Prep & Reporting Flashcards
A lower extremity venous Doppler that is performed for suspected DVT should be performed with the patient in the \_\_\_\_\_\_\_\_\_\_ position. A. prone B. reverse Trendelenburg C. Trendelenburg D. standing
B
A venous Doppler that is performed for suspected DVT should be performed with the patient in the reverse Trendelenburg position. This semi-erect position increases intra-abdominal pressure and reduces outflow to engorge the veins with blood for easier visualization.
A patient is referred for a Doppler ultrasound of the IVC and hepatic veins due to an abnormal echocardiogram. The report states that the hepatic veins appear to empty directly into the right atrium with limited visualization of the upper IVC. What are you looking for in the abdomen? A. situs inversus B. duplicated IVC C. azygous or hemiazygos IVC D. portal HTN
C
Interrupted IVC - failure of the IVC to form correctly in the upper abdomen/liver; azygous and hemiazygos vein drain blood from the distal IVC segment; hepatic veins drain directly into the right atrium.
Patients are examined in the ________ position for a lower extremity arterial Doppler exam in order to ________.
A. semi-erect, increase hydrostatic pressure
B. supine, reduce hydrostatic pressure
C. supine, increase hydrostatic pressure
D. semi-erect, reduce hydrostatic pressure
B
Patients are examined in the supine position for a lower extremity arterial Doppler exam in order to reduce hydrostatic pressure.
Which of the following is the best patient position for performing a transcranial Doppler exam to obtain a waveform from the MCA?
A. supine with chin in neutral position
B. left lateral decubitus with left hand placed under the head for support
C. seated on a stool, facing you and the machine
D. seated on a stool, with their back to you and the machine
A
The transcranial window is used to evaluate the MCA flow bilaterally.
If a patient forgets to take their hypertension medication before a renal duplex exam, what effect can this have on the findings?
A. underestimation of peak renal artery velocity
B. overestimation of renal parenchymal thickness
C. overestimation of renal artery stenosis
D. underestimation of renal artery stenosis
C
Elevated systemic BP can cause increased velocity in the systemic arteries. If the pressure is high, velocity measurements will be overestimated and renal artery stenosis can be overestimated. The patient should be evaluated when the HTN is controlled, whenever possible.
An upper extremity venous Doppler that is performed for suspected DVT should be performed with the patient in the \_\_\_\_\_\_\_\_\_\_ position. A. prone B. Trendelenburg C. supine D. standing
C
Patient should be evaluated in the supine position with the head turned slightly away from the affected side; the affected arm should be in the dependent position and externally rotated.
Which of the following describes an important reason to verify the US examination that is ordered, is the exam that should really be performed?
A. sonographers should not question the orders written by physicians and perform the exams as ordered.
B. when the suspected abnormality is better visualized by another modality
C. when the exam is ordered after hours and no reading physician is available
D. when the suspected diagnosis is not able to be evaluated by the exam that is ordered
D
When the suspected diagnosis is not able to be evaluated by the exam that is ordered, this is an important reason to verify the US examination that is ordered is the exam that should really be performed.
What technique is recommended for evaluation of the main portal vein in an obese patient with ascites and significant bowel gas?
A. patient in the left lateral decubitus or oblique position with intercostal transducer position
B. patient in the supine position with subcostal transducer position
C. patient in the left lateral decubitus or oblique position with subcostal transducer position
D. patient in the right lateral decubitus or oblique position with intercostal transducer position
A
The preferred technique for evaluation of the main portal vein is to place the patient in the left lateral decubitus or oblique position with an intercostal transducer position. The intercostal approach from the right side uses the liver as an acoustic window. It also provides a shorter distance from the probe to the MPV than using a subcostal approach on an obese patient with a large abdominal girth. This approach also allows for the use of proper Doppler angles of 60 degrees or less. This is important when evaluating the velocity of flow in the MPV.
Which of the following is a required part of the Sonographer’s preliminary report for a lower extremity segmental pressure exam?
A. systolic and diastolic pressure measurements
B. patient position during the exam
C. peak velocity of the flow in the arteries
D. duration of cuff inflation during the exam
B
If the patient is unable to be examined in the supine position, this must be documented on the preliminary report for the interpreting physician because the pressures obtained may be artifactually elevated. The systolic pressure measurements are obtained in the legs. Flow velocity is not reported on a segmental pressure exam. It is an important part of an arterial duplex exam.
A patient presents for a mesenteric Doppler to rule out stenosis. They have a history of diabetes, HTN, pain and nausea post-prandially. You obtain a Doppler tracing from the SMA that appears low resistance with mild diastolic flow. What is the most important patient history question to ask the patient after viewing the waveform?
A. do you have diabetes?
B. do you have a history of median arcuate ligament compression syndrome?
C. how long have you experienced the symptoms?
D. when was your last meal?
D
In order to evaluate the SMA waveform, it is important to know the activity level in the digestive tract. Pre-prandial (NPO) = no digestion, high resistance flow with minimal diastolic flow. Post-prandial - digestion increases inflow needs, low resistance flow with mild diastolic flow.
A 62yr old female presents with left leg pain. She states she had a prior DVT in her left leg 6 months ago. The left popliteal and femoral vein are filled with thrombus and the proximal end of the clot has a free-floating tail. What should you do next?
A. tell the patient to limit all movement because the DVT is unresolved and you need to consult the reading physician immediately
B. check the great saphenous vein for thrombus propagation
C. call for a code blue due to significant increased risk of embolism
D. check the patient chart for a history of Coumadin therapy
D
The free floating tail can be a critical finding. The recent history of DVT could indicate that the patient is on anticoagulant therapy. If she is on Coumadin, this greatly reduces the risk of a pulmonary embolism from the tail. A preliminary report should be given to the nurse and the exam should be read by a physician immediately. A Sonographer should never give results or medical advice to a patient. Code blue is reserved for patients that are not breathing and in cardiac arrest.
A 75yr old female presents for a transcranial Doppler evaluation for suspected basilar artery stenosis. She suffers from emphysema and cannot lie down for the exam. Which of the following describes how you can evaluate the basilar artery in the patient?
A. patient seated in chair, lean forward to reach for their toes and flex the neck
B. patient in the left lateral decubitus position, hand supporting the head
C. patient seated in chair, neck hyperextended with a wedge behind the head for support
D. patients seated in chair, neck flexed and head supported by her arms/hands
D
If a patient is unable to lie down in the supine or decubitus position for TCD evaluation of the basilar artery, they should be seated in a chair, neck flexed and head supported by her arms/hands. If the patient is able to lie supine, just not in the decubitus position, then ask them to turn their head away from the side of interest and place the transducer to the left or right side of the foramen magnum.
Why is an acute arterial occlusion in the lower extremity considered a critical finding?
A. the risk of stroke is significantly increased
B. the risk of arterial rupture is significantly increased
C. collaterals have not had time to form to redistribute the blood
D. because it is not treatable
C
Without collaterals present to redistribute blood flow, the risk of tissue death and possible amputation increases.
Which of the following transducers would be preferred for a lower extremity saphenous mapping on an average sized patient? A. 7-10MHz sector B. 5-7MHz linear C. 5-7MHz curvilinear D. 7-10MHz linear
D
Linear arrays are preferred for vascular exams. 5-7MHz transducers are used for DVT evaluation in an average sized patient. 7-10MHz transducers are used for evaluation of the superficial system for insufficiency or vein mapping.
Which of the following acronyms refers to the standard image file storage format used in medical facilities in the United States? A. JPEG B. MPEG C. AVI D. DICOM
D
DICOM - Digital Imaging & COmmunications in Medicine provides a standard for handling, storing, and transmitting information in medical imaging.
You perform a carotid Doppler exam that demonstrates minimal atheroma formation bilaterally. You record waveforms that demonstrate laminar flow with the following velocities:
Right Proximal CCA PSV 135cm/s, EDV 35cm/s
Right Proximal ICA PSV 175cm/s, EDV 50cm/s
Left Proximal CCA PSV 140cm/s, EDV 40cm/s
Left Proximal ICA PSV 166cm/s, EDV 40cm/s
What will you report on your worksheet?
A. flow velocities are increased bilaterally, which is most likely related to soft plaque formation not visible on 2D and color evaluation
B. flow velocities are increased bilaterally, which is most likely related to increased cardiac output
C. flow velocities are normal bilaterally
D. flow velocities are increased bilaterally, which is most likely related to stenosis at the aortic valve.
B
Bilateral increased velocities in the CCA and ICA with no evidence of stenosis is usually related to increased cardiac output. Bilateral CCA velocities can be increased with aortic stenosis also, but the flow would not be laminar in the proximal CCA.
All of the following should be included in the report from an exercise segmental pressure exam, except:
A. duration of exercise
B. symptoms that occurred and when they started during the exercise
C. pressure recovery time in ankles
D. venous refill time (VRT)
D
Venous refill time is a part of a PPG report for insufficiency.
What is the best way to explain a renal Doppler exam to a 9yr old female?
A. give her a pamphlet that describes the procedure
B. tell their mom to tell them it won’t hurt and just pretend to be asleep
C. tell her you will be using Doppler ultrasound to evaluate the blood flow to the kidneys and it will take about 30 minutes
D. demonstrate the gel on the probe and how you will slide it around on her belly to obtain pictures for the doctor
D
Always revise your communication for the audience it is intended.
Which exam would be improved by the administration of Simethicone prior to the ultrasound evaluation? A. renal artery duplex B. carotid duplex C. transcranial duplex D. lower extremity segmental pressures
A
Simethicone is a medication that is used to reduce bowel gas. It may be beneficial when performing abdominal duplex exams.
A recent CT scan demonstrates an acute infarct in the parietal lobe and a new blockage in the proximal left MCA. Which of the following is the most likely source for the embolism?
A. plaque broke away from the wall of the proximal ECA
B. thrombus formation in the left jugular vein
C. plaque broke away from the sclerotic aortic valve
D. plaque broke away from the wall of the ACA
C
A sclerotic aortic valve can send an embolus through through the aorta into one of the arch branches. If the embolus enters the left carotid system, it could lodge in the left MCA. Thrombus in the jugular vein would move into the right side of the heart/lungs. The ECA does not supply flow to the MCA, therefore there is no way for the embolism to enter the circle of Willis (without getting stuck in a smaller ECA branch first). Flow in the ACA normally moves away from the MCA. An embolus in the ACA will move into smaller branches toward the front of the brain and eye.
You are performing a left upper extremity venous duplex exam. DVT is identified in the axillary and subclavian veins. Which of the following must also be included in the exam protocol for this patient?
A. arterial flow pattern in the arteries associated with the thrombosed veins
B. bilateral brachial pressures
C. pulse volume recording of the ipsilateral upper arm and forearm
D. flow in the contralateral subclavian vein
D
For all unilateral extremity venous exams, the flow in the contralateral extremity should be documented for comparison. Common femoral vein for the lower extremities and subclavian or internal jugular vein for the upper extremities.
A 55 year old female presents for a venous Doppler exam due to intermittent swelling, increasing in frequency over the last few months. There is no prior history of DVT. Which of the question(s) listed below would provide pertinent history information for the venous Doppler exam?
A. do your legs/calves hurt more when walking but the pain stops if you sit and rest?
B. if you place your legs in a dependent position, does this reduce the swelling?
C. do you stand on your feet for extended periods of time on a regular basis?
D. do you have any ulcer formation on your toes?
C
Standing for long periods of time can cause venous insufficiency and the related symptoms in the patient. Arterial disease can cause leg pain with exercise that is relieved by rest. The muscles require an increased blood supply with exercise. If there is arterial disease present, it may not allow the necessary increase in flow and ischemia/pain presents. Stopping the exercise will assist in the relief of the symptoms as the muscles decrease their need for blood flow. Arterial ulcers are found on the toes and heel of the foot. Venous ulcers are found on the distal calves.
If a patient complains of a single 12hr episode of right arm paresthesia and paralysis, what will you report on your technologist worksheet?
A. history of transient ischemic attack
B. history of amaurosis fugax
C. history of cerebrovascular accident
D. history of reversible ischemic neurological defect
A
Symptoms that last less than 24hrs = TIA.
When preparing for a patient with suspected thoracic outlet syndrome, what other information should you review for pertinent information? A. lab results for hematocrit levels B. chest x-ray C. aortogram D. CT of the brain
B
A chest x-ray could demonstrate the cervical rib that is a common cause for TOS.
A patient presents for a carotid ultrasound. The exam demonstrates significant calcification in the proximal ICA on the left side and the Doppler signal is not obtained. Antegrade flow in the mid ICA has a peak velocity of 30cm/s and end diastolic velocity of 10 cm/s. How will you report these findings?
A. Normal exam with limited evaluation of the proximal ICA
B. suspected critical stenosis in the proximal left ICA, but the exam was limited by shadowing from atheroma formation
C. critical stenosis proximal left ICA
D. normal exam
B
Any limitation in the exam that obscures your view of anatomy should be reported to the physician in the technologist findings.
A patient presents for a segmental pressure exam. She states she has had DVT in her right leg three times over the last 2 years. Today she complains of right leg pain and mild swelling, but no color change. She states that the doctor could not find the pedal pulses on the right side. What should you review in the patient chart prior to starting the exam?
A. lab values for hematocrit levels
B. medical history for current Coumadin therapy
C. lab values for lipid levels
D. surgical history for endoluminal graft placement
B
The pressure cuffs can increase the risk for embolization to occur in the right leg. Current Coumadin therapy drastically reduces the ability of the embolism to make it to the lungs if it does form. Hematocrit levels can give you a clue to the blood thickness, but this does not assist you when considering the risk for embolism.
If the velocities in both carotid arteries are increased since last year’s exam with no visible change in plaque formation, what should you review in the patient chart as a possible explanation?
A. lab values for decreased hematocrit levels
B. medical history for ploycythemia vera
C. recent echocardiogram for signs of decreased cardiac output
D. medical history for controlled HTN
A
Decreased hematocrit will lead to thinned blood with increased bilateral carotid velocities. Polycythemia vera leads to thickening of the blood which would decrease carotid velocities bilaterally. Increased output and uncontrolled HTN would cause increased bilateral carotid velocities.
Which of the following describes the proper explanation of a carotid Doppler exam to a female patient?
A. you will tell her the exam uses Duplex ultrasound to evaluate the extracranial arteries in the cervical region
B. you will tell her that the exam uses ultrasound waves that are not harmful to look at the blood flow in the neck that is going toward the brain
C. you will tell her that this exam looks for stenosis in the neck arteries and if it is positive, she will most likely need an MRI
D. you will tell her the exam will check to see if she has had a stroke
B
Always tailor your communication to meet the needs of the recipient.
