Review, Test 1, Test 2, Test 3, Test 4, Test 5

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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.


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