Review, Test 1, Test 2, Test 3, Test 4, Test 5
How many branches does the ICA have in the cervical section? 4 8 1 0
0
What is the typical pressure in the left ventricle? 6 mmHg 120 mmHg 2 mmHg 50 mmHg
120 mmHg
Which is the average diameter of the abdominal aorta? 1.0cm 4.0cm 2.0cm 3.0cm
2.0cm
How much blood volume is thought to be in the veins at one time? 2/3 of overall volume 1/3 of overall volume Half of overall volume None
2/3 of overall volume
There is a formula used to predict the likelihood of turbulence, and it gives us the Reynolds number. Turbulent flow likely if Reynolds number is greater than___________________. What is it called if we hear the turbulent flow with stethoscope? 2000; bruit 2020; bruit 1800; CBT 2000; dissection
2000; bruit
When will patient with bypass graft or stent placement possibly develop neointimal hyperplasia? 30 days to 2 years after placement > 2 years after placement < 15 days after placement < 30 days post placement
30 days to 2 years after placement
How much of the blood flow to the brain is supplied by the ICA? 50% 65% 75% 25%
75%
What is criteria for AAA? > 5cm > 3mm > 2cm > 3cm
> 3mm WRONG
In the presence of right ICA occlusion, discuss how right side of brain will receive blood flow. Multiple Answers Branches of ECA anastomosing to redirect flow to brain Circle of Willis-terminal ICA Common Carotid Artery Circle of Willis-Anterior communicating artery Circle of Willis -posterior communicating artery Internal Jugular Vein
Branches of ECA anastomosing to redirect flow to brain Circle of Willis-Anterior communicating artery Circle of Willis -posterior communicating artery Internal Jugular Vein
Which muscle is supplied by the deep femoral artery? Soleus Gastrocnemius Deep muscles of the thigh Pelvic muscles
Deep muscles of the thigh
Patient presents with long history of questionable TIAs and irregular plaque at origin of bilateral carotid arteries. Referring physician request exam to monitor for emboli. This is your patient and you obtain this waveform of MCA. Answer following questions. 1. As scanning sonographer, how do you know you are in MCA? 2. If you detect embolus, will patient have stroke symptoms? 3. Which type of waveform is this?
Direction of flow to transducer and depth No Low resistance.
Which veins form the CFV? Femoral and deep femoral vein Deep femoral and circumflex veins External and internal iliac veins Femoral and great saphenous
External and internal iliac veins WRONG
How would you describe plaque composition? Smooth Homogeneous Irregular Heterogeneous or Complex
Heterogeneous or Complex
Which of the following not associated with Virchow's Triad? Trauma Stasis Hypocoagulability Hypercoagulability
Hypocoagulability
The best method to positively identify external carotid artery is by: Continuous diastolic flow in spectral display More lateral anatomic orientation inrelation to ICA Identification of branching arteries of ECA Temporal tap Larger arterial lumen than ICA
Identification of branching arteries of ECA
Volumetric flow rate (Q) is defined as the amount of blood that flows past a certain point per minute (or per second). When resistance decreases within the vessel due to low viscosity, what happens to the volume flow rate? Increases Drops Decreases Stays constant
Increases
Name the branches of aortic arch.
Innominate/brachiocephalic LT CCA LT Subclavian
How will you describe plaque surface? Complex Irregular Smooth Heterogeneous
Irregular
If patient has blood pressure in RT arm measuring 125 mmHg systolic and 84 mmHg systolic LT arm, which side is abnormal? RT LT
LT
Which is the most common type of blood flow pattern? Plug flow Laminar also known as parabolic Blunt flow Turbulent flow
Laminar also known as parabolic
Which of the following is a true statement about the vertebral arteries? Left VA is usually larger than the right The VA are symmetric The right VA is usually larger than right The VA feeds anterior brain
Left VA is usually larger than the right
Which type of waveform will you find in the ICA? Why is it this type?
Low resistance Brain requires constant perfusion
Which of the following is characterized by constant forward flow in systole and diastole? High resistant flow Low resistant flow
Low resistant flow
Consider sound beam, sonographer is primarily evaluating which artery? Basilar ACA MCA PCA
MCA
Note annotation of image. Is this image of distal ICA? No Yes
No
Consider this image of flow through proximal right ICA and answer following questions. What are your next steps with ultrasound to prove this narrowing is hemodynamically significant? According to the Bernoulli Principle, what happens to velocity and pressure at the area of narrowing? Where will you obtain tardus parvus waveform?
Obtain PSV/EDV measurements walking through narrowing. Document prox to tightest narrowing, at area of tightest narrowing, dist to tightest narrowing documenting post stenotic turbulence Velocity increases, pressures drop Distal
If patient has blood pressure in RT arm measuring 125 mmHg systolic and 84 mmHg systolic LT arm, which is not a possible finding with duplex imaging? Occlusion aorta arch, just proximal to origin of subclavian artery Occlusion LT CCA Occlusion left subclavian artery Reversed flow LT vertebral arterv
Occlusion LT CCA
The ICA terminates by branching into all, except: ACA MCA Ophthalmic
Ophthalmic
The Circle of Willis is composed of all of the following, except: Posterior cerebral artery Anterior cerebral artery Anterior communicating artery Ophthalmic artery
Ophthalmic artery
The first branch of the ICA is the Middle cerebral artery Ophthalmic artery Supraorbital artery Anterior cerebral artery
Ophthalmic artery
All vessels except________________ considered anterior circulation. PCA MCA ACA ICA
PCA
Which artery is posterior to the medial malleolus? ATA Popiteal PTA Peroneal
PTA
Hematocrit contains three types of blood cells. Which of the following is not included? Plasma White blood cells Platelets Red blood cells
Plasma
Which of the following help the body with the clotting process to stop excessive bleeding? WBCs RBCs Plasma Platelets
Platelets
Consider diagram of organization of RBCs as blood flows. Explain the differences in flow patterns and when/where they occur.
Plug: occurs at bifurcations and origin of vessel. All RBCs traveling at same speed Parabolic: Most common flow pattern, flow in center stream fastest secondary to frictional losses at wall Turbulent: RBCs disorganized and flowing in different directions secondary to significant narrowing, irregular plaque formation or tortuous vessel
Considering image, describe location of ICA to ECA. Describe location of ECA to ICA. Name two additional anatomical structures you will visualize while scanning through neck not annotated on this diagram.
Posterior Anterior Vertebral artery SCM Thyroid IJ Glands Longus Collis muscle Esophagus
The main form of energy present in blood flow is the pressure distending the vessels. What form of energy does this represent? Hydrostatic energy Potential energy Kinetic energy Velocity energy
Potential energy
------ is the amount of force placed on an artery at any given point in time. Resistence Viscosity Flow Pressure
Pressure
The function of the white blood cell (WBC) is to? Transfer oxygen to body Transfer carbon dioxide to lungs Protect body from infection Aid in clotting
Protect body from infection
Which of the following is typically not a symptom of venous thrombosis? Swelling Warm extremity Pulselessness Redness
Pulselessness
Poiseuille's equation gives us flow rate if we know the pressure differential, the viscosity of the blood, and the length and radius of the vessel. Which of these is Poiseuille's equation? Q = ΔP x π x r4 / 8 x L x η Q = 8 x L x η / π x r4 Q = ΔP x V2 Q = R / ΔP
Q = ΔP x π x r4 / 8 x L x η
Which is the most powerful component of resistance? Viscosity Length of vessel Radius Pressure
Radius
In equation Q=(P1-P2)/R, what is P? resistance Represents pressure gradient, pressure 1 and pressure 2 flow
Represents pressure gradient, pressure 1 and pressure 2
In equation Q=(P1-P2)/R, what is R? Resistance Pressure gradients Flow
Resistance
The right vertebral artery arises from _______ Right Subclavian artery Directly from Aortic arch Right CCA Right Innominate artery
Right Subclavian artery
Where does the superior vena cava enter the heart? Left atrium Left ventricle Right ventricle Right atrium
Right atrium
Which vessels are anterior branches off the aorta? SMA Renal SMA and CA CA
SMA and CA
What is the term used to describe area that the saphenous veins travel? Saphenous compartment Posterior partition Superficial tract Deep fascia
Saphenous compartment
Identify risk factors that contribute to atherosclerosis and plaque formation. Multiple answers Smoking DM TIA Hypolipidemia HTN Paralysis Emboli
Smoking DM HTN
Consider surface of plaque, how will you describe? Irregular Hetergeneous Smooth Complex
Smooth
Which window provides access to the vertebral and basilar arteries. Submandibular Transtemporal Transorbital Suboccipital
Suboccipital
Which is the first branch off the ECA? Lingual artery Facial artery Superior thyroid artery Occipital artery
Superior thyroid artery
Which of the following is a rare form of vasculitis affecting medium and large arteries? CBT Takayasu's Coarctation of aorta TOS
Takayasu's
Patient presents with suspected fem-pop bypass graft failure. He is s/p surgery x 2 weeks. What is mechanism for graft failure? Restenosis secondary to atherosclerosis Neointimal hyperplasia Technical or placement error
Technical or placement error
Internal carotid artery distributes blood to all, except: Forebrain Middle cerebral artery Thyroid gland Eyes
Thyroid gland
Fluid travels from high pressure to low pressure. True False
True
Which type of vessels control the level of resistance within the arterial system by constricting and dilating as necessary? capillaries arteries the aorta arterioles
arterioles
If the pressure at the left end of a vessel is 100 mmHg and the pressure at the right end is 120 mmHg, which way will the fluid flow? from left to right it will not flow at all from right to left away from the patient's head
from right to left
When calculating ABl, which pressures will you use? highest brachial, DPA highest brachial, PTA lowest brachial, highest of PTA and DPA highest brachial, highest of PTA and DPA
highest brachial, highest of PTA and DPA
In hemodynamically significant stenosis, the velocity at the point of tightest narrowing will increase significantly. decrease significantly. remain consistent.
increase significantly.
If vessel size decreases, resistance will stay the same decrease. increase.
increase.
In general, insufficient oxygenated blood supply to the tissue is called: gangrene isoechoic necrosis ischemia
ischemia
May-Thurner syndrome is the vein. artery compresses the right common iliac: left external iliac left common iliac; left common iliac right common iliac; left common iliac right common iliac; right external iliac
left common iliac; left common iliac WRONG
Hydrostatic pressure is highest at the lower portion of the body. highest portion of the body
lower portion of the body.
What units are usually used to measure blood pressure? cmHg cm/sec cc mmHg
mmHg
Which unit is used when measuring pressure? cm/sec mmHg dB L/min
mmHg
Superficial veins are: accompanied by an artery. not accompanied by an artery. larger than veins found in the thigh. travel in the deep fascia.
not accompanied by an artery.
If the blood is flowing toward the transducer, the Doppler shift will be: impossible to detect zero negative positive
positive
Patient presents with history of amaurosis fugax left eye. Carotid ultrasound ordered and you take this image. Consider velocity information on image. According to the Bernoulli Principle, what happens to pressure at the area of a hemodynamically significant stenosis such as this in the LT ICA? pressure decreases pressure remains constant pressure increases pressure always doubles
pressure decreases
Which is an abnormal response to exercise? pressure drop pressure increase pressure stays the same
pressure drop
Select best answer to describe reason for blood flow throughout body. pressure gradients gravity fluid pressure resistance to flow
pressure gradients
Which are the two main circulatory pathways in the body? pulmonary and arterial venous and systemic proximal and distal pulmonary and systemic
pulmonary and systemic
During inspiration, the lowering of the diaphragm increases the intra- abdominal pressures causing compression the IC. This will cause No change in phasicity of blood flow. increase in venous flow from lower extremities. reduction or cessation of venous flow from lower extremities
reduction or cessation of venous flow from lower extremities
Patient presents for an arterial lower extremity segmental blood pressure exam. In your effort to obtain accurate patient history, you learn patient has severe leg pain while in supine position and pain is only relieved with legs in a dependent position. This indicates dependent rubor acute occlusion intermittent claudication rest pain
rest pain
Which of the following is the first branch off of the ECA.? lingual artery occipital artery superior thyroid artery facial artery
superior thyroid artery
Waveform distal to segmental occlusion of the SFA will appear as Turbulent extremely high resistant-staccato. normal tardus parvus
tardus parvus
Flow is defined as at any given time the amount of liquid moving past a point. the force needed to be overcome a change in pressure the amount of force placed on an artery.
the amount of liquid moving past a point.
The normal direction of arterial blood flow in the upper extremity would be from: the subclavian to the right innominate. the subclavian to the cephalic. the left innominate to the subclavian. the subclavian to the axillary.
the subclavian to the axillary.
The Doppler Principle states that when sound reflects off an object which is moving either toward or away from the source (transducer): there will be an increase in intensity there will be negative Doppler shift there will be a change in received frequency there will be a positive Doppler shift
there will be a change in received frequency
The outer-most layer of a vessel wall is called: tunica adventitia lumen tunica intima tunica media
tunica adventitia
Capillaries have only one layer, called: tunica media tunica intima tunica externa tunica adventitia
tunica intima
The diaphragm moves during expiration. stays in same position downward upward
upward
In spectral Doppler displays, the vertical axis (y-axis) normally represents: time velocity spectral window Dicrotic notch
velocity
Which two factors are directly related to resistance? vessel length and viscosity vessel radius and viscosity vessel length and radius vessel radius and π
vessel length and viscosity
Patient presents with uncontrolled hypertension. Which duplex exam is appropriate for physician to order? Arterial duplex Carotid artery duplex Renal artery duplex Indirect physiological testing
Arterial duplex
Explain why it is so important to carefully evaluate this area of carotid system seen in the 3 ultrasound images. How do we manipulate probe to clear lumen?
Answer: area of plaque formation-we need to characterize plaque to determine risk for emboli Answer: move probe lateral, posterior-lateral, use acoustic window such as SCM
Which of the following will be used to provide toe pressures? photo plethysmography duplex imaging ABI CW Doppler
ABI
Select image optimization techniques to improve image. Multiple Answers Adjust angle of color box Move probe more lateral or posterior/lateral Increase color gain Decrease depth Increase depth Move probe more anterior Decrease color gain
Adjust angle of color box Move probe more lateral or posterior/lateral Increase color gain Decrease depth
Valves Prevent reflux All answers correct Propel blood back to heart Point in direction of blood flow
All answers correct
Which is the longest vein in the upper extremity? Cephalic Median cubital Brachial Basilic
Basilic
The following is a mechanism to compensate for hemodynamic effect of stenosis or occlusion. Bifrucations Arterioles Arterial branches Collateral flow
Collateral flow
The main purpose and advantage of Circle of Willis? Provides direction of flow High velocity flow Arterial and venous flow join together Collateralization
Collateralization
The spectral waveform for CCA is Combination of low velocity and low volume Combination of both high and low resistance Combination of high volume and high resistance Combination of very high velocity and low volume
Combination of both high and low resistance
Patient s/p surgery carotid artery to remove plaque. What is this procedure called? Carotid Endarterectomy Bypass graft Carotid Stent Angioplasty
Carotid Endarterectomy
The network of vessels that feed the tunica media and tunica adventitia is called: Arterioles Vaso-vasorum Capillary network Pampiniform plexus
Vaso-vasorum
Patient presents with hyperpigmentation lower legs, swelling × 2 years and complaints of leg congestion at end of day. Which of the following is an appropriate diagnostic test to order? Venous duplex exam for acute DVT Venous duplex exam for acute superficial thrombophlebitis Indirect physiological testing arterial system Venous valvular insufficiency duplex exam
Venous valvular insufficiency duplex exam
Consider information on this image you obtained for your patient with HX of TIA x 2. Is this ultrasound finding considered a hemodynamically significant stenosis? Explain the color pattern distal to narrowing Define a TIA? Provide one example of TIA symptoms.
Yes Answer: Post stenotic turbulence Transient Ischemic Attack, symptoms resolve < 24 hours Several examples!
The amount of blood ejected from the heart (left or right ventricle) per minute is called: stroke volume cardiac output heart rate blood pressure
cardiac output
When one vessel becomes blocked, the body will often create new connections or alternate pathways overtime in order to bypass the blockage and patient remains asymptomatic. This is called ________ circulation. collateral compliant constricted collective
collateral
Power Doppler mode is good for looking at very small, low-velocity vessels. We can get information about amount of flow, but the disadvantage is that: beams cannot be focused, so we lose lateral resolution we get range ambiguity (no way of knowing where the flow is located) we are more likely to get high P.R.F. error depending on age of equipment, we cannot obtain information about direction of flow.
depending on age of equipment, we cannot obtain information about direction of flow.
