should resemble the flow in the normal ______ artery.
A. hepatic artery
B. vertebral artery
C. superior mesenteric artery
D. peroneal artery
```
D
The normal brachial artery waveform will normally resemble the flow in the normal peroneal artery. Extremity flow will demonstrate a high resistance, triphasic waveform.
59
Which of the following statements regarding venous perforators is correct?
A. they each contain a single valve.
B. Perforator flow is normally unidirectional, but becomes bidirectional with exercise.
C. Thrombosis rarely occurs within the perforators and cannot be easily demonstrated on ultrasound evaluation.
D. Flow in the perforators normally moves from the deep superficial system.
A
Venous valves are designed to allow unidirectional flow. If the valves are damaged or the vein is dilated to prevent proper valve movement, flow reversal may occur. Flow in the perforators normally moves from the superficial to the deep system. They each contain a single valve. Thrombosis can occur within the perforators, which can lead to the formation of varicosities.
60
How do you test the capillary blush response on the upper extremity?
A. press your finger into the fleshy part of the arm to create pallor, then release to time the return of normal skin coloring.
B. Apply a blood pressure cuff to the upper arm and inflate above the systolic pressure for 90 seconds then release the cuff to time the return of normal coloring in the arm.
C. Raise the arm above the head for 60 seconds to produce pallor and then place the arm in neutral position to time the return of normal coloring in the arm.
D. Compress the radial and ulnar artery simultaneously for 60 seconds to create pallor in the hand and then release to time the return of normal coloring in the hand,
A
Press your finger into the fleshy part of the arm to create pallor, then release to time the return of normal skin coloring. Longer times indicate the presence of arterial disease or obstruction.
61
What is the preferred patient position for performing an upper extremity arterial duplex exam?
A. arm abducted to 45 degrees and externally rotated
B. arm raised above head with patient in supine position
C. arm abducted to 90 degrees and externally rotated
D. Arm adducted to 45 degrees and internally rotated
A
The preferred patient position for performing an upper extremity arterial duplex exam is to abduct the arm 45 degrees with external rotation.
62
```
The _______ is formed by the junction of the splenic vein and the superior mesenteric vein.
A. main portal vein
B. right hepatic vein
C. left hepatic vein
D. inferior mesenteric vein
```
A
| The MPV is formed by the junction of the splenic vein and the superior mesenteric vein.
63
```
_______ reflux will be normally seen in the lower extremity superficial system.
A. No (0s)
B. Less than 0.5s
C. Less than 1.5s
D. Less than 3s
```
B
| A small amount of reflux (Less than 0.5s) may be seen in normal vessels with flow normalization following augmentation.
64
```
The posterior tibial artery courses along:
A. the medial aspect of the thigh
B. the medial aspect of the calf
C. the lateral aspect of the calf
D. the posterior aspect of the knee
```
B
| The PTA courses along the medial aspect of the calf.
65
```
A branch of which artery joins the terminal ulnar artery to form the superficial palmar arch?
A. Radial
B. Ulnar
C. Brachial
D. Antecubital
```
A
A branch of the radial artery joins the terminal ulnar artery to form the superficial palmar arch. A branch of the ulnar artery joins the terminal radial artery to form the deep palmar arch.
66
```
The lateral plantar artery originates:
A. at the PTA
B. at the ATA
C. at the popliteal artery
D. at the peroneal artery
```
A
| The lateral plantar artery originates at the PTA.
67
```
Which vessel(s) supplies the majority of the blood to the hand?
A. ulnar artery
B. digital veins
C. radial artery
D. metatarsal arteries
```
A
| The ulnar artery supplies the majority of the blood to the hand.
68
```
The hypogastric artery is another name for what vessel?
A. superior mesenteric artery
B. internal iliac artery
C. inferior mesenteric artery
D. splenic artery
```
B
| The hypogastric artery is another name for the internal iliac artery.
69
```
You receive an order for a pre-op arterial mapping to evaluate the internal mammary artery. What vessel should you evaluate to locate the origin of the internal mammary artery?
A. descending aorta
B. aortic arch
C. subclavian artery
D. innominate artery
```
C
| The internal mammary artery originates from the subclavian artery.
70
Which of the following lists the most common anatomic variation in aortic arch anatomy?
A. Pulmonary sling
B. Two branches originate from the arch: a shared innominate/left CCA trunk and the left subclavian artery
C. Double aortic arch
D. The coronary arteries originate from the innominate artery or the right CCA
B
The most common anatomic variant of the arch branches is only two direct branches of the arch:
1. The innominate and left CCA originate as one short segment and then split
2. Left subclavian artery
71
Which of the following is unaffected by vasoconstriction and vasodilation in the arterioles?
A. peripheral resistance
B. the amount of diastolic flow in the artery
C. hydrostatic pressure
D. the number of phases of flow in the arterial waveform
C
Hydrostatic pressure is the weight of the column of blood in the vessels when standing. Vasoconstriction will increase peripheral resistance and increase resistance in the feeding arteries. Higher resistance flow will have less antegrade flow in diastole. Vasodilation will decrease peripheral resistance and decrease resistance in the feeding arteries. Lower resistance flow will have more antegrade flow in diastole. A biphasic waveform can become monophasic.
72
```
The subocciptial window is used in TCD exams to evaluate which of the following arteries?
A. ICA siphon, vertebral and basilar
B. vertebral and basilar
C. ICA siphon
D. MCA and ICA siphon
```
B
| The suboccipital window is used to evaluate the vertebral and basilar arteries.
73
```
Branches of the ______ connect to branches of the vertebral arteries to allow collateral flow from the anterior circulation to the posterior circulation.
A. ophthalmic artery
B. occipital artery
C. subclavian artery
D. basilar artery
```
B
The occipital artery is a branch of the ECA. Branches of the occipital artery meet branches of the vertebral artery. This is a possible collateral pathway for obstruction in the vertebral system or the ICA system on the same side.
74
```
Which of the following principles produces an equation that relates pressure gradient to flow and resistance within the circulatory system?
A. Poiseuille's Law
B. Bernoulli Principle
C. Doppler Principle
D. Raynaud's Phenomenon
```
A
Poiseuille's Law states the pressure gradient in a vessel is equal to the flow volume multiplied by the resistance. Bernoulli's equation uses flow velocity to determine the pressure gradient at a specific location within the circulatory system.
75
Flow through venous perforators is:
A. normally unidirectional from the superficial to the deep venous system
B. normally unidirectional from the deep venous to the superficial system
C. normally bidirectional to help equalize pressures in the deep and superficial systems
D. normally absent unless the deep system becomes overloaded and forces the excess blood into the superficial system
A
| Flow through venous perforators is normally unidirectional from the superficial to deep venous system.
76
```
When evaluating the GSV for use as a bypass graft, what is the preferred diameter for the vein?
A. >5mm
B. >10mm
C. >3mm
D. >7mm
```
C
| When evaluating a vein for use as a bypass graft, a 3mm diameter or greater is preferred.
77
```
The paratibial perforators connect:
A. the SSV and PTVs
B. the GSV and PTVs
C. the SSV and popliteal vein
D. the GSV and the ATVs
```
B
| The paratibial perforators connect the GSV and the PTVs.
78
During a TCD exam the depth is set to 100mm while using the suboccipital window. What vessel will be interrogated and what direction will the flow be moving?
A. basilar, toward the transducer
B. carotid siphon, varies with portion of the siphon evaluated
C. vertebral, toward the transducer
D. basilar, away from the transducer
D
60-90mm suboccipital window = vertebral
80 - 120mm suboccipital window = basilar
Both vessels will normally exhibit flow moving away from the transducer and toward the brain.
79
```
The _______ artery terminates at the external calcaneal artery.
A. peroneal
B. posterior tibial
C. anterior tibial
D. medial gastrocnemius
```
A
| The peroneal artery terminates at the external calcaneal artery.
80
```
Which of the following describes the proper technique for evaluating the ACA through the temporal window?
A. Anterior angulation with 65mm depth
B. Posterior angulation with 65mm depth
C. Midline placement with 50mm depth
D. Anterior angulation with 50mm depth
```
A
| When using the temporal window, the ACA is evaluated with anterior probe angulation set at a 65mm depth.
81
```
If the acceleration time in the common femoral artery is 110ms:
A. there is a proximal stenosis
B. there is a distal stenosis
C. the inflow vessels are normal
D. there is an AV malformation
```
C
If the AT in the common femoral artery is >140ms, iliac disease is suspected. If the AT in both of the common femoral arteries is >140ms, aortic disease is suspected. 110ms is a normal finding.
82
```
Which of the following arteries is normally only an intracranical vessel?
A. basilar artery
B. internal carotid artery
C. vertebral artery
D. superficial temporal artery
```
A
The basilar artery is formed by the convergence of the left and right vertebral arteries inside the posterior aspect of the base of the skull.
83
Which of the following explains the increased incidence of DVT in the left leg when compared to the right leg?
A. The anatomic course of the left iliac vein leads to increased risk of extrinsic compression.
B. The left iliac vein is usually smaller than the right.
C. Left iliac vein is a common location for DVT formation with pregnancy
D. There are more valves present in the left iliac vein which can lead to increased venous stasis.
A
Left iliac vein courses beneath the right iliac artery at the aortic bifurcation. Extrinsic compression has been linked to increased incidence of the left leg DVT. This condition is called May Thurner syndrome.
84
```
Which imaging plane can demonstrate the IVC and the aorta on the same image in a normal patient?
A. transverse only
B. coronal and transverse
C. coronal only
D. mid sagittal only
```
B
85
Which of the following statements refers to the internal pudendal artery?
A. is the injection site for papaverine
B. branch of the external iliac artery
C. supplies the penis with blood through the penile artery and its branches
D. most common location for stenosis causing vasulogenic impotence
C
The internal pudendal artery is a branch of the internal iliac artery and supplies the penis with blood through the penile artery and its branches. Papaverine is injected into the tissues at the lateral side of the base of the penis.
86
```
Which of the following normal arteries is not palpable on physical exam?
A. common femoral
B. peroneal
C. posterior tibial
D. dorsalis pedis
```
B
| Because of the location in the calf, the peroneal artery is not normally palpable.
87
The subclavian artery becomes the axillary artery:
A. when it crosses anterior to the clavicle
B. when it crosses over the deltoid muscle
C. at the level of the first rib
D. at the level of the fourth rib
C
The subclavian artery extends from the innominate artery to the axillary artery. It courses posterior to the anterior scalene muscle and clavicle. It becomes the axillary artery at the level of the first rib.
88
The ______ supplies arterial blood to the small intestine and proximal colon, while the _____ supplies blood to the distal colon.
A. celiac axis, superior mesenteric arteries
B. superior and inferior mesenteric arteries
C. gastroduodenal artery, superior mesenteric arteries
D. left gastric artery, inferior mesenteric arteries
B
| The proximal colon and small intestine are supplied by the SMA. The distal colon is supplied by the IMA.
89
Normal hepatic venous flow will demonstrate:
A. two large retrograde and systolic waves followed by a small retrograge component that corresponds with the atrial contraction
B. two large antegrade diastolic and systolic waves followed by a small retrograde component that corresponds with the atrial contraction
C. two large antegrade diastolic and systolic waves followed by a small antegrade component that corresponds with the atrial contraction
D. two large retrograde diastolic and systolic waves followed by a small antegrade component that corresponds with the atrial contraction
B
Normal HV flow is considered triphasic. The tracing normally demonstrates respiratory phasicity and cardiac pulsatility. The majority of the flow moves forward into the right atrium until the atrial "kick" occurs. The Doppler tracing will demonstrate two large antegrade diastolic and systolic waves followed by a small retrograde component that corresponds with the atrial contraction.
90
```
If you are unable to locate the distal ICA through the temporal window, which of the following is an alternative acoustic window that can be used?
A. submandibular
B. occipital
C. posterior foramen
D. anterior foramen
```
A
If you are unable to locate the distal ICA through the temporal window, the submandibular window is an alternative approach that can be used.
91
```
The inner most layer of an arterial wall is called _______, while the outermost layer of an arterial wall is called ______.
A. tunica adventitia, tunica intima
B. tunica intima, vasa vasorum
C. vasa vasorum, tunica adventitia
D. tunica intima, tunica adventitia
```
D
The inner most layer of an arterial wall is called tunica intima, while the outermost layer of an arterial wall is called tunica advenitia.
92
The profunda artery:
A. courses posterior and medial to the fermoral artery
B. supplies blood to the prostate and pelvic organs in a male patient
C. demonstrates low resistance flow compared to the femoral artery
D. courses posterior and lateral to the femoral artery
D
| The profunda artery courses posterior and lateral to the femoral artery.
93
```
Transcranial Doppler most commonly uses which Doppler measurement to evaluate flow in the cerebral vessels?
A. peak systolic velocity
B. end diastolic velocity
C. resistive index
D. time average maximum velocity
```
D
| Time average maximum velocity or mean flow velocity is used to assess flow in the cerebral arteries.
94
While performing an arterial Duplex exam, the patient complains that she is cold. What effect could this have on your exam?
A. decreased ankle pressures
B. increased pulsatility in the vessels evaluated
C. decreased ankle pressures and monophasic flow may be demonstrated in normal arteries
D. monophasic flow may be demonstrated in normal arteries
B
Cold temperatures cause vasoconstriction in the medium to small arteries of the body. This will lead to increased flow resistance and pulsatility of the flow.
95
```
What patient position should be used when mapping the great saphenous vein for harvest?
A. Trendelenburg
B. left lateral decubitus
C. reverse Trendelenburg
D. supine
```
C
Place the extremity in a dependent position.
Leg: reverse Trendelenburg for the GSV and decubitus for the SSV.
Arms: supine with arms extended at side at a level lower than the heart or seated position with hand on lap; tourniquets can be applied in cases where the veins are very small.
96
The superficial venous system of the lower extremities contains vessels that are located
A. on the lateral aspect of each leg
B. within the connective tissue between the muscle tissue
C. superficial to the deep muscular fascia
D. adjacent to an artery with the same name
C
| The saphenous veins and their tributaries course within the subcutaneous tissue, between the fascial layers.
97
```
Normal extremity arterial flow should demonstrate a _______ acceleration time.
A. blunted
B. variable
C. prolonged
D. rapid
```
D
| Normal extremity arterial flow should demonstrate a rapid acceleration time.
98
Bank tellers, teachers, cashiers and assembly line workers have an increased risk of all of the following, except:
A. venous hypertension
B. varicose veins
C. thrombus formation in the soleal sinuses
D. jugular vein thrombosis
D
Bank tellers, teachers, cashiers and assembly line workers are on their feet, standing still for several hours of the day. This will cause venous blood to pool in the legs and increase pressure in the veins (venous hypertension). Stasis of venous flow can lead to thrombus formation. Flow in the jugular veins would flow easily into the vena cava with no stasis or increased risk of thrombus formation.
99
The internal iliac artery:
A. branches into the superficial and deep femoral arteries
B. demonstrates lower resistance flow than the external iliac artery
C. courses lateral to the external iliac artery to reach the pelvis
D. supplies the bladder, prostate and testicles in a male patient
B
The gonadal arteries originate from the aorta not the internal iliac artery. Flow in the internal iliac artery is less resistant than the external branch because it supplies the pelvic organs with blood.
100
```
Normal perforator valves allow blood flow in the perforator to move:
A. toward the heart
B. toward the ankle
C. from the GSV to femoral vein
D. from the femoral vein to the GSV
```
C
Normal perforator valves allow blood flow in the perforator to move from the superficial system to the deep system. Dilated perforators will allow bidirectional blood flow.
101
```
There are normally _______ perforator veins in each leg.
A. about 25-30
B. about 100
C. about 300
D. over 500
```
B
| There are normally about 100 perforator veins in each leg.
102
```
Which of the following can be found immediately posterior to the inguinal ligament?
A. saphenopopliteal junction
B. popliteal vein and artery
C. common femoral vein and artery
D. profunda femoral vein
```
C
The CFA and CFV course posterior to the inguinal ligament. The GSV joins the CFV near the ligament. The FV and PFV join to form the CFV just distal to the ligament. The saphenopopliteal junction is located in the upper calf or popliteal fossa in most patients.
103
```
During inspiration the flow in the veins of the upper extremities ________.
A. increases
B. decreases
C. remains unchanged
D. reverses direction
```
A
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.
104
In cases of interrupted IVC, how does the blood from the distal IVC and lower extremities reach the right atrium?
A. an AV malformation of the pelvis must be present for the patient to survive birth
B. umbilical vein serves as a collateral pathway and empties into the portal system
C. azygos vein serves as a collateral pathway and empties into the SVC
D. iliac veins empty directly into the renal veins
C
Interrupted IVC: the intrahepatic segment of the IVC does not develop; the azygos vein drains the flow from the pelvis and lower extremities into the SVC; hepatic veins empty directly into the right atrium.
105
Which of the following correctly describes the venous system of the upper extremity?
A. the superficial venous system of the arm is the primary drainage system of the extremity
B. patients with May Thurner syndrome have an increased risk of developing upper extremity thrombosis
C. the veins of the upper extremity have nearly twice the number of valves compared to the lower extremity
D. effort thrombosis refers to clot in the veins of the hand caused by repetitive wrist motion
A
The superficial venous system of the arm is the primary drainage system of the extremity. The deep system is the primary drainage system in the legs. The veins of the upper extremity have far fewer valves than the lower extremity. They do not need as many because the arm is closer to the heart and experiences lower hydrostatic pressures. May Thurner syndrome affects the left common iliac vein. Effort thrombosis refers to thrombus formation at the shoulder caused by repetitive shoulder movement that compresses the vein in the thoracic outlet.
106
```
The highest velocity in the normal common carotid artery is usually identified:
A. mid CCA
B. in the first 3cm of the vessel
C. <1cm from the bulb
D. <3cm from the bulb
```
B
The highest ICA velocity is usually identified in the first 3cm of the vessel. The highest CCA velocity is also usually identified in the proximal artery.
107
```
Which of the following veins does not normally contain any functioning valves?
A. common femoral vein
B. deep femoral vein
C. small saphenous vein
D. inferior vena cava
```
D
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.
It is important to note that the Eustachian valve may be identified in the IVC at the junction with the right atrium. It is a remnant of fetal circulation and does not function as a valve in an adult.
108
```
Which artery courses anteriorly along the calf and laterally through the interosseous membrane of the leg?
A. anterior tibial artery
B. peroneal artery
C. posterior tibial artery
D. distal superficial femoral artery
```
A
The interosseous membrane connects the medial tibia and anterior fibula and separates the muscles of the calf. The ATA and ATV course just anterior to the membrane.
109
```
Where is the eustachian valve found?
A. antecubital fossa
B. popliteal fossa
C. near the junction of the IVC with the right atrium
D. thoracic outlet
```
C
A Eustachian valve is a single flap of tissue at the junction of the IVC with the right atrium that is necessary for fetal circulation. The Eustachian valve may persist in some adults, but it has no effect on circulation. It is not a TRUE venous valve in an adult and the IVC is described as having no valves.
110
```
Normal brachial pressures should not differ more than _______mmHg between arms.
A. 30
B. 20
C. 5
D. 10
```
B
| If the brachial pressures differ by more than 20mmHg, a subclavian steal should be suspected.
111
Which of the following veins receives blood from the superficial and deep venous systems?
A. popliteal vein and inferior vena cava
B. brachial vein and small saphenous vein
C. femoral vein and great saphenous vein
D. subclavian and popliteal vein
D
The subclavian vein receives blood from the cephalic vein and the axillary vein. The popliteal vein receives blood from the lesser saphenous and deep calf veins.
112
```
The popliteal artery ______ the popliteal vein.
A. is larger than
B. is more tortuous than
C. courses posterior to
D. courses anterior to
```
D
| The popliteal artery courses anterior to the popliteal vein.
113
```
Which of the following veins is located deep to the muscular fascia in the proximal arm and superficial to the fascia in the forearm?
A. cephalic
B. basilic
C. brachial
D. median cubital
```
B
| The basilic vein penetrates the muscular fascia just above the elbow and courses cephalad to join the axillary vein.
114
```
Which of the following Doppler imaging characteristics should not be used when trying to identify a vessel on a TCD exam?
A. sample size
B. direction of flow
C. sample location/depth
D. velocity of flow
```
A
TCD exams rely on range resolution to determine the vessels interrogated on the exam. The depth of the sample, flow velocity and direction of the flow detected are used to determine the vessel being interrogated by PW Doppler. The sample size will only affect the amount of flow sampled and is not useful for determining the vessel being evaluated.
115
Which of the following describes a normal response to the Valsalva maneuver?
A. flow in the subclavian vein will be augmented toward the heart with slight reversal upon release
B. flow in the femoral vein will stop at onset of the maneuver
C. flow in the iliac vein will reverse for at least 1 second before normalizing
D. the femoral vein will demonstrate cardiac pulsatilty
B
The Valsalva maneuver will significantly decrease or stop flow toward the heart in the deep veins. Upon release of the maneuver, flow will be briefly augmented toward the heart and then normalize.
116
```
Which of the following is not a branch of the subclavian artery?
A. thyrocervical trunk
B. posterior auricular artery
C. internal thoracic artery
D. costocervical trunk
```
B
Branches from the subclavian artery: vertebral artery, internal mammary artery (AKA internal thoracic artery), Thyrocervical trunk, Costocervical trunk
117
```
What is the name of the tiny network of vessels that supply/drain blood to/from the vessel wall?
A. venules
B. arterioles
C. capillaries
D. vasa vasorum
```
D
The tiny network of vessels that supply/drain blood to/from the vessel wall is called the vasa vasorum. The tiny vessels wrap around the larger vessel within the tunica externa. The arteries and veins penetrate the tunica media to deliver and drain blood from the wall.
118
Which of the following is a limitation of a CW Doppler evaluation of the lower extremity veins?
A. Difficult to differentiate deep veins from superficial veins and superficial veins from perforators due to lack of range resolution
B. cannot evaluate duplicated systems
C. cannot be certain which vein you are evaluating
D. all of the above
D
119
```
In most patients, the first branch of the ECA is:
A. the superficial temporal artery
B. the internal thoracic artery
C. the superior thyroidal artery
D. the ophthalmic artery
```
C
In most patients, the first branch of the ECA is the superior thyroidal artery. The internal thoracic artery is a branch of the subclavian artery. The superficial temporal artery is a branch of the ECA but more distally. The ophthalmic artery is a branch of the ICA.
120
```
The dorsalis pedis artery is a branch of the:
A. posterior tibial artery
B. anterior tibial artery
C. popliteal artery
D. peroneal artery
```
B
| The dorsalis pedis artery is a branch of the ATA.
121
Using the transtemporal window, the normal MCA _________.
A. will demonstrate flow away from the probe
B. will not be evaluated using this transcranial window
C. will demonstrate flow toward the probe
C
| Using the transtemporal window, the normal MCA will demonstrate flow toward the probe.
122
What venous valves are closed in the lower extremity during calf muscle relaxation?
A. all of the valves in the deep and superficial system
B. all of the valves in the deep system
C. proximal thigh veins
D. calf veins
C
During muscle contraction, the large blood volume residing in the deep calf veins and soleal sinuses is squeezed up and out of the calf. The proximal valves of the deep veins are forced open. The distal valves close to prevent caudal flow. The perforator valves close to prevent flow into the superficial venous system. During calf muscle relaxation, the proximal valves close due to the hydrostatic pressure forcing blood back the veins to the level of the valve. During relaxation, the distal and perforator valves open, and blood flows into the calf deep veins.
123
```
Which normal variant of the ICA anatomy is most commonly associated with symptomatic cerebral ischemia?
A. coiling
B. kinking
C. tortuosity
D. bifurcating
```
B
Normal variants in the ICA anatomy:
Tortuosity - S-shaped curve
Kinking - takes a sharp turn, most commonly associated with symptomatic cerebral ischemia
Coiling - vessel forms a circle during its course
124
```
The innominate veins lie _______ to the innominate artery.
A. posterior and medial
B. posterior and lateral
C. anterior and lateral
D. inferior and posterior
```
C
| the innominate veins lie anterior and lateral to the innominate artery.
125
What two vessels are palpated to assess the pulse when peripheral arterial disease is suspected?
A. posterior tibial and dorsalis pedis arteries
B. posterior tibial and peroneal arteries
C. dorsalis pedis and peroneal arteries
D. anterior tibial and peroneal arteries
A
If peripheral arterial disease is suspected, the physician will palpate the PTA and DPA to assess the strength of the pulse. The PTA is palpated between the posterior border of the medial malleolus and the Achilles tendon. The DPA is palpated at the dorsal most prominence of the navicular bone. The peroneal artery is not usually able to be palpated due to its anatomic course.
126
```
Diastolic flow reversal is normal in which of the following vessels?
A. renal arteries
B. celiac artery
C. internal carotid artery
D. common iliac artery
```
D
The lower extremities are normally a high resistance vascular bed. This leads to diastolic flow reversal and a triphasic or biphasic waveform. Any low resistance vessel with a monophasic waveform has no flow reversal during diastole.
127
```
While performing a lower extremity venous exam, you identify a small pair of veins with an accompanying artery deep in the calf muscle, that connect to the popliteal vein. What veins are these?
A. posterior arch veins
B. veins of Giamcomini
C. sural veins
D. anterior tibial veins
```
C
Sural veins are also called the gastrocnemius veins. They are located deep in the calf muscle and course alongside their accompanying artery. The sural veins empty their blood into the popliteal vein.
128
The inguinal ligament:
A. connects the greater turberosity to the superior edge of the iliac crest
B. connects the ischial tuberosity to the anterior pubic bone
C. connects the greater and lesser tuberosities of the femur
D. connects the superior edge of the iliac crest with the anterior pubic bone
D
| The inguinal ligament connects the superior edge of the iliac crest to the anterior pubic bone.
129
```
A pulsaltility index of > 5.0 in the extremities indicates:
A. normal resistance
B. mildly decreased resistance
C.moderately decreased resistance
D. severely decreased resistance
```
A
The pulsatility index describes the resistance of the blood flow. The higher the PI, the greater the resistance. Normal PI in the extremities is > 5.0 and in most organs normal valves are <1.5.
130
```
The term for the most common anatomic variant of the aortic arch anatomy is the:
A. bovine arch
B. talbot arch
C. bifurcating arch
D. simpson arch
```
A
A bovine arch indicates that there are two branches originating from the aortic arch, instead of 3. The innominate artery and left CCA origin are combined and the left subclavian artery is the second branch. Although "bovine" indicates a cow, this arch formation is NOT related to the arch formation in cattle.
