Vascular exam 11-16
0.8
A normal TBI (toe/brachial index) should be at least ________.
3mm Hg/s
An ideal cuff deflation rate for accurately determining the return of Doppler signal when measuring systolic pressure at any segment should be approximately ________________.
qualitative
CW Doppler and PVR waveforms analysis are examples of ___________ criteria for the diagnosis of arterial disease.
suturing
Determining/ characterizing the "nature" of a plaque or wall thickening is important information a sonogrpaher can convey to a surgeon because _____________ through a calcified plaque is almost impossible.
severe
Elevation pallor and dependent rubor is usually observed with _____________ arterial disease.
c
On a posterior approach of the popliteal fossa, what is the branch identified on the anterior aspect of the image in relation to the popliteal artery? a. the anterior tibial artery b. a geniculate artery c. a gastrocnemius artery d. the tibioperoneal trunk
less than 5%
PAOD in the upper extremities occurs in __________ of all cases.
posterior
The below-knee segment of the popliteal artery is best examined through a ____________ approach.
idiopathic
The cause of primary Raynaud's disease is _____________.
anastomosis
a connection created surgically to connect two vessels that were formerly not connected
Duplex arteriography
ultrasound imaging of the arterial system performed to identify atherosclerotic disease and other arterial pathology
Raynaud's disease
vasospasm of the digital arteries brought on by exposure to cold; can be caused by numerous etiologies
0.15
A change in ABI of _______ between repeat studies indicates a significant change associated with worsening of PAOD.
1.5
A vessel is considered aneurysmal if the diameter is _______ times greater than the more proximal segment.
multilevel disease
ABIs returning to resting values more than 10 minutes post exercise are a good indication of ___________________.
d
All of the following can result in inaccurate systolic pressure measurements in the lower extremities EXCEPT: a. the cuff is too narrow b. the deflation rate is too fast c. the limb segment is elevated above the heart d. the dorsals pedis artery is used to listen to the signal
Vr
Although the peak systolic velocity (PSV) is the primary measurement obtained, stenoses are classified based on _______________.
hyperemia
An increase in blood flow; this can occur following exercise; it can also occur following restoration of blood flow following periods of ischemia.
lumen
As compared to contrast arteriography, duplex ultrasound allows direct visualization of the entire artery and not just the __________.
normal dilated
At a measured diameter of 1.1 cm, a common femoral artery would be considered ______________, whereas a popliteal artery that measures 1.1 cm would be considered ___________________.
the same
Conditions and risk factors for which patients are referred for duplex ultrasound of the lower extremity arteries are _________ as those for indirect physiologic testing.
turbulence
Distal to a hemodynamically significant stenosis, the Doppler waveform demonstrates poststenotic _________________.
b
Doppler spectra with a characteristic low-resistance outline may be seen distal to a hemodynamically significant stenosis. What will the Doppler spectra also display? a. delay on the downstroke in systole b. delay on the upstroke in systole c. retrograde flow in diastole d. retrograde flow in systole
softest
Duplex ultrasound is superior to contrast angiography in determining a suitable site for the distal anastomosis of a graft because it can detect the _________ area of the vessel wall.
rest
For recording of accurate segmental systolic pressures, it is important not only to ensure the cuff is appropriate sized for the limb segment but also to allow the patient __________ before beginning the exam.
a
How is low-resistance blood flow characterized on a Doppler spectrum? a. antegrade flow throughout diastole b. antegrade flow in systole only c. retrograde flow in systole d. sharp downstroke in early diastole
a
How is the velocity ratio (Vr) calculated? a. PSV at stenosis divided by PSV proximal to stenosis b. PSV proximal to stenosis divided by PSV at stenosis c. PSV at stenosis divided by PSV distal to stenosis d. PSV distal to stenosis divided by PSV at stenosis
Localization
In general, color and power Doppler's primary advantage is for ______________ and tracking of the vessels.
20mm Hg
In the upper extremities, using segmental pressure as diagnostic criteria, significant disease will be likely when a drop of at least ___________ is recorded between two consecutive segments (from proximal to immediately distal segment).
bidirectional
Independently of the increasing discussion about the "correct" nomenclature to be used to describe continuous-wave (CW) Doppler waveforms, a normal CW Doppler waveform from an artery of the lower extremity should be ______________.
spinal stenosis
Lower extremity symptoms that require sitting and/or spinal flexure to relieve is usually associated with _______________.
medial
Most arteries of the lower extremity can be examined by duplex ultrasound using a ___________ approach.
with exercise
Most often, symptoms of arterial disease are described as "intermittent" claudication because the symptoms occur _______________.
anterior tibial artery
On a posterior approach of the upper calf, the artery branching off the popliteal artery deep to the popliteal artery is most likely the ____________________.
d
Progression of PAOD can be established on follow-up of patients by physical examination and clinical history because the patient may describe all the following EXCEPT: a. diminution of walking distance b. increase of recovery time c. skin and nails changes d. resolution of pain by changing position
a
Severe PAOD can be suspected with all the following EXCEPT: a. leg pain while sitting b. skin discoloration and scaling c. claudication pain after less than 50-foot walk d. constant forefoot pain
proximal
Symptoms observed or described with intermittent claudication can determine the site of disease because the disease is ______________ to the site of symptoms.
primary Raynaud's disease
Testing for increased sensitivity to cold using immersion in ice water should only be used in patients with suspected ______________________.
c
The Allen test is typically performed by placing a PPG sensor on the middle of index finger to record digit perfusion while: a. the radial and ulnar arteries are compressed concomitantly b. the radial and ulnar arteries are compressed sequentially c. the radial artery is compressed individually d. the ulnar artery is compressed individually
the heart
The ideal positioning of patients for indirect arterial testing should take great care that all extremities are not elevated above ________________.
0.9
The lowest limit of ABI to b considered within normal range at rest is ____________.
adductor or Hunter's canal
The superficial femoral artery typically changes name to become the popliteal artery as the vessel exits the ________________________.
b
The techniques commonly used for indirect testing of arterial perfusion in the thick and leg include all of the following EXCEPT: a. plethysmography b. photoplethysmography c. Doppler waveform analysis d. segmental systolic pressure
anterior tibial artery
The two arteries or arterial segments, which cannot be well examined with duplex ultrasound via a medial approach, are the popliteal artery and _______________________.
55 to 65 mm Hg
The typical cuff inflation for segmental pulse volume recording (PVR)is _______________.
a
Thoracic outlet syndrome can include all the following presentations EXCEPT: a. pain with arm in neutral position b. neurologic pain c. edema of the arm and forearm d. pain with the arm elevated above head
b
To ensure accuracy of data, particularly for recording of segmental systolic pressures, how long should the patient be allowed to rest? a. 5 to 10 minutes b. 10 to 15 minutes c. 20 minutes d. does not need to rest
pressure
To evaluate the dorsals pedis and distal posterior tibial arteries adequately, a sonographer should be particularly careful with the ________ from the transducer.
30mm Hg
Under normal conditions (absence of disease), the high-thigh pressure using a 4-cuff method will usually be at least _______ greater than the normal brachial pressure.
a
Using PPG sensor on a digit demonstrating signs of increased vasospasm from primary Raynaud's disease, what characteristic will the waveform typically display? a. a peaked pulse on the anacrotic portion b. an anacrotic notch in late diastole c. a dicrotic notch in sytole d. a dicrotic notch in diastole
resolution
Using a lower frequency transducer to view the SFA at the adductor canal or the tibioperoneal trunk at the upper calf will reduce ________________.
expeditious
Using duplex ultrasound instead of contrast angiography in patients with severe-to-critical limb ischemia is recommended because the examination with duplex is more ___________________.
power Doppler
Very low flow, particularly to assess the patently of possible outflow vessels, is more easily achieved with duplex ultrasound than with contrast angiography with the use of ______________________.
a
What aspects of duplex ultrasound assessment of the lower extremity arteries allow better estimation of the true hemodynamic significance of an arterial lesion, when compared to contrast angiography? a. Doppler spectrum analysis and color Doppler b. Doppler spectrum analysis only c. power and color Doppler d. flow velocities and velocity ratio
a
What characteristic outline will Doppler spectra in an arterial segment proximal to a hemodynamically significant stenosis or an occlusion have? a. no flow in diastole b. no flow in systole c. retrograde flow in diastole d. retrograde flow in systole
b
What is an advantage of synthetic grafts when compared to autogenous vein grafts? a. high thrombogenic potential b. low rate of early technical problems c. high rate of progressive stenosis at the inflow artery d. high long-term patency rate
d
What is the appropriate size for a blood pressure cuff to be used on an extremity to ensure accuracy of data obtained for systolic pressure determination? a. a 12-cm wide cuff at the upper arm b. a 10-cm wide cuff at the ankle c. between 10% and 15% wider than the diameter of the limb segment d. 20% wider than the diameter of the limb segment
a
What is the main technical limitation in the routine use of duplex ultrasound instead of contrast angiography to visualize the arteries of the lower extremities due to? a. most plaque will be calcified b. most equipment does not have that imaging capacity c. most sonographers are not trained to obtain diagnostic data d. most physicians are not trained to interpret data
b
What is the most convenient (and reliable) technique to obtain digital pressures while using a small digital cuff? a. PVR b. PPG c. CW Doppler d. PW Doppler
d
What is the most convenient technique to record changes of arterial insufficiency with thoracic outlet syndrome with a specific (and sometimes tailored) set of maneuvers? a. PVR on a limb segment b. CW Doppler at the brachial artery c. pressure recordings at the brachial artery d. PPG on a digit
d
What is the primary tool to evaluate disease of the lower extremity arteries using duplex ultrasound (at the exception of aneurysm)? a. aliasing on color Doppler b. B-mode image c. color display with power Doppler d. peak systolic velocity
a
What is the typical skin color changes (in the hands and fingers) associated with Raynaud's disease from room temperature to exposure to cold temperature and ending with rewarming? a. white, blue, red b. red, blue, white c. blue, white, red d. blue, red, white
c
What will the use of a 4-cuff versus a 3-cuff method to estimate arterial disease in the lower extremities help determine? a. whether the disease is present at the distal femoral level b. whether the disease is present at the proximal femoral level c. whether the disease is present at the iliofemoral level d. whether the disease is present at the popliteal level
reconstituted
When an occlusion is discovered during duplex ultrasound assessment of the lower extremity arteries, documentation of where the vessel is ___________________ by collateral flow is useful to the vascular surgeon.
c
When assessing the appearance of a plaque on a grayscale image, what might an irregular plaque surface indicate? a. stable plaque unlikely to rupture b. an area of necrosis c. an area of ulceration d. thrombus formation on top of the plaque
deep femoral
When assessing the lower extremity arterial system with duplex ultrasound, only the first few centimeters of the ________ artery are evaluated.
d
When can a greater than 70% stenosis in any arteries of the lower extremities be safely inferred? a. the PSV is half distal to the stenosis b. the PSV is doubled at the stenosis c. the Vr is equal to or greater than 2 d. the Vr is equal to or greater than 3
highest
When recording pressures from sites proximal to the ankle, the vessel (PTA or DPA) with the ______________ pressure is used to obtain the Doppler's signal.
d
When using duplex ultrasound to record slow flow (<20 cm/s) in an arterial segment, which of the following adjustments would NOT be useful? a. describe the PRF b. use a low wall filter c. increase the persistence of color d. decrease the Doppler gain
b
Which artery is best visualized by a posterolateral approach at the level of the calf? a. the posterior tibial arteyr b. the peroneal artery c. the popliteal artery d. the tibioperoneal trunk
b
Which method is most commonly used to calculate ABI? a. the lowest pressure at the ankle to the lowest systolic pressure of the right or left brachial artery b. the highest pressure at the ankle to the highest systolic pressure of the right or left brachial artery c. the lowest pressure at the ankle to the highest systolic pressure of the right or left brachial artery d. the highest pressure at the ankle to the lowest systolic pressure of the right or left brachial artery
d
Which method represents good practice to thoroughly evaluate arterial disease in the lower extremities when using B-mod to view the vessel? a. viewing in sagittal only b. viewing in transverse only c. moving from medial to lateral d. using both transverse and longitudinal planes
d
Which of the following is NOT a common method to induce symptoms with exercise in a patient suspected to have arterial insufficiency but relatively normal results at rest? a. using a treadmill for walking with a set protocol b. having the patient walk at own pace until symptoms occur c. having the patient perform heel raises until symptoms occur d. raising the limb above the heart while the patient is supine on the exam table
b
Which of the following is NOT a consideration when assessing for the possibility of treatment of an arterial lesion by angioplasty or stunting (or both)? a. size of artery b. position of branches c. length of the stenosis d. location of the stenosis
c
Which of the following is NOT a factor typically associated with the need to perform contrast angiography after a limited duple ultrasound of the arterial system? a. high infrapopliteal vessel calcification b. limb-threatening ischemia c. female gender d. older age
b
Which of the following is NOT a potential pathologic finding when the Doppler spectrum of an artery of the lower extremity displays low-resistance characteristics? a. arteriovenous fistula b. postreactive hyperemia c. cellulitis d. trauma
c
Which of the following is NOT considered a method of assessment of a lower extremity infrainguinal bypass graft? a. physical/clinical evaluation b. ankle to brachial index c. chemical blood chemistry panel d. plethysmography
d
Which of the following is NOT one of the main advantages of pulse volume recording (PVR)? a. records overall segment perfusion b. can give data even with calcified arteries c. is easy and quick to perform d. provides quantitative values
a
Which of the following is a main pitfall of duplex ultrasound (in general) in examining arterial disease? a. flow at velocities less than 20cm/s b. flow at velocities over 400 cm/s c. length of occluded segment d. collateral vessels
a
Which of the following is clear diagnostic criteria to estimate disease between two limb segments when using systolic pressure determination? a. a drop of more than 30mm Hg between the proximal and immediate distal segment b. an increase of more than 30mm Hg between the proximal and immediate distal segment c. a drop of 50mm Hg between the proximal and immediate distal segment d. an increase of 50mm Hg between the proximal and immediate distal segment
d
Which statement about intermittent claudication is FALSE? a. pain with exercise is relieved by rest b. it can be asymptomatic at rest c. ABI values are generally between 0.5 and 1.3 d. ABI value can never be greater than 1.3
c
Which statement regarding the importance of early assessment of the presence of PAD is FALSE? a. patients are at increased risk for cardiovascular mortality b. patients are at increased risk for cardiovascular morbidity c. patients will eventually require amputation d. PAD is a marker for systemic arterial damage
d
Which veins would be typically used for an in situ bypass in the lower extremity? a. the cephalic vein b. the basilic vein c. the small saphenous vein d. the great saphenous vein
c
Why does duplex ultrasound have an advantage over contrast angiography for the examination of vessel walls? a. the plaque thickness can be measured b. the plaque characteristics can be determined c. the wall thickness can be measured d. the remaining lumen can be measured
b
Why is reporting the presence of a partial thrombus in an aneurysm important? a. partial thrombus may not be visible on contrast angiography b. pieces of thrombus can embolize c. the lumen may not be enlarged d. it will likely proceed to an acute occlusion
b
Why is the use of contrast angiography in diabetic patients particularly worrisome? a. ionizing radiation b. nephrotic agents c. poor visualization of calcified agents d. poor visualization of low flow
bypass
a channel that diverts blood flow from one artery to another, usually done to shunt flow around an occluded portion of a vessel
graft
a conduit that can be prosthetic material or autogenous vein used to divert blood flow from one artery to another
arteriovenous fistula
a connection between an artery and a vein that was created because of surgery or by other iatrogenic means
aneurysm
a localized dilation of an artery involving all three layers of the arterial wall
contrast arteriography
a radiologic imaging technique performed using ionizing radiation to provide detailed arterial system configuration and pathology information
Allen test
a series of maneuvers testing the digital perfusion of the hand while compressing and releasing the radial and ulnar arteries
photoplethysmography
an indirect physiologic test that detects changes in back-scattered infrared light as an indicator of tissue perfusion
Plethysmography
an indirect physiologic test that measures the change in volume or impedance in a whole body, organ, or limb
thoracic outlet syndrome
compression of the brachial nerve plexus, subclavian artery, or subclavian vein at the region where these structures exit the thoracic cavity and course peripherally toward the arm
claudication
pain in muscle groups brought on by exercise or activity that recess with cessation of activity; can occur in the calf, thigh, and buttock
rest pain
pain in the extremity without exercise or activity thus at rest can occur in the toes feet or ankle area
plaque
the deposit of fatty material within the vessel walls, which is characteristic of atherosclerosis
in situ bypass
the great saphenous vein is left in place in its normal anatomical position and used to create a diversionary channel for blood flow around an occluded artery
ankle-brachial index
the ratio of ankle systolic pressure and brachial systolic pressure
