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Adult Echocardiography > Venous > Flashcards

Flashcards in Venous Deck (101):
1

What vessel on the arm is antero-lateral to surface of arm, what is this vein?

Cephalic vein

2

Characteristics at the medial and lower calf that caused an onset of ankle swelling:

Lack of spontaneous, phasic flow is normal in tibial veins

3

Ulcers caused by severe arterial/venous disease:

Arterial ulcers are Deep w/ regular shape, bony prominences, trophic changes. Least likely is brawny discoloration related to venous insufficiency

4

May-turner syndrome

DVT, compression of left common iliac vein

5

A PT w/ swelling bilaterally in lower extremities, an acute DVT proximal to groin, where?

Inferior vena cava

6

Peripheral vascular occlusive disease(PVOD) in elderly PT with swollen extremity:

Check popliteal artery is deeper than popliteal vein

7

A duplex imaging exam finds a 9cm swelling and bluish discoloration in one leg compared to other leg:

Phlegmasia cerulea dolens(red), if leg is very pale would be phlegmasia alba dolens.

8

A hydrostatic pressure at the ankle of a 6 foot supine man would be?

0 mmHg

9

What veins have the greatest number of valves?

Posterior tibial veins, venous valves increase distally(peroneal veins). More distal the vein in LE, the more valves it has

10

In an abdominal imaging in a PT w/ ascites , what is not a support for diagnosis of thrombi of the portal vein?

Hepato-petal flow is a normal finding

11

Lymph node images appear:

Brighter in center, surrounded by low level echoes

12

Lower left leg swelling, heaviness and varicosities in a 30 yr old mom, what is the cause most likely?

Chronic venous insufficiency

13

Least likely to occur w/ an effective calf muscle pump?

Increase in venous volume. Will have a decrease in venous volume/pressure and return blood to the heart, unidirectional flow from superficial to deep system, prevents reflux from happening

14

Femoral vein, used to be called superficial femoral vein:

Is not normally paired

15

A PT w/ a DVT, during exam what is least likely to cause a false positive study?

Presence of a bifed system

16

True about the GSV(great saphenous)vein:

Terminates at the saphenousfemoral junction, flow from posterior arch vein flows into GSV, GSV is longest vein in body

17

An approximate venous pressure at the ankle level is?

15mmhg

18

True of portal hypertension:

Elevated venous pressure is secondary to obstructive process, treatment usually require decompression of the portal venous system, related to some form of chronic liver disease, hepatitis-fugal flow may be evident in the portal vein, blood on portal vein is going away from liver cuz elevated venous pressure, elevated pressure can alter blood flow in portal vein going away from liver

19

Normal venous volume change inflow/outflow during air-plethysmorgraphic(APG) evaluation?

Venous system empties with passive leg evaluation

20

How does normal Doppler venous signal of arm differ from that of the leg?

Flow from the arm decreases during exhalation, while flow from the leg increases on exhalation

21

What effect does inspiration have on the lower extremity veins?

Inspiration causes venous outflow from the legs to be halted

22

During contraction of the calf muscles, venous pressure in the deep veins is greater than the pressure in superficial veins. What prevents blood from flowing into the superficial system from the deep?

Flow maintains its unidirectional flow because of the closed valves in the perforators

23

Veins are not completely passive structures, but have some reactivity referred to as venomotor tone, things that effect a venomotor:

Exercise, trams, deep breathing, temperature, light has no effect

24

In a duplex exam what is medial aspect of the lower calf? What can you see in transverse view represents which vessel is near fascia and fibula?

Posterior tibial artery and veins near fascia and peroneal artery and veins near fibula

25

True about an ineffective calf muscle pump?

Increase in volume/pressure is a result of ineffective muscle pump, incompetent valves cause reflux or venous pooling.. Possible increase in ambulatory venous pressure is secondary(venous hypertension)

26

What is the normal direction of blood flow in the perforating veins during muscle contraction?

The perforating veins always carry blood from superficial veins into deep veins, into deep from superficial

27

A PT w/ tender mass in R. Upper quadrant, in saggital view, the portal vein and hepatic artery are identified in the same plane, what colors would be displayed in this condition?

Both vessels will have same color, both carry blood to liver, should be the same color

28

What vessels form superior vena cava (SVC)?

SVC is formed by the confluence of the right and left innominate veins

29

A thrombectomy is usually reserved for limb threatening situation

Lyric therapy is usually reserved for limb threatening sit.

30

Edema, Fluid the subcutaneous tissue, what's related to this condition?

CHF, electrolyte imbalance, renal dysfunction

31

Normally, how does venous volume change with infow/outflow during an air-plethysmographic(APG) evaluation?

Venous system empties with passive leg evaluation

32

A PT had 9cm swelling and blush color on one leg, what will exam find?

Extensive, acute ilio -femoral deep venous thrombosis, phlegmasia cerulea dolens

33

True about the portal vein:

Hepato- petal(into liver), Portal vein formed by confluence of the superior mesenteric and splenic vein, flow in portal vein is little phasic, more continuous in nature, liver received blood from pancreas/gall bladder thru portal vein, not involved hepato-fugal= means flow away from liver

34

PPG detects peripheral arterial or venous systems, AC coupling (alternating current) for arterial exams and DC coupling (direct current) for venous studies.

DC detects slower flow changes than AC, electrical voltage is either positive or negative. Wall outlet not an example of DC. Wall outlet is alternating of 120 volts

35

What occurs w/ an effective calf muscle pump:

Venous return to heart increased w/ unidirectional flow is maintained from the superficial system into deep system. Bad pump increase in venous volume

36

In venous anatomy how are the veins in foramen most likely positioned from a lateral to medial orientation?

Cephalon, radial, basilic

37

Medial to lateral

Basilic, brachial, cephalic

38

An interruption device(filer) device normally placed?

IVC below renal veins

39

Blood in the basilic vein normally revels into what vessels?

Axillary vein

40

A PT w/. Mass in upper R. Quadrant in an abdominal exam, in saggital view, the portal vein and hepatic artery are identified as the same:

Both have same color

41

Where does blood from the cephalic vein normally flow into?

Subclavian vein

42

CHF, hypotension and COPD disease can predispose a PT to which Virchow's triad?

Venous stasis

43

A 26 yr old PT has 3 day pain, swelling, redness in R. Lower extremity, you are able to compress veins, flow pattern is accelerated rather than contra-laterally, what is this consistent w/?

Findings are suggestive of hyperemic flow associated w/ inflammatory process

44

A venous duplex exam order on a pt w/ 4 day pain and swelling in lower L extremity(calf area), what could this be?

Baker's cyst, lymphangitis, muscle tear, this is related to distal arteries. Thromboangiitis obliterans related to arteries not veins

45

What is the appropriate hydrostatic pressure(HP) at ankle level of a supine PT?

HP would be 0 mmHg

46

Venous flow is affected by respirations resulting in phasic signals, what effect does inspiration have on lower extremity veins?

Venous outflow from the legs is halted

47

A woman that's 32 weeks pregnant complaining of pain in left lower extremity, using continuos wave Doppler exam you can not obtain flow signal from left common femoral vein site, what can you do?

Reposition the PT in an extreme side-laying position and reevaluate. This try's to diminish extrinsic compression of IVC from pregnancy

48

The tibial veins

Do not normally have spontaneous/phasic flow

49

During a venous duplex exam, you document increases flow during the valsalva maneuver, what is this finding?

It is constant with venous reflux

50

A venous duplex exam finds an acute deep vein thrombosis of left common femoral vein w/ extension into the distal femoral vein( proximal obstruction) what following venous flow patterns would you see?

Left popliteal venous signal could lack spontaneous flow, venous signal of left popliteal will have diminished/absent augmentation w/distal compression, poor/absent phasic left popliteal venous flow

51

How are the veins positioned in the upper arm from medial to lateral?

Basilic, brachial, cephalic

52

An older PT w/ history of DVT is scanned to rule out an acute DVT pre-operatively, the PT asks how to prevent DVT?

Limit inactivity/bed rest, wear support hose, elevate legs and intermittent pneumatic calf compression during/after surgery. Heparin not needed to prevent DVT

53

What is most likely alteration in hemodynamics associated w/ an acute deep vein thrombosis(DVT)?

Decreases in pressure gradient between arteriole and venule

54

Why is there tourniquet used in venous studies utilizing photo plethysmography(PPG) & air-plethysmography(APG)?

Tourniquet eliminates the influence of the superficial venous system to differentiate superficial from deep venous system incompetence

55

An abdominal duplex exam ordered to evaluate a tender mass in upper right quadrant in Sagittal view, portal & hepatic vein identified on some plane, in normal conditions, what colors will be displayed in those vessels?

Both are the same coloration

56

Ulcers can be the result of many conditions, including severe arterial insufficiency. All are characteristics of arterial insufficiency:

Develop on bony prominences, deep w/ regular shape, trophic changes, dry skin, loss of hair and thickened toenails. brawny color not included

57

Usually the vein is able to accommodate large increases in volume without a significant increase in venous pressure, what is this term?

Vessel compliance

58

Paired veins:

Anterior/posterior tibial veins, radial veins and brachial veins. Femoral veins not paired. Femoral vein previously called superficial femoral vein

59

A PT is in for an emergency venous duplex exam, what signs/symptoms is likely related to an acute deep venous thrombosis:

History of 4cm swelling, 3day leg pain, acute onset of swelling , pain & pallor/cyanosis. 4 day old of redness and warmth.

60

A PT w/ history of bilateral LE swelling, Doppler findings have good color filling, complete compressibility of vessel wall w/ spontaneous flow, pulsatile venous flow pattern that augments w/ distal compression, what could this be?

Findings suggest systematic venous hypertension, pulsatile venous signal secondary to venous hypertension, maybe associated w/ CHF or fluid overload.

61

Venous pressure in LE is affected by hydrostatic pressure, weight of column of blood above it, when standing, what factor is directly related to hydrostatic pressure(HP)?

Hydrostatic pressure is directly related to height of person

62

A 73 yr old admitted for acute onset of shortness of breath is being worked up for a pulmonary embolism(PE), what is the best test for this?

Most accurate test to document a PE is pulmonary angiogram

63

Normal direction of blood in the perforating veins:

Perforating veins carry blood from superficial into the deep veins towards heart

64

True about Superior vena cava(SVC):

Drains venous flow from head, neck and arms formed by confluence of the right and left innominate veins, blood from SVC drains into right atrium. SVC has no valves

65

What major differences between ascending and descending venography?

Ascending venography is primarily used to diagnose thrombus & contrast agent injected into the dorsum of foot

66

Trophic changes are related to?

Arterial insufficancy

67

Incompetence in what perforating veins/s most likely develops a venous stasis ulcer?

Perforators to the posterior arch vein

68

A PT w/ a DVT of left common femoral vein w/ extension into the distal femoral vein, what venous patterns would be expected of the left popliteal?

Poor/absent phasic flow of left popliteal, lack spontaneous flow, left popliteal have diminished/absent augmentation w/ distal compression. Won't see phasic flow

69

True about ineffective calf muscle pump?

Results of incompetent valves cause reflux, increase in venous pooling, an increase in venous volume & pressure

70

True about rouleau formation:

Vessel can coapt, flow can be phasic flow or heterogenous material, maybe normal in some PT's, augmentation w/ distal compression

71

Venous pressure in the LE affected by hydrostatic pressure, when standing, what factor directly related to hydrostatic pressure(HP)?

Hydrostatic pressure directly related to height of person

72

How does Doppler venous signal of the arm differ from legs?

Flow from arm deceased during exhalation, while flow from legs increases

73

What veins have the most valves?

Peroneal veins

74

A PT has history of large varicosities along the medial thigh w/ increasing discomfort, what study is best?

Ascending/descending venography, air-plethysmography, venous duplex exam, not a good exam for this is photoplethysmography

75

An upper venous study ordered the PT in the surgical ICU w/ a suspected acute superior vena cava syndrome, how would you expect venous return to the heart w/ inspiration?

Flow would stay the same, proximal compression will be continuos flow

76

What vessel does the internal jugular vein(IJV) carry blood to?

Left innominate vein, IJV joins the left subclavian vein

77

A pregnant woman has pain in LE, the tech cannot obtain a flow signal from L common femoral vein site, what needs to happen?

Reposition in an extreme side-lying position and reevaluate, this try's to diminish extrinsic compression on the IVC from pregnancy

78

A PT w/ history of bilateral lower extremity swelling, duplex shows good spontaneous color flow/filling compressibility of vessel wall, pulsatile venous flow that augments with distal compression, what's the explaination?

These findings suggest systematic venous hypertension, pulsatile venous signal is secondary venous hypertension maybe associated w/ CHF or fluid overload

79

Tech working on PT documents increased flow during the valsalva maneuver, what does this mean?

This is consistent with venous reflux, also during valsalva maneuver ,the color in the vessel goes from blue to red is venous reflex

80

A PT in ICU, duplex exam finds 9cm swelling and blush color of L lower leg compared to R leg, what do you expect to find?

Acute ilio-femoral deep vein thrombosis

81

Acute DVT has:

Very low level echos in a dilated vein, a PT has DVT with evidence brighter echos consistent w/ evidence of recanalization, flow in vein

82

A PT comes in w/ history of large varicosities in medial thigh and discomfort, what study does not look for incompetence, only obstruction?

Ascending phlebography(venography)

83

What is the hemodynamics associated with acute DVT?

Decreases pressure gradient between arteriole and venule

84

A PT is having a upper venous duplex exam w/ a suspected acute superior vena cava syndrome, how would you expect the heart to be affected by inspiration?

Flow would be the same, proximal compression would result in continuos flow

85

A DVT is described by Virchow's triad from these factors:

MI, hormone replacement therapy and intravenous infusions

86

A PT has onset of SOB, chest pain, coughing up blood, what's the most accurate test for a PE?

Angiogram for PE

87

A younger PT has history of 4 day old pain and swelling in lower left extremity, possibility's are:

Lymphangitis, bakers cyst, muscle tear. Can't be thromboangitis obliterans, this is distal arteries not veins

88

Bright echos are more consistent with a chronic process

Low-level echoes more consistent with acute process

89

Normal direction of flow in the perforating veins?

Perforating veins carry blood from superficial into deep veins

90

Signs/symptoms are related to an acute DVT?

Acute pain, swelling, pallor, couple days of pain in lower extremities, redness and warmth.

91

Edema fluid in the subcutaneous tissue is related to these conditions:

Renal dysfunction, electrolyte imbalance, CHF and increased venous pressure

92

IJV, internal jugular vein carry blood to?

Left innominate

93

A PT being evaluated for a DVT, the right lower leg is swollen, know that:

In a bi-fed system, can cause a false negative exam, when actually is positive

94

Arterial ulcers have little to no bleeding and very painful, also arterial usually deeper w/ regular shape and often on bony prominences and has tropic changes.

Venous ulcers are shallow and irregular shape, ooze(bleed) and milder pain, often shallow near medial malleolus w/ brawny discoloration, can result in venous stasis dermatitis

95

Major difference between ascending/descending venography is?

Ascending is primary used to diagnose thrombus, contrast agent is injected into dorsum of foot

96

These precipitating factors of a DVT are described by virchow's triad?

Intravenous infusions, MI, hormone replacement therapy

97

What vessels form the tib-peroneal trunk?

Common peroneal and common posterior tibial veins

98

A PT is diagnosed w/ phlegmasia alba dolens of LLE, what treatment would be most recommended?

Venous thrombeectomy

99

Procedures for a limb threatening situation:

Lytic therapy, femoral vein thrombectomy, anticoagulation, IVC filter

100

Tests for diagnosing a pulmonary embolism:

Venous duplex, ascending/descending venograms, a ventilation/perfusion (VQ) scan, angiogram is least accurate for PE

101

Chronic venous obstruction seen is:

Swelling, heaviness, discoloration, ulcers & varicosities