Venous

During a PPG examination for the evaluation of venous reflux a normal venous refill time is? A) 20 sec B) 10 sec C) 15 sec D) 5 sec

A) 20 sec (Anything less than 20 sec is considered positive for reflux. A VRT less than 10 seconds indicates severe venous reflux)

Tailed thrombus with motion seen on duplex is a finding consistent with? A) Acute vein thrombosis B) Chronic post thrombotic scarring C) Venous insufficiency D) Pulmonary embolism

A) Acute vein thrombosis (When a clot appears to be poorly attached to a vessel wall it is always considered to be an acute thrombus. It is typically the most distal portion of the clot that has propagated upward in the leg. The other findings associated with acute thrombosis are low-level echogenicity, dilated veins, and non compressible vein)

Which of the following is NOT a potential limitation of a lower extremity venous duplex examination? A) Patient body habitus B) Venous access lines C) Bony anatomy D) Recent incision

A) Bony anatomy (It can be a limitation for the central upper extremities)

The vein that runs along the lateral aspect of the upper extremity and joins the axillary vein just before becoming the subclavian vein is known as the? A) Cephalic vein B) Brachial vein C) Basilic vein D) Innominate vein

A) Cephalic vein (Runs along the lateral aspect of the arm until terminating in the axillary vein just before it becomes the subclavian. The basilica vein runs along the medial aspect of the arm and terminates at the axillary vein. The brachial vein is located in the upper arm and eventually becomes the axillary vein at the level of the axilla.)

The normal response to venous flow during the Valsalva maneuver is? A) Cessation of flow B) Augmentation of flow C) Reversal of flow D) Increase in flow

A) Cessation of flow

Sonographic findings consistent with acute thrombosis are? A) Hypoechoic, dilated, and noncompressible B) Hyperechoic, dilated, and noncompressible C) Hypoechoic, non dilated, and compressible D) Hyperechoic, non dilated, and noncompressible

A) Hypoechoic, dilated and noncompressible

A normal venous spectral waveform of the lower extremities is? A) Phasic B) Continuous C) Pulsatile D) Bidirectional

A) Phasic (A normal spectral waveform for the lower extremity veins should be phasic with changes in respiration and in one direction. Pulsatile waveforms suggest increased pressure in the venous system while continuous waveforms suggest the presence of a more proximal obstruction)

Varicose veins that occur when there is no DVT are called? A) Primary varicose veins B) Secondary varicose veins C) Cardinal varicose veins D) Hydrostatic varicose veins

A) Primary varicose veins (Primary varicose veins are isolated to the superficial system in the absence of a deep venous obstruction. Primary varicose veins are often due to congenital defects of the venous valves)

An ascending venogram is used to evaluate for? A) Thrombosis B) Venous insufficiency C) Baker's cyst D) Varicose veins

A) Thrombosis (Ascending venograms are used to evaluate for an obstruction caused by thrombosis. Descending venograms are used to evaluate for incompetent venous valves)

The venous valves are attached to which layer of the vessel walls? A)Tunica intima B) Tunica media C) Tunica adventitia D) Tunica interstitial

A) Tunica intima (the venous valves are attached to the innermost layer known as the tunica intima. They are bicuspid valves that assist in promoting blood flow in one direction toward the heart)

While scanning a patient's upper extremity veins you obtain a phasic spectral Doppler waveform within the right subclavian vein and a pulsatile spectral Doppler waveform within the left subclavian vein. What does this suggest? A) An obstruction proximal to the left subclavian vein B) An obstruction proximal to the right subclavian vein C) An obstruction distal to the left subclavian vein D) An obstruction distal to the right subclavian vein

B) An obstruction proximal to the right subclavian vein

The deep vein that runs along the lateral portion of the lower leg between the tibia and fibula and joins the tibioperoneal trunk is the? A) Posterior tibial vein B) Anterior tibial vein C) Peroneal vein D) Gastrocnemius vein

B) Anterior tibial vein (The deep vein that runs along the lateral aspect of the lower leg between the tibia and fibula is the anterior tibial vein. The posterior tibial vein runs along the medial aspect of the lower leg.)

Which location of DVT is more likely to travel to the lung as a pulmonary embolus? A) Peroneal vein DVT B) Common femoral vein DVT C) Posterior tibial vein DVT D) Gastrocnemius vein DVT

B) Common femoral vein DVT (The common femoral vein DVT is more likely to travel to the lung as a pulmonary embolism because it is located above the knee. DVT located above the knee is more likely to become a PE)

Which of the following statements about lower extremity venous duplex is always true? A) If a vein fills with color flow then there is no presence of DVT B) Graded compression should always be performed in the transverse plane C) A continuous flow, steady waveform is indicative of a normal lower extremity venous waveform D) Respiratory phasicity in the lower extremity veins is always normal

B) Graded compression should always be performed in the transverse plane

A study that is positive for reflux will demonstrate a flow reversal time of? A) <5 SEC B) >0.05 SEC C) >0.5 SEC D) >0.005 SEC

C) >0.5 sec (A flow reversal time that exceeds o.5 second in the venous system is considered significant for reflux. There is some literature that allows longer flow reversal times for the deep system due to the large size of the vein and longer valve closure times. A flow reversal time that exceeds 1 second in the deep system would be considered significant for reflux)

A patient presents with large varicose veins that have enlarged over the past few years and are becoming increasingly painful. What is the LEAST likely examination to be done to determine the cause of his disease? A) Venous duplex B) Photoplethysmography testing C) Ascending venogram D) Descending venogram

C) Ascending venogram

The radial and ulnar veins join at about the level of the antecubital fossa to form which vessel? A) Basilic vein B) Axillary vein C) Brachial vein D) Brachiocephalic vein

C) Brachial vein

All of the following veins contain internal valves EXCEPT the? A) Internal jugular vein B) Brachial vein C) Brachiocephalic vein D) Cephalic vein

C) Brachiocephalic vein (There are no internal valves located in the brachiocephalic veins. The internal jugular, brachial, and cephalic veins all contain internal valves.)

Venous stasis ulcers are most commonly located? A) In the proximal thigh B) In the adductor canal C) By the medial malleolus D) In the popliteal fossa

C) By the medial malleolus (aka gaiter zone. They are typically caused by an incompetent perforator in this area and can be very resistant to treatment)

Most deep venous thrombi become established in the? A) Groin B) Thigh C) Calf D) Foot

C) Calf (The majority of DVTs become established in the calf veins, specifically in the solar sinusoids. However, DVT can develop in any deep vein)

The paired posterior tibial veins in the lower leg join in the upper portion of the calf to form the? A) Tibioperoneal trunk B) Common perineal trunk C) Common tibial trunk D) Soleal sinuses

C) Common tibial trunk (The common tibial trunk is formed in the upper calf by the paired posterior tibial veins. The common perineal trunk is formed by the paired perineal veins. These two common trunks eventually join to form the tibioperoneal trunk higher in the calf)

The innermost layer of the vein wall is known as the tunica? A) Media B) Adventitia C) Intima D) Superficial

C) Intima (The innermost layer of the vein wall is the tunica intimal. The middle layer is the tunica media and the outermost layer is the tunica adventitia)

All of the following are classic symptoms of deep vein thrombosis EXCEPT? A) Pain B) Edema C) Paralysis D) Redness

C) Paralysis (Paralysis is a symptom more related to arterial disease or stroke like symptoms. Pain, edema, and redness are all symptoms related to DVT)

The condition involving an outflow obstruction of the venous system that presents with extreme swelling, cyanosis, and reduced arterial inflow is known as? A) Dependent rubor B) Phlegmasia alba Dolens C) Phlegmasia cerulea Dolens D) Venous insufficiency

C) Phlegmasia cerulea Dolens (Phlegmasia cerulea dolens is an outflow obstruction with extreme swelling accompanied by cyanosis and reduced arterial inflow. Phlegmasia alba dole's is an outflow obstruction with extreme swelling without cyanosis and reduced arterial inflow)

After initial treatment of deep vein thrombosis patients are often treated with oral anticoagulation in an effort to? A) Serve as a thrombolytic B) Prevent chronic scarring of the vein lumen C) Prevent reoccurrence D) Prevent post thrombotic syndrome

C) Prevent reoccurrence (Oral anticoagulation is initiated after the initial treatment with heparin for a DVT in an effort to prevent reoccurrence. The duration of treatment will varying depending on the patient's condition and circumstances. It cannot prevent scarring or postthrombotic syndrome nor can it serve as a thrombolytic)

Which of the following is TRUE regarding lower extremity venous anatomy? A) The small saphenous vein typically terminates at the perineal vein B) The great saphenous vein typically terminates at the deep femoral vein C) The great saphenous vein typically terminates at the common femoral vein D) The great saphenous vein is part of the deep venous system

C) The great saphenous vein typically terminates at the common femoral vein

What is the treatment known as sclerotherapy? A) Surgical removal of superficial veins B) Ablation of superficial veins by use of radiofrquency induced heating C) Ablation of superficial veins through a series of injections with a chemical agent D) Removal of superficial veins through mini surgical incisions

C) ablations of superficial veins through a series of injections with a chemical agent

Which veins of the upper extremity should have cardiac pulsations coupled with respiratory patterns normally? A) Internal jugular vein B) Brachiocephalic vein C) Subclavian vein D) All of the above

D) All of the above (Due to the proximity of the heart)

The distention of the distal veins that occurs when a patient has venous insufficiency is a result of? A) Increased hydrostatic pressure B) Abnormal vein walls C) Pooling and stasis of blood D) Both A and C

D) Both A and C (When a patient has venous insufficiency the distal veins start to dilate because of a markedly increased hydrostatic pressure as well as pooling and stasis of blood in these distal veins of the calf. Vein walls are normally very elastic and will stretch when under these types of pressures)

All of the following are sonographic findings associated with chronic postthrombotic scarring EXCEPT? a) Partially compressible B) Hyperechoic C) Recanalization lumen D) Dilated vein

D) Dilated vein (Dilated vein is not a finding associated with chronic postthrombotic scarring. The findings that are associated with chronic changes are increase in echogenicity, attached to vein wall, larger collateral veins, contracted vein, and recanalization of vein)

The following vein is a component of the superficial venous system A) Common femoral vein B) Posterior tibial vein C) Popliteal vein D) Great Saphenous vein

D) Great Saphenous (The great saphenous vein is part of the superficial system in the lower extremities. The common femoral, posterior tibial, and popliteal veins are all part of the deep system of the lower extremities)

Which of the following is not a predisposing risk factor for DVT? A) Trauma B) Cancer C) Pregnancy D) Headache

D) Headache

All of the following are symptoms associated with chronic venous insufficiency EXCEPT? A) Varicose veins B) Discoloration at the gaiter zone C) Swelling D) Heel ulceration

D) Heel ulceration (Heel ulcerations are typically an indication of peripheral arterial disease not peripheral venous disease. Varicose veins, discolorations, and swelling are all symptoms associated with venous insufficiency)

The majority of patients have how many perforating veins in each leg? A) 20 B) 30 C) 50 D) More than 100

D) More than 100 (There are typically more than 100 perforating veins connecting the superficial system to the deep system. They are typically small in size (<3 mm) and not always visualized during a routine ultrasound)

In relation to arteries and veins which statement is true? A) Only veins have internal valves B) Arteries have a much higher internal pressure C) Arteries and veins both have a tunica intima, media, and adventitia D) All of the above

D) Only veins internal valves (Arteries do not. The internal pressure of the arterial system is much higher than the of the venous system. Both arteries and veins have three distinct layers known as the tunica intimal, media, and adventitia.)

Which perforators connect to the posterior accessory great saphenous vein and typically play a significant role in regard to venous stasis ulcers? A) Paratibial perforator B) Perforator of femoral canal C) Superficial epigastric vein D) Posterior tibial perforator

D) Posterior tibial perforators (Posterior tibial perforators connect to the posterior accessory great saphenous vein near the gaiter zone just above the medial malleolus. They commonly play a significant role in venous stasis ulcerations)

All of the following veins are paired except? A) Posterior tibial B) Anterior tibial C) Peroneal D) Small saphenous

D) Small saphenous

Which of the following veins act as a reservoir for the "calf-muscle pump"? A) Popliteal vein B) Gastrocnemius vein C) Small saphenous vein D) Soleal vein

D) Soleal vein (Solea veins are venous sinuses that serve as reservoirs for the calf muscle pump just before it contracts to propel blood back toward the heart)

The three predisposing conditions are known as "Virchow's Triad" are? A) Trauma, hypertension, and hypercoagulability B) Trauma, sclerosis, and hypercoagulability C) Thrombosis, stasis, and hypertension D) Trauma, stasis, and hypercoagulability

D) Trauma, stasis, and hypercoagulability

When the calf-muscle pump and venous valves become inadequate at returning blood back to the heart it leads to the pooling of blood in the lower extremities. A condition known as? A) Deep vein thrombosis B) Phlegmasia alba dolens C) Phlegmasia cerulea dolens D) Venous insufficiency

D) Venous insufficiency

Wet ulcers in the gaiter zone are indicative of? A) Deep venous thrombosis B) High blood pressure C) Pulmonary embolus D) Venous insufficiency

D) Venous insufficiency (Wet ulcers that are commonly found in the gaiter zone are often referred to as venous stasis ulcers and are an indication that the patient has venous insufficiency)

While performing a PPG venous examination on a patient without a tourniquet you obtain an abnormal venous refill time. In order to determine where the insufficiency is occurring you proceed to apply a tourniquet just above the knee and get a normal venous refill time. Where is the patient's insufficiency occurring?

B) Great saphenous system (When an abnormal venous refill time (<20 seconds) is achieved it indicates the venous insufficiency is present. Tourniquets are often used in an effort to distinguish between deep venous reflux and superficial venous reflux. If an abnormal VRT is achieved without the tourniquet and a normal VRT is achieved with tourniquet applied above the knee it must be the great saphenous vein that is the problem because its contributory flow has been eliminated by the tourniquet)

The common femoral vein becomes the external iliac vein above the level of what structure? A) Adductor canal B) Inguinal ligament C) Profunda hiatus D) Popliteal fossa

B) Inguinal ligament (Above the inguinal ligament is the anatomical landmark where the common femoral vein becomes the external iliac vein)

The inferior vena cava is formed by the union of the? A) Superior vena cava and right heart B) Left and right common iliac veins C) External iliac vein and internal iliac vein D) Portal venous system and systemic veins

B) Left and right common iliac veins (Form IVC at the level of umbilicus)

What is the most significant clinical concern for a patient with acute DVT? A) Venous insufficiency B) Pulmonary embolism C) Chronic postthrombotic scarring D) Superficial thrombophlebitis

B) Pulmonary embolism

Which of the following best describes a normal waveform of the brachiocephalic veins? A) Phasic B) Pulsatile C) Continuous D) Oscillating

B) Pulsatile (Because of its close proximity to the heart. Upper extremity veins that are further from the heart such as the axillary vein will be more phasic)

Varicosities that are a result of insufficiency that started in the deep system and extended into the superficial system by way of the perforator veins are known as? A) Primary varicose veins B) Secondary varicose veins C) Spontaneous varicose veins D) First varicose veins

B) Secondary varicose veins (Secondary varicose veins are the result of an obstruction in the deep venous system. In some cases the pressure in the deep system gets so great that it backs up into the superficial system by way of the perforating veins)

A catheter-based procedure where thrombolytic agents are introduced to the vein at the area of a clot in a n effort to dissolve it and reduce the chances of postthrombotic syndrome is known as? A) Thrombectomy B) Thrombolysis C) Anticoagulation D) Phlebectomy

B) Thrombolysis

The muscular layer of a blood vessel is the? A) Tunica media B) Tunica adventitia C) Tunica intima D) Tunica externa

B) Tunica media (Middle layer of the blood vessel wall that is composed of smooth muscle and fiber)

During expiration, as abdominal pressure decreases and thoracic pressure increases? A) There is no significant change in venous blood flow return B) Venous blood flow return in the lower extremities increases while decreasing in the upper extremities C) Venous blood flow return in the lower extremities decreases while increasing in the upper extremities D) Flow is suspended in both the upper and lower extremities

B) Venous blood flow return in the lower extremities increases while decreasing in the upper extremities (Flow always goes from an area higher pressure to an area of lower pressure. The pressure in the abdomen decreases as a person exhales. This causes venous flow to increase in the lower extremities. At the same time the pressure in the chest increases causing venous flow in the upper extremities to decrease. The opposite is true when a person inhales

Which of the following is an advantage of venous duplex over venography? A) Venous duplex use ionizing radiation B) Venous duplex is noninvasive C) Venous duplex uses an iodinated contrast D) Venous angiography is painless

B) Venous duplex is noninvasive