Scan Lab Final 2025 Flashcards
1
Q
What are the components / materials that make up an acute thrombus?
A
A mixture of fibrin and RBCs w/ platelets and acute inflammatory cells.
2
Q
What are the components/materials that make up a chronic thrombus?
A
Mostly collagen
3
Q
What characteristics of a DVT is not recommended to utilize for diagnosis and why?
A
Echogenicity because an acute thrombus varies in appearance.
(Can be hypoechoic, hyperechoic, anechoic, or echogenic.)
4
Q
A thrombus is characterized as acute or chronic, although some facilities use a third catagory called ___________
A
Subacute
5
Q
What is the biggest muscle in the neck?
A
Sternocleidomastoid
6
Q
What is the most frequently, sonographically encountered pathology in the neck?
A
Enlarged lymph node.
7
Q
The carotid and vertebral arteries feed the…
A
Brain
8
Q
What happens when pieces of plaque travel to your brain due to a carotid artery stenosis?
A
Stroke
9
Q
What is the most severe treatment option for a carotid stenosis?
A
Carotid endarterectomy
10
Q
What part of the body do the carotid arteries supply blood to?
A
Head and neck
11
Q
What protects the common carotid arteries from superficial injuries?
A
Sternocleidomastoid muscle
12
Q
What structure has a blood supply connected to the branches of the external carotid artery?
A
Thyroid
13
Q
What are the first sign(s) of a pulmonary embolism?
A
Shortness of breath and chest pain
14
Q
DVT can often lead to a…
A
pulmonary embolism
15
Q
Varicose veins are a major risk factor for…
A
Deep Vein Thrombosis (DVT)
16
Q
How does a DVT disrupt varicose veins?
A
It causes increased blood pressure in the veins
17
Q
What is atherosclerosis?
A
A buildup of plaque on the inner walls of the arteries.
18
Q
List two ways to prevent diabetic neuropathy:
A
-Blood sugar management
-Keeping feet clean
19
Q
What would the waveform look like if you were to suffer from severe PAD (Peripheral artery disease) ?
A
Monophasic
20
Q
What are the two types of DVT?
A
Acute DVT and Chronic DVT
21
Q
What is the biggest difference between the two types of DVT?
A
The duration of symptoms
22
Q
What is Mrs Welch’s favorite and least favorite exam?
A
Favorite: LEVDOPP exam
Least-Favorite: Transvaginal pelvic exam
23
Q
Which of the two types of DVT is anechoic or hypoechoic, poorly attached, has smooth borders, and appears in dilated veins?
A
Acute DVT
24
Q
How long should reflux in a normal vein last?
A
< 0.5 sec
25
According to the American Vein and Lymphatic society (AVLS), what is the recommended patient position when performing a LE venous reflux study?
Standing
26
What area is key in evaluating reflux?
Saphenofemoral and saphenopopliteal junction
27
Where are ulcers more likely to develop on diabetic feet?
On the bottom of the foot (plantar)
28
What is the primary imaging modality for planning the treatment of peripheral artery disease (PAD)?
CE-Magnetic Resonance Angiography (MRA)
29
What is the most common presentation of PAD (peripheral artery disease)?
Claudification (Pain while walking/standing)
30
What is another name for a lower venous reflux exam?
Venous insufficiency ultrasound.
31
What is the best patient positioning for a lower extremity reflux exam?
Standing
32
In a lower venous reflux exam, how long must reflux persist to be considered abnormal in the superficial veins?
> 0.5 secs
33
What are the two most common upper extremity vessels that PICC lines are inserted through?
Basilic vein and cephalic vein
34
Which chamber of the heart is the PICC lines positioned next to?
Right atrium
35
What is one of the most common complications to occur due to a PICC line?
UE DVT
36
What is the primary purpose of vein harvesting in the arteriovenous fistula (AVF) creation?
To create a high flow connection between an artery and a vein for a dialysis access.
37
What is the key benefit of endoscopic vein harvesting (EVH) compared to open vein harvesting (OVH)?
Reduced risk of nerve damage and wound complications.
38
Which vein is most commonly used for vascular bypass procedures?
Greater saphenous
39
What does the term “venous reflux” describe?
Backward flow of blood in veins due to valve insufficiency
40
Which modality is preferred for diagnosing venous reflux?
Ultrasound
41
Which condition can mimic the symptoms of DVT but typically does not involve a blood clot?
Bakers cyst
42
What condition is most commonly mistaken for DVT due to similar symptoms such as swelling and pain?
Cellulitis
43
Which condition can mimic DVT but involves fluid buildup in the tissues rather than a blood clot?
Chronic venous insufficiency
44
When smoking cigarettes, what is the main cause for blood vessels to constrict and become narrow?
Nicotine
45
What is a common cause of CAS, PAD, and stroke?
Atherosclerosis
46
What is the preferred method of imaging for CAD (coronary artery disease)?
CCTA (coronary computed tomography angiography)
47
While scanning a LEVDOPP on a male with a history of high blood pressure, what is a likely pathology that you will find?
Thrombus
48
What is the most common cause of CVAs (Cerebrovascular accident / stroke) ?
Atherosclerosis
49
What is the first step in diagnosing a TIA (Transient Ischemic Attack “mini stroke”)?
Medical history and physical exam
50
If a patients mapped veins are determined to be unsuitable for surgical use due to factors such as poor size, stenosis, or insufficient quality, what are the common alternatives or approaches to ensure the success of the surgical procedure?
Use of a different vein in the same limb, or use of a synthetic/artificial graft such as a Dacron or ePTFE
51
When evaluating veins in the lower extremities for surgical use, which veins are prioritized for mapping?
Femoral vein, great saphenous vein, and popliteal vein.
52
When evaluating veins in the lower extremities for surgical use, how do factors like diameter, wall thickness, and valve integrity influence the selection of veins for vascular surgery?
Veins with…
-A diameter greater than 3mm,
-Thick walls
-Good valve function
53
What 3 specific veins are typically assessed when mapping veins in the upper extremities for surgical use?
Cephalic vein,
basilic vein,
median antebrachial vein
54
What are the key characteristics that determine whether the patients veins are suitable for procedures such as bypass grafting?
Veins must…
-Have a minimum diameter of 2mm,
-Be free from thrombosis,
-Have no significant valve incompetence.
55
How do you calculate ABI?
Highest systolic pressure at the ankle divided by the systolic pressure at the arm
56
How often are ABI values accurate?
95% of the time
57
accuracy for ABI values increases with…
Exercise
58
Why is exercise important in ABI testing?
It increases the sensitivity by 25%
59
What two imaging modalities are affected by patient movement?
MRA and U/S
60
What modality is most successful in predicting which plaque is most vulnerable to embolization?
Angiography
61
What metal is used in the contrast for an MRA?
Gadolinium
62
39-year-old male presents to the emergency room with tingling pain in both of his hands and a history of chewing tobacco. While scanning, you notice an occlusion in his right radial artery and a corkscrew collateral vessel branching off. What is the most likely diagnosis?
Buerger’s Disease
63
While performing an UEADopp on a 62-year-old male with a history of CKD, you notice the walls of his left brachial artery are echogenic and you can't get color flow through the vessel. What is the most likely diagnosis?
Monckeberg's Arteriosclerosis
64
You are performing a BUEADopp on a 23-year-old woman with a history of numbness and tingling in her fingers. While you are scanning her right subclavian artery, you notice the tips of her fingers have turned white. What is the most likely diagnosis?
Reynauds Disease
65
What is an immediate effect of smoking on the vascular system?
Vasoconstriction and increased blood pressure
66
Long term smoking increases the risk of abdominal aortic aneurysm primarily by:
Weakening the aortic wall through inflammation and tissue breakdown
67
A patient with a 30-year smoking history complains of leg pain when walking, which subsides at rest. Which physiological process best explains this symptom?
Chronic atherosclerosis seen in PAD limits blood flow to the limbs, causing claudication
68
What is the key difference between a cerebrovascular accident (CVA) and a transient ischemic attack (TIA)?
A CVA involves a permanent blockage of blood flow, while a TIA is a temporary reduction in blood flow
69
List some common factors which contribute to the occurrence of cerebrovascular accidents (CVAs), or strokes, by affecting the brains blood vessels?
Aneurysms,
arteriovenous malformations (AVMS),
atherosclerosis,
hemorrhagic events,
traumatic brain injury (TBI)
(All of these can all lead to a stroke risk)
70
What is another term for CVA?
Stroke
(Cardiovascular accident)
71
What is another term for TIA
Mini Stroke
(Transient ischemic attack)
72
How do the effects of a CVA differ from a TIA ?
-CVA causes permeant damage with long-lasting effects,
-TIA is temporary with no lasting damage.
73
What is cardiac dysfunction?
The hearts inability to pump blood effectively
74
Describe the appearance of a normal arteriole waveform?
Sharp systolic upstroke,
Briefly reversal of flow in early diastole,
Forward flow in late diastole
75
What pathology is commonly seen with continuous venous flow?
Right heart failure / DVT
76
What does a patient who is presenting with symptoms of a DVT commonly look like?
-Swelling
-Unilateral edema
-Warm feet
-Discoloration
77
If a patient is presenting with very cold feet, should they have an order for an arterial exam, or a venous exam?
Arterial
78
What is the fist thing you should ask a patient when you get them for their exam?
Confirm patients name and DOB
79
What vessels pass through the spine and are located posterior to the carotid arteries?
Vertebral arteries
80
What is a key ultrasound finding that suggests the presence of restenosis following a carotid endarterectomy?
Increased flow velocity with post-stenotic turbulence
81
What is the most common type of graft used in carotid artery bypass surgery?
Saphenous vein graft
82
What are the main vessels used in the upper extremity for vein mapping?
Cephalic and Basilic
83
What is the main goal of preoperative vein mapping?
To determine the best available veins for grafting
84
What 2 methods are used for harvesting veins?
Open vein harvesting and Endoscopic vein harvesting.
85
What type of waveform seen in a lower extremity arterial ultrasound is most likely to indicate severe stenosis or occlusion of a proximal artery (such as the iliac or common femoral artery)?
Tardus parvus waveform
86
What type of waveform seen in an upper extremity arterial ultrasound is typically indicative of normal, healthy, arterial flow?
Triphasic waveform
87
A monophasic waveform observed in the common femoral artery during a lower extremity arterial ultrasound is most likely indicative of:
Proximal stenosis
or
Occlusion / Atherosclerotic disease
88
What else may you find while performing a LE venous study?
Baker’s cyst,
lymphadenopathy,
cellulitis,
superficial thrombophlebitis,
varicosities,
hematomas.
89
What else may you find while performing a UE venous study?
PICC lines,
Catheter-associated thrombus,
Paget-Schroetter syndrome,
Thoracic outlet compression,
Masses compressing veins.
90
What are the signs/symptoms of a DVT?
Swelling,
pain,
redness,
warmth,
Homan’s sign,
and sometimes fever or positive D-dimer.
91
What other condition(s) may mimic a DVT?
Cellulitis,
Baker’s cyst,
lymphedema,
hematoma,
muscle tear,
venous insufficiency.
92
What are the causes of an upper and lower extremity DVT and are they different?
What makes you more predisposed to form a thrombus?
—Causes follow Virchow’s triad: venous stasis, endothelial damage, hypercoagulability.
—UE DVTs often catheter-related;
—LE DVTs linked to immobility/surgery.
—Risk factors: cancer, trauma, hormones, obesity, smoking.
93
How can you tell the difference between an acute and chronic DVT?
Acute: hypoechoic, vein distension, non-compressible.
Chronic: echogenic, small, with collaterals.
94
How what are the treatment options for an acute DVT vs a chronic DVT?
anticoagulants (acute),
compression and monitoring (chronic).
95
What is an upper extremity PICC line used for?
For long-term IV access.
96
How do you evaluate an upper extremity PICC line placement and patency?
Use ultrasound to…
-confirm location,
-evaluate for thrombosis,
-ensure vein patency and flow around the catheter.
97
What are the treatment options for an arterial stenosis/occlusion in the upper and lower extremities?
Lifestyle modification, antiplatelets, angioplasty, stenting, or surgical bypass.
98
What are the signs/symptoms of peripheral vascular disease and how do they differ from venous pathologies?
PVD: claudication, cold limbs, rest pain, non-healing ulcers.
Venous disease: swelling, aching, heaviness, discoloration, relieved by elevation.
99
What are three upper extremity arterial pathologies/disorders (other than stenosis/occlusion/TOS).
Aneurysms,
Vasculitis,
Embolism/Thrombosis,
Raynaud’s phenomenon.
100
What are the different types of UE fistulas/grafts, how do they work, and what are they used for?
Types: radiocephalic, brachiocephalic, brachiobasilic.
Used for dialysis access.
101
Describe the ultrasound protocol used to evaluate the functionality of UE fistulas/grafts
Evaluate inflow artery, anastomosis, outflow vein, flow volume, and check for stenosis or thrombosis.
102
What test(s) can a patient have done to diagnose lower extremity pain (other than ultrasound of veins/arteries)?
ABI (functional),
CTA/MRA (anatomical),
angiography (gold standard).
103
Describe how ABI, CTA/MRA, and Angiography differ from each other:
ABI (functional) is fast and noninvasive
CTA/MRA (anatomical) show structural issues
Angiography (gold standard) is invasive but most detailed.
104
Describe the lower extremity complications a diabetic may encounter.
Neuropathy,
arterial insufficiency,
poor wound healing,
ulcers,
infections,
increased risk of gangrene or amputation.
105
What does retrograde flow in the vertebral artery look like on spectral Doppler and what is the significance of this finding?
Appears below baseline, indicating reversed flow—sign of subclavian steal syndrome.
106
What velocity measurements are indicative of significant disease?
PSV >125 cm/s =
50% stenosis or greater
(Peak systolic velocity greater than 125 cm/s is indicative of disease)
107
What % stenosis is considered problematic, operable, and non-operable?
(<50% Stenosis: Typically not problematic, managed medically (PSV < 125 cm/s))
50–69% Stenosis: Moderate disease; operability depends on symptoms and other risk factors (PSV 125-230 cm/s)
≥70% Stenosis: Severe; usually considered still operable with endarterectomy or stenting (PSV > 230 cm/s)
Near Occlusion: Still potentially operable, though technically challenging
Total Occlusion: Non-operable by standard surgery; managed conservatively or via collateral assessment
108
What is a normal PSV?
Normal peak systolic velocity greater is <125 cm/s
109
What is indicative of a normal amount of stenosis ?
0% — <50%
0% stenosis is most normal, but velocities UNDER 125 cm/s with minimal plaque will typically fall under the <50% range and still be considered normal.
110
What % Stenosis would be considered a near occlusion?
>95%
Not completely occluded — still a trickle of flow
Still technically operable.
111
What is the expected PSV for a near occlusion?
Highly variable (trick question)
It can be…
- Very high due to a tight jet through the narrowed lumen
- Very low due to severely reduced flow
- show a classic "string sign" (narrow trickle of flow in color Doppler)
112
What is the % stenosis and PSV measurement expected from a total occlusion?
100% Stenosis
0 cm/s PSV — no measureable flow.
(Non operable)
113
What else may you find while performing a carotid ultrasound (outside the carotid system)?
-Thyroid nodules
-Lymph nodes
-Parotid masses
-Neck soft tissue abnormalities.
114
What is the difference between a CVA and a TIA and how are they treated?
CVA = stroke, permanent
TIA = temporary (<24 hrs).
Treatments: meds, risk modification, surgery.
115
What treatment options does a patient have with operable stenosis?
Endarterectomy or stenting.
Post-op ultrasound checks for restenosis, thrombosis, dissection, or intimal flap.
116
What postoperative complications does ultrasound evaluate for following surgical treatment of an operable stenosis?
Following an endarterectomy or stenting procedure, post-op ultrasound checks for…
restenosis,
thrombosis,
dissection,
or intimal flap.
117
What would the carotid system look like sonographically on a post-op endarterectomy patient?
Endarterectomy:
irregular vessel wall
118
What would the carotid system look like sonographically on a post-op stent-placement patient?
stent:
echogenic with shadowing
119
What would the carotid system look like sonographically on a post-op bypass graft patient?
Bypass:
visible anastomosis and graft segment.
120
What three imaging modalities are used to evaluate the carotid system?
Describe their limitations, contraindications, and how the information they give differs from one another and ultrasound.
1. Ultrasound: real-time, noninvasive.
2. CTA/MRA: detailed anatomy but requires contrast/radiation.
3. Angiography: invasive, highest resolution.
121
Upper and lower extremity vein mappings may be preoperative for which vascular bypass procedures?
Describe how the vein is harvested and used for those procedures.
CABG or peripheral bypass.
The vein is harvested, reversed, or left in-situ, and then used to bypass occluded arteries.
122
What veins are usually mapped in the upper and lower extremities?
A: UE: cephalic, basilic.
LE: GSV, SSV
123
For vein mapping procedures, what characteristics does the vein need to have to be considered “useable” by the surgeon?
What is done if there is not a “useable” vessel?
Vein must be…
≥2.5 mm,
compressible,
patent,
thrombus-free.
124
What is done if the patients vein does NOT meet the criteria for vein mapping?
A synthetic graft or alternate vein is used
125
What problems, signs, or symptoms may occur postoperatively at the donation site?
Which patients’ may be more inclined to have complications postoperatively?
Problems include edema, hematoma, & infection.
Higher risk in diabetics, obese, and immunocompromised patients.
126
What is the patient positioning and maneuvers used for a lower venous reflux exam?
Positioning: Standing or reverse Trendelenburg.
Maneuvers: Augmentation or Valsalva.
127
What vessels are evaluated during a lower extremity reflux study?
GSV, SSV, perforators, femoral, & popliteal veins.
128
Describe what venous reflux is and what causes it.
Venous Reflux is retrograde flow that is >0.5 sec from valve failure.
129
Describe the normal lower extremity venous waveform and how it differs from that found in a vein with reflux.
Normal waveform = phasic, respiratory.
Reflux waveform = shows reversed flow post-augmentation.
130
What are the treatment options for venous reflux, how are they performed, and are they permanent?
Compression therapy - not permanent
Thermal ablation - Usually permanent (85-95%)
Sclerotherapy - Can be permanent, better for small veins (80-90%)
Ligation - Most invasive, can be permanent (80-90%).
Some are long-lasting but may require maintenance.
131
How does cardiac dysfunction affect the vascular system?
It reduces cardiac output, causing a decrease in arterial flow
This can cause dampened arterial waveforms and venous pulsatility,
(especially in the upper extremities.)
132
What alterations to the waveforms will be seen on venous vs. arterial spectral Doppler exams in cardiac dysfunction?
Venous Doppler: Increased pulsatility (especially in central and upper extremity veins)
Arterial Doppler: Dampened, monophasic waveforms due to decreased forward flow from low cardiac output
133
What type of effects does long term smoking have on the vascular system?
Vasoconstriction,
endothelial damage
atherosclerosis
arterial stiffening
134
What information is needed when gathering a complete patient history prior to performing an arterial study versus a venous study?
Arterial: claudication, smoking, diabetes
Venous: swelling, recent surgery, blood pressure medication
135
What are pulse volume recordings (PVR) and how are they used?
-PVRs are non-invasive and measure volume changes in a limb with each heartbeat using air-filled cuffs to assess flow.
-Used to localize arterial disease, (especially when Doppler signals are difficult to interpret)
136
When is photoplethysmography (PPG) used and what information does it give?
-Photoplethysmography (PPG) is used to evaluate superficial blood flow, especially in toes or digits.
-Helpful when vessels are non-compressible
-Often used for toe pressures or venous reflux testing.
-Measures capillary perfusion
137
What does a normal vs. an abnormal PVR waveform look like?
Normal PVR waveform is triphasic or sharp with a dicrotic notch
Abnormal PVR waveform will be dampened or rounded, indicating obstruction.
138
What are the normal/abnormal ABI values?
Are they always correct?
Normal: 0.90–1.30.
Abnormal: Less than <0.90 - Peripheral artery disease (PAD).
ABI may be falsely elevated with calcified vessels
139
Why do we do “exercise testing” when performing an ABI?
exercise will make increase the accuracy of the exam and will reveal any masked ischemia
140
Describe the normal and abnormal waveforms found in the upper and lower extremities?
Normal = triphasic;
Abnormal = monophasic or dampened (indicating disease).
141
Describe the segmental pressures protocol for the upper and lower extremities, how to interpret the information, and the goal of “exercising” the patient.
Measure pressures at multiple levels (brachial, thigh, calf, ankle).
Greater than >20 mmHg drop between segments = disease.
Exercise identifies functional limitations.
142
Are there any patient limitations/contraindications you need to be aware of or may encounter when performing a segmental pressures exam?
Yes:
-DVT
-Wounds
-Recent surgery
-Pain
-Inability to exercise.
