Test 1

Question 1

TORTUOSITY & KINKING

Symptoms & Appearance

Answer 1

Symptoms - None

Appearance - Angulated, twisted vessel

Question 2

Dissection-

Blind ending & Secondary tear

Answer 2

o Blind-ended tear characteristics
•To and fro blood flow pattern – blood goes into and out – high resistant
•False lumen forms a pouch
o Secondary tear characteristics
•False lumen forms another channel allowing flow to continue through

Question 3

FMD (Fibromuscular Dysplasia)

Answer 3

o Abnormal growth of smooth muscle
o Areas of stenosis followed by areas of widening causing string of beads appearance - string of beads
o Primarily Young females
o Suspected in a young patient with TIA’s or uncontrolled HTN
o Renal artery most common location, followed by mid to distal ICA
May involve intima, media, &/or adventitia (Media = most common

Question 4

Carotid body Tumor

Answer 4

Mass with vascularity between ICA/ECA

Question 5

Carotid Aneurysm

Answer 5

Ballooning of all walls of artery

Symptoms - None/stroke symptoms

Question 6

Arteritis: Takayasu

Symptoms & Appearance

Answer 6

Young women, arm claudication, No radial pulses, bruit

No specific- think subclavian

Question 7

Giant Cell/ Temporal

Symptoms & Appearance

Answer 7

Symptoms; Elderly, Jaw claudication, Headache

Appearance; no specific - Halo around STA

Question 8

Anterior circulation pathology

Symptoms & Appearance

Answer 8

Symptoms; Typical stroke symptoms

Appearance; Deficit on contralateral side (Except amaurosis fugax)

Question 9

Posterior circulation pathology

Symptoms & Appearance

Answer 9

Symptoms; whole body

Appearance; think balance, movement, etc.

Question 10

TIA

Answer 10

Resolves in 24 or less

Question 11

RIND

Answer 11

Resolves in 24-72 hrs

Question 12

CVA

Answer 12

Permanent neurologic deficit

Question 13

String flow
When is it seen?
How to determine?

Answer 13

Trickle flow - Decressed blood volume passing though the tight stenosis. Velocities lower and energy is lost to heat.
Seen in tight stenosis, very low slow flow
> Low color scale, turn up color gain, use power doppler, turn wall filter down/off

Question 14

Flow separation

Answer 14

Non-laminar flow at bulb

-Due to changes in vessel diameter & direction of flow

Question 15

Tardus Parvus (mole hill)

Answer 15

Strongly suggestive of proximal disease

- Low velocity, low resistant waveform seen far distal to severe stenosis.

Question 16

% Diameter reduction

* Normal
* 1% - 49%
* 50% - 79%
* 80% - 99% Doppler findings & Clinically

Answer 16

Question 17

Causes of overestimation of disease

Answer 17

o	Hypertension
o	Cardiac arrhythmias ( sharp wave form)
o	Tortuosity- can mimic a stenosis
o	Contralateral occlusion or stenosis
o	Bilateral stenosis
o	Tech error

Question 18

Causes of underestimation of disease

Answer 18

o	Hypotension
o	Reduced cardiac output-started with low cardiac output, low ejection fraction
o	Aortic stenosis
o	Tandem lesions
o	Distal occlusion
o	Tech error

Question 19

ICA/CCA PSV Ratio
Normal
Greater than 70% stenosis

Answer 19

o Normal – < 2.0

o Greater than 70% stenosis - > 4.0

Question 20

Types of plaque

• Fatty Streak
• Fibrous
• Complicated lesion

Answer 20

o Fatty streak – minimal accumulation – soft plaque
•Thin layer of lipid material on the intima
•Low level echoes & homogenous, dark to medium level grey
o Fibrous – thicker accumulation of lipids with additional debris
•Low to medium echoes and appears homogenous, brighter grey
o Complicated lesion – most likely to break off – includes additional debris and calcification, may shadow
•Heterogeneous in appearance with bright echos, brightest type of plaque