Doppler segmental LE and UE

Question 1

Calcified vessels (medical calcinosis) render falsely elevated doppler pressures
(diabetics)

Answer 1

Limitations

Question 2

Artifactually elevated high thigh pressures when narrow cuff used on thigh.

Answer 2

Limitations

Question 3

Difficult to interpret in presence of multi-level disease

Answer 3

Limitations

Question 4

DVT, dialysis access, lymphedema, stent, bypass graft, patient who had mastectomy

Answer 4

Limitations (can’t do segmental limb pressures

Question 5

How long should patient rest prior to exam, especially when vascular disease is present

Answer 5

20 minutes

Question 6

What position should patient be in so that hydrostatic pressure cannot affect the BP measurements.

Answer 6

Supine

Question 7

width of the cuff should be about what than the diameter of limb

Answer 7

20% greater

Question 8

The size of the call cuffs except thigh

Answer 8

12 x 40 cm.

Question 9

Thigh cuff size is

Answer 9

19 x 40 cm.

Question 10

Four cuff method

Answer 10

brachial (arm)
High thigh
Above the knee (AK) low thigh
Below the knee (BK) (CALF)
Ankle

Question 11

Three cuff method

Answer 11

Brachial (ARM)
High thigh
Blew knee (BK) (Calf)
Ankle

Question 12

What size frequency probe should be used

Answer 12

8-10 MHz

Question 13

Angle the CW doppler probe at what degrees to the skin

Answer 13

45-60

Question 14

Due to vessel angulation, probe angle behind the knee may be closer to what

Answer 14

90 degree

Question 15

Angle the probe so blood flow moves

Answer 15

Antegrade (towards the probe)

Question 16

Brachial (upper arm) using brachial artery

Answer 16

done 1st to get systolic pressure

Question 17

Ankle

Answer 17

Use PTA or DPA which one is ever the highest (Peroneal A only if neccessary

Question 18

Calf BK

Answer 18

Use PTA or DPA which one was ever the highest

Question 19

Above the knee (AK)

Answer 19

Same as calf (PTA or DPA) which one was the highest

Question 20

High thigh (HT)

Answer 20

PTA or DPA which one was the highest

Question 21

Start at the ______ and move proximally to eliminate the possible underestimation of the systolic pressure measurements

Answer 21

Ankle

Question 22

The systolic pressure is recorded when?

Answer 22

First audible doppler arterial signal returns.

Question 23

Sphygmomanometer

Answer 23

Manual

Question 24

calculated by dividing the ankle pressure by the higher of the two brachial pressures

Answer 24

Ankle/brachial index (ABI)

Question 25

Another term for ABI is

Answer 25

Ankle/arm pressure index (API)

Question 26

> 1.0

Answer 26

Normal

Question 27

> 0.9 - 1.0 (90-80%)

Answer 27

Maybe within normal limits

Question 28

0.8 - .9

Answer 28

Mild arterial disease

Question 29

0.5 - 0.8

Answer 29

Claudication (moderate disease)

Question 30

< 0.5

Answer 30

Rest pain (sever arterial disease)

Question 31

Falsely elevated and inaccurate pressures

Answer 31

Incompressible vessels (calcified)

Question 32

Considered incompressible/unreliable

Answer 32

ABI > 1.3-1.5

Question 33

ABI of ______ represents single segment disease

Answer 33

> .5

Question 34

ABI of ______ suggests multiple lesions

Answer 34

< .5

Question 35

Segmental pressure drops of 30 > mmHg two consecutive levels suggests

Answer 35

significant stenosis

Question 36

Horizontal difference of > 20 to 30 mmHg suggests

Answer 36

obstructive disease at or above the level in the leg with the lower pressure.

Question 37

The thigh high pressure is normally > 30 mmHg than highest brachial pressure

Answer 37

4 cuff method

Question 38

The AK and BK pressure should be at least the same as the highest brachial

Answer 38

4 cuff method

Question 39

Thigh pressure is similar to the highest brachial pressure thigh=brachial

Answer 39

3 cuff method

Question 40

Does not allow for differentiation of high thigh to AK (above knee) pressures

Answer 40

3 cuff method

Question 41

Toe pressure maybe more reliable in a _____ patient

Answer 41

diabetic

Question 42

Immediately (normal = Increase ABI post exercise) Abnormally, ABI decreases minimally or to a severe amount With drop after exercise, pressures obtained every two minutes until pre-exercise pressures are attained

Answer 42

Post - exercise ABI's are obtained

Question 43

Shortness of breath, severe hypertension, significant cardiac problems, stroke, walking problems.

Answer 43

Contraindications for not doing exercise

Question 44

Takes 2-6 minutes for the ABI's to increase back to resting levels after they dropped to low or unrecordable levels after exercise

Answer 44

Single level disease

Question 45

Takes from 6-12 minutes for the ABI's to increase back to resting levels after they remained low or at unrecordable levels after exercise

Answer 45

Multi-level disease

Question 46

To evaluate patency of the palmar arch: asses for adequate perfusion to the hand if radial artery harvested or used for dialysis access

Answer 46

Allen Test

Question 47

Reappearance of the normal color to indicate the ulnar artery is providing flow to the palmar arch PPG documents pulsations during compression

Answer 47

Normal

Question 48

Color does not reappear to indicate; an ulnar artery occlusion or palmar arch obstruction PPG documents loss of pulsations during compression

Answer 48

Abnormal Cannot harvest radial artery

Question 49

15-20 mmHg difference from one brachial pressure to the other Suggests

Answer 49

50% stenosis of subclavian artery and or the vessel under the cuff

Question 50

A difference of > 20 mm Hg between radial and ulnar pressures suggests

Answer 50

obstruction in vessel with lower P

Question 51

An alternate method stressing the peripheral circulation. Used when patients: have PVOD in contralateral leg, use a cane or walker have pulmonary problems, poor cardiac status, or other situations

Answer 51

Reactive hyperemia

Question 52

Bilateral thigh cuffs (19x40) inflated to suprasystolic pressure levels (usually 20-30 mmHg above the higher brachial BP) maintaining the pressure 3 to 5 minutes

Answer 52

Reactive Hyperemia

Question 53

Produces ischemia and vasodilation distal to the occluding cuffs

Answer 53

Reactive hyperemia

Question 54

The ______ testing is the preferable test because it produces physiologic stresses that reproduces a patient's ischemia symptoms

Answer 54

Treadmill

Question 55

< 50% in ankle pressure with reactive hyperemia

Answer 55

Single level disease

Question 56

> 50% ankle pressure drop is seen (reactive hyperemia)

Answer 56

Multi-level disease