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Terms in this set (91)
Which category of veins are the main conduit for blood, are surrounded by muscle, and have an accompanying artery?
a. deep veins
b. superficial veins
c. muscular veins
What is the main function of the superficial venous system under normal conditions?
a. to provide a collateral pathway for the deep veins
b. to connect with the deep system through perforating veins
c. to help regulate the body temperature
d. to provide a reservoir for blood
In which way to valves in perforating veins ensure that blood moves, under normal conditions?
a. dissipate around the perforator
b. from the superficial to the deep system
c. from the deep to the superficial system
d. stay in the superficial system
From epidemiologic studies, what percentage of patients develop postthrombotic systems?
Which limb of virchow's triad is demonstrated by a venous thrombus that starts at a valve cusp?
a. wall injury
d. congenital component
A patient presents to the vascular lab for lower extremity venous evaluation. The patient has a known Factor V Leiden genetic factor. Under what risk factor of Virchow's triad does this patient fall?
a. wall injury
d. congenital component
Many patients with venous thrombosis are asymptomatic; however, when symptoms occur, what are some of the most common?
a. extremity pain, tenderness, and swelling
b. muscle pain with exercise
c. ulcerations on toes and thickened toenails
d. extremity weakness, numbness, and tingling
What would a high probability for DVT correspond to on Well's score?
a. < 3 points
b. > 2 points
c. > 3 points
d. > 5 points
When can a false negative D-dimer be seen in the presence of DVT?
a. the patient has underlying malignancy
b. the patient has active inflammation/infection
c. Assay cannot detect high level of fibrin
d. Assay cannot detect low levels of fibrin
For routine operation of a vascular lab, the use of a high- frequency linear transducer (10-18 MHz) is recommended for the evaluation of which of the following?
a. superficial vein reflux
c. distal femoral vein
d. iliac veins
Why will using a reverse trendelenburg position to examine the lower extremity venous system make the exam more difficult?
a. veins will be collapsed
b. veins will be under low pressure
c. veins will be deeper
d. veins without thrombus will be harder to compress
What is the primary method used to determine the presence of thrombus in the extremity veins?
a. color-flow doppler
b. transducer compression of the veins
c. spectral doppler waveforms
d. sagittal B-mode images
Which of the following is NOT a normal qualitative doppler feature evaluated in the lower extremity venous system?
a. continuity of signal
b. spontaneity of signal
c. phasicity of signal
d. augmentation of signal
Which of the following large deep veins are commonly bifid?
a. the profound and popliteal veins
b. the femoral and popliteal veins
c. the external iliac and femoral veins
d. the common femoral and popliteal veins
Which vessels are NOT routinely evaluated in a lower extremity venous duplex examination?
a. femoral vein
b. great saphenous vein
c. anterior tibial veins
d. small saphenous vein
Which veins are one of the major blood reservoirs located in the calf?
a. the tibial veins
b. the small saphenous vein
c. the soleal veins
d. the popliteal vein
What do bright intraluminal echoes and well attached thrombus suggest?
a. acute thrombosis
b. chronic thrombosis
c. too much gain
d. risks of embolization
In what case will indirect assessment of the iliac veins and IVC using doppler at the common femoral veins suggest evidence of obstruction?
a. the doppler spectrum exhibits phasicity
b. the doppler spectrum exhibits pulsatility
c. The doppler spectrum exhibits continuity
d. The doppler spectrum ceases with valsalva
During a lower extremity venous duplex examination, a thin white structure is noticed moving freely in the lumen of the vein. What does this most likely represent?
a. valve leaflet
b. mobile thrombus
d. chronic scarring
Which of the following is a normal response to venous flow with a valsalva maneuver?
a. augmented flow
b. phasicity of flow
c. continuous flow
d. cessation of flow
A patient presents to the vascular lab with sudden onset of left lower extremity pain and swelling. Upon duplex examination, lightly echogenic material is noted within a dilated femoral vein, and the femoral vein does not compress with applied transducer pressure. What do these findings suggest?
a. chronic deep venous thrombosis
b. acute deep venous thrombosis
c. acute superficial venous thrombosis
d. superficial venous valvular incompetence
When a patient presents with right heart failure, what impact is often observed in the spectral doppler waveform in the lower extremities?
a. increased pulsatility
b. continuous flow
c. decreased phasicity
d. loss of augmentation
A patient presents to the emergency department with a massively swollen right lower extremity which is extremely painful and bluish in color. What do these findings suggest?
a. May-Thurner syndrome
b. phlegmasia alba dolens
c. phlegmasia cerulen dolens
d. venous gangrene
Which treatment option is typically reserved for emergent situations in larger veins of the iliofemoral region?
c. elastic stockings
What is the primary treatment of acute lower extremity deep venous thrombosis?
d. elastic stockings
A patient with localized tenderness with limb swelling and a recent history of major surgery would score ________ points based on Well's scoring of risk factors
Greater than 3
What is the main reason that venous thrombosis in the upper extremities has become more common?
a. a more sedentary lifestyle
b. increased injury to vein walls
c. an increase in hyper coagulable disease states
d. decreased rates of prophylactic anticoagulation
Unlike the lower extremities, what do the upper extremities NOT have that may allow spontaneous thrombus formation?
a. deep veins
b. superficial veins
c. soleal sinuses
d. respiratory phasic flow dynamics
What is venous thrombosis secondary to compression of the subclavian vein at the thoracic inlet?
a. paget-schroetter syndrome
b. May-Thurner syndrome
c. Raynaud's syndrome
A patient presents to the vascular lab for upper extremity venous evaluation with face swelling and prominent veins on the chest and neck. What do these findings suggest?
a. subclavian vein thrombosis
b. cephalic vein thrombosis
c. internal jugular vein thrombosis
d. superior vena cava thrombosis
Transducer compressions are limited over several veins in the upper extremity because of limited access from bony structures. What are the most common veins that are NOT able to be compressed?
a. brachiocephalic and subclavian veins
b. subclavian and axillary veins
c. cephalic and basilic veins
d. brachial and radial veins
What is the most appropriate transducer for mapping of the upper extremity superficial venous system?
a. 5 to 10 MHz straight linear array
b. 5 to 10 MHz curved linear array
c. 10 to 18 MHz straight linear array
d. 3.5 to 5 MHz curved linear or sector array
Why are the subclavian and jugular veins assessed with the patient lying flat?
a. to reduce hydrostatic pressure
b. to reduce compression from the clavicle
c. to reduce heart pulsatility
d. to reduce respiration
How does the external jugular vein lie in relation to the internal jugular vein?
With which vein does the brachial vein become the axillary vein at the confluence?
a. cephalic vein
b. radial vein
c. basilic vein
d. median cubital vein
During an upper extremity venous examination, the technologist has made the patient take in a quick, deep breath through pursed lips while viewing the subclavian vein. What is the purpose of this action?
a. dilate the subclavian vein
b. increase color filling of the vein
c. collapse/coapt the subclavian vein
d. show pulsatile flow in the vein
In the upper extremity, in general, which venous system is larger?
a. deep system
b. superficial system
c. deep and superficial of equal size
d. perforating system
During an upper extremity venous duplex examination, the technologist notes significant pulsatility in the spectral doppler waveform from the internal jugular vein. What does this finding suggest?
a. proximal venous obsruction
b. distal venous obstruction
c. normal findings for the IJV
d. superficial venous obstruction
Which vessel may NOT be routinely evaluated in a UE venous duplex examination but is often added in the event of significant thrombosis?
a. internal jugular vein
b. subclavian vein
c. basilic vein
d. external jugular vein
Because of the location of the brachiocephalic veins, documentation of patency of these vessels is usually performed with which of the following?
a. grayscale image with additional color-flow and spectral doppler images
b. grayscale imaging alone
c. grayscale image with and without transducer compression
d. color-flow imaging alone
Which vessel connects the basilic and cephalic veins?
a. radial veins
b. anterior jugular vein
c. medial cubital vein
d. interosseous vein
Which forearm vessels are NOT routinely evaluated during upper extremity venous duplex testing
a. basilic and cephalic veins
b. basilic and ulnar veins
c. cephalic and radial veins
d. radial and ulnar veins
A 34-year-old female presents to the vascular lab with a 1 day history of arm swelling and redness. The patient has recently had a PICC line inserted. During the duplex evaluation, the axillary and subclavian veins are incompressible with hypo echoic echoes noted within their lumens. What do these findings suggest?
a. chronic venous thrombosis
b. acute venous thrombosis
c. acute venous insufficiency
d. normal findings in these vessels
A 78 year old male presents to the vascular lab with right arm swelling for the past several days. The patient notes that he is currently being treated for cancer. During the upper extremity duplex examination, decreased pulsatility is noted in the right internal jugular and subclavian veins as well as rouleaux (slow) flow formation. What do these findings suggest?
a. normal upper extremity duplex examination
b. a more distal obstruction, likely in the brachial and cephalic veins
c. a more proximal obstruction, likely in the brachiocephalic vein or superior vena cava
d. congestive heart failure
During an upper extremity venous duplex evaluation, color flow is noted filling the axillary vein. However, in a transverse view, the axillary vein is noted be only partially compressible. Which of the following could explain these findings?
a. color priority set too low and color gain too high
b. color scale too high and color gain too low
c. color priority and scale too high
d. color packet size and gain too low
A 22 year old male patient presents to the vascular lab with a 3 day history of left arm swelling with no apparent injury or risk factors. Upon further questioning, the patient does state that he has recently begun weight training. What do the vascular technologist suspect in this patient?
a. effort thrombosis
b. superficial venous thrombosis
c. superior vena cava syndrome
Which of the following characteristics are assessed during preoperative evaluation of the superficial venous system?
a. vein patency
b. vein depth and size
c. vein position
d. all of the above
How many common configurations does the thigh portion of the great saphenous vein have?
What is a vein that penetrates the muscular fascia of the leg and connects the superficial system to the deep system?
a. accessory saphenous vein
b. perforating vein
c. deep muscular vein
d. venous sinus
To maximize venous pressure and distention, in what position should the patient's limbs be placed when mapping the superficial venous system?
What measures can be taken to ensure that a patient's vessels do not vasoconstrict?
a. keep the exam room cool and the patient uncovered
b. keep the exam room cool but cover the patient, only exposing the limb being evaluated
c. keep the exam room warm and cover the patient, only exposing the limb being evaluated
d. keep the exam room warm and only cover the foot of the limb being evaluated
Because superficial veins are under low pressure and just under the skin, what type of transducer compression must be used to compress these veins?
Which of the following describes the proper technique for marking a superficial vein in a longitudinal image orientation?
a. vein should appear ovoid in shape; transducer should be perpendicular to skin surface
b. vein should appear ovoid in shape; transducer should be oblique to skin surface
c. vein should fill screen from left to right; transducer should be perpendicular to skin surface
d. vein should fill screen from left to right; transducer should be oblique to skin surface
At what distance should marks be placed along the length of vein when marking?
a. 2 to 3 in
b. 2 to 3 cm
c. 5 to 6 cm
d. 8 to 9 cm
When mapping and marking superficial veins, what is the transverse orientation useful to help identify?
a. the relationship of superficial veins to deep veins
b. branch points and vein diameter
c. vein diameter only
d. branch points and perforator location only
When measuring vein diameters for use as a conduit, how should the veins be measured?
a. outer wall to outer wall
b. outer wall to inner wall
c. inner wall to outer wall
d. inner wall to inner wall
In which part of the arm are the superficial veins easiest to identify?
a. upper arm
c. near the wrist
d. at the antecubital fossa
Why are the vessels easier to identify in the upper arm?
a. the vessels are deeper and smaller in diameter
b. the vessels are larger and have the least amount of branches
c. the vessels are more superficial with multiple branches
d. The vessels follow the deep system
Which landmark can be used to identify the cephalic vein in the upper arm?
a. brachial artery
b. radial artery
c. biceps muscle
Which transducer frequency would be most appropriate for mapping of the cephalic vein?
a. 7 MHz
b. 3.5 Mhz
c. 10 MHz
d. 15 MHz
During a vein mapping procedure, the technologist visualizes a portion of the great saphenous vein that is partially compressible with decreased phasicity upon doppler interrogation. What does this most likely represent?
a. acute, occlusive thrombosis
b. partial thrombosis of the great saphenous vein section
c. chronic thrombosis of a caricosity
d. normal findings in the great saphenous vein
Which condition results in a vein that is unusable as a bypass conduit?
a. wall thickening with evidence of recanalization
b. vein wall calcifications
c. isolated valve abnormalities
d. all of the above
During a venous mapping procedure, the patient notes that she has had prior vein stripping; however, the technologist finds a large superficial vein on the anterior medial aspect of the thigh. What does this most likely represent?
a. the main great saphenous vein, which has recanalized
b. the anterior accessory saphenous vein, which has become dominent
c. the posterior accessory saphenous vein, which has become dominant.
d. a varicosity that should not be evaluated
What minimum size is required for a vein to be used as a conduit?
a. 1-2 mm
b. 1-2 cm
d. 1.5-2 mm
During a venous mapping procedure, the technologist notes a thin, echogenic line protruding into the vessel lumen that does not appear to be mobile. The patient does not have a history of previous superficial thrombophlebitis. What does this finding likely represent?
a. chronic thrombosis
b. stenotic, frozen valve
c. vein wall calcification
When using color and spectral doppler to evaluate the superficial venous system, which settings should be used?
a. high gain and high PRF/scale
b. low gain and a high PRF/scale
c. low gain and a low PRF/scale
d. high gain and a low PRF/scale
In which population are varicose veins typically more common?
c. varicose veins occur as frequently in men as women
d. men older than 65
What are other causes of leg edema that may mimic venous obstruction or valvular insufficiency?
a. lymphatic obstruction
b. cardiac disorders
d. all of the above
A patient presents to the vascular lab with visible spider veins. Based on this information, what would this patients clinical CEAP classification likely be?
Venous pressure in the legs in a supine individual is _____ mm Hg at it's highest, whereas it increases to about _____ mm Hg with standing, depending on a person's height.
a. 25, 200
b. 10, 20
c. 10, 100
d. 50, 120
What is the reason for the increase in venous pressure with standing?
a. cardiac pulsatility
b. the effect of valves on venous flow
c. systolic pressure gradients
d. introduction of hydrostatic pressure
Within which of the following positions can a true saphenous vein be determined?
a. deep muscular fascia
b. subdural lipid layer
c. saphenous fascia
d. anterior vascular compartment
Which of the following is aligned with the deep system?
a. anterior accessory saphenous vein
b. great saphenous vein
c. posterior accessory saphenous vein
d. small saphenous vein
into which of the following vessels does the small saphenous vein terminate?
a. popliteal vein
b. gastrocnemius vein
c. distal femoral vein
d. any of the above
Before assessing the venous system for insufficiency/reflux, which of the following should be performed?
a. evaluation of the deep venous system for obstruction or thrombosis
b. evaluation of the arterial system for atherosclerotic development
c. mapping of the superficial venous system
d. auscultation for bruits in the lower extremities
To best demonstrate valvular incompetence, which position should the patient be examined in?
b. reverse trendelenburg
When performing an examination for CVVI, patency and flow characteristics should be documented at all the following locations EXCEPT:
a. common femoral vein
b. femoral vein
c. popliteal vein
d. anterior tibial vein
Which technique should be used to quantify reflux flow patterns?
a. b-mode imaging with b flow
b. color flow imaging
c. spectral doppler
d. power doppler
Pathologic flow or reflux occurs during _____ of an automatic cuff when the cuff is distal to the site of insonation
d. none of the above
Which of the following describes the proper use of an automatic cuff compression device?
a. rapid inflation from 70 to 80 mm Hg of pressure, held for a few seconds and released quickly
b. Paced inflation from 70 to 80 mm Hg of pressure, then released quickly
c. Rapid inflation from 120 to 150 mm Hg with immediate rapid deflation
d. gradual inflation and deflation of the cuff with the patient's respiratory cycle
What is the major advantage of using hand compression instead of automatic cuff inflators?
b. adaptability to unusual venous segments
c. standardized technique and pressures
d. less technical error
Which of the following is NOT a pitfall in measuring reflux?
a. high persistence resulting in false-positive color flow findings
b. high velocity scale setting affecting color flow sensitivity
c. Low wall filter settings allowing visualization of low velocity venous flow
d. gain settings too high altering the sensitivity of spectral doppler
After thermal ablation of a vein, what do the sonographic findings include?
a. smooth, thin-walled veins that are fully compressible with anechoic lumens
b. dilated, incompressible veins with hypoechoic material filling the vein
c. small-diameter vein that is partially compressible with an echogenic lumen
d. potentially monographically absent, fibroses, or recanalized veins at different locations along the vein length
Valvular reflux times as measured on a spectral doppler display are typically considered abnormal when greater than how many seconds?
What is the main purpose for venous photoplethysmography of the lower limb?
a. definitive diagnosis of venous reflux
b. determination of level of reflux
c. screening for detection of reflux
d. screening for venous thrombosis
What can the use of a tourniquet during venous PPG testing help determine?
a. deep versus superficial venous reflux
b. great saphenous versus accessory saphenous vein reflux
c. venous reflux versus venous thrombosis
d. perforating vein reflux
A patient presents to the vascular lab for evaluation of valvular incompetence. A venous PPG exam is performed. The results of the exam demonstrate a venous refill time of 10.5 seconds without the use of a tourniquet and 22 seconds with a tourniquet. What do these findings demonstrate?
a. normal findings
b. presence of deep venous reflux
c. presence of superficial venous reflux
d. presence of both deep and superficial venous reflux
What is air plethysmography useful for?
a. determining deep versus superficial venous thrombosis
b. determining deep versus superficial venous reflux
c. qualification of deep venous reflux
d. quantification of chronic venous insufficiency
Using APG, increased ambulatory pressures suggestive of the inability to empty the calf veins owing to poor or nonfunctional calf muscle pump are indicated with which of the following findings?
a. residual volume greater than 20% to 35%
b. low venous volume
c. venous filling rate less than 2 mL/s
d. venous filling time greater than 25 seconds
Which of the following is an emerging technology that may help with guidance of venous access, phlebotomy, and injection sclerotherapy?
a. venous photoplethysmography
b. near-infrared imaging
c. air plethysmography
d. radio frequency imaging
Venous photoplethysmography is performed to measure:
a. volumetric filling rate
b. residual venous volume
c. venous emptying time
d. venous recovery time
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