Combination Flashcards

Question

26. The first branch proximal to the tibioperoneal trunk is: A. the tibial artery B. the peroneal artery C. the tibioperneal artery D. non of the above

Answer 1

D. non of the above The first branch proximal tot the tibioperoneal trunk is the anterior tibial artery

Answer 2

C. the arterioles

Answer 3

D. A and B - The normal communicating system does not allow blood to flow from the deep system to the superficial system.

Answer 4

D. non of the above

Answer 5

C. it increases in amplitude

Answer 6

B. decreasing the heart rate during times of relaxation

Answer 7

C. the basilar artery will supply flow to the brain When a single vertebral artery is occluded, the unobstructed vertebral artery provides sufficient collateral flow to supply the basilar artery. When both are occluded, the posterior communicating arteries of the Circle of Willis supply collateral flow via the internal carotid arteries

Answer 8

A. 15% the brain recieves 15% of total cardiac output

Answer 9

E. B and C The statement makes sense when you consider that hydrostatic pressure is greater at the ankle than at thigh level

Answer 10

E. A, b and C

Answer 11

B. decreases

Answer 12

D. non of the above the internal iliac artery (hypogastric artery)bifurcates into tow separate divisions, the anterior and posterior divisions. The anterior division includes the umbilical, obturator, INTERNAL PUDENDAL, middle rectal and inferior gluteal arteries. The external iliac artery continues distally to become the common femoral artery, but not before it gives off tow dorsal branches; the inferior epigastric and the deep iliac circumflex arteries. This leads tot the femoral arterial system.

Answer 13

D. A and B Buerger's disease is uncommon and is associated with cigarette smoking

Answer 14

D. 200,000

Answer 15

B. the roportion of people with a positive test who actually have the disease. PPV is a measure of how likely it is that disease is actually present when the test result is positive. in other words, it is the proportion of people with a positive test who actually have the disease.

Answer 16

The ability of a test to find disease when disease is present A / A+C

Answer 17

the ability of a test to indicate no disease when there is not disease present (i.e to exclude disease when a patient is normal) D / (D + B)

Answer 18

A. 4 - 120 mmHg Remember that the vascular system includes both the arterial and venus systems with their widely varying pressures

Answer 19

D. none of the above The cephalic vein is a superficial vein in the upper extremity. Distally, the cephalic vein joins the basilic vein at the the elbow via the median cubital vein. Proximally, the cephalic vein is the last vein to join the axillary vein before it becomes the subclavian vein.

Answer 20

D. non of the above The supraclinoid portion of the ICA gives rise to the anterior Cerebral artery. The ECA has NO supraclinoid portion!

Answer 21

C. the middle sacral artery Although the final VISCERAL branch of the aorta before the bifurcation is the inferior mesenteric artery, the FINAL branch is the middle sacral artery.

Answer 22

A. because there is a pressure gradient between the arterial and venous sides of the circulation

Answer 23

C. hypertension Although high cholesterol, cigarette smoking and atherosclerosis are certainly predisposing factors, the greatest contributor to stroke in the USA is hypertension.

Answer 24

D. A and B Although the ECA is usually the smaller and more medial of the CCA branches, this is not always the case, and in order to definitely identify the ECA, you should look for a vessel with branches. Remember, the ICA has no extracranial branches.

Answer 25

D. A and B A - includes the frontal, nasal and supraorbital arteries B - may provide flow around an obstructed internal Carotid artery The MOST important source of collateral flow to the brain is the Circle of Willis

Answer 26

False, Perforators, which are most prominent in the lower leg (calf) also contain valves which direct blood from the SUPERFICIAL TO THE DEEP venous system

Answer 27

TRUE, Because it is not possible for the capillary network to transmit 70 cc's of blood with each heartbeat, the elastic walls of the conducting arteries serve to store this excess volume of blood by STRETCHING DURING SYSTOLE AND RELAXING DURING DIASTOLE

Answer 28

False, The plantar arch of the foot is formed by the deep plantar branch of the dorsalis pedis arter and the lateral plantar branch of the posterior tibial artery ( not the peroneal artery)

Answer 29

TRUE, | In other words, it is the proportion of people with a positive test who actually have the disease

Answer 30

FALSE, | Up to 22% of the population have a common origin of the BRACHIOCEPHALIC AND LEFT CCA ARTERIES NOT BOTH CCA

Answer 31

TRUE, | This is the best way to differentiate the tow vessels. The ICA has NO extracranial branches

Answer 32

False This statement is true only for the deep system BELOW THE KNEE. Above the knee, there is only one vein for each aratery supplying the leg.

Answer 33

TRUE Atherosclerosis is the most common cause of chorionic arterial occlusive disease in the Western World. this disease is also known as arteriosclerosis OBliterans (ASO)

Answer 34

FALSE Valves are found in grater abundance in the LOWER extremities where there is a greater possibility of reflux ( becuase of the greater hydrostatic pressure)

Answer 35

TRUE Compression of the subclavian artery between the first rib and the scalene muscle may result in the thoracic outlet syndrome

Answer 36

FALSE | Approximately 50% of our patients have a complete circle of Willis ( meaning the other fifty percent don't

Answer 37

TRUE | The right renal arataery runs posterior to the IVC, and is the only vessel to do so!

Answer 38

FALSE The human brain receives 15 % of total cardiac output and consumes 20% of the body's oxygen supply, but the renal arteries receive approximately 25% of the total cardiac output to be processed by the kidneys.

Answer 39

TRUE Blood vessels themselves need a source of nutrients as well as a conduit for their own waste products. This function is fulfilled by tiny vessels in the tunica adventitia of both the arteries and veins called the VASA VASORUM which literally means " vessels of vessels"

Answer 40

FALSE The temporary flow reversal during diastole occurs because of a negative pressure gradient caused by peripheral resistance to forward flow

Answer 41

TRUE The Aorta acts as a "subsidiary pump". The aorta and other elastic arteries near the hear serve to store energy by "stretching" with each systole, acting as a RESERVOIR, storing much of the blood expelled by the heart. During diastole, the energy stored in the arterial walls dissipates the large volume of blood stored in the aorta by forcing blood forward in the arteries, causing the aorta to return to normal caliber

Answer 42

FALSE Thromboangitis obliterans or Buerger's disease accounts for approximately 1% of all diseases involving the large and medium size arteries. It occurs in YOUNG MALES and is related to cigarette smoking

Answer 43

FALSE | The first branch of the ECA is the SUPERIOR THYROID ARTERY.

Answer 44

FALSE The majority of pulmonary emboli (more than 90%) are thought to arise form THE DEEP VEINS ( not superficial) of the lower extremities, many following abdominal or orthopedic surgery.

Answer 45

FASLE This is the second most popular theory. Most researchers feel that plaque develops as a response to injury of the endothelial lining of the arteries. This "injury" is caused by the turbulence that occurs at any vessel bifurcation

Answer 46

FALSE The celiac artery(or trunk or axis) is the FIRST MAIN VISCERAL BRANCH OF THE AO. It arises from the anterior surface of the aorta at the L1 level and courses ventrally only a few centimeters before it bifurcates into the splenic, left gastric and common hepatic arteries

Answer 47

FALSE As a cardiac pressure wave propagates through the arterial system, the systolic portion of the pressure wave actually INCREASES due to the increasing stiffness of the vessel walls towards the periphery

Answer 48

E. atherosclerosis of the lower extremity arterial system. Claudication is a Symptom, NOT a diagnosis

Answer 49

D. digital artery occlusion

Answer 50

B. white, blue, red The finger turns white or pale immediately following the episode of vasospasm, soon to become blue (cyanotic) followed by red ( once normal tissue perfusion returns.

Answer 51

D. all of the above left subclavian, right subclavian, brachiocephalic (innominate) ARTERIES

Answer 52

C. post prandial SMA flow has a low resistance pattern Before mesenteric angina shows up, two of the three vessels supplying the bowel must be significantly stenosed. The SMA has little or no diastolic flow prior to eating (i.. while fasting) and in fact demonstrates some diastolic flow reversal. The SMA flow pattern after eating is typical of low resistance vascular beds like the brain and kidney.

Answer 53

B. multiphasic with sounds heard in systole and diastole

Answer 54

C. the examiner feels their own pulse

Answer 55

C. crampy pain in the buttock and thigh with exercise, that is quickly relieved by rest.

Answer 56

C. left popliteal artery entrapment These symptoms are typical of popliteal artery entrapment and you will most likely encounter at least one " young athlete" type question on your exam. Be careful to distinguish popliteal artery entrapment from the anterior tibial compartment syndrome - arterial compression that occurs following trauma

Answer 57

E. all of the above

Answer 58

D. 1.09 remember to divide the highest ankle pressure obtained by the highest arm pressure. In this case, 125 / 115 = 1.086

Answer 59

B. It decreases blood pressure at the ankle level In a normal individual, vigorous exercise should cause NO DROP in ankle pressure and may cause a slight INCREASE in ankle pressure. When significant arterial disease is present, ther will be a definite drop in pressure distal to the stenosis when compared with the pre exercise pressure.

Answer 60

D. A and B

Answer 61

D. the presence of a bruit may be the first indication of arterial disease

Answer 62

E. these symptoms are not typical of vascular disease The patternof pain described by the patient in this question is not typical of vascular disease because of its lack of progression with continued walking. A patient with arterial occlusive disease would have pain necessitating a res ( to perfuse the oxygen starved tissues)

Answer 63

C. not evident using duplex ultrasound The most important indicator of impending refection of the liver in a post transplant patient are liver function tests.

Answer 64

C. Not evident using duplex ultrasound The most important indicator of impending rejection of the liver in a post transplant patient are liver function tests.

Answer 65

C. indicates that further testing should be done Tghe lack of an abnormal pressure at rest does not necessarily rule out arterial disease, the patient requires stress testing in order to obtain more information.

Answer 66

C. Questionable unless the patient has medial calcification The fact that the patient has rest pain would lead you to expect an ABI of t make sense in the context of the clinical findings and should lead you to suspect possible medial calcification at the level of the left ankle.

Answer 67

B. monophasic and low pitched The low pitched, monophasic flow that may be identified in the Scenario is mosts likely due to collateral flow.

Answer 68

20. Common signs of peripheral arterial insufficiently of the legs include witch of the following? A. skin pigmentation B. loss of hair on toes D B and C E. All of the above

Answer 69

D. B and C Skin pigmentation is a sigh of venous stasis and not peripheral arterial disease. Hair loss and dependent rubor are common signs of arterial disease.

Answer 70

B. an absent reverse flow component

Answer 71

B. it may be absent in vasodilated limbs Diastolic flow reversal varies with the degree of resistance of the distal peripheral vascular bed. When the distal arterioles are fully dilated, they provide little resistance to flow.

Answer 72

A. A distinct "thump" sound

Answer 73

E. all of the above

Answer 74

C. The patient has bilateral arterial disease Despite the fact that the patient did not have symptoms of claudication in his left leg, the pre and post-exercise pressure measurements suggest bilateral lower extremity arterial disease. The most likely reason is' the pain the patient's right leg stopped him Befor left sided symptoms became evident

Answer 75

D. none of the above Reactive hyperemia is defines as: an increase in blood in a region following the restoration of the blood supply after a period of temporary arrest. (i.e following the application of a tourniquet, but not following exercise.)

Answer 76

E. A, B and C rest pain in always located in the foot, affecting to dorsum of the foot and toes primarily. In its early stages, patients describe rest pain only at nigh and find the can relive the discomfort by hanging their feet over the edge of the bed(i.e the foot becomes dependent after this maneuver, increasing blood supply somewhat). Walking around the room (mild exercise ) may also provide some relief by increasing the blood supply to the foot ** Rest pain IS ALWAYS an indicator of far - advanced multi segmental arterial disease and is a precursor to limb loss unless medical intervention is undertaken

Answer 77

C. atherosclerotic disease of the upper extremity usually involves the subclavian or axillary arteries Upper extremity arterial disease is relatively uncommon

Answer 78

E. A, B and C

Answer 79

B. False aneurysms occur spontaneously | is a false statement

Answer 80

D. and embolus Single digit ischemia is most likely related to an embolus(Blue toe syndrome). Buerger's disease Or TAO affects the digits of the hands and feet.

Answer 81

A. a normal ankle pressure measurement usually precludes significant arterial occlusive disease of the lower extremities Although a normal ankle pressure at rest usually precludes significant lower extremity arterial disease, always remember to take ankle pressures before and after exercise in patients who complain of intermittent claudication

Answer 82

B. The four cuff technique results in a more accurate estimation of the level of vascular disease.

Answer 83

B. a moderate stenosis CATEGORIES OF STENOSIS MILD 1-19% Normal velocities and waveform contour (i.e triphasic) but spectral broadening is evident Moderate 20 - 49 % Increased PSV (by 30 - 50%) with marked spectral broadening. The reverse flow component may be attenuated, resulting in a biphasic waveform Severe 50-99% Increased PSV (BY >100%) with marked spectral broadening. After 80% stenosis, flow diminishes and the wave forms becomes damped. Revers flow component of the waveform is absent( monophasic ) with rounded upslope TOTAL OCCLUSION - NO flow systolic "thumping"

Answer 84

A. the penile brachial index is less than .65 A normal PBI is 0.75 or greater (potent young males typically have ratios greater than 0.8 and usually equal to arm pressures.) Ratios between 0.65 and 0.74 are marginal and equivocal, and ratios less than 0.65 are consistent with Vasculogenic impotence

Answer 85

A. a reduction in the amplitude of the reverse flow component of the Doppler velocity waveform

Answer 86

D. All of the above

Answer 87

D. none of the above Aneurysms of iliac aries are LESS COMMON than abdominal aortic by a factor of ten;aortic aneurysms by definition are greater than 3 cm. in diameter and angiography only demonstrates the "true lumen" of the aneurysm not the size

Answer 88

B. it may result in digital ulceration

Answer 89

B. moderate claudication

Answer 90

C. monophasic Abnormal doppler sounds are MONOPHASIC with a systolic component but no diastolic sounds identified. This type of signal is obtained distal to a severe stenosis or occlusion, where flow may be originating from collateral sources

Answer 91

A. decreases as more proximal arteries are used for the calculation

Answer 92

B. a mycotic aneurysm

Answer 93

C. A PPG and a SCR set to AC mode Digital pressure measurements are best performed with A PPG and a SCR set to AC mode

Answer 94

C. always proximal to the symptomatic muscle group The diseased segment is always proximal o the site of musculr discomfort. Think About It!

Answer 95

D. The thoracic aorta

Answer 96

D. A and B measuring pressure difference greater thatn 20 mmHg between the patient's arms and identifying retrograde flow in a vertebral artery While the actual site of subclavian artery stenosis is infrequently visualized, one should always measure a pressure difference > 20 mmHg between arms and identify retrograde or oscillatory flow int the vertebral artery.

Answer 97

C. 10- 15 minutes

Answer 98

E. a stenosis of 75%

Answer 99

E. all of the above

Answer 100

False In general, a pressure difference greater than 20 mmHg between arms is a good indicator that a subclavian steal ma be present. Retrograde flow in the vertebral artery nails the diagnosis.

Answer 101

TRUE Patients complaining of rest pain usually have an ABI in the -.25 - 0.30 range and patients with impending gangrene have extremely low ABI's in the 0.05 to 0.08 range. When arterial occlusive disease is this severe, the ankle pressures measured are usually below 40 mmHg.

Answer 102

FALSE This is actually an advantage,

Answer 103

TRUE The pressure measured using the pneumatic cuff technique is at the site of the cuff, not the site of the Doppler device

Answer 104

TRUE Raynaud's Disease is Vasospasm with NO underlying disease, while Raynaud's phebinenon is vasospasm that is SECONDARY to underlying arterial disease

Answer 105

FALSE Then normal penile/brachial i ndex (PBI) is 0.80 or greater (potent young males typically have ratios grater that 0.8 and usually equal to arm pressure). Ratios between 0.06 and 0.75 are euivocal, and ratios less than 0.60 are consistent with vasculogenic impotence.

Answer 106

TRUE Normal patients demonstrate NO SIGNIFICANT PRESSURE DROP with finger cooling to 15 degrees C. Subjects with Raynaud's disease have normal pressures until their digits are cooled to blow 15degrees C. Subjects with Raynaud's phenomenon have pressure drops WITH OR WITHOUT a finger cooling maneuver

Answer 107

FALSE Patients with significant SMA and/or IMA disease (not Ciliac disease) may develop severe, crampy, abdominal pain. Tjois symptoms often referred to as "mesenteric angina" and is the result of partial occlusion of the mesenteric vessels, resulting in a degree of bowel ischemia.

Answer 108

FALSE TAKAYASU'S syndrome i or arteritis is also know as pulseless disease. It is caused by and inflammation of the media of the arterial wall and characterized by a diminishing arterial pulse noted over a period of time

Answer 109

TRUE The normal Doppler spectrum of flow obtained from the protal system is LOW VELOCITY, TOWARD THE LIVER AND PHASIC with RESPIRATION, decreasing with inspiration and increasing w/ expiration

Answer 110

FALSE A normal patient demonstrates NO DROP in ankle pressure following exercise and may show a SLIGHT INCREASE in pressure

Answer 111

TRUE Hypertension secondary to renal artery disease results from the pressure drop which occurs distal tot he stenosis, which initiates a RENIN-ANGIOTESIN RESPONSE, incresing arterial blood pressure.

Answer 112

FALSE A peak graft systolic flow velocity less that 45 cm/sec or a decrease in flow velocity of more than 30 cm/sec when compared to the normal arterial segment is a potential sigh of Graft failure. When this situation is present, the patient requires anticoagulant therapy to prevent thrombus formation with the graft

Answer 113

TRUE Patients controlled by blood pressure medication often suffer an increase in claudication becuase their uncontrolled blood pressure forced MORE blood through the stenosed arterial tree!

Answer 114

FALSE Segmental volume plethysomography is especially useful in patients with calcified or non - compliant arteries, in which segmental pressure measurement is ineffective

Answer 115

TRUE The sound of collateral flow distal to an arterial occlusion should be low pitched and monophasic

Answer 116

FALSE An ABI of 0.7 obtained following segmental pressure measurement is consistent with moderate claudication, usually caused by single level arterial disease.

Answer 117

TRUE In many labs today, a peak flow velocity of 200 c/sec or greater and /or a max. stenotic to pre stenotic velocity ratio of 2:1 is consistent with a significant stenosis >50 % diameter reduction. A peak flow velocity of 400 cm/sec with a ratio of 4:1 is consistent with a severe stenosis >80%

Answer 118

FALSE The symtoms that occur with exercise ad are relieved by rest are consistent with claudication

Answer 119

TRUE The modified Allen test is performed on patients prior to having surgery requiring radial artery canulation or for construction of A.V fistulae for hemodialysis, or prior to harvesting the radial artery for coronary artery bypass. If the palmer arch is not complete, a surgical procedure may result in severe ischemia of the hand

Answer 120

FALSE in addition to the risk of occluding an otherwise functioning graft by pneumatic cuff occlusion, grafts are resistant to compression and would yield falsely elevated pressure measurements

Answer 121

FALSE Students who have completed the vascular physics course will recall being examined

Answer 122

TRUE In normal patients, peak arterial systolic velocity decreases between common femoral and proximal superficial femoral arteries and again across the adductor canal between the distal superficial femoral artery ad popliteal artery

Answer 123

FALSE IF one toe is "blue" the acute arterial occlusion should be considered. However, if all of the patient's toes are blue, a critical decrease in cardiac output may be the cause

Answer 124

E. All of the above Compression of a deep vein causes stasis, trauma may cause vascular wall damage and cancer may result in hyper coagulability

Answer 125

B. a pulmonary embolus may result

Answer 126

E. B and C use of support stockings at work and frequent elevation of the legs above the heart It is not practical to suggest surgical intervention with its related risks as method of avoiding ulceration from chronic venous insufficiency when support stockings and limb elevation may provide the same benefit. Therefore, B and C is the best response

Answer 127

D. acute superficial cellulitis answers A-C may all result in compression of the deep venous system, resulting in an abnormal venous response during venous outflow testing( amongst others), and may suggest the presence of DVT when it does not exist, Similarly, poor patient cooperation in terms of limb positioning etc., may end in a false positive result.

Answer 128

D. Soleal vein The diagnosis of DVT in the subclavian, jugular and posterior tibial veins can usually be made by either direct visualization or by abnormal response as discussed in Doppler examinations of the upper and lower extremity venous systems, The soleal sinuses are difficult to evaluate with /doppler because the Soleal veins are very small in caliber and are located in a portion of the body that is very well perfused (i.e the large muscular beds).

Answer 129

D. all of the above

Answer 130

B the patient has deep venous thrombosis patient has deep venous thrombosis is the only choice that results i an increased pressure in the deep venous system,causing a change in the normal flow patterns. When DVT or some other reason for venous obstruction is present, flow in calf may be from the deep to the superficial system and secondary varicosities may result.

Answer 131

A. a 63 year old female with a history of recent transient ischemic attack A recent history of T.I.A does not increase the likelihood of developing DVT, while the other scenarios do.

Answer 132

D. High resolution ultrasound imaging Since both the IPG and /Doppler studies are normal, /DVT is unlikely. A contrast venogram is very uncomfortable and not without risk. Since the patient is symptomatic, an non - in invasive, high resolution sonogram is the best choice for further investigation in order to confirm or exclude a /Baker's cyst (which is the most likely cause for the patient's symptoms.)

Answer 133

11. A. Varicose veins most often result from valve incompetence

Answer 134

A. Lymphedema usually results in swelling of the foot and lower leg, while edema of the leg is more commonly associated with DVT or chronic venous disease.

Answer 135

D. All of the above Lymphedema is due to obstruction, destruction or hypoplasia of lymph vessels and may occur secondary to an inflammatory process.

Answer 136

D. A and C An air plethysomograph and a strain gauge plethysmograph In order to perform venous outflow plethysmography, we need to be able to measure the change in limb volume using a device that encircles the limb. Air, impedance and strain gauge plethysmographs all serve this purpose, while A a PPG does not.

Answer 137

C. 2 to 3 weeks 2-3 weeks is the most critical time to diagnose thrombus if it is present

Answer 138

E. A and C - pigmentation and dermatitis Pigmentation and dermatitis are associated with chronic venous insufficiency. Thickened toenails are more commonly associated with chronic arterial insufficiency.

Answer 139

C. recurrent DVT Recurrent DVT cannot be ruled out and must be excluded because of its life threatening nature. Because venous hemodynamics may not be altered enough to make the diagnosis in a patient with chronic venous insufficiency, this is a very difficult situation. Duplex imaging may be the best method to investigate this patient because of the varying characteristics of acute vs. chronic venous thrombus.

Answer 140

C. Calf pressure Calf pressure cannot be obtained during venous occlusion plethysomography using the method described in the text because the collecting cuff placed around the patient's thigh is inflated to 50 mmHg, which will temporarily occlude venous return to the heart yet offer no resistance to arterial inflow. (recall that in order to measure pressure in a limb segment, the cuff pressure musts exceed arterial pressure)

Answer 141

A. they are compressed with minimal pressure The deep veins are often beyond the penetrating capabilities of a 10 MHz transducer. The presence of low level internal echoes suggest thrombosis which is not present in normal veins

Answer 142

C. venous stasis, hyper coagulability, venous wall damage Virchow's Triangle

Answer 143

B. why edema collects in soft tissue

Answer 144

C. chronic arterial insufficiency

Answer 145

E. A, B and C

Answer 146

C. phlegmasia cerulea dolens

Answer 147

A. are not a significant health risk

Answer 148

D. A and B - 30 and 25 sec, venous refilling times < 20 are ABNORNAL

Answer 149

C. the posterior tibial vein

Answer 150

D. Non of the above Homan's sign is NOT a reliable indicator of DVT Homan's sign is calf pain w/ dorsi flexion of foot

Answer 151

D. A and B - venous insufficiency and venous reflux secondary to valve damage Following DVT, valve damage often results (recall that venous thrombus often forms in the low flow and areas adjacent to the valve cusps) and if recanalization of the vein occurs, retrograde flow past the damaged valve will result. The term venous insufficiency is synonymous with valvular insufficiency, resulting in venous reflux.

Answer 152

B. ankle edema

Answer 153

C. is a normal finding The upper extremity veins proximity to the heart results in a degree of pulsatility which is normal in the upper extremity veins

Answer 154

A. primary varicose veins

Answer 155

B. Pain or tenderness of the affected region

Answer 156

D. all of the above Lymphedema is described as the accumulation of excessive lymph fluid with associated swelling of the subcutaneous tissues. This is due to obstruction, destruction, or hypoplasia of lymph vessels. More common in women, and is usually unilateral ad painless, presenting w/ swollen foot and lower leg. It seems to get worse with warm weather, pregnancy, before menstuation and after a prolonged period of dependency

Answer 157

E. B and C | normal ankle pulses, hemosidern deposition

Answer 158

E. B and C | normal ankle pulses and hemosiderin depostion

Answer 159

E. A, B and C maximum venous outflow determination of the foot peripheral vascular venography and duplex imaging of the lower extremity Although less accurate than determining the presence of DVT above the knee, all three examination may be used.

Answer 160

C. posterior to the lateral malleolus

Answer 161

D. A and B

Answer 162

B. a change in the Doppler signal following respiration note that augmentation is performed DISTAL to the probe position, not proximal as suggested in selection "a"

Answer 163

C. have a non-invasive test initially, in order to prove or exclude the diagnosis note that many institutions now consider a duplex examination of the lower extremity venous system to be the gold standard in testing for DVT especially above the knee

Answer 164

C. have a non - invasive test initially, in order to prove or exclude the diagnosis Note that may institutions now consider a duplex examination of the lower extremity venous system to be the gold standard in testinf for DVT, especially above the knee

Answer 165

B. we are interested in the Venous refilling time following temporary emptying of the calf veins

Answer 166

B. phasic with respiration, showing an increase with expiration

Answer 167

A. Bed rest, warm compresses and aspirin

Answer 168

C. may not be significant superficial venous signals are only spontaneous when the patient is warm, and are often elicited only following foot compression. the superficial venous signal should be phasic w/ respiration, when the signal is not phasic but continuous this finding suggests the possibility of collateral circulation or may be due to the increased flow that accompanies superficial tissue inflammation (cellulitis)

Answer 169

B. usually found on the sides of the ankles

Answer 170

B. distend the venous system by making the lower limbs dependent

Answer 171

C. allow arterial flow int the limb, but prevent venous outflow, thereby causing venous blood to collect distally in the leg Blood collects in the calf, not the thigh page 3-28

Answer 172

B. prevents the compression of deep veins with the probe during duplex examination

Answer 173

C. more frequently on the left leg DVT occurs on the left side with 2:1 incidence when compared with the right leg, and ore frequently in females, than in males

Answer 174

True Ambulatory venous hypertension occurs in the presence of valve incompetence at the calf level because the calf muscle pump, which is activated with any lower extremity movement, pumps blood in a retrograde manner through the incompetent calf valves, increasing venous pressure (hence - ambulatory)

Answer 175

False The rapid deflation of the cuff can only occur if the internal diameter of the tubing is large enough to drain the air in the collecting cuff almost instantly, For this reason = a piece of tubing with at least 17 mm inside diameter should be used

Answer 176

True A major difference between the upper and lower extremity veins is the upper extremity veins proximity to the heart. The necessarily results in a degree of pulsatility which is normal in the upper extremity veins, and not evident in the lower extremity veins.

Answer 177

True We can differentiate between superficial and deep venous valvular incompetence by eliminating one of the systems from the test and repeating it. If we apply a above ankle pneumatic cuff inflated to a pressure of 50 mm Hg, we will occlude the superficial system's lesser saphenous vein, thereby eliminating its flow from the test. If the test is repeated and the results are normal (i.e venous refilling time is > 25 seconds), we know that the superficial venous system is responsible for the valvular incompetence identified during the previous abnormal test.

Answer 178

True Phlegmasia cerulea dolens is a clinically obvious condition resulting from extensive thrombosis of the deep veins of the involved extremity, including the iliac, common and superficial femoral veins as well as the greater saphenous vein.

Answer 179

False Lyphedema may be differentiated from edema caused by venous disease by the fact that the latter is characterized by swelling in the ankles and legs, but NOT in the feet. Lymphedema also affects the feet.

Answer 180

True | the term phasicity refers to the change in the venous signal that occurs in response to patient respiration

Answer 181

False A significant venous obstruction (DVT) will always result in a substantial decrease in maximum venous outflow. An M.V.O < 20 - 25 ml/min per 100 ml of tissue is a reliable sign of large vein obstruction.

Answer 182

True The most visible superficial vein of the upper extremity is the cephalic vein which may be identified along the anterior border of the biceps muscle.

Answer 183

False Venous claudication is defined as: pain that results from venous distention, often secondary to chronic venous obstruction and or valvular incompetence, usually brought on by exercise and relieved by limp elevation.

Answer 184

True | The anterior tibial veins are identified on top of the interosseous membrane close to the fibula.

Answer 185

False | Acute Venous disease is usually UNILATERAL

Answer 186

False | The ulceration that may occur with venous disease occurs on the ANKLES, not the toes

Answer 187

False Dialysis graft flow is typically of high velocity at the arterial end, settling down somewhat near the venous end, with moderate to marked turbulence evident throughout the course of the graft.

Answer 188

False Some patients with DVT have calf pain with DORSIFLEXION of the foot when the knee is exended. This symptom is know as Homan's sign DORSIFLEXION NOT PLANTARFLEXION

Answer 189

True Finally, inflammatory processes involving the lower limb may result in HIGH PITCHED venous doppler signals secondary to relatively increased flow through the area of inflammation

Answer 190

False While CHRONIC is easily identified, as it is highly echogenic in most cases, acute thrombus may be difficult to visualize as it is similar in echogenicity to blood

Answer 191

False SUPERFICIAL venous thrombosis does not necessarily indicate that DVT is also present and in fact it seldom is. SVT does not result in P.E. or chronic venous insufficiency even when it is recurrent

Answer 192

True When examining the lower extremity veins we have tow factors in our favor. First of all, acute venous thrombosis causes the veins to BECOMe DILATED because of the clot making them easier to visalize.

Answer 193

True Virchow's triad 1 - stasis of blood 2 - increased blood coagulability 3 - vascular wall damage

Answer 194

True you will find the Popliteal vein SUPERFICIAL TO THE POPLITEAL ARTERY

Answer 195

False Starling's hypothesis describes for us the mechanism regulating fluid passage across the capillaries

Answer 196

False The presence of multiple paired deep veins in the calf make the decrease in outflow and limb expansion less obvious than above the knee where a thrombus occluding a single deep even in such as the superficial femoral vein has easily demonstrable effects. Therefore an SPG with its increased sensitivity is best utilized for foot outflow plethysmography

Answer 197

False It is important to realize that venous doppler alone test for OBSTRUCTIOIN, not thrombosis(although thrombosis is most likely the cause of the obstruction)

Answer 198

A. it resolves completely within 24 hrs

Answer 199

D. aphagia

Answer 200

C. symptomatic patients with ICA stenoses greater than 70% diameter reduction should be treated surgically

Answer 201

A. Compression should be performed for a period of one to three heart beats

Answer 202

E. All of the above All of the techniques described in this question utilize ultrasound

Answer 203

B. B-Mode-imaging is the most suitable answer as high resolution imaging ma define ulceration s which may result in micro emboli

Answer 204

D. the presence of and ICA occlusion Supraorbital PPG identifies significant disease in the ICA indirectly. Choices A, B and C may all be present with non flow or pressure reducing lesions. When present the severity of ICA disease is not revealed by this test

Answer 205

C. Bruits never originate from a kinked ICA Recall that bruits result form turbulent flow (and Reynold's number greater than 2000) and a kinked vessel may contribute to turbulance.

Answer 206

E. To identify flow in the intracranial ICA if it is present The confirmation of even minimal ICA flow beyond a critical stenosis is usually sufficient grounds for surgery

Answer 207

D. A and B A. Carotid phonoangiography B. spectral analysis of the Doppler shifted sounds Choices A and B examine the extracranial carotid circulation directly while choice C obtains information regarding ICA flow INDIRECTLY

Answer 208

Direct tests are described as those examinations that investicage the site of the disease itself. The direct tests enclude : ``` Carotid phonoangiography CW Doppler Carotid Examimantion B- Mode REal Time imaging of the Carotids PULSED DOPPLER CAROTID EXAMINATION DOPPLER FLOW MAPPING Apectral analysis angiography ``` DIRECT TESTS INVESTIGATE THE SITE OF DISEASE

Answer 209

C. The right side of the body When the CAROTID artery is the source of the embolus, a TIA of the left anterior hemisphere will cause CONTRALATERAL hemiparesis ( often with IPSILATERAL blindness if the ophthalmic artery also suffers and embolic event)

Answer 210

E. All of the above Recall that a significant stenosis results in a DECREASE in flow and pressure distal to the stenosis. Immediately within a and after the stenosis, flow velocities will increase and a little further on, turbulence will result. The CCA spectral waveform will show signs of externalization (i.e a wave form typical of the ECA ) when the ICA is occluded because it now supplies a high resistance vascular bed( the face and neck) The ICA/CCA ratio is elevated when significant ICA disease is present. Therefore, a significant stenosis may result in all of the choices presented.

Answer 211

D. All of the Above When a 10kHz frequency shift is identified on spectral analysis, the stenosis is VERY severe (I.E 80 -99%) Marked spectral broadening and increased diastolic flow velocities will also be evident

Answer 212

D. the highest frequency transducer that will peneetrate to the depth of the vessel under investiagion The highest frequency transducer (i.e 10Mhz) will result in the best axial resolution, however if the patient is thick-necked a 10 MHz probe is not suitable, Therefore, the best answer is D; the highest frequency transducer that will penetrate to the depth of a vessel to be investigated.

Answer 213

E. The word "significant" has not been used to describe the stenosis in the question, therefore non of the scenarios described will necessarily result (although several could)

Answer 214

B. The waveform in B demonstrates slightly higher velocities that A and return to baseline early in diastole, consistent with ECA flow.

Answer 215

C. Spectral analysis of a Doppler signal9

Answer 216

D. The aliased waveform in the question shows > 175 cm/sec consistent with a stenosis of 80-99%

Answer 217

D. The aliased waveforms in this question shows flow > 175 cm/sec consistent with a stenosis of 80-99%

Answer 218

B. The normal ICA demonstrates a Monophasic flow pattern with considerable flow in diastole.

Answer 219

C. allows us to differentiate between post bifurcation and CCA bruits

Answer 220

E. A, B and C

Answer 221

E. A carotid territory symptoms would be unilateral weakness of the arm and leg on the oppisite side of the disease ICA.

Answer 222

E. Non of the above Amaurosis fugax affects ONE EYE not both

Answer 223

B. the precursors of strokes

Answer 224

E. A, B and C Normal frontal artery flow is out of the orbit, towards the transducer and therefore above the baseline

Answer 225

D. Diplopia is the seeing of a single object as double and occurs as a BILATERAL visual field defect. It is therefore a vertebrobasilar territory symtom.

Answer 226

B.the inability to define the precise site of atherosclerotic disease Since indirect tests evaluate the physiologic effects of cerebrovascular disease, they can only indicate SIGNIFICANT ICA disease resulting in collateral flow. The ICA disease may range form >50% diameter reduction to total occlusion with no change in the results of the indirect test. It will be positive in either case.

Answer 227

B. first find the middle cerebral artery, then postion the samble volume slightly deeper

Answer 228

C. Spectral analysis of the Doppler signal obtained from the ICA Soft plaque with echogenicity similar to flowing flood may not be visible on 2D exam, but may cause enough turbulence tht spectral broadening is evident during spectral analysis. Therefoer, of the available choices, spectral anlysis is the most sensitive indicator of mild ICA atherosclerosis.

Answer 229

A. A different frequency shift being measured from identical sites in the vessel The frequency shift measurd by a Doppler instrument varies directly with the frequency of the Doppler crystal.

Answer 230

D. > 50% and Therefoer fairly reliable for detecting ICA disease

Answer 231

E. B and C - there is diastolic flow reversal in the vertebral artery during doppler examination - there is systolic flow deceleration in the vertebral artery during Doppler examination

Answer 232

B. a significant stenosis note that a 5 kHz Doppler shift indicates a significant stenosis for both transmitted Doppler frequencies

Answer 233

D. A and B - calcific plaque formation - a stroke

Answer 234

E. Drop attacks are a symptom of vertebrobasilar insufficiency, which may be the result of subclavian steal syndrome. If so, retrograde or oscillatory flow may be identified in the vertebrqal artery during Doppler sampling. Brachial pressure measurements will show a > 20 mmHg difference in pressure if a subclavian steal is present

Answer 235

C. Carotid phonangiographic analysis of a carotid bruit Choices A and B are not correct because the question states that the spectral analysis is of a carotid bruit detected with a sensitive microphone, indicating that the data was obtained during a CPA study, not a duplex examination of the Carotid arteries

Answer 236

E. A, B and C - all of the above

Answer 237

D. A high pitched monophasic signal with considerable flow evident during diastole

Answer 238

B. duplex scanning

Answer 239

D. an ICA stenosis An ECA occlusion would result in 100% of CCA flow supplying the ICA, which in turn supplies the low resistance vascular bed of the brain. Therefore, the CCA signal would not return to baseline but show continuous flow in diastole. A CCA signal that returns to baseline is most suspicious of a significant ICA stenosis.

Answer 240

C. B-Mode imaging of the extracranial carotid circulation 2D imaging with ultrasound will identify plaque that does not narrow the lumen and would therefore be missed on a carotid arteriogram

Answer 241

B. Branchless, larger and more posterior than the ECA Remember that the ICA has no extracranial branches

Answer 242

E. B and C B - the RBC's being sampled are moving at a similar velocity C - a relative absence of turbulence A well defined Spectral envelope simply implies that all RBC's are moving at a similar velocity. This velocity may be quite abnormal, as occurs in a tight stenosis if the Doppler sample is placed within the stenosis where velocities are high, yet flow is relatively laminar. Turbulence does not become evident until the sample volume is placed a few centimeters distal to the stenosis, where maximum turbulence will be identified.

Answer 243

C. non uniform plaque echodtextdure, with areas of increased and decreased echogenicity

Answer 244

D. A and B A - hypertension B - Diabetes mellitus

Answer 245

A. a more defined " window" that obtained from a CW signal remember that CW Doppler samples all velocities across the vessel, resulting i a broader spectrum of velocities on spectral analysis. Also, CW is capable of demonstrating much higer velocities, than pulsed Doppler. Finally, CW is more capable of showing arterial and venous signals simultaneously as the region of sensitivity is much larger than the sample volume used in PW Doppler.

Answer 246

E. A, B and C Angiographic examination of the extracranial carotid arteries may be performed via Catheter following femoral, axillary, brachial, translumbar or direct carotid artery puncture TRANSLUMBAR - access to Aortic arche - for pt significant femoral artery stenosis DIRECT METHOD - accessed low on the neck **angiography is considered superior to duplex examination of the carotid system with ultrasound because the entire carotid artery can be imaged regardless of pt habitus. Duplex examination is excellent for imaging the bifurcation of most patients, but falls short of angiography for imaging the proximal carotid artery and high ICA.

Answer 247

B. Color flow Doppler is and independent

Answer 248

FALSE During a periorbital Doppler examination, prior to compression, a normal patient demonstrates antegrade (forward flow towards the Doppler transducer) when the periobital arteries are examined. If flow is reversed in either the supaorbital or frontal arteries, there must be a significant (i.e >50% ) ipsilateral ICA stenosis or occlusion.

Answer 249

True More important than peak velocity measured in these vessels is the ICA/CCA VELOCITY RATIO. In general, the ICA/CCA velocity ratio is one of the most reliable indicators of significant ICA disease. This is especially true in labs that use peak flow velocities alone to categorize percent stenosis. * *ICA/CCA velocity ratio = Peak ICA/ Peak CCA * * Ratios >= 4.0 is consistent with a significant stenosis (>70% stenosis) **Ratios between 1.5 and 1.8 are considered to be in a "gray zone" my many imaging labs.

Answer 250

TRUE Many of the cerebrovascular symptoms can be classified as to the territory from which they originate. For instance, symptoms which are HEMISPHERIC are usually classified as carotid territory, while those that are non - hemispheric are often located in the VERTEBROBASILAR territory.

Answer 251

FALSE The major limitation of Doppler flow mapping is the lack of visual control of the angle of incidence of the Doppler beam. When acutely curved or kinked vessels are present, there may be a high incidence of false positives and false negative examinations

Answer 252

FALSE The extracranial carotid system is not the only source of emboli. The heart may also give rise to free floating bodies which may result from cardiac vegetations or tumors(i.e myxomas) or THROMBUS that often results from myocardial infarction

Answer 253

TRUE A duplex examination consists of DIRECT 2D VISUALIZATION of the Carotid vessels as well as THE ACQUISITION OF THE FLOW INFORMATION usually obtained by simultaneous Doppler sampling from the carotid vessels.

Answer 254

FALSE | A bruit lasting throughout systole (panslstolic) is consistent with a moderate to severe (60-75%) stenosis.

Answer 255

TRUE The term Rouleau Formation comes from theFrench word for a roll and is used to describe a stack of 3 to 10 or more erythrocytes, resembling a roll of coins. These formations contribute to turbulence in flowing blood by disturbing the normal flow patterns of single red blood cells, Rouleau formation is often the result of and increase in the patients's plasma immunoglobulin

Answer 256

True Color Doppler also allows for the rapid determination of normal anatomy based on flow For example, the portal triad consisting of and artery, vein and duct can be accurately differentiated by flow direction in the case of the artery and vein and lack of flow in the case of the bile duct

Answer 257

FALSE Close, but not quite the correct answer. The CAROTID BIFURCATION is the most frequent site of extra-cranial atherosclerosis and a common source of stroke

Answer 258

True Angiography is considered superior to duplex examination of the carotid system with ultrasound because the entire carotid artery can be imaged regardless of patient habitus. Duplex examination is excellent for imaging the bifurcation of most patients, but falls short of angiography for imaging the proximal carotid artery and high internal carotid artery.

Answer 259

FALSE The color information that appears on the screen is the MEAN ( not the PEAK) frequency of he moving reflectors being sampled in multiple sample volumes withe the color box.

Answer 260

TRUE The audible change in pitch is due to the CHANGE IN SIZE OF THE VESSEL as well as the difference in the vascular ben tht each branch of the carotid artery supplies.

Answer 261

True Transcranial Doppler examination allows us to determine if there is flow in an obstructed ICA at a level that is not accessible from the neck, in other words, we can identify flow in the cranium that would not be evident with the extra cranial approach.

Answer 262

FALSE Aside from age, the greatest contributor to stroke is UNCONTROLLED HYPERTENSION. High blood pressure serves to accelerate the process of atherosclerosis, damaging arterial walls, leading to aneurysm and potential risk of rupture. Along with the potential for aneurysm formation, hypertension increases the risk of embolization because of the increased flow states and turbulence that often accompany high blood pressure.

Answer 263

TRUE Below 50% stenosis, only systolic flow velocities increase. Beyond 50%, diastolic flow velocities. The ratio of the systolic to diastolic flow velocities can be used as an indicator of the degree of stenosis. A systolic/diastolic ratio < 4 in the area of stenosis suggests a 70-80% stenosis.

Answer 264

TRUE While the North American Symptomatic Carotid Endarterectomy Trial (NASCET) suggests that most SYMPTOMATIC patients with high grade stenoses greater than 70% diameter reduction be treated surgically with endarterectomy, a second trial, the Asymptomatic Carotid Atherosclerosis Study (ACAS), suggests that even ASYMPTOMATIC patients with high grade stenosis greater thatn 60% will benefit from carotid endarterectomy.

Answer 265

False Although the ICA is usually the larger and more posterior lateral vessel, this is not always the case. The ICA is always branchless, so this is the best method of differentiating it from the ECA.

Answer 266

TRUE When reviewing spectral analysis of intracranial blood flow during Transcranial Doppler examination, must re think our expectations.Where "spectral broadening" is abnormal in an extra-cranial Doppler exam, it is the norm in TCD because of the tiny vessel size and frequent branching.

Answer 267

FALSE When discussing the potential for developing cerebrovascular disease, the MAJOR risk factors UNCONTROLLED DM HYPERTENSION DM Other minor risk factors include cigarette smoking, obesity, high cholesterol, coronary heart disease and a poor family history.

Answer 268

FALSE Direct tests are described as those examinations that investigate the site of the disease itself, including Doppler flow mapping

Answer 269

TRUE In cases where the ICA is stenosed, causing the waveform to become of higher resistance (like the ECA ), and the vessels are full of shadowing plaque, making the identification of branches with 2D difficult it is helpful to perform a temporal tap to identify the ECA

Answer 270

FALSE | A stroke is defined as a PERMANENT NEUROLOGICAL DEFICIT. Your patient is describing a TIA, not a stroke

Answer 271

FALSE Power Doppler is VERY SENSITIVE TO THE PRESENCE OF FLOW, but displays NO direction, speed or flow character information and is therefore not suitable for studies where this information is important

Answer 272

3.0- 6.0 cm

Answer 273

Towards the transducer

Answer 274

retrograde (away from the transducer)

Answer 275

5.5 to 6.5 cm

Answer 276

towards the transducer

Answer 277

6.0 -7.0 cm

Answer 278

Towards the transducer

Answer 279

5.5 - 6.5 cm deep | and flows toward the transducer.

Answer 280

6.0 - 9.0 cm | flow is away from transducer

Answer 281

8.0 -12 cm | flows away from transducer.

Answer 282

4.0 - 6.0cm | flow is toward the transducer

Answer 283

6.0 - 9.0 cm | flow is away from the transducer

Answer 284

8.0 - 12cm | flow is away from the transducer

Answer 285

E. Flow patterns have a flattened profile

Answer 286

A. Origin of internal carotid artery

Answer 287

E. symptom associated with vertebrobasilar insufficiency Dysphagia (with a "g" ) is difficulty with swallowing

Answer 288

B. even double - projection arteriography may fail to fully determin diameter stenosis, especially in the event of vessel overlapA. The systolic components from each arm are averaged to determine the likelihood of cerebrovascular disease One of the main advantages of duplex is the ability to visualized in cross sections to the artery. Vessel overlap is a common problem. Kink would show up on angiography. "Background ultrasound noise" would not cause accelerated velocities.

Answer 289

E. Neointimal hyperplasia This is common phenomenon following any trauma to an arterial wall, including endartectomy and angioplasty. It involves proliferation of smooth - muscle cells in response to the injury.

Answer 290

A. Small to sample flow only from center stream

Answer 291

C. 500,000

Answer 292

A. Photoplethysmography PPG is not helpful in diagnosing acute thrombosis: it is used for diagnosing chronic venous insufficiency. IPG, SPG and Air Plethysmography are all capacitance/ outflow modalities, and their tracings look essentially the same

Answer 293

Diagnosing chronic venous insufficiency

Answer 294

E. Are different from any of the above A low PRF (scale) setting is necessary for the slower flow in lower extremity veins.

Answer 295

B. The left side of the Body TIA affect the side of the body opposite that of the ischemic hemisphere.

Answer 296

A. Ipsilateral carotid obstruction, with right - to - left collateralization Flow in the ACA is normally away from the beam, so this is not normal. It suggests flow coming across from the other hemisphere via the anterior communicating artery.

Answer 297

D. Ambulatory venous pressure Ambulatory venous pressure increases dramatically in chronic venous obstruction

Answer 298

D. arthritis Patients with CA are at increased risk because of systemic fibrinolytic changes

Answer 299

B. They usually have a quick decrease in venous pressure that takes a minute or tow to return to pre-exercise levels A prolonged return to pre-exercise pressure would be the normal response; return to maximum pressure should take a fairly long time in the patient with competent valves preventing reflux. In patients with complete recanalization of thrombus, the obstruction may even cause increased pressure with exercise because of congestion. Secondary varicies may fill via incompetent perforators during exercise.

Answer 300

C. Cellulitis - inflammation of skin and deeper tissues caused by and infections process - is one of the common differential diagnoses for deep venous thrombosis.

Answer 301

E. B,C and D

Answer 302

C. Hypertension

Answer 303

B. Valvular insufficiency Ascending venography defines the location and extent of venous obstruction. DESCENDING venography identifies specific valvular incompetence. Answer Choice E is a dirty trick: the IVC has no valves

Answer 304

E. Increasing the beam angle to 70 degrees This would create a lower frequency shift than the proper 60 degrees( Doppler equation again) The other choices would more likely increase, not decrease, the frequency shift.

Answer 305

A. Dysphasia "Aphasia" is widely used as well, but technically this is incorrect, since it means " absence of speech"

Answer 306

A and C Semi-Fowler's position Reverse Trendelenburg's position Semi - Fowler's position is raising the trunk and head, but not the knees (True Fowler's position includes raising teh knees, Which is what ost hospital beds do when you raise the head) Reverse Trendelenburg's position is patient supine, head up, ad feet down. A combination of these is usually used for venous duplex studies. Trendenleburg's position is patient supine, head down, and feet up - useful for pooling blood in the central circulation in hypotensive patients, but not for venous imaging or Doppler in the lower extremities. Supine, leg elevated is good for venous outflow plethysography.

Answer 307

C. A 75% diameter reduction i equivalent to a 50% area reduction

Answer 308

C. Hyperventilation

Answer 309

* ULCERATIONS LOCATED : TIBIAL AREA, FOOT, TOES. * DEEP AND MORE REGULAR IN SHAPE * QUITE AINFUL AS COMPARED TO VENOUS ULCERS * DURATION OF ULCERS IMPORTANT (I,E., (DAYS, WEEKS) * GANGRENE: DEATH OF TISSUE; USUALLY DUE TO DEFICIENT OR ABSENT BLOOD SUPPLY.

Answer 310

DIABETES HYERTENSION HYPERLIPIDEMIA SMOKING UNCONTROLLABLE - AGE, FAMILY HISTORY

Answer 311

A FORM OF ATHEROSCLEROSIS - OBSTRUCTION OF AORTA: OCCURS IN MALES FATIGUE IN HIPS, THIGHS, OR CALVES WITH EXCERCISE ABSCNCE OF FEMORL PULSES IMPOTENCE OFTEN TIMES, PALLOR AND COLDNESS OF LE

Answer 312

``` A FORM OF ARTERITIS ASSOCIATED WITH HEAVY CIGARETTE SMOKING OCCURS PRIMARILY IN MEN. < 40 YR OLD PRESENTS WITH OCCLUSION OF DISTAL ARTERIES RESP AIN AND ISCHEMIC ULCERATION ```

Answer 313

* INFLAMMATION OF ARTERIAL WALL LEADS TO THROMBOSIS OF VESSEL * CAN AFFECT TIBIAL AND PERONEAL VESSELS * TYPE - BUEGER'S DISEASE(THROMBOANGITIS OBLITERANS) * ASSOCIATED WITH HEAVY CIGARETTE SMOKING * OCCURS PRIMARILY IN MEN <40 YRS OLD * PATIENTS PRESENT WITH OCCLUSIONS OF THE DITAL ARTERIES * REST PAIN AND ESCHEMIC ULCERATION PRESENT

Combination Flashcards

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