Ch. 17, 30,31 Flashcards
(154 cards)
1
Q
Two pulmonary veins enter posteriorly in which one of the following?
A. Right ventricle
B. Left atrium
C. Left ventricle
D. Right atrium
A
Left atrium
2
Q
The inferior vena cava is guarded by a fold of tissue called the _____ valve, whereas the coronary sinus is guarded by the _____ valve
A. thebesian; eustachian
B. eustachian; coronary
C. eustachian; thebesian
D. eustachian; atrial
A
eustachian; thebesian
3
Q
Atrial contraction follows the _________ on an electrocardiogram (ECG).
A. S wave
B. P wave
C. T wave
D. QRS complex
A
P wave
4
Q
Which of the following has a slight bulge seen at the aortic valve cusps?
A. Sinus of Valsalva
B. Recess of the oblique sinus
C. Crista supraventricularis
D. Coronary sinus
A
Sinus of Valsalva
5
Q
Most coronary venous drainage is into the ________________.
A. thespian veins
B. coronary sinus
C. coronary veins
D. atrial sinus
A
Coronary sinus
6
Q
The base of the heart is formed by the ______________.
A. Right ventricle
B. Left atrium
C. Left ventricle
D. Right atrium
A
left atrium
7
Q
The mitral valve separates which of the following sets of structures?
A. Right and left ventricles
B. Left atrium and left ventricle
C. Right and left atria
D. Right atrium and right ventricle
A
Left atrium and left ventricle
8
Q
The greatest muscle mass in the heart is found in which one of the following structures?
A. Right atrium
B. Right ventricle
C. Left ventricle
D. Left atrium
A
Left ventricle
9
Q
The forceful contraction of the cardiac chambers is ___________, and the relaxed phase of the cycle is ___________.
A. diastole; systole
B. systole; diastole
C. systole; dicrotic
D. up slope; down slope
A
Systole, diastole
10
Q
The _____________ is the pleural reflection between the costal and diaphragmatic portions of the parietal pleura.
A. costophrenic sinus
B. costal pleura
C. mediastinal pleura
D. diaphragmatic pleura
A
costophrenic sinus
11
Q
Which one of the following structures initiates the normal cardiac impulse?
A. Bundle of His
B. Sinoatrial node
C. Purkinje fibers
D. Atrioventricular node
A
Sinoatrial node
12
Q
Defects in the valves may cause turbulence or regurgitation on auscultation, which is called _____________.
A. insufficiency
B. arrhythmia
C. stenosis
D. murmur
A
murmur
13
Q
The apex of the heart is formed by the _____________.
A. left ventricle
B. right ventricle
C. left atrium
D. right atrium
A
left ventricle
14
Q
Which valve prevents retrograde flow between the aorta and left ventricle?
A. Tricuspid
B. Mitral
C. Semilunar
D. Atrioventricular
A
Semilunar
15
Q
The tricuspid valve opens when the:
A. pulmonic valve opens.
B. papillary muscle contracts.
C. right ventricle pressure drops below the right atrial pressure.
D. velocity of blood flow in the right ventricle exceeds the velocity of flow in the right atrium.
A
right ventricle pressure drops below the right atrial pressure.
16
Q
The pericardial sac protects the heart from:
A. hernia invasion.
B. tumor.
C. diaphragmatic motion.
D. friction.
A
D. Friction
17
Q
The roof of the right ventricle is occupied by the _______________, which lies between the tricuspid and pulmonary orifices.
A. crista supraventricularis
B. fossa ovalis
C. coronary sinus orifice
D. right atrial appendage
A
A. crista supraventricularis
18
Q
The superior vena cava (SVC) enters the right atrium __________.
A. medially
B. anteriorly
C. posteriorly Incorrect
D. ventrally
A
A. Medially
19
Q
The outflow tract of the right ventricle is also called the _______________.
A. infundibulum
B. conus arteriosus
C. right atrial appendage
D. crista terminalis
A
A. infundibulum
20
Q
The wall of the aorta bulges slightly at each semilunar cusp to form which one of the following?
A.Sinus of Valsalva
B. Coronary arteries
C. Chordae tendinae
D. Arantius nodule
A
A.Sinus of Valsalva
21
Q
The right border of the heart is formed by the ______________.
A. right ventricle
B. superior vena cava
C. pulmonary trunk
D. right atrium
A
D. Right atrium
22
Q
Approximately how many beats per minute is the normal adult heart rate?
A. 50
B. 90
C. 100
D. 70
A
D. 70
23
Q
The most posterior chamber to the left of the sternum is the ___________.
A. left atrium
B. right ventricle
C. left ventricle
D. right atrium
A
A. Left atrium
24
Q
Select the structure that the medial wall of the right atrium contains.
A. Interventricular septum
B. Right upper pulmonary vein
C. Interatrial septum
D. Right lower pulmonary vein
A
C. Interateial septum
25
What is the first major branch arising from the abdominal aorta?
Celiac Artery
26
What is the most common indication of mesenteric artery duplex evaluation?
Chronic Mesenteric ischemia
27
How many arteries are typically involved in atherosclerotic occlusive disease before a patient becomes symptomatic?
2
28
When does the abdominal pain many patients feel, which is associated with chronic mesenteric ischemia, typically occur?
After eating
29
Because of the abdominal pain, which of the following do patients often experience?
a. overeating and weight gain
b. fear of exercise
c. nausea and vomiting
d. fear of food and weight loss
Fear of food (sitophobia) and weight loss
30
Which of the following is a collateral system that is present in the mesenteric vascular system?
A. Pancreaticoduodenal arcade
B. Arc of Roland
C.Internal Iliac to inferior mesenteric artery connections
D. All of the Above
D. All of the above
31
From which vessel does a replaced right hepatic artery originate most often?
a. celiac artery
b. SMA
c. Right renal artery
d. IMA
Superior Mesenteric Artery
32
With a patient in a fasting state, what should the superior mesenteric artery exhibit?
a. High-resistance flow pattern
b. low-resistance flow pattern
c. mixed high and low resistance flow pattern
d. respiratory phasic flow pattern
High-resistance flow pattern
33
What vessels make the seagull sign?
Celiac, hepatic and splenic arteries
34
What type of flow obtained from the celiac, splenic and hepatic arteries is demonstrated on Doppler?
Low-resistance flow
35
During a mesenteric artery evaluation, retrograde flow is noted in the common hepatic artery. What does this finding suggest?
a. common hepatic artery stenosis
b. celiac artery occlusion
c. superior mesenteric artery stenosis
d. replaced right hepatic artery
Celiac artery occlusion
36
What is the transient compression of the celiac artery origin during exhalation, which is relieved by inhalation?
Median accurate ligament compression syndrome
37
Visceral artery aneurysms (rare) usually occur in which vessel?
Splenic artery
38
The celiac artery is best visualized with the transducer oriented in a _______________ plane, where as the superior mesenteric artery is best visualized with the transducer oriented in a _________________ plane
Transverse
Sagittal
39
Postprandial abdominal pain that occurs when there is insufficient visceral blood flow to support the increased oxygen demand required by intestinal motility, secretion and absorption is often termed
Chronic Mesenteric Ischemia
40
The inferior mesenteric artery arises from the aorta just proximal to the ___________ _____________
Aortic Bifurcation
41
The superior mesenteric artery changes dramatically from ____________ resistance flow to ______________ resistance flow after eating
High, Low
42
When performing a spectral Doppler and high velocities are noted in a mesenteric artery, it is important to document ___________ ___________ to confirm a flow-limiting stenosis
Post-stenosis turbulence
43
What technique can be used to decrease movement of the mesenteric vessels and help capture Doppler waveforms with a correct angle?
Have the patient suspend breathing
44
If the celiac artery is occluded, the common hepatic artery almost always demonstrates ______________ flow
Retrograde
45
Increased velocities in the absence of stenosis could be the result of _____________ flow
Compensatory
46
An advantage or using duplex ultrasound to evaluate median arcuate ligament compression syndrome is that Doppler waveforms can be obtained during changes in _________________
Respiration
47
Splenic artery aneurysm, when discovered during pregnancy, is associated with a 95% ____________ rate, leading to high maternal and fetal mortality
Rupture
48
Visceral artery dissections are most common in the _____________ and often extensions of aortic dissection
SMA
49
In patients with suspected MALS, if the velocities fail to normalize with inspiration, the patient can be put in a _____________ position
Standing
50
Embolus to or thrombosis of the mesenteric arteries can lead to _________ _________ __________
Acute mesenteric ischemia
51
Symptoms of Acute mesenteric ischemia are typically described as pain ______ ____ ___________ to physical findings
Out of proportion
52
The findings below describe which disease
* 2-3 of the mesenteric vessels may be affected
* Abdominal pain and cramping after eating
* presence of abdominal bruitt
* weight loss secondary to sitophobia & Diarrhea
Chronic Mesenteric Ischemia
53
What is the purpose of using a "test meal" when evaluating the mesenteric vessels?l
Because after eating the SMA changes dramatically from triphasic high resistance flow to low resistance flow. Post prandial US can increase specificity
54
Relating to additional blood vessels that aid or add to circulation
Collateral flow
55
Relating to or affecting the viscera
Splanchnic
56
Relating to internal organs or blood vessels in the abdominal cavity
Visceral
57
Term for "after a meal"
Postprandial
58
Lack of blood flow to the viscera is
Mesenteric ischemia
59
According to one study, when end diastolic velocities are used as thresholds for >50% stenosis the corresponding velocities are ___________ cm/s in the celiac artery and ________ cm/s in the SMA
55; 45
60
According to one study, a PSV in the celiac artery of >200 cm/s and a PSV in the SMA of > 275 cm/s corresponded to a stenosis of _____________%
>70 %
61
Recent studies suggest velocity guidelines for IMA stenosis, with a PSV of _________________ corresponding to a >50% stenosis
>200-250
62
When evaluating the SMA, Doppler waveforms should be obtained from _________, _________ and _________ segments
Proximal, mid and distal
63
To examine the Inferior mesenteric artery, the aortic bifurcation should be located and then scan _________ ____ to ____ cm
Proximal 1 to 3 cm
64
True or False
The IMA typically does not change after eating
True
65
Flow direction is important when the ________ _________ is occluded or severely stenosis. Retrograde flow in common hepatic artery
Celiac artery
66
When evaluating the mesenteric vessels, ___________ can hide important features such as intimate flap in dissections, stents, atherosclerotic plaque, wall abnormalities. Therefore, ____________ imaging is preferred
Color; B-mode
67
True stenosis usually demonstrates what two things?
* increased flow
* poststenotic turbulence/spectral broadening
68
___________ _____________ has little spectral broadening and no stenotic profile
Compensatory flow
69
___________ ___________ ___________ can result from an embolus to mesenteric arteries and/or thrombosis of an artery with existing chronic disease
Acute mesenteric ischemia
70
____________ ___________ is a common treatment for mesenteric ischemia
Bypass grafting
71
60% of visceral artery aneurysms occur in the _________ ___________ and women are ________ affected than men.
Splenic artery, more affected
72
Causes pain referred to as "intestinal angina"
Chronic Mesenteric Ischemia
73
Fear of food is called
Sitophobia
74
This vessel usually lies 1-2 cm below the diaphragm
Celiac artery
75
This vessel typically arises from the anterior surface of the aorta 1-2 cm below the celiac
SMA
76
This vessel arises from the distal aorta just proximal to the bifurcation
IMA
77
Replaced right hepatic artery anomaly has a prevalence of _______%
17%
78
Describe the normal celiac Doppler waveform
Sharp systolic upstroke and a low resistance flow pattern with forward flow throughout the cardiac cycle
79
When the celiac artery is occluded or severely stenotic, SMA collaterals divert blood towards the liver and spleen through the ___________
GDA
80
The most common locations for a stenosis in the bypass graft
Proximal and distal anastomoses
81
MALS stands for
Median arcuate ligament compression syndrome
82
Ratio of female to male occurrence of splenic artery aneurysm
3:1
83
The collateral system that bridges the IMA to the SMA
Arc of Roland
84
Color Bruitt in a vessel indicates
Significant stenosis
85
Sonographic (color) appearance of celiac compression syndrome
Increase in color velocity with exhalation
86
Sonographic (color) appearance of stenosis (>50%)
High velocity flow with aliasing
Color bruitt
87
Sonographic (color) appearance of dissection
Color separation with separate flow channels
88
________ of patients with Acute mesenteric ischemia are women around _______ years of age
Two-thirds
70 yrs
89
Downfalls to percutaneous visceral artery intervention
- restenosis
- recurrent symptoms
- requirement for re-do intervention
90
The uterine arteries in a non-gravid uterus typically demonstrate which of the following flow characteristic with Doppler interrogation?
A) low resistance throughout the menstrual cycle
B) increasing resistance with age
C) no change in velocity or resistance at any menstrual phase
D) low velocity flow
B) increasing resistance with age
91
Doppler analysis of blood flow to the ovaries in the periovulatory and luteal phases commonly demonstrates?
A) a high resistive index value
B) low resistance in the ovary with the dominant follicle
C) minimal arterial and venous flow to both ovaries
B) low resistance in the ovary with the dominant follicle
92
In women of menstruating age, arterial Doppler waveforms of a potential ovarian malignancy may not be reliable. At what ovarian phase should assessment be done?
A) late luteal
B) early follicular
C) ovulatory
D) early luteal
B) early follicular
93
Metabolically active tissue, such as an ovarian malignancy, has all of the following Doppler characteristics except?
A) color Doppler flow evident in the solid components of the mass
B) low resistance and high velocity
C) obvious flow throughout the cardiac cycle
D) low velocity and high resistance
D) low velocity and high resistance
94
Typical Doppler waveforms of an ovarian malignancy exhibit which of the the following?
A) minimal flow throughout the cardiac cycle
B) low resistance, high velocity
C) peripheral flow only
D) low velocity, high resistance
B) low resistance, high velocity
95
Umbilical artery resistance is evaluated during gestation for what purpose?
A) to predict erythroblastosis fetalis
B) to determine possible placental insuffiency
C) to determine if the fetus is at risk for asphyxia
D) to predict preterm labor
B) to determine possible placental insuffiency
96
Describe the spectral Doppler patterns associated with the uterus and ovaries.
The UTERINE ARTERIES exhibit moderate to high velocity/high resistance flow. The uterine and radial arteries exhibits flow which is higher resistance in the proliferative phase than in secretory.
Flow in the OVARY during the follicular phase is often low velocity and high resistance. Following ovulation, the impedance drops dramatically on the side with the dominant follicle, resulting in low resistance flow. The ovaries display high resistance flow in postmenopausal women.
97
Which of the following best describes the normal ovarian Doppler flow during the secretory phase of the menstrual cycle?
A) varies with respiration
B) low-resistance flow pattern
C) decreased
D) high-resistance flow pattern
B) low-resistance flow pattern
98
The Doppler analysis of malignant ovarian masses often reveal:
A) increased vascularity
B) decreased vascularity
C) lower diastolic flow
D) higher diastolic flow
D) higher diastolic flow
99
During the menstrual and proliferative phases of the menstrual cycle, normal ovarian flow is said to be:
A) high-resistant
B) phasic
C) diminished
D) low-resistant
A) high resistant
(Typical ovarian flow is said to be high-resistant during the menstrual and proliferative phases and low-resistant at mid cycle)
100
In the third trimester, symmetric intrauterine growth restriction (IUGR) may be associated with which if the following Doppler findings?
A) low-resistance umbilical artery
B) low-resistance renal artery
C) low-resistance middle cerebral artery
D) low-resistance ductus venosus
C) low-resistance middle cerebral artery
101
Doppler waveforms obtained from an artery supplying an intracranial arteriovenous malformation will exhibit:
A) absent diastolic flow
B) low diastolic velocity
C) a low pulsatility index
D) triphasic flow
E) decreased velocities
C) a low pulsatility index
102
Doppler waveforms of the uterine arterial flow typically show:
A) high-velocity, high-resistance pattern
B) high-velocity, low-resistance pattern
C) low-velocity, high-resistance pattern
D) low-velocity; low-resistance pattern
E) reverse-flow pattern
A) high-velocity, high-resistance pattern
103
Doppler waveforms of arterial flow in the dominant ovary in a premenopausal woman typically show:
A) low-velocity, low-resistance pattern
B) high-velocity, high-resistance pattern
C) high-velocity, low-resistance pattern
D) reverse-flow pattern
E) low-velocity, high resistance pattern
A) low-velocity, low-resistance pattern
104
All of these Doppler ultrasound findings in the uterine arteries are associated with a growth-restricted pregnancy except:
A) reversal of end-diastolic flow
B) increase of end-diastolic flow on serial surveillance
C) decrease of end-diastolic flow on serial surveillance
D) no end-diastolic flow
E) C and D
B) increase of end-diastolic flow on serial surveillance
105
On color Doppler sonography, most malignant ovarian tumors yield flow signals that are best characterized as:
A) variable
B) low-impedance
C) high-impedance
D) lacking flow
E) avascular
B) low-impedance
106
The spectral Doppler measurement that provides the best indicator of diastolic runoff into a distal vascular bed is the:
A) S/D ratio
B) pulsatility index
C) resistivity index
D) end-diastolic velocity
E) thermal index
B) pulsatility index
107
The diastolic notch is best describe as:
A) flow reversal in early diastole
B) late diastolic flow reduction
C) early diastolic reduction
D) flow reversal in late diastole
E) none of the above
C) early diastolic reduction
108
In the umbilical artery absent diastolic flow in the umbilical artery is?
Not good.
109
In the umbilical artery if there is reversed diastolic flow it indicates?
Really bad, sign of impending demise.
110
The uterine artery in the second and third trimesters is _____ resistance.
Low resistance.
111
In the uterine artery appearance of a "notch" in Doppler waveforms is _____, and thought to predict what 2 things?
Abnormal.
Placental insufficiency and IUGR.
112
The ductus venosus has which kind of waveform?
Triphasic forward flow.
113
If the the ductus venosus has an abnormal waveform (flow below baseline) is associated with?
Chromosome abnormalities and IUGR.
114
Middle cerebral artery (MCA) Doppler can help determine the likelihood of?
Fetal anemia.
115
The volume of blood ejected from each ventricle during a contraction is called the
stroke volume
115
Ultrasound results should be compared to a:
gold standard test
116
Gold standard tests:
Digital subtraction angiography
CTA (computerized tomography angiography with contrast)
MRA (magnetic resonance angiography)
Surgical findings
Clinical outcome
117
Gold Standard for Venous Imaging Comparison:
Venography (seldom performed)
Repeat exam within 3 days
Repeat exam by another sonographer- do results concur?
Exam interpreted by a second physician.
Compare to clinical outcome (was there a PE?)
118
For carotid QA, coordinate the reporting method with the
interpreter of the gold standard.
119
if you report 70-99 % ICA stenosis, and the radiologists reports "moderate to severe disease", results:
cannot be compared in a meaningful fashion
120
Make sure your carotid criteria is based on the same method used to:
measure arteriogram , CTA, or MRA, e.g., Bulb or NASCET methods.
121
the ability of a test to find disease when it's present
sensitivity
122
The ability of a test to show there is no disease when there is no disease present
specificity
123
The portion of individuals with a POSITIVE test result that actually have the condition.
Positive Predictive Value (PPV)
124
The portion of individuals with a NEGATIVE test result that actually do NOT have the condition.
Negative Predictive Value (NPV)
125
When TP, TN, TN and TP are considered, then:
overall accuracy can be calculated.
126
TP:
truly positive
127
FP:
falsely positive
128
TN:
truly negative
129
FN:
falsely negative
130
The proportion of all individuals whose tests results agree with their condition. The percentage of time the Ultrasound exam was correct.
Accuracy
131
Used to calculate statistics:
2 x 2 square
132
What is the 2x2 square sometimes called?
Chi Square
133
If there are 91 positive venograms, 85 positive ultrasounds, and 82 of those ultrasounds agreed with the venograms, how many are true positives and false positives?
82 true positives, and 3 false positives
134
If there are 53 negative venograms, and ultrasound indicated 59 negatives, venography found 50 legs to be normal and 9 positive for DVT...how many true negatives and how many false negatives?
50 true negatives, and 9 false negatives
135
Once the 2 x 2 square is filled in, it's easy to calculate the following stats:
Sensitivity
Specificity
Positive Predictive Value (PPV)
Negative Predictive Value (NPV)
Accuracy
Prevalence
136
Equation for sensitivity:
TP / [TP + FN ] x 100%
137
Equation for specificity:
TN/[FP + TN] x 100%
138
Equation for Positive Predictive Value:
PPV= TP/[TP + FP] x 100%
139
Equation for Negative Predictive Value:
NPV= TN/ [FN + TN]
140
Combine sensitivity and specificity
accuracy
141
Equation for accuracy:
[TP + TN]/ [TP + FN + FP+ TN]
142
the proportion of individuals in the study that have the disease
Prevalence
143
If prevalence is low, it's best to have a test with
high sensitivity
144
Prevalence data is important because:
if the study population is loaded with disease versus no disease statistics can be skewered.
145
Equation for Prevalance
[TP+ FN]/ [TP + FN + FP + TN]
146
For the RVT exam, beware that Headings might be:
switched
147
Both sensitivity and specificity deal with test
"ability"
148
Predictive values deal with:
how "good" is a test result
149
The portion of individuals with a POSITIVE test result that actually have the condition.
Positive Predictive value (PPV)
150
When the test result is NEGATIVE, how many times is it truly NEGATIVE
Negative Predictive Value (NPV)
151
The proportion of all individuals whose tests results agree with their condition
Accuracy
152
How would you explain the difference between laminar and parabolic flow?
Laminar flow all has the same velocity, while parabolic flow has slow flow at the outer areas
153
If a study produced no false positive results it would have 100% ____.
A. Accuracy
B. Sensitivity
C. Specifity
D. Negative predicitve value
C. Specifity
