Davies vascular review dvd
The most common anatomic variant of the aortic arch is:
A common origin of the innominate and left common carotid arteries A common origin of the innominate and left common carotid arteries is by far the most common variant anatomy of the aortic arch, occurring in approx 22% of individuals
What is the most common anomaly of the circle of Willis?
Absence or hypoplasia of one of both of the communicating arteries The circle of Willis as a "normal" configuration in only 50% of cases. There are many variations, the most common of which is absence or hypoplasia of one or both communicating arteries. The accompanying figures illustrates the normal config of the circle of Willis (A) together w the 3 common variations: (B) hypoplasia of the ACA, © hypoplasia of the PCA and (D) hypoplasia of the ACA
All of the following may represent symptoms from the brain stem or posterior circulation EXCEPT:
Amaurosis fugax -Dizziness, vertigo, ectasia, syncope Amaurosis fugax is a transient blindness, usually in one eye. Lateralizing symptoms are usually from the anterior circulation, whereas nonlateralizing ischemic attacks are usually rom the posterior circulation
A patient complains of a temporary shading of the vision in one eye. This symptom is called?
Amaurosis fugax By definition amaurosis fugax is a unilateral symptom that is temporary in nature. It is freq described by the patient as a curtain or a shade that blocks vision temporarily
The popliteal trif is actually a double bif. Which pairs form these two bifurcations?
Anterior tibial and tibioperoneal trunk; then posterior tibial and peroneal
The superior mesenteric artery typically originates from the:
Aorta between the celiac trunk and the renal arteries
What is the name of the tiny intrarenal branches that arise from the interlobar arteries at right angles and course above the renal pyramids?
Arcuate arteries The main renal artery divides at the hilum of the kidney into segmental renal arteries. These in turn give rise to the interlobar arteries, which course alongside the renal pyramids. The arcuate arteries arise at right angles from the interlobar arteries and course on top of the renal pyramids. Within the renal cortex, the arcuate arteries give rise to the radially oriented interlobular arteries.
A dz that affects primarily the intima and may extend into the media is:
Atherosclerosis
Which of the following is NOT true regarding atherosclerosis?
Atherosclerosis is a red blood cell dz -atherosclerosis starts as a breakdown of the intima -Atherosclerosis usually develops at bifurcations -atherosclerosis is a generalized dz -Intimal damage/repair may begin in adolescence Atherosclerosis is a generalized dz that begins most often at bifs due to the shear forces generated at the wall surfaces. Patients w atherosclerosis in the periphery will have other atherosclerotic changes in the carotid and coronary vessels even though these maybe clinically silent. Disruption of intimal continuity is the primary initial manifestation.
In this cross section, which letter represents the small saphenous vein?
B
The axillary artery connects the:
Brachial artery to the subclavian artery
In this cross section, which letter represents the fibula?
C
The smallest vessels in the body are:
Capillaries
After carotid bif dz, the next most common source of stroke symptom is:
Cardiac source embolization Atrial fib and myocardial infarction are the two most common causes of mural thrombus in the heart
The circle of Willis receives its blood supply from which combination of arteries?
Carotid and vertebral arteries This remarkable connection of the carotid and vertebral arteries makes possible the ability of the brain to withstand extra cranial carotid occlusion without significant symptoms
A 24 yr old patient w a hx of recent auto accident arrives in the ICU w symptoms of acute right sided weakness and aphasia. The most likely etiology of these symptoms is:
Carotid dissection Any kind of severe inertial injury, as w the sudden and violent movement of a car accident, can cause a tearing injury to the aorta or other arteries. A patient this young is unlikely to have atherosclerotic carotid dz. Cerebral aneurysm is more distantly possible, but the hx of auto accident makes carotid dissection the best answer
The splenic, common hepatic and the left gastric arteries arise from this abdominal artery:
Celiac trunk The celiac is the first major branch of the abd aorta. It divides into the common hepatic, splenic and left gastric arteries
What is NOT a deep vein of the upper extremity?
Cephalic vein The deep veins of the upper extremity include the deep palmer venous arch, radial veins, ulnar veins and interrosseous veins of the forearm, brachial veins and axillary vein. The deep veins accompany the same named arteries and are usually paired. The cephalic, basilic and median cubital veins are superficial veins. They do not accompany an artery and are usually not paired.
At the inguinal ligament, the external iliac artery becomes the:
Common femoral artery
Because of the location of the inferior cava, the left renal vein:
Crosses anterior to the aorta inferior to the left renal artery The aorta is to the left of midline, while the vena cava is to the right. Thus, structures located in the left side of the abdomen must have their venous outflow across the aorta. The left renal vein is anterior to the aorta, usually just inferior to the level of the renal artery
The left common iliac vein
Crosses post to the right common iliac artery just dist to the aortic bifurcation The left common iliac vein is medial to the artery. The vena cava is to the right of the aorta. Thus, the left venous system must cross some arterial structure to communicate w the vena cava,
The NASCET (North American Symptomatic Carotid Endarterectomy Trial) used the following arteriographic criteria to classify internal carotid artery dz:
Diameter percentage stenosis calculated by dividing the minimal diameter by the diameter of the un-stenosed distal internal carotid artery Many studies prior to the NASCET study used the maximum diameter of the carotid bulb as a reference. Since an angiogram cannot accurately determine the outer diameter of the bulb, this method has probably caused inaccurate results. On the other hand, our diagnostic velocity criteria were based on the old method, which makes correlation w angiography more complex
A symptom of vertebrobasilar insufficiency is:
Diplopia Diplopia-double vision-is a symptom of vertebrobasilar insufficiency
What is the LEAST imaged vein segment?
Distal deep femoral vein
In this cross section of the calf, which letter represents the posterior tibial vessels?
E
In this cross section, which letter represents the membrane?
E
The vessel courses along the medial aspect of the poses muscle:
External iliac artery
A patient relates a 10-min episode of loss of vision. He closed each eye and the reduction in the right half of his visual field was present bilaterally. This patient is describing amaurosis fugax. T or F
False Amaurosis fugax is transient monocular blindness. This patient is describing homonymous hemianopia
Which of the following is NOT considered a risk factor for atherosclerosis?
Female gender Hypertension, diabetes mellitus, lipoprotein abnormalities, tobacco use are risk factors. Being female is not considered a risk factor, although post menopausal females are at greater risk for atherosclerosis than pre menopausal females. Indeed, male gender is considered a minor risk
Cerebrovascular fibromuscular dysplasia occurs in:
Females
Muscular veins of the calf that empty into the popliteal vein behind the knee are:
Gastrocnemius veins Gastrocnemius veins are commonly seen on the venous duplex scan and may be thrombosed like other calf veins. They should be distinguished from solar sinuses, which empty into the posterior tibial and perineal veins in the calf itself
From this cross-sectional diagram of the thigh, reading from superficial to deep, identify the vessels marked:
Great saphenous vein, femoral vein, profunda femoris vein
Peripheral resistance increases w:
Greater length, smaller diameter and higher blood viscosity Poiseuille's resistance equation demonstrates the influences on resistance of length, viscosity and radius
The strongest risk factor for stroke is:
Hypertension
The first major arterial branch of the aorta?
INNOMINATE ARTERY The innominate artery (also called the brachiocephalic trunk) is the first of the three great vessels to arise from the aorta
Which of the following is not correct regarding the GSV?
IT PASSES SUPERIORLY ON THE LATERAL SIDE SIDE OF THE KNEE -It passes superiorly on the medial side of the thigh -It enters the common femoral vein -It extends distally to the dorsum of the foot -It has more valves in the calf than in the thigh
A left arm blood pressure that is 40 mmHg lower than the right can be the result of any of the following EXCEPT:
Innominate artery occlusion If the innominate were involved, it would lower pressure on the right, not the left. The other answer choices are at least dimly possible, if not always likely
Match each proximal vessel with its branch or continuation:
Innominate artery- Subclavian Subclavian -Vertebral Common Carotid -Internal carotid Vertebral -Basilar External carotid -Superficial temporal
The following arteries have low resistance flow character:
Internal carotid, postprandial superior mesenteric and renal arteries postprandial (after a meal) superior mesenteric flows have lower resistance, higher diastolic flor character
Another name for the hypogastric artery is:
Internal iliac artery
Another name of the hypogastric artery is:
Internal iliac artery
Atherosclerosis is a disease that begins in the:
Intima The intimal lining of the endothelial cells becomes disrupted in the first stage of the atherosclerotic process
The most prevalent type of stroke is:
Ischemic Approx 85% of strokes are ischemic in nature; only 15% of strokes are caused by intracerebral hemorrhage. Strokes caused by hemorrhage, however, account for most stroke fatalities
With a subclavian artery stenosis on the right side:
None of the above will necessarily be present -The flow in the right vert will be reversed -The patient will have right arm claudication -The Arm pressure will be reduced -The right axillary artery doppler signal will be mono phasic All of the answer choices are possible w right subclavian stenosis, but whether they actually occur depends on the severity of the stenosis
Helical flow w flow separation on the wall away from the flow divider is a sign of:
Normal flow dynamics Flow separation at the post wall of the carotid bulb occurs bc the linear momentum of the flow is disrupted by the large sinus and sharp curve at the carotid bulb. Flow separation depends on a relatively disease-free bulb
A hypertensive, diabetic 65 yr old male presents for cerebrovascular testing bc of an asymptomatic bruit on the right side. You are considering all of the following to be potential sources of the bruit EXCEPT:
Occlusion of the common carotid artery -Stenosis of the external carotid artery -Stenosis of the subclavian artery -Dissection of the common carotid A bruit is the result of vibration in the tissue surrounding a stenotic vessel, An occluded vessel cannot produce a bruit
The brachiocephalic vein is found:
On both the right and left sides The venous anatomy in the upper torso differs from the arterial anatomy: There are right and left brachiocephalic veins, which receive flow from the internal jugular and subclavian veins, but there is just the right innominate, also called the brachiocephalic artery
The first intracranial branch of the internal carotid artery is the:
Ophthalmic artery Even tho there is often a branch called the caroticotympanic artery, the ophthalmic artery is regarded as the first major branch of the internal carotid artery. It is central to indirect physiological testing
In the cerebrovascular system, atherosclerosis occurs most commonly in the:
Origin of the internal carotid artery
The superficial vein that sends flow to the three main perforating veins of the distal calf (Cockett's perfs) is called:
Posterior accessory vein The post accessory vein (post arch vein), since it connects the post tab perf veins in the mid to dist calf, is implicated in the formation of venous stasis ulcers
In B mode imaging of the common femoral artery and its bif into the profunda femoris and superficial femoral arteries, normally the profunda femoris artery courses:
Posterolateral to the superficial femoral artery Profunda femoris is latin for deep femoral and the two are used interchangeable; thus, the profunda femoris artery is posterior (deep) to the superficial femoral artery. It is usually branches posterolateral to the superficial femoral artery
The superior vena cava is formed by the junction of the:
Right and left brachiocephalic veins Also called the right and left innominate veins The brachiocephalic veins turns into the subclavian vein at the junction of the internal jugular vein
Which of the following does NOT arise from the subclavian artery?
SUPERIOR THYROID ARTERY The superior thyroid artery is usually the first branch of the external carotid artery.
The vertebral artery usually arises from the:
Subclavian artery The vertebral artery arises from the dorosuperior aspect of the ascending (first) portion of the subclavian artery. A not-uncommon variant is the vertebral artery arising directly from the aortic arch
A useful landmark for locating the renal arteries is the:
Super mesenteric artery The renal artery origins lie just distal to the origin of the SMA from the aorta. The left renal vein, which passes across to the inferior vena cava under the prox SMA and lies anterior an a bit distal to the renal arteries, can also be a useful landmark
Two of the major branches of the external carotid arteries include the:
Superficial temporal and facial arteries The supraorbital, frontal and ophthalmic arteries are all fed by the internal carotid. The vertebral artery is part of the posterior circulation
Intracranial collateral pathways of clinical significance include all of the following except:
Superficial temporal arteries -Anterior communicating -Posterior communicting -Leptomeningeal pathways -Rete mirable The superficial temporal artery is not an intracranial vessel. Leptomeningeal collaterals and the rate mirable ('wonderful net") are potential collateral pathways of lesser importance than the circle of Willis arteries.
The common carotid artery divides into its external and internal branches usually at the level of the upper border of the:
Superficial temporary artery The superficial temporal artery is the terminal branch off the external carotid, as depicted in the ilustration
The term tunica intima denotes:
The inner lining of the arterial wall
The term tunica adventitia denotes:
The outer lining of the arterial wall
Compared to the arteries, veins have:
Thinner adventitia and media Intimal linings are the same size in arteries and veins- a layer of endothelial cells
The arterial pulsations felt in front of the ear and just above the zygomatic arch are from which artery?
Thyroid cartilage The external and internal carotid arteries are formed from the common carotid artery, usually at the upper border of the thyroid cartilage.
The prominence of the larynx is formed by the:
Thyroid cartilage The thyroid cartilage forms a prominence that is especially visible in tall, thin socially awkward males
On opthalmogic examination, a bright yellow spot is noted within a branch artery. This is a Hollenhorst plaque? T or F
True These patients have a 75% risk of TIA or stroke over the next several years
A venule contains which vessel layers?
Tunica adventitia and tunica intima
The layer of arterial or venous wall composed entirely of endothelial cells is the:
Tunica intima
The brachial veins connect the:
Ulnar and radial veins to the axillary veins The second illustration shows the veins of the upper extremity
The blood supply to vascular tissue is provided by:
Vasa Vasorum Vasa vasorum is Latin for "vessels of vessels"- i.e., the small arteries and veins that perfuse the larger vessels
The term hemiparesis means:
Weakness of one side Hemiparesis is also referred to as unilateral paresis
Vessels and structures of the penis include:
-Deep artery of the penis -Dorsal artery of the penis -Corpus spongiosum -Dorsal vein
Which of the following vessels are found on or near the foot?
-Dorsalis pedis -Posterior tibial -Peroneal
The great vessels arising from the aortic arch include all of the following:
-Innominate artery -Left common carotid -Left subclavian- The right subclavian artery arises from the innominate artery (brachiocephalic trunk).
Which of the following anatomic lesions can produce a vertebral steal?
-Innominate artery occlusion -Left subclavian artery origin stenosis To produce a vertebral steal, the lesion must be prox to the vert artery, creating an abnormal pressure gradient that pulls blood from the vert art to perfuse the arm. Vert steal is also know as "Subclavian steal" and "coronary subclavian vert steal syndrome."
The Great Saphenous vein:
-Originates along the medial dorsum of the foot -Passes superiorly, ant to the medial malleolus -Is accompanied by the saphenous nerve -Received tributaries from all surfaces of the lower extremity The GSV passes upward on the anteromedial calf and the posteromedial to medial thigh. It ends by passing through the saphenous hiatus in the deep fascia of the proximal thigh to enter the common femoral vein
Which of the following arteries arise from the external carotid artery?
-Superior thyroid artery -Lingual artery -Facial artery -Ascending pharyngeal artery The external carotid artery has eight branches. The following 4 branches arise in the carotid triangle: the superior thyroid, lingual, facial and ascending pharyngeal arteries
The dorsalis pedis artery is a continuation of:
-The dorsalis pedis artery continues the anterior tibial artery to the pedial arch -It is typically the continuation of the anterior tibial artery -It joins the pedal arch about halfway along the dorsum of the foot -It begins at the bend of the foot and ankle
Regarding capillaries:
-They measure approx 8 microns in diameter -The transmit time of blood through capillaries is approx one to three seconds -They lose fluid at the arteriolar end -They resorb fluid at the venular end Capillaries are made only of endothelial cells-just intima
Which of the following is a complication of plaq ulceration?
-Thrombosis -Intraplaque hemorrhage -Embolization Ulceration of atherosclerotic plaque can be described as erosion of the intimal layer over the plaq surface. The erosion may progress to deep ulceration w embolization of plaq fragments. Thrombus formation is initiated by erosion of the plaq surface. Platelet aggregation occurs, forming a thrombus directly over the ulceration. Distal embolization of thrombus fragments maybe the source of thrombus maybe the source of TIA's. Intraplaque hemorrhage can occur as leakage of blood into the atherosclerotic plaq through the ulceration or by rupture of the vasa vasorum
The incident of new strokes per year is:
700,000 In 1998 the National Institutes of Health (NIH) revised its estimate of the number of strokes per year in the US from 500,000 to 700,000
Which of the following vessels joins the brachial veins to form the axillary vein?
Basalic vein The basilic vein is a superficial vein of the upper extremity that joins w the brachial veins to form the axillary vein. It begins on the ulnar side of the forearm and crosses ventrally at the anticubital region. The basalic vein lies medial to the brachial artery in the upper arm
The vertebral arteries branch from the subclavian arteries to unite and form the:
Basilar artery This system is called the vertebrobasilar system and its responsible for the circulation to the posterior portion of the brain
The paratibial perf veins (Boyd's) are located:
Below the knee There are many perf veins (veins that penetrate the deep fascia that covers the muscles of the leg, sending flow from superficial veins to deep veins.) The main ones are the post-tin perfs in the mid to distal calf, paratibial perfs below the medial knee, femoral canal perfs around mid to dist thigh
Where are carotid body tumors located?
Between the internal and external carotid arteries Carotid body tumors are highly vascular structures that develop between the internal carotid and external carotid are are usually fed by the ECA.
Which statement about subclavian steal are true?
It occurs most commonly on the left side Most pts are asymptomatic Lower blood pressure is seen in the affected arm In subclavian steal, a severe stenosis or occlusion is present in the prox subclavian artery. This results in retrograde flow in the ipsilateral vert. The flow is "stolen" from the contralateral vert by way of the basilar artery. Although subclavian steals occur most freq on the left, they are seen on the right occasionally w obstruction of the prox right subclavian or innominate artery. Most subclavian steals are asymptomatic. When symptoms do occur, the term subclavian steal syndrome is used to describe the condition. the symptoms ass w subclavian steal include dizziness, vertigo, diplopia, ataxia and bilaterally blurred vision. Arm claudication or numbness is not common but may occur in approx ⅓ of patients
Which of the following is NOT true regarding the internal carotid artery?
It supplies a high resistance system. -Its first major branch is the ophthalmic artery -It supplies a low resistance system -It is part of the anterior cerebral system -It originates at the carotid bifurcation
The renal arteries arise from the aorta:
Laterally From the lateral aspect. The right renal artery is usually anterolateral, the left renal usually posterolateral
In a cross section of the aorta and surrounding regions, the vein that is visualized superficial to the aorta and the origins of the right and left renal arteries and deep to the superior mesenteric artery is the:
Left renal vein
The infraorbital artery is a terminal branch of the:
Maxillary artery The infraorbital artery is a terminal branch of the maxillary artery. It creates one of the potential anastomoses w orbital branches that can provide collateral pathways in the event of carotid obstruction
Which vein in the antecubital fossa connects the cephalic and basilic veins?
Median cubital vein
The two arteries creating the bidirectional signal observed 60-65 mm deep during transcranial intonation of the temporal window are the:
Middle and anterior cerebral arteries At a depth of approx 60 mm, the ICA at its distal limit bifs into the middle cerebral and anterior cerebral arteries. Flow in the MCA is toward the doppler beam, while flow in the ACA is away from the beam. The TCD sample volume is fairly large , so both arteries appear on the spectral display, above and below the baseline, and the question specifies a bidirectional waveform . The MCA?ACA bif waveform is a common reference point that helps the practitioner of blind TCD to be sure of orientation and identification.
Which of the following is not an artery in the circle of Willis?
Middle communicating artery -Anterior cerebral -Middle cerebral -Anterior communicating -Posterior communicating There are only the anterior and posterior communicating arteries
The most common anatomic variation of the renal arteries is:
Multiple renal arteries Multiple renal arteries are the most common anatomic variant of the renal arteries, occurring in as many as 30% of individuals. Multiple renal arteries may occur unilaterally or bilaterally and they occur w equal freq on both the right and left sides. They most commonly originate from the abd aorta or common iliac arteries but may arise from the superior and inferior mesenteric, median sacral, intercostal, lumbar, adrenal, inferior french, right hepatic or right colic arteries. These anomalous origins of the renal arteries are commonly seen in individuals w ectopic or horseshoe kidneys
The 3 terminal branches of the ophthalmic artery are the:
Nasal, frontal and supraorbital arteries These arteries are potentially involved in the ECA branch to the ophthalmic branch collateral pathway
A patient undergoes carotid endarterectomy. Six months later angiography is performed bc of symptoms referable to the other side. The angiogram reveals that the operated carotid is significantly narrowed. The most likely cause is:
Neointimal hyperplasia This is a common phenomenon following any trauma to an arterial wall, including endarterectomy and angioplasty. It involves proliferation of smooth muscle cells in response to the injury
Which artery supplies the small intestine, right colon, and transverse colon?
Superior mesenteric The superior mesenteric artery (SMA) is the second major branch of the abd aorta. It arises approx 1 cm below the origin of the celiac trunk. Major branches of the SMA include the inferior pancreaticoduodenal artery, jejunal and ileal branches, ileocolic artery, right colic artery and the middle colic artery. The inferior mesenteric artery (IMA) feeds the left third of the transverse colon and part of the rectum. It is usually much smaller than the SMA. It arises on the left ventral aspect of the abd aorta a few cm before the aortic bif. It's major branches include the left colic, sigmoid branches and superior rectal artery.
The portal vein is formed by the junction of the:
Superior mesenteric and splenic veins The inferior mesenteric vein joins w the splenic vein, which in turn joins w the superior mesenteric vein to become the portal vein
What artery is usually the first branch of the external carotid artery?
Superior thyroid artery
Which of the following statements about venous valves is FALSE?
THEY ALLOW FLOW ONLY AWAY FROM THE HEART -They are essential the the muscle pump -They are bicuspid -They consist of endothelial tissue -They have sinuses to facilitate closure Valves when they are working properly allow flow only toward the heart
The term "muscle pump" refers to:
The calf muscles The term "muscle pump" refers to the mechanism of the venous return from the lower extremities, which must overcome significant hydrostatic pressure in the upright patient. The veins and sinuses fill during relaxation; then contraction of lower extremity muscles propels blood cephalad
The angular artery is the terminal part of the:
The facial artery terminates as the angular artery. The transverse facial artery is a branch of the superficial temporal artery.
