SON 250 - Arterial PPT/Lab images
c
A mature fistula must have a flow rate of > _________ ml/min. a. > 100 ml/min b. > 200 ml/min c. > 350 ml/min d. > 600 ml/min
d
Normal mean graft flow velocity (GFV) is greater than _____ cm/s a. 400 cm/s b. 100 cm/s c. 200 cm/s d. 45 cm/s
a
Where is the stenosis location in relation to the transducer location according to the waveform characteristics? a. Proximal b. Distal
a
70% of all peripheral aneurysms are in the ___________ artery a. Popliteal artery b. Iliac artery c. Posterior tibial artery d. Deep femoral/profunda artery
d
A peripheral aneurysm is present if the artery diameter is ______ greater than the adjacent, more proximal segment a. 0.5 cm b. 1.0 cm c. 1.25 cm d. 1.5 cm
a
A positive vascular thoracic outlet syndrome (TOS) means the systolic pressures/waveforms must be significantly affected by maneuvers and symptoms a. True b. False
b
An Allen's test showing a normal response with compression of the radial and ulnar artery means the _____ artery can be harvested. a. Brachial b. Radial c. Ulnar d. Basilic
a
Aneurysmal disease can be bilateral and multilevel a. True b. False
c
Can there be a hemodynamically significant stenosis in the SCA that doesn't drop the brachial pressure on the affected side? a. Yes, if it's on the right side b. Yes, if it's on the left side. c. No
d
Can there be a hemodynamically significant stenosis in the SCA that doesn't reverse flow in the ipsilateral vertebral artery? Explain answer. a. Yes, definitely b. No, not if it's in the left SCA c. No, not if it's in the innominate d. Yes, a steal only happens if the stenosis is proximal to the vertebral origin on the SCA
b
Cold immersion PPG should not be used on patients with _________ Raynaud's. a. primary b. secondary
c
Digit pressures in patients with dialysis fistuals are done to assess _______. a. Native grafts b. PTFE grafts c. Steal
b
Distal to a hemodynamically significant stenosis, the waveform would look like _______. a. Image A b. Image B
b
Do we ultrasound PTFE grafts (double line wall appearance) on a regular basis after placement? a. Yes b. No
b
Does this dialysis fistula waveform demonstrate a normal or abnormal condition? Caption: Radio-cephalic fistula Left image caption: Arterio-venous anastomosis is PSV 438 cm/s Right image caption: Radial artery PSV 130 cm/s a. Normal b. Abnormal hint: PSV in a normal fistula should be between 150 & 300 cm/sec
a
Does this fistula waveform demonstrate a normal or abnormal condition? Peak systolic velocity = 213 cm/s a. Normal b. Abnormal hint: PSV in a normal fistula should be between 150 & 300 cm/sec
a
Does this patient have symptoms? a. Yes b. No hint: Left image labelled "R Prox SCL A" Right image is probably a vertebral artery...and you can see blue color Doppler in the lumen...
a
False claudication (not true peripheral arterial occlusive disease (PAOD)) symptoms from spinal stenosis are reduced by: a. Sitting b. Quietly standing c. Increased activity d. Warm compresses
c
Fistula maturity generally takes ______ weeks a. 1 to 2 weeks b. 4 to 11 weeks c. 8 to 12 weeks d. 52 weeks
c
Focal velocity increases PSV velocity ratio ≥ 2 _____ % stenosis a. 30% b. 40% c. 50% d. 70%
d
Focal velocity increases PSV velocity ratio ≥ 3 _____ % stenosis a. 30% b. 40% c. 50% d. 70%
c
Graft flow velocity (GFV) ____ cm/s is consistent with large graft diameters or those with limited outflow a. Greater than 45 cm/s b. Greater than 40 cm/s c. Less than 40 cm/s d. Less than 45 cm/s Hint: Less than 45 cm/s GFV is abnormal Greater than 30 cm/s GFV on a serial exam is abnormal
c
How might the wall calcifications in this posterior tibial artery affect an ABI reading? a. Normal pressure reading despite abnormality b. Compressible (accurate pressure totally possible) c. Non-compressible (accurate pressure not possible)
a
If a Pulse Volume Recording (PVR) baseline bows toward the baseline in diastole it is ________ a. Normal b. Abnormal PVR measures the change in limb volume related to each cardiac cycle. Blood is forced into the leg in systole and the girth of the limb increases and air in the segmental pressure cuff is temporarily displaced. Specific air pressure in the cuff = 60-65 mm Hg. Proximal disease will affect the contour of all PVR's distally. (just think of it as a type of waveform similar to spectral doppler...)
b
If a basilic vein is used, it must be transposed. What does that mean? a. It can be an in-situ graft b. It must change position to a more superficial location
a
If claudication symptoms are present in the buttocks, where is the disease location? a. Inflow (aorta/iliacs) b. Outflow (Fem/Pop) c. Trifurcation (PTA, DPA, ATA, Peroneal A) Hint: Symptoms are always distal to disease site
b
If claudication symptoms are present in the calf, where is the disease location? a. Inflow (aorta/iliacs) b. Outflow (Fem/Pop) c. Trifurcation (PTA, DPA, ATA, Peroneal A) Hint: Symptoms are always distal to disease site
c
If vessels are incompressible and toe pressures aren't possible, can any useful information be usefully gleaned about the status of the arteries? a. No b. Yes, the highest blood pressure exceeding 300 mm Hg c. Yes, waveform characteristics
d
In peripheral arterial occlusive disease (PAOD) assessment, the cuff must be inflated to at least _______ a. 55-65 mm Hg b. 200 mm Hg c. 100 mm Hg above point where signal disappears d. 20 mm Hg above point where signal disappears
a
In what 2 areas do most fistula complications occur? a. Anastomotic and vein stenosis b. Anastomotic and arterial stenosis c. Mid-vessel stenosis and vein stenosis d. Mid-vessel stenosis and arterial stenosis
a
Is Blue Toe Syndrome (Trash foot) an acute or chronic condition? a. Acute b. Chronic
b
Is acute Blue Toe syndrome (Trash foot), painful or not? a. It's not painful b. It's painful
b
Is this normal flow at an AV fistula anastomosis? a. Yes, normal b. No, abnormal (anastomosis stenosis) Systolic peak is - 400 cm/s (4 m/s) hint: Normal AV fistula velocities are between 150 to 300 cm/sec
a
Is this waveform normal or abnormal for a peripheral artery? a. Normal b. Abnormal
c
Label the sign demonstrated in these images as: Cyanosis a. Image A b. Image B c. Image C
b
Label the sign demonstrated in these images as: Dependent rubor a. Image A b. Image B c. Image C
a
Label the sign demonstrated in these images as: Pallor a. Image A b. Image B c. Image C
d
List 3 indications of advanced peripheral arterial occlusive disease (PAOD) 1- Sitting reduces symptoms 2 - Foot pain while lying down 3- Thick toenails 4- Wet ulcers 5- Loss of toe hair 6- Brawning/dermatitis 7- Skin discoloration & scaliness 8 - Elevation pallor/dependent rubor 9 - Raynaud's disease 10 - Ulceration/gangrene 11 - Blue toes may mean aneurysmal disease 12- Dry ulcers a. 1, 4, 6, 9 b. 1, 2, 3, 4, 7, 8, 10, 11 c. 2, 3, 4, 5, 7, 8, 10, 11 d. 2, 3, 5, 7, 8, 10, 11, 12
b
Name the waveform according to it's shape a. Biphasic-bidirectional b. Biphasic unidirectional c. Monophasic moderate/severe d. Monophasic severe/critical
c
Name the waveform according to it's shape a. Biphasic-bidirectional b. Biphasic unidirectional c. Monophasic moderate/severe d. Monophasic severe/critical
d
Name the waveform according to it's shape a. Biphasic-bidirectional b. Biphasic unidirectional c. Monophasic moderate/severe d. Monophasic severe/critical
a
Name the waveform according to it's shape a. Triphasic b. Biphasic-bidirectional c. Biphasic unidirectional d. Occlusion
b
Name the waveform according to it's shape a. Triphasic b. Biphasic-bidirectional c. Biphasic unidirectional d. Occlusion
c
PSV in a normal fistula should be between ____ & _____ cm/sec. a. 55-65 mm Hg b. > 350 ml/min c. 150-300 cm/sec d. 1.5-3 cm/sec
b
Post exercise ABI that returns to pre-exercise level in > 10 minutes is associated with: a. Single-level disease b. Multiple-level disease c. Spinal stenosis d. Osteoarthritis Notes: Ankle pressures that drop to low unrecordable levels immediately after exercise and then increase to resting levels in 2-6 minutes suggests obstruction at a single level When ankle pressures remain reduced to unrecordable for up to 12 minutes - multilevel obstruction
a
Proximal to an occlusion or near occlusion, the spectral waveform will look like _________ a. Image A b. Image B
c
The most common AV fistula is called the Brescia-Cimino, which connects the _______ and the wrist 1- Brachial 2- Ulnar 3- Radial 4- Cephalic 5- Bacilic a. 2 and 4 b. 2 and 5 c. 3 and 4 d. 3 and 5
d
The most common AV fistula is called the __________ a. PTFE b. TCPO2 c. Brescia-Cimino (radial artery/bacilic vein) d. Brescia-Cimino (radial artery/cephalic vein)
c
This disease is primarily seen in smokers. Give 2 names for it a. Tar fingers from thromboangina obliterans b. Raynauds disease from neurologic hypotension c. Buerger's disease or thromboangitis obliterans d. Buerger's disease from arteriosclerosis obliterans
d
This patient needed a fasciotomy. What condition did he have? a. Buerger's disease (Thromboangitis obliterans) b. Raynaud's disease c. Peripheral arterial occlusion disease (PAOD) d. Compartment syndrome
d
This question is referring to serial testing...from one test to the next... Decrease in graft flow velocity (GFV) ______ cm/s (in any graft segment) indicates pending graft failure. a. Less than 45 cm/s b. Less than 40 cm/s c. Less than 30 cm/s d. Greater than 30 cm/s Hint: Normal GFV is > 45cm/s GFV < 40cm/s consistent with large graft diameters or those with limited outflow
c
To achieve a mature fistula, pre-op vein size must be ________. a. > 1.0 mm b. < 2.5 mm c. > 2.5 mm d. > 5 mm hint: The minimum pre-op ARTERY diameter necessary for a successful fistula is > 2.0 mm
b
True claudication symptoms are reduced by: a. Sitting b. Quietly standing c. Increased activity d. Warm compresses
b
What Transcutaneous Oximetry (TcPO₂) readings indicate the best outcome? a. < 20 b. > 40 c.< 90 d. > 20
a
What Transcutaneous Oximetry (TcPO₂) readings indicate the worst outcome? a. < 20 b. > 40 c. < 60 d. > 20
c
What abnormality is indicated by this waveform? a. Thoracic outlet syndrome b. Buerger's disease c. Pseudoaneurysm d. AV fistula
c
What abnormality is seen in this vein bypass graft (BPG)? a. Popliteal cyst b. Neointimal hyperplasia c. Aneurysm d. Pseudoaneurysm
d
What acute and painful condition is demonstrated? a. Pallor b. Cyanosis c. Dependent rubor d. Blue Toe syndrome (Trash foot)
c
What are the arrows pointing out in this posterior tibial artery? a. Vertebral columns b. Three arteries instead of one c. Calcification in wall d. Ribs causing shadows
c
What are the arrows showing in this in-situ bypass graft? a. Thrombosis b. Calcification in the wall c. Retained valve leaflet d. Dissection
c
What commonly causes this abnormality? a. arteriosclerosis b. compartment syndrome c. catheter injury from angiogram/heart cath d. AV fistula
d
What conduit material has the longest term patency success? a. Asbestos b. Cadaver c. Biotextiles d. Patients own vessel
b
What does the Transcutaneous oximetry (TcPO₂) test determine? a. Site of arterial occlusion b. Healing potential c. Stenosis site d. Blood pressure
c
What does the double line wall appearance tell you about this bypass graft (BPG)? a. Bernio-Cermuli b. TPCO2 c. PTFE graft d. Native graft
b
What exam is more routinely used to assess digital vessels? a. Duplex b. PPG
b
What feature of an in-situ graft is considered the most desirable? a. Smaller incision b. Better size match (large end of vein to large end of artery/small end of vein to small end of artery) c. Better size match (small end of vein to large end of artery/small end of vein to large end of artery)
b
What indicates a more serious condition, primary or secondary Raynaud's syndrome? a. Primary is more serious b. Secondary is more serious
a
What is a disadvantage of a retrograde (orthograde)(reversed) bypass conduit? a. Not a good size match (large end of vein to small end of artery/small end of vein to large end of artery) b. Valves don't need to be lysed c. Smaller incision d. Better size match (large end of vein to large end of artery/small end of vein to small end of artery)
b
What is an in-situ bypass conduit? a. Artery (usually GSV) removed and flipped around (opposite position from normal) b. Vein (usually GSV) left in original position c. Vein (usually SSV) left in original position d. Vein (usually GSV) removed and flipped around (opposite from normal position)
b
What is most adventageous about using a retrograde (orthograde)(reversed) bypass conduit? a. Valves need to be lysed and branches ligated b. Valves don't need to be lysed c. Smaller incision d. Better size match (large end of vein to large end of artery/small end of vein to small end of artery)
c
What is the inflation pressure range used in a Pulse Volume Recording (PVR) study? a. 30-35 mm Hg b. 40-45 mm Hg c. 55-65 mm Hg d. 200-300 mm Hg
c
What is the minimum pre-op ARTERY diameter necessary for a successful fistula? a. > 1.5 mm b. > 2.0 mm c. > 2.5 mm d. > 5 mm hint: Well...according to one of the slides in the powerpoint this is wrong. However, this comes from the Lab PPT with an answer key...so, > 2.5 mm it is. To acheive a mature fistula, pre-op VEIN size must be > 2.5 mm
b
What is the most common type of Thoracic Outlet Syndrome (TOS)? a. Malignant b. Neurogenic c. PAOD d. Subclavian steal syndrome
d
What is the preferred arm to use for a hemodialysis fistula? a. Right arm b. Left arm c. Dominant arm d. Non-dominant arm
d
What is this condition called? a. Buerger's disease (thromboangitis obliterans) b. Popliteal cyst c. Pseudoaneurysm d. Popliteal entrapment syndrome
d
What is this test called? a. PPG b. ABI c. Allen's test d. Transcutaneous Oximetry (TcPO₂)
c
What position should the arm be in for a pre-op evaluation for a hemodialysis fistula? a. Elevated above head b. Adducted to side and horizontal to heart c. Gravity dependent d. Reverse trendelenburg lithotomy position
d
What post graft complication are the arrows pointing out? a. Myointimal hyperplasia b. Neointimal hyperplasia c. Calcification of the walls d. Both A and B
d
What problem might be caused by a retained valve leaflet in this in-situ bypass graft? a. Nothing, no problems. b. Stenosis c. Thrombosis d. Both B and C
c
What term would you use for the normal waveform seen in a peripheral artery? a. Monophasic b. Biphasic c. Triphasic d. Quadruphasic
c
What two things need to be done to prepare an in-situ bypass conduit for bypass use? a. Removed and flipped around b. Removed and put somewhere else in original orientation c. Ligate (lyse) valves and branches d. Removed and reinserted upside down and ligate (lyse) valves
b
What's #77? a. Superficial femoral artery b. Deep femoral artery (profunda a.) c. Common femoral artery d. Genicular arter
d
What's #78? a. Superficial femoral artery b. Peroneal artery c. Tibial artery d. Popliteal artery
d
What's #79? a. Small saphenous artery b. Gastrocnemius artery c. Soleal artery d. Anterior tibial artery
b
What's #80? a. Anterior tibial artery b. Peroneal artery c. Posterior tibial artery d. Soleal artery The lab ppt answer key is wrong here...I fixed it.
c
What's #81? a. Superficial palmar arch b. Dorsalis pedis c. Pedal/plantar arch d. Palmar/deep arch
a
What's #82? a. Aorta b. Iliac c. Common femoral artery d. Common iliac artery
b
What's #83? a. Aorta b. Iliac A c. External iliac artery d. Internal iliac artery
a
What's #84? a. CFA b. SFA c. External iliac artery d. Internal iliac artery
c
What's #85? a. CFA b. DFA c. SFA d. Popliteal
d
What's #86? a. Soleal/gastrocnemius A. b. Peroneal artery c. Anterior tibial artery d. Posterior tibial artery
b
Where is the stenosis location in relation to the transducer location according to the waveform characteristics? a. Proximal b. Distal
b
Which of the following describes the Mid SCA? a. Beneath the clavicle to the outer border of the first rib b. Behind the scalenus anticus c. Inner border of the scalenus anticus muscle
c
Which of the following describes the origin of the SCA? a. Beneath the clavicle to the outer border of the first rib b. Behind the scalenus anticus c. Inner border of the scalenus anticus muscle
a
Which of these waveforms indicates that the radial artery CANNOT be harvested? a. Image A b. Image B
b
Which of these waveforms indicates that the radial artery can be harvested? a. Image A b. Image B
b
Which waveform in a patent bypass graft would indicate significant native artery inflow disease? a. Image A b. Image B
a
Which waveform in a patent graft would indicate significant native artery outflow disease? a. Image A b. Image B
b
Which waveform is typical of a normal subclavian artery? a. Image A b. Image B c. Image C
c
Who is most likely to develop symptoms from popliteal entrapment syndrome? a. Men b. Women c. Athelets d. Smokers
