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47-year-old patient with a history of DVT one month ago presents for a follow-up examination. The scan reveals an echogenic thrombus adhered to the vessel wall. The vein is still partially compressible and the vein walls are slightly echogenic. Small channels of flow are seen. The patient is on anticoagulants. This is most likely consistent with:
Penile blood supply is derived from the:hypogastric arteryA patient is referred for intradermal venules of 0.9 mm in diameter. The appropriate terminology for this symptom is:TelangiectasiasSecondary venous insufficiency, i.e. valves damaged as a result of a previous thrombophlebitis, is also often referred to as:Post-phlebitic syndrome: Renal fibromuscular dysplasia usually occurs in__________, in the _______segment of the renal artery.Women; mid-distalDoppler spectral waveforms acquired during an arterial duplex scan are performed in the _______________ plane.LongitudinalIf the Saphenous vein is left in place (in situ) for a lower extremity graft, the surgeon disables the ____________ in order to allow flow down the vein.ValvesCriteria for a >70% stenosis of the celiac artery is a velocity > _______ with post stenotic turbulance.200 cm/secA Brescia-Cimino Fistula goes from the __________ artery to the ___________ vein and is the most common fistula.Radial ; cephalicNormal internal jugular vein flow should be __________ , and flow direction should be towards the heart.Pulsatilet/f
The thoracic aorta ascends from the aortic arch.falsePosterior tibial perforating veins (Cockett's) connect the posterior accessory GSV to the:Posterior tibial veins: During exercise, peripheral resistance in the capillary beds __________ as vasodilatation occurs in the arterioles.decreasesThe cephalic vein joins the subclavian vein just _________ to the clavicle.distalA young patient with no vascular risk factors presents with distal carotid artery occlusion. This patient should be evaluated for:dissectionNormally the ankle systolic pressure is the same as or greater than the highest ____________ blood pressure.BrachialAV fistulas created for dialysis access grafts are preferred over synthetic access grafts because:They are natural in the body and last longerNormal toe brachial indicies should be 0.75 or greater. A TBI < ______ is considered to be abnormal.0.60The segment of the ICA that passes between the 2nd and 3rd cranial nerves at the Sylvian fissure is the:Cavernous portionQ: If a common carotid occlusion is found, the ICA, distal to the bifurcation, may remain patent, enabled by retrograde flow in the _______________ feeding the patent ICA.ECAWhat is a positive Homan's Sign?Calf discomfort with passive dorsiflexion: Arterioles are small arteries that lead into thin walled_______________.capillariesVelocity signals in a venous Doppler examination should be obtained in ______________view (s) to maximize the Doppler shift.SagittalAll of the following are venous return "pump systems" EXCEPT:: The popliteal pumpA heterogeneous plaque, without an acoustic shadow, most commonly signifies a __________ lesion.fibro-fattyNormal penile duplex values during erectile state are:PSV >35cm/sec ; EDV <5cm/sec___________ flow is characterized by concentric layers of blood moving in parallel down the length of a blood vessel. The highest velocities will be found in the center of the vessel and the lowest velocities will be found along the vessel wall as demonstrated in this image.ParabolicQ: Renal - Aortic velocity ratio measurement is valid only when the aortic peak systolic velocity is in the normal range of40-100 cm/sec.In Transcranial Doppler, there are several approaches to obtain Doppler signals. For the vertebral and basilar arteries the best approach is the ____________ window.SuboccipitalAll of the following are treatments for varicose veins EXCEPT:Anticoagulant therapyQ: The Saphenous vein is removed, turned upside down and sewn back in to be used as an arterial conduit. This is known as a (an) _____________ _______________ graft.reverse vein: Velocities in Transcranial Doppler are routinely measured in: ________ velocity.meanHemodialysis fistulas are commonly placed in the _____________ segment of the patient's non-dominant arm.distalTranscranial Doppler studies are normally performed with a2 MHz __PW TransducerRenal fibromuscular dysplasia usually occurs in__________, in the _______segment of the renal artery.Women; mid-distal: All are parameters for the sonographic diagnosis of portal hypertension, EXCEPT:: SMA flow directionIf a common carotid occlusion is found, the ICA, distal to the bifurcation, may remain patent, enabled by retrograde flow in the _______________ feeding the patent ICA.ECAPulsatile venous flow has two primary causes. They are:Pulmonary hypertension and congestive heart failureArterial obstruction can result in reduced pressure and flow ___________to the site of blockage.distalIn general, propagation speeds are lower through ________, higher through ________and highest ingases, liquid, solidsBilateral acute DVT occurs less than _______ of the time, therefore leg swelling should be compared to the unaffected leg.1%All of the following are examples of non-athrosclerotic disease EXCEPT:AneurysmsQ: The property that causes a fluid or object not to change direction or speed:InertiaA common site for a hemodialysis access graft is in the non-dominant wrist. This is known as a (an) ______________ fistula.Brescia-CiminoIn a near total internal carotid artery occlusion, only a trickle flow condition may be present. The sonographer would need to adjust which of the following controls to enhance this flow:Only 2 and 3____________is a condition that may mimic deep venous thrombosis, but is actually the accumulation of subcutaneous fat, usually in adult females, producing edema. This condition is called:: LipedemaQ: Velocity signals in a venous Doppler examination should be obtained in ______________view (s) to maximize the Doppler shift.SagittalQ: Portal hypertension is confirmed by all of the following except:Hepatopetal flowQ: The arterial layer composed of collagen and elastic fibers is the:Tunica adventitiaCellulitits of the lower extremities is more likely to develop into thrombophlebitis in a(an)______________ patient.elderlyA PVR waveform is a qualitative reflection of the volume of blood coming into:One particular cuff segmentQ: The subclavian artery on the left originates from the _____________.Aortic archIf the Saphenous vein is left in place (in situ) for a lower extremity graft, the surgeon disables the ____________ in order to allow flow down the vein.ValvesIn Transcranial Doppler, there are several approaches to obtain Doppler signals. For the vertebral and basilar arteries the best approach is the ____________ window.Suboccipitalin the following image, there is pathology that is consistent with fresh thrombus in the common carotid artery. This patient is at risk for:Cerebrovascular accidentA spectral Doppler signal at 60 degrees to the vessel axis is acquired. There is marked spectral broadening with an end-diastolic velocity calculation of 150 cm/sec in the proximal ICA. Based on the NASCET criteria, this is consistent with:>70% stenosisDoppler spectral waveforms acquired during an arterial duplex scan are performed in the _______________ plane.Longitudinalvelocities in Transcranial Doppler are routinely measured in: ________ velocity.meant/f
Q: Under normal conditions, the brain is a high resistance vascular bed.falsePortal hypertension is confirmed by all of the following except:Hepatopetal flowArterial bypass grafts may develop a stenosis anywhere along the graft, but particularly at the _____________ or at any valve sites.Distal anastamosisA 47-year-old patient with a history of DVT one month ago presents for a follow-up examination. The scan reveals an echogenic thrombus adhered to the vessel wall. The vein is still partially compressible and the vein walls are slightly echogenic. Small channels of flow are seen. The patient is on anticoagulants. This is most likely consistent with:Recanalized DVTrenal transplants are evaluated for kinks, stenosis and rejection.The normal RI (resistive index) in evaluating the renal artery leading to a transplanted kidney would be:<0.73 + (-) 0.04A reflux time of _______ seconds is consistent with perforator incompetence.>0.35A young patient with no vascular risk factors presents with distal carotid artery occlusion. This patient should be evaluated fordissectionArterial obstruction can result in reduced pressure and flow ___________to the site of blockage.DistalWhich of the following factors determines a transducers resonance frequency?Crystal thicknessThe portion of individuals with a NEGATIVE test result that actually do not have the condition:Negative predictive valueThe ABI, or Ankle Brachial Index, is based on the ankle pressures bilaterally and the ipsilateral upper extremity blood pressure?False: Common hemodialysis loop grafts include:1 and 2 onlyAll of the following would be appropriate in preparing a patient for a mesenteric artery Doppler EXCEPT:A 10 MHz transducer is positioned left of midline in longitudinal planRetrograde flow in the right vertebral artery and the proximal subclavian artery usually indicates:Innominate artery occlusionQ: A normal lower extremity venous ultrasound is performed on a patient with swelling, tenderness, skin erythema and pain. What could be the differential diagnosis?Cellulitist/fQ: When performing a Doppler exam on a renal transplant patient, the indirect method should be used in conjunction with the direct method.trueQ: Normal peak shunt velocities in a TIPS Stent range from ____________ .100 - 200 cm/sec____________is a condition that may mimic deep venous thrombosis, but is actually the accumulation of subcutaneous fat, usually in adult females, producing edema. This condition is called:Lipedema: The portion of individuals with a NEGATIVE test result that actually do not have the condition:Negative predictive valueFactors that can affect flow resistance are all of the following EXCEPT:Pressure gradientA tanning or brown discoloration of the skin in the lower leg:Stasis dermatitisAll of the following statements about carotid dissection are true EXCEPT:Low resistant waveforms are seenA Brescia-Cimino Fistula goes from the __________ artery to the ___________ vein and is the most common fistula.cephalicQ: Abnormal post-endarterectomy findings may include:allQ: In non-diabetics, foot lesions are unlikely to heal if the ankle pressure is less than _________.50 mm HgQ: As the operating frequency of the transducer increases, the frequency shift ______________.IncreasesQ: There is an occluded CCA with a patent ICA. The ICA is being supplied by:Retrograde ECAt/f
The brain receives 15% of total cardiac output.trueQ: When obtaining a peak systolic velocity measurement using duplex techniques, the angle cursor should be adjusted ______________ to the vessel wall.parallelMesenteric Ischemia often presents with the patient complaining of dull achy abdominal pain _____________ a mealafterQ: A patient is seen post endovascular aortic aneurysm repair (EVAR) with a leak at graft ends due to inadequate seal. This occurs when there is a gap between the graft and the vessel wall at "seal zones" This gap allows blood to flow along the side of the graft and into the aneurysm sac, which creates pressure within the sac and increases the risk of sac rupture. This type of endoleak usually requires urgent attention due to the risk of sac enlargement and rupture and is called a Type _____ endoleak.type 1Q: The common femoral vein lies ____________________ to the common femoral artery.medialQ: There are more _____________in the upper extremity, making this examination more difficult.Anatomic variationsQ: Plethysmography is any technique that measures volume changes in the peripheral vasculature. These volume changes are caused by changes in _____________________.Blood volumeQ: A decrease in diameter of 50% of an internal carotid artery corresponds to a ________% decrease in cross-sectional area.75Intraluminal thrombi frequently originate at the cusps of the venous valves or in the ___________________because of stagnation.Soleal sinusesQ: The cerebral artery branches of the internal and vertebral arteries come together at the base of the brain to form an important collateral pathway called the __________________________________.Circle of WillisQ: PVR cuffs are sequentially connected to the plethysmograph and inflated to a specific pressure of:65 plus or minus 5 mm HgQ: The physiologic arterial Doppler study is done with a _________________ probe.Continuous waveRenal fibromuscular dysplasia usually occurs in__________, in the _______segment of the renal artery.Women; mid-distalAll of the following are true regarding lower arterial physiologic exercise stress testing, EXCEPT:It is performed on all patients that complain of claudication and known cardio-vascular diseaseQ: The EJV (external jugular vein) lies __________ to the subclavian vein.superficialQ: In the diagram provided, what is F pointing to?Vertebral arteryQ: When there is disease in the proximal arteries of the limb, the resistance in the popliteal and tibial arteries will:DecreaseQ: One of the limitations of arterial physiologic testing is its inability to identify the:Precise location of diseaseQ: Hydrostatic pressure is equal to the weight of a column of blood extending from the heart to ____________________.The level of where the pressure is being measuredQ: Renal - Aortic velocity ratio measurement is valid only when the aortic peak systolic velocity is in the normal range of:: 40-100 cm/sec.In this image, identify the vessel best seen with a transtemporal window with 30-60 mm of depth and flow toward the transducer:Middle cerebral arteryQ: The ______ window can be used to locate the proximal intracranial portion of the ICA.SubmandibularQ: What is a disadvantage of Photoplethysmography (PPG)?Both 2 and 3Q: The definition of Sensitivity is the ability of the test to detect:Disease when presentQ: Compared to flow in a normal artery, flow in the artery proximal to an arterio-venous fistula is greatly:IncreasedQ: The Saphenous vein is removed, turned upside down and sewn back in to be used as an arterial conduit. This is known as a (an) _____________ _______________ graft.reverse veinQ: The right renal artery runs ___________to the IVCposteriorQ: The three mesenteric arteries examined in a full mesenteric artery study:Celiac, SMA and IMAQ: At rest, blood flow to an extremity may be normal, even in the presence of a severe blockage or complete obstruction of the main artery, due to _______________and _________.Collateral circulation; reduced peripheral resistanceQ: A 2:1 systolic velocity ratio with focal velocity acceleration followed by post stenotic turbulence is the most reliable indicator for the presence of a ______ % or greater stenosis.50Q: A "tardus parvus" Doppler waveform with low systolic velocity is seen in a unilateral common carotid artery. The most likely cause is:CCA origin or brachiocephalic artery stenosisQ: The saphenous vein as seen in this image confluences with which vessel?The common femoral vein at the inguinal ligamentQ: If a common carotid occlusion is found, the ICA, distal to the bifurcation, may remain patent, enabled by retrograde flow in the _______________ feeding the patent ICA.ECAQ: It is the Technologist's responsibility to obtain the ultrasound information in a clear and accurate manner, using the least amount of power and time. This principle is referred to as the ______________ principle.alaraQ: 90% of incompetent perforators are > _____.3.5 mmQ: Which of the following factors determines a transducers resonance frequency?Crystal thicknessQ: Anatomically, the popliteal vein lies _______________ to the popliteal artery.: PosteriorQ: During Doppler interrogation of the MCA, the velocity is 210 cm/sec to 225 cm/sec during a series of waveforms. This is most consistent with:VasospasmQ: All of the following would be appropriate in preparing a patient for a mesenteric artery Doppler EXCEPT:A 10 MHz transducer is positioned left of midline in longitudinal planeQ: All are parameters for the sonographic diagnosis of portal hypertension, EXCEPT:SMA flow directionQ: A common dialysis access graft anastomosis site in the lower extremity:All of the aboveQ: A patient presents with focal pain and a palpable subcutaneous cord in the lower extremity. The patient should be assessed for:Superficial thrombophlebitisQ: Common signs of pulmonary embolism include all of the following EXCEPT:Positive Homan's signQ: Normal internal jugular vein flow should be __________ , and flow direction should be towards the heart.pulsatileQ: Volume flow rate is proportional to the difference in _________at the ends of a tube.PressureQ: Transcranial Doppler studies are normally performed with a ________2 MHz __PW TransducerQ: Tardus Parvus waveform in the vertebral artery indicates:Proximal vertebral artery obstructionQ: The following patient was referred for possible mesenteric ischemia. The celiac artery PSV = 412 cm/sec. This most likely represents:Stenosis > 70%Q: A PVR waveform is a qualitative reflection of the volume of blood coming into:One particular cuff segmentQ: Deep veins carry _____ % of blood volume in legs.: Both 2 and 4Q: During systole, the _________________ and________________ have the highest pressure in the arterial system.Left ventricle; thoracic aortaQ: All of the following are related to a subclavian steal except:All are correctQ: If a vein lumen does not recanalize but remains substantially narrowed or occluded it is known as:Fibrous cordQ: In the following diagram, identify the artery labeled A:Hypogastric arteryQ: A RIND is a ___________ __________ __________ __________, that lasts longer than a TIA, but the deficit resolves in time (usually within 72 hours or less.) Brain tissue is damaged but recovers completely.Reversible Ischemic Neurologic DeficitQ: Venous intraluminal pressure in the legs is about _______ mm Hg when recumbent, and about _______ when standing.10; 80Q: In the presence of severe proximal arterial disease, the Doppler waveform may be ______________with a delayed _________.Monophasic; rise timeQ: An increase in the viscosity of blood, or in the length of the vessel, ___________ the resistance.IncreasesQ: To obtain consistent and comparable ratio measurements, the CCA measurement for the ICA/CCA ratio should be obtained...1 to 2 cm proximal to the carotid bulbQ: The normal renal artery flow pattern is characterized as:Low resistanceQ: Pulsatile changes in minute arteries, arterioles and capillaries are reduced by _______________and enhanced by ______________.vasoconstriction; vasodilatationQ: Bilateral arm blood pressure differential of 20mmHg or more suggests the presence of _______________ on the side with the lower pressure.Subclavian obstructionQ: A significant renal artery stenosis (>60%) will demonstrate the following:1, 2, and 3 are all correctQ: MCA (middle cerebral artery) flow direction should be _________ the transducer.towardQ: When comparing a normal PVR waveform to a normal Doppler waveform, the PVR waveform would have a sharp upstroke and a prominent reflected wave in late systole, and early diastole.
t/fTrueQ: Using the SRU criteria, an ICA PSV of 200 cm/sec and ICA EDV of 80 cm/sec corresponds to a __________ stenosis:50-69%Q: The deep veins course adjacent to major __________.ArteriesQ: Echo signals moving toward the transducer would be:Higher than the frequencies moving away from the transducerQ: Distal venous compression should increase the venous flow to the heart and _____________flow distal to the site of the compression if the _________are competent:Stop; valvesQ: Criteria for a >70% stenosis of the SMA is a velocity > _______ with post stenotic turbulance.275 cm/sevQ: Criteria for a >50% AV graft or fistula stenosis is peak systolic velocities:>400 cm/secQ: The normal Vertebral Doppler spectrum will demonstrate a __________ resistance Pattern.lowQ: We should attend all infectious disease in-services and follow the specific "precautions" signs on in-patient doors. The term Universal Precautions, recommends that we wear gloves for _____________ patient testing.allQ: The cephalic vein joins the subclavian vein just _________ to the clavicle.DistalQ: In post-exercise ankle brachial recordings, prolonged recovery time to baseline pressure is suggestive of ____________.Both 1 and 2t/f
Q: A true aneurysm is one in which the artery walls are intact, but stretched.trueQ: When multiple atherosclerotic lesions are present in the cerebral vessels, the adequacy of the collateral channels may be greatly ___________.DecreasedQ: All of the following are true regarding an in situ fem-pop graft EXCEPT:Newer flexible fabrication may allow placement to extend below the knee.Q: Tissue breakdown, due to lack of oxygen and nutrients, usually occurring near the medial malleolus, where incompetent perforators are located, best describes________________.Venous ulcerationQ: At rest, the total blood flow to an extremity may be normal in the presence of a severe stenosis or even a complete obstruction of the main artery, because of the development of _____________.Collateral circulationQ: All of the following are venous return "pump systems" EXCEPT:The popliteal pumpQ: If a patient with a hemodialysis access graft presents with symptoms of an arterial steal, the perfusion _____________ to the graft will need to be evaluated.DistalQ: Under normal conditions, the brain is a high resistance vascular bed.FalseQ: A spectral Doppler signal at 60 degrees to the vessel axis is acquired. There is marked spectral broadening with an end-diastolic velocity calculation of 150 cm/sec in the proximal ICA. Based on the NASCET criteria, this is consistent with:>70% stenosisQ: In computing the ABI (Ankle Brachial Index) the ankle pressures are compared to the:Highest brachial pressureQ: Budd-Chiari Syndrome can be characterized by:all but 2Q: The _____________ artery lies adjacent to the border of the fibula.PeronealQ: The most common complaints of lower extremity symptomatic venous thrombosis are:Persistent calf pain, tenderness and swellingQ: Which statement best describes this image?Normal color and spectral Doppler of the CCAQ: The common carotid artery located contralateral to an ICA stenosis or occlusion may demonstrate increased flow velocity overall, particularly elevation of the _________ diastolic velocity.EndQ: If the Saphenous vein is left in place (in situ) for a lower extremity graft, the surgeon disables the ____________ in order to allow flow down the vein.ValvesQ: A peripheral vein must be visualized clearly in the transverse view to ensure complete__________;CompressionQ: In a near total internal carotid artery occlusion, only a trickle flow condition may be present. The sonographer would need to adjust which of the following controls to enhance this flow:2 and 3Q: Extravascular sources such as tumor, hematoma or cyst may cause __________ of a vein that is difficult to differentiate clinically from deep venous thrombosis.Both 2 and 3Q: A patient is referred for intradermal venules of 0.9 mm in diameter. The appropriate terminology for this symptom is:TelangiectasiasQ: Secondary venous insufficiency, i.e. valves damaged as a result of a previous thrombophlebitis, is also often referred to as:Post-phlebitic syndromeQ: Flow velocities in the basal cerebral arteries _________with age.DecreasesQ: The portal vein diameter should not exceed ______mm in quiet respiration.13Q: Enhanced flow through a stenosis results in increased loss of energy, which can be detected by a decrease in ____________distal to the lesion.pressureQ: During exercise, peripheral resistance in the capillary beds __________ as vasodilatation occurs in the arterioles.DecreasesQ: AV fistulas created for dialysis access grafts are preferred over synthetic access grafts because:They are natural in the body and last longerQ: Effects of a cold room temperature in arterial testing include:all of the aboveQ: The property that causes a fluid or object not to change direction or speed:InertiaQ: If you have your patient perform a valsalva maneuver, the vein will dilate as the _______________ pressure and consequently the ____________pressure increases.Intra-abdominal; intravenousQ: The segment of the ICA that passes between the 2nd and 3rd cranial nerves at the Sylvian fissure is the:\Cavernous portionQ: The radius in Poiseuille's Law is the radius for the:Entire tube or vesselQ: Arterial bypass grafts may develop a stenosis anywhere along the graft, but particularly at the _____________ or at any valve sites.Distal anastamosisQ: Criteria for a >70% stenosis of the celiac artery is a velocity > _______ with post stenotic turbulance.200 cm/secQ: Posterior tibial perforating veins (Cockett's) connect the posterior accessory GSV to the:posterior tibial veinsQ: In the following diagram, identify the vessel labeled P:main portal veinQ: One of the most common types of arteritis is Buerger's disease. The characteristics of this include all of the following EXCEPT:Primarily in women over 40Q: In the following image, there is pathology that is consistent with fresh thrombus in the common carotid artery. This patient is at risk for:Cerebrovascular accidentQ: In Transcranial Doppler, there are several approaches to obtain Doppler signals. For the vertebral and basilar arteries the best approach is the ____________ window.SuboccipitalQ: Sonographers should be conscious of the possibility of a "double system", particularly in the deep veins. For example, one estimate indicates that 20% of patients have a double ___________________.Femoral veinQ: Based on this image, the vein has the following pathological properties:VaricositiesQ: Hemodialysis fistulas are commonly placed in the _____________ segment of the patient's non-dominant arm.distalQ: The Continuity Rule refers to flow increase across:the stenosisQ: In this image, the common femoral vein appears to be:Acutely ThrombosedQ: Doppler waveform analysis is an important aspect of evaluating lower extremity arterial disease. Normal Doppler waveforms in the lower limb should exhibit ________________characteristicsBoth 1 and 3Q: In the following diagram, identify the vessel labeled S:Right renal arteryt/fQ: A continuous wave Doppler instrument is capable of examining at a particular depth.falseQ: An alternative to color flow imaging is _________________imaging. This method ignores the velocity and simply estimates the _______of the signal detected from each location.Power mode; amplitudeQ: The carotid bulb can display complicated flow patterns due to changes in geometry. This is referred to as the _______ ________ zone.Boundary separation
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