Week 13 Davies Score Cards: ARTERIALS

Which ABI is indicative of rest pain? a. > 1.0 b. 0.9-1.0 c. 0.5-0.9 d. < 0.5

d

A disease in which segmental pressure studies may show falsely elevated Doppler pressures due to arterial wall calcification is: a. diabetes mellitus b. Takayasu's arteritis c. Raynaud's syndrome d. Marfan syndrome

a

A patient with a history of tibial artery surgical repair now presents with foot drop, muscle necrosis, and severe pain. What diagnosis is suspected? a. compartment syndrome b. pseudoaneurysm c. Raynaud's syndrome d. arteriovenous fistula

a

A smooth, painful ulcer located on the dorsal of the foot is most likely a(n): a. ischemic ulcer b. stasis ulcer c. lymphedema ulcer d. neurotrophic ulcer

a

A type of plethysmography that detects cutaneous blood flow by sending infrared light into the tissue is termed: a. photoplethysmography b. air plethysmography c. volume plethysmography d. impedance plethysmography

a

Arteriography is contraindicated in a patient with: a. renal failure b. diabetes c. malignancy d. vascular disease

a

During performance of a postoperative study for a reversed saphenous bypass graft, which of the following potential complications should you consider? a. stenosis at the proximal anastomosis b. arteriovenous fistula c. increased flow secondary to retained valve cusp d. pseudoaneurysm at mid-graft level

a

Following cessation of exercise in an individual with normal vascular function. how long does it take for lower extremity blood flow to return to resting values? a. 1-5 minutes b. 5-10 minutes c. 10-15 minutes d. as long as 30 minutes

a

How is vasospasm demonstrated arteriographically? a. as a severe narrowing of the arterial lumen b. as having a "string of beads" appearance c. as a vibrating artery d. Vasospasm cannot be detected arteriographically.

a

How should the patient be positioned to obtain digital pressures of the toes? a. supine b. Trendelenburg c. standing d. decubitus

a

In duplex imaging, the best arterial wall image quality is obtained when the beam is at the following angle to the artery walls: a. 90° b. 60° c. 0° d. oblique

a

Symptoms associated with thoracic outlet syndrome include all of the following EXCEPT: a. increased blood pressure on the affected side b. aching of shoulder and forearm c. numbness or tingling of the arm d. increased discomfort with upward arm positions

a

The ankle/brachial index is calculated by dividing the ankle pressure by: a. the highest of the two brachial pressures b. the left brachial pressure c. the lowest of the two brachial pressures d. the right brachial pressure

a

The measurement that helps in differentiating between inflow and outflow disease by determining the time between the onset of systole and the initial systolic peak is the: a. acceleration time b. volume flow c. A/B ratio d. resistive index

a

What symptom involves cramping muscle pain that is induced by exercise and relieved by rest? a. claudication b. rest pain c. bruit d. thrill

a

Which method of Doppler display exhibits a gray-scale trace representing the entire range of reflected frequency shifts from the location of the sample volume? a. spectral analysis b. analog waveform c. power Doppler d. color flow

a

Which of the following is a late complication of extremity bypass grafts? a. intimal hyperplasia b. pseudoaneurysm c. arteriovenous fistula d. hematoma

a

Which of the following would NOT be associated with arterial trauma? a. fibromuscular dsyplasia b. hematoma c. psuedoaneurysm d. dissection

a

Which of these conditions most commonly affects the subclavian, renal, and carotid arteries and the ascending aorta and predominantly affects females? a. Takayasu's arteries b. temporal arteries c. polyarteritis nodosa d. Kawasaki disease

a

Which of these statements about primary Raynaud's phenomenon is correct? a. It results from ischemia caused by distal arterial spasm. b. It relates to vasodilation of a healthy vessel. c. It can be the first manifestation of thromboangiitis obliterans. d. It is often evident after an acute arterial occlusion.

a

Which one of the following changes occurs in the peripheral blood flow of limbs with obstructive arterial disease in response to laboratory-induced ischemia or exercise? a. Hyperemia is prolonged in obstructed limbs in comparison to limbs with no obstruction. b. Flow decreases in order to redistribute blood volume to the central circulation. c. Flow increases more in obstructed limbs than in limbs with no obstruction. d. Peripheral resistance is increased due to muscle contraction.

a

A 57-year-old male presented to the vascular lab for lower extremity arterial testing. Exercise testing was stopped due to symptoms of claudication. Postexercise ankle pressures measured slightly above resting ankle pressures. What is suspected in this patient? a. occlusion or stenosis at a single level b. a nonvascular cause of leg pain c. multilevel arterial disease d. isolated iliac artery occlusion

b

A stenosis of the superficial femoral artery showed a peak systolic velocity of 180 cm/sec and a prestenotic velocity of 85 cm/sec. What percentage diameter stenosis is suggested by these values? a. ≥25% b. ≥50% c. ≥75% d. ≥90%

b

An aneurysm resulting from infection is known as: a. fusiform b. mycotic c. saccular d. ectatic

b

During ultrasound-guided compression of a pseudoaneurysm, you know to observe all of the following points of technique EXCEPT: a. Use color flow to monitor flow in the common femoral artery. b. Use color flow to confirm that flow remains biphasic within the pseudoaneurysm. c. Use color flow to confirm that flow is obliterated in the pseudoaneurysm. d. Release pressure for a short time at 10-15 minute intervals.

b

Following repair of injuries to the anterior tibial artery after a motor vehicle accident, your patient complains of weakness in the calf muscle, paresthesia, and pain on passive stretching of the calf muscle. What condition does this suggest? a. cystic adventitial disease b. compartment syndrome c. Paget-Schroetter syndrome d. acute arterial occlusion

b

How should the patient be positioned to allow segmental pressures of the lower extremity to be obtained? a. reverse Trendelenburg b. supine with the extremities at the same level as the heart c. Trendelenburg d. supine with the extremities below the level of the heart

b

In the presense of arterial obstructive disease and distal ischemia: a. vasoconstriction increases, and distal resistance increases b. vasodilation increases, and distal resistance decreases. c. vasoconstriction increases, and distal resistance decreases d. vasodilation decreases, and distal resistance decreases

b

In which syndrome does recurrent digital vasospasm occur in response to cold exposure or emotional stress? a. Buerger's syndrome b. Raynaud's syndrome c. Takayasu's syndrome d. thoracic outlet syndrome

b

Lower extremity arterial grafts using the great saphenous vein are typically termed either reversed or: a. nonreversed b. in situ c. allograft d. synthetic

b

What does a high-pitched signal heard on audible Doppler analysis always indicate? a. the presence of high-velocity flow b. high frequency shifts c. the presence of a stenosis d. a vessel kink

b

What does a volume plethysmographic waveform with a normal aplitude, a rounded peak, and an absent dicrotic notch most likely indicate? a. normal arterial inflow b. arterial disease proximal to the level of tracing c. arterial disease distal to the level of tracing d. arterial occlusion at the level of the tracing

b

What is suggested by an acceleration time of less than 133 msec obtained in the femoral artery? a. proximal iliac artery stenosis b. the absence of significant iliac artery disease c. distal femoral artery occlusion d. pseudoaneurysm of the femoral artery

b

What is the best method for evaluation of a suspected popliteal aneurysm? a. pulse volume recording b. duplex ultrasound c.. segmental pressures d. continuos-wave Doppler

b

What is the name of the nonatherosclerotic, noninflammatory, occlusive, and aneurysmal disorder that primarily affects women and is referred to as a "string of beads" or "string of pearls"? a. Takayasu's disease b. fibromuscular dysplasia c. polyarteritis nodosa d. mycotic aneurysm

b

Which bypass graft would most likely be seen in a patient with bilateral common iliac artery obstruction? a. femoral to posterior tibial artery b. aortobifemoral c. femoral to femoral d. femoral to popliteal

b

Which disease involves thrombosis of the small or medium-sized arteries of the extremities and occurs predominantly in male smokers? a. Allen's disease b. Buerger's disease c. Raynaud's disease d. thoracic outlet disease

b

Which of the following is NOT a contraindication for treadmill stress testing? a. history of cardiac problems b. history of claudication c. history of stroke d. shortness of breath

b

Which of the following is always TRUE of patients who suffer from intermittent claudication? a. Peripheral blood flow is reduced at rest. b There is pressure drop distal to the obstructed segment after exercise. c. Marked peripheral vasoconstriction occurs in response to exercise. d. There is always a pressure drop distal to the obstructed segment at rest.

b

Which of these statements about bruits is NOT true? a. A bruit is a low-frequency sound heard on auscultation. b. A prominent bruit will be heard over an arterial occlusion c. The absence of a bruit cannot rule out disease d. A bruit persisting through diastole is usually associated with severe stenosis.

b

With which type of bypass graft will there be a size discrepancy between the graft and the native artery at both the proximal and distal anastomotic sites? a. in situ vein graft b. reversed vein graft c. synthetic graft d. Greenfield graft

b

Your patient has undergone a femoral to anterior tibial bypass graft. During routine postoperative surveillance of the graft, you detect retrograde flow in the native anterior tibial artery just proximal to the distal anastomosis. What is the most likely explanation for this finding? a. It is consistent with severe obstruction in the native outflow artery. b. It is evident because blood moves from a higher-pressure energy in the bypass graft to the lower-pressure energy of the diseased native vessel. c. It represents a steal phenomenon that may result in graft failure. d. It is a normal finding because blood moves from the lower pressure of the bypass

b

A 72-year-old female is referred to the vascular lab for evaluation of right lower extremity claudication. Bilateral brachial blood pressures are 135 mmHg and bilateral ankle pressures are 300 mmHg. This is most likely related to: a. severe hypertension b. cuff artifact due to improper size c. incompressible arteries due to arterial calcification d. misalignment of cuff on the extremity

c

A dampened waveform demonstrating a delayed acceleration time is obtained in the common femoral artery. What is the most likely reason for this finding? a. distal occlusion b. pseudoaneurysm c. inflow disease d. exercise

c

A pulse palpated in the groove behind the medial malleolus of the ankle corresponds to which artery? a. anterior tibial artery b. peroneal artery c. posterior tibial artery d. plantar artery

c

A technique whereby atherosclerotic plaque is mechanically removed by cutting or pulverizing it and then extracted by suction or downstream embolization is termed: a. thrombectomy b. angioplasty c. atherectomy d. endarterectomy

c

After catheterization of a cardiac patient, you find a pulsatile mass in the groin. What is the most likely cause? a. a femoral artery aneurysm b. a hematoma c. a pseudoaneurysm of the femoral artery d. an arteriovenous fistula

c

Common graft configurations include all EXCEPT: a. fem-fem b. fem-pop c. tib-tib d. ax-fem

c

From which artery is a Doppler tracing at the medial malleolus obtained? a. dorsalis pedis b. peroneal c. posterior tibial d. anterior tibial

c

How would you characterize retrograde flow in the native artery at the site of distal anastomosis of a lower extremity? a. an early indication of graft failure b. indicative of arteriovenous fistula c. a normal finding d. diagnostic of distal occlusive disease

c

In measurements of segmental pressures, gradients of 20-30 mmHg between corresponding segments of the legs indicate: a. disease below the level in the leg with higher pressure b. disease above the level in the leg with higher pressure c. disease at or above the level in the leg with lower pressure d. no significant disease

c

In reactive heyperemia testing, the blood pressure cuffs are inflated to supraslystolic pressure levels for how long? a. 45 seconds b. 1-2 minutes c. 3-5 minutes d. 8 minutes

c

The best way for a vascular technologist to palpate a pulse is to: a. place the back of his hand over the pulse b. place his thumb over the pulse site c. place his fingertips over the pulse site d. push hard over the pulse site with both hands

c

The incidence of pseudoaneurysms is: a. staying the same b. decreasing c. increasing d. not associated with iatrogenic causes

c

The internal thoracic artery is a branch of which of the following arteries? a. innominate b. vertebral c. subclavian d. axillary

c

What complication that may follow femoral artery catherization involves a characteristic to-and-fro Doppler waveform seen within a tract leading to a perivascular hematoma? a. arteriovenous fistula b. occlusion c. pseudoaneurysm d. mycotic aneurysm

c

What is indicated by the presense of a bruit? a. arterial occlusion beneath the point of auscultation b. the absence of arterial disease c. arterial stenosis proximal to the point of auscultation d. venous thrombosis

c

What is the difference between the protocols for cardiac treadmill testing and claudication treadmill testing? a. A single, faster speed is used for cardiac testing. b. The patient is closely monitored by technologists during cardiac testing. c. Speed is varied during cardiac testing. d. Elevation is varied during claudication testing.

c

What is the most common form of nonsurgical intervention for focal atherosclerotic disease in the lower extremity? a. atherectomy b. thrombectomy c. angioplasty d. endarterectomy

c

What is the most serious risk from femoropopliteal aneurysms? a. fistula b. rupture c. embolization d. infection

c

What quantitative index is calculated by dividing the peak-to-peak frequency difference by the mean frequency? a. resistive index b. volume index c. pulsatility index d. acceleration index

c

What should the patient's position be when you are taking ankle pressures? a. sitting b. standing c. supine d. reverse Trendelenburg

c

What test is used to detect arterial patency of the palmar arch? a. photoplethysmography b. reactive hyperemia c. Allen test d. thoracic outlet evaluation

c

Which of the following correctly describes an advantage of pulsed-wave (PW) Doppler over continuous-wave (CW) Doppler? a. PW Doppler is more accurate in measuring high velocities. b. PW Doppler does not exhibit aliasing. c. Echoes can be received from a specific depth with PW Doppler. d. PW Doppler is more accurate in measuring low velocities.

c

Which of the following is NOT a risk factor for development of atherosclerotic disease? a. diabetes mellitus b. male sex c. underweight d. hypertension

c

Which of the following is a common feature of temporal arteritis? a. dissection b. aneurysm c. intimal thickening d. tortuosity e. ectasia

c

Which syndrome below is caused by swelling within the osteofacial compartments of the leg or arm and results in decreased vascular perfusion? a. thoracic outlet syndrome b. Raynaud's syndrome c. compartment syndrome d. Marfan syndrome

c

You are performing a Doppler exam on a 32-year-old female who was recently involved in a car accident. She received a blow to the left side of her body. She presents with an abdominal bruit, back, and hypertension. Which of the following conditions is most likely? a. Takayasu's arteritis involving the abdominal aorta. b. fibromuscular dysplasia involving the splenic and common hepatic arteries c. dissection involving the abdominal aorta and possibly the renal arteries d. inflammatory aneurysm of the infrarenal abdominal aorta

c

You are performing an ultrasound exam on a patient with a gunshot wound involving the posterior tibial artery. What artifact is associated with metallic objects such as bullets? a. enhancement b. multipath c. comet-tail d. mirror-image

c

A great toe pressure of 30 mmHg or less indicates: a. a good chance of healing for foot or toe ulcer b. normality c. arterial calcification due to diabetes d. a poor chance of healing for foot or toe ulcer

d

A loss of the triphasic waveform in the popliteal artery can result from: a. distal vasodilation b. proximal occlusion c. exercise d. all of the above

d

A patient presents to the vascular lab with a history of recent brachial artery cauterization and a palpable thrill over the brachial artery. Which diagnosis is most likely? a. complete thrombosis of the brachial artery b. deep venous thrombosis of the brachial vein c. hematoma surrounding the brachial artery d. arteriovenous fistula involving the brachial artery and vein.

d

All of the following statements regarding arteriography are true EXCEPT: a. It requires an intra-arterial injection. b. It gives anatomic information regarding the vascular system. c. It employs a liquid contrast agent to image the arterial lumen. d. It gives functional information regarding the vascular system.

d

Following exercise, what is a normal response for ankle pressures in comparison with resting values? a. no change b. decrease c. gradual decrease over 5 minutes d. increase

d

Hemorrhage within the layers of the arterial wall is known as: a. ulceration b. pseudo aneurysm c. arteriovenous fistula d. dissection

d

How would you describe the velocities measured in a reversed saphenous vein bypass graft? a. lower proximally and higher distally b. greater than 100 cm/sec throughout the graft c. the same throughout the graft d. higher proximally and lower distally

d

In a normal study, what should the ankle systolic pressure be? a. less than the highest brachial blood pressure b. less than the right brachial blood pressure c. equal to the lowest brachial blood pressure d. the same as or greater than the highest brachial blood pressure

d

The "kissing stent" angioplasty/stent technique is useful for: a. the adductor canal region b. total occlusions c. infrarenal arteries only d. bifurcations

d

The cuff for obtaining pressures in the fingers should be what size? a. 0.5-1 cm b. 3 cm c. 5 cm d. 2-2.5 cm

d

The vein most commonly used in the lower extremity as a reversed vein bypass graft is the: a. cephalic vein b. femoral vein c. small saphenous vein d. great saphenous vein

d

Using the four-cuff technique for segmental pressures, what is the relationship of normal high-thigh pressures and brachial pressure? a. High-thigh pressures are not compared to brachial pressure. b. They are equal. c. High-thigh pressures are at least 30 mmHg less than brachial pressure. d. High-thigh pressures are at least 30 mmHg greater than brachial pressure.

d

What is an advantage of using the radial artery instead of the great or small saphenous vein for coronary artery bypass grafts? a. vessel caliber similar to that of coronary arteries b. thicker vessel wall c. longer latency rates d. all of the above

d

What severe symptom of decreased blood perfusion is aggravated by elevation, is relieved by dependency, and often occurs when the patient goes to bed at night? a. claudication b. cyanosis c. postprandial pain d. rest pain

d

Which of the following describes the Adson maneuver used in diagnosis of thoracic outlet syndrome? a. The patient hyperabducts the arm in conjunction with rapid opening and closing of the hand. b. The patient sits straight and crosses the arms in front during deep inspiration. c. The patient assumes a military posture with the shoulders braced down. d. The patient's arm is at a 90° angle to the torso with the head turned toward the affected side and then away from the affected side during deep inspiration.

d

Which of the following is a cause of blue toe syndrome? a. venous thrombosis of the pedal veins b. hyperemic flow from arteriovenous fistulas c. congenital absence of the dorsalis pedis artery d. embolization from proximal arteries

d

Which of the following is thought normally to occur in stented arteries? a. increased arterial compliance b. resected plaque c. spectral broadening d. elevated peak systolic velocities

d

Which of the following may be a source of emboli? a. ulcerated atherosclerotic plaque b. mural thrombus within an aneurysm c. cardiac dysrhythmias d. all of the above

d

Which syndrome results in medial displacement of the vessel due to compression by fibrous bands or the medial head of the gastrocnemius muscle? a. thoracic outlet syndrome b. compartment syndrome c. adductor canal compression syndrome d. popliteal entrapment syndrome

d

Which term describes a pale skin color due to insufficient blood flow? a. cyanosis b. rubella c. rubor d. pallor

d

You obtain the following segmental pressure readings from your patient: right brachial = 144 mmHg, left brachial = 140 mmHg, right high thigh = 110 mmHg, left high thigh = 164 mmHg. These findings would NOT result from: a. right common femoral obstruction b. right common iliac obstruction c. right external iliac obstruction d. aortoiliac obstruction

d