RVT Practice Test
how can you acquire the specificity of a diagnostic exam?
# of true negatives / all negative diagnoses
how many valves are in the IVC
0
depth to find MCA
30-60 mm
+ vasospasm characteristics
MCA velocity >120 cm/s Lindegaard ratio >3.0
First branch of aortic arch
brachiocephalic artery
Which description represents the type of waveform morphology demonstrated in this image? a) Pre-steal b) To and Fro c) Pulsus Bisferiens d) Tarvus-Parvus
c) pulsus bisferiens
ABI ______ after exercise
increases
where is arterial PPG recorded from
surface of the skin
why do we use the lindegaard ratio
to differentiate increased volume flow from decreased diameter when high velocities are encountered in the MCA or ICA
a dissection of an artery occurs between which vessel layers
tunica media and tunica intima
helical flow
twisting type of blood flow
normal claudication range
0.5 - 0.8
in the presence of ICA occlusion, name all of the potential collateral pathways to perfuse the ipsilateral cerebral hemisphere
1. contralateral ICA through reversed flow in the ipsilateral ACA 2. vertebrobasilar system through the PCA 3. ipsilateral ECA through the orbit to the ophthalmic artery
Mild MCA vasospasm mean velocities
120-149 cm/sec
Moderate MCA vasospasm mean velocities
150-199 cm/sec
celiac axis/trunk
1st branch off aorta usually found withing first 2cm; divides into 3 arteries: Hepatic, splenic & left gastric
how many brachiocephalic veins and arteries are there
2 veins and 1 artery on the right side
cuff should be ____ wider than limb diameter
20%
veins hold what % of the bodies blood volume
25 - 40%
depth to find ACA
60-75 mm
depth to find PCA
60-75 mm
depth to find Vertebral A
60-90 mm
depth to find Basilar A
70-120 mm
normal toe-brachial index
>0.8
Severe MCA vasospasm mean velocities
>200 cm/sec
normal hemodialysis graft
>800 mL/min
most common anatomic variant of the aortic arch
A common origin of the innominate and left CCA
Renal artery stenosis is mainly caused by 2 things
Atherosclerosis and medial fibromuscular dysplasia
what is the name of the radiocephalfc dialysis graft
Brescia-cimino
Celiac artery occlusion causes retrograde flow in which artery a) ima b) sma c) splenic artery d) common hepatic artery
D) common hepatic artery
in the presence of a carotid body tumor, what happens to the ECA
ECA resistance will decrease
median arcuate ligament syndrome causes celiac artery PSV to increase during
Exhalation
vein with the most valves
GSV
Which characteristics best describes the Doppler wavefrom seen in this image of Posterior Tibial Artery without obstruction? a) Pulsus Bisferiens b) Tardus parvus c) Hyperemic d) High Resistance
Hyperemic
a patient returns to the hospital two days after a liver transplant c/o severe abdominal pain, which can you expect to see on ultrasound
IVC thrombus
pulsatility index equation
PI = Systolic - diastolic / mean velocity
what is known as a "pulseless" disease
Takayasu's arteritis
Which description represents the type of waveform morphology demonstrated in this image? a) Pre-steal b) To and Fro c) Pulsus Bisferiens d) Tarvus-Parvus
Tardus-Parvus
Which description represents the type of waveform morphology demonstrated in this image? a) Pre-steal b) To and Fro c) Pulsus Bisferiens d) Tarvus-Parvus
To and Fro (pseudo)
proximal ICA waveform with a distal ICA occlusion
abnormal high resistance
what is the most common anomaly of the circle of willis
absence or hypoplasia of one or both of the communicating arteries
dicrotic notch indicates what
aortic valve closing
an arterial spectral Doppler indentation on the PSV in the CCA is caused by what
aortic valve closure
arteries that course above the renal pyramids
arcuate arteries
an ulcer on the bone prominence indicates what
arterial insufficiency
if a patient has fibromuscular dysplasia, they're at most risk for what
artery dissection
portal hypertension causes
ascites and esophageal varices
what is the effect of increasing sample volume depth on the Doppler system a) SPL increases b) time interval between pulses is longer c) attenuation decreases d) PRF is higher
b) time interval between pulses is longer
right and left vertebral arteries divide into the
basilar artery
bruit
blowing, swooshing sound heard through a stethoscope when an artery is partially occluded
Which finding on preoperative vein mapping would likely make AVF creation unsuccessful? a) Presence of prior AV graft b) Presence of prior AV Fistula c) Vein diameter less than 2 mm d) Arterial diameter less than 3 mm
c) vein diameter less than 2 mm
in a patient with portal hypertension, you notice a network of varices on the abdominal wall, this is described as
caput medusae
your patient has erythema (redness) & edema along his anterior tibial regions, this is
cellulitis
during a treadmill test, a patient experiences decreased ankle pressures bilaterally, this suggests
claudication (induced by exercise)
waveform distal to occlusive DVT
continuous venous flow, reduced phasicity
which vessel is most likely to be enlarged in the presence of vertebral artery occlusion
contralateral vertebral artery
first branch of ascending aorta
coronary artery
which of the following arteries does NOT arise from the intracranial ICA a) MCA b) PCA c) ACA d) ascending pharyngeal artery
d) ascending pharyngeal artery
Which flow change will occur as a result of an acute ICA occlusion? a) Ipsilateral vertebral artery flow velocity will double b) Ipsilateral vertebral artery flow velocity will retrograde c) Ipsilateral CCA velocity will become dampened d) Ipsilateral CCA velocity will become high resistance / triphasic
d) ipsilateral CCA velocity will become high resistance / triphasic
A 65 yo PT was referred or amaurosis fugax on the Left side. The symptoms are most likely due to lesion in which artery? a) Ipsilateral ECA b) Ipsilateral vertebral c) Ipsilateral carotid d) Ipsilateral MCA
d) ipsilateral MCA
Which vein will exhibit pulsatile flow as a normal variant? a) Common Femoral b) Popliteal c) Radial d) Subclavian
d) subclavian vein
during the valsalva maneuver, what happens to venous flow?
decreases or stops venous flow in the body
when a patient exhales
diaphragm raises and thoracic pressure increases
abnormal, resistive, and blunted waveform in the vertebral artery indicates
distal disease
high resistance, low velocity in vertebral artery suggests:
distal occlusion
median arcuate ligament syndrome also known as
dunbar syndrome
in the lower extremity, maximum flow return in the venous system is present with
exhalation
normal plethysmography waveforms
exhibit a dicrotic notch
ICA string sign
extensive plaque causing narrowing of the vessel or occluded ICA
three major branches of ophthalmic artery
frontal, supraorbital, and nasal arteries
how do we calculate the lindegaard ratio (hemisphere index)?
highest MCA divided by highest ICA
how to calculate ABI
highest systolic pressures at ankle level divided by the higher of the two brachial pressures
less reflection occurs for PPGs for which types of blood flow?
increased blood flow
hypogastric artery = ________
internal iliac artery
which of the following is NOT a collateral for ICA obstruction
intersegmental to arcuate branches
a 48-year old male presents with retrograde flow in the left vertebral artery, which vessel is most likely to be occluded and what is this phenomenon called?
left or ipsilateral (same side) subclavian artery and this is termed subclavian steal syndrome
plaque build up in the arteries is an accumulation of what
lipoprotein
a patient has a resting ABI of 0.76, this is indicative of
mild disease
a patient has a resting ABI of 0.57, this is indicative of
moderate disease
what is the most common anatomic variant of the renal arteries
multiple renal arteries
which branch of the ECA provides a collateral pathway to the vertebral artery a) lingual artery b) facial artery c) occipital artery d) superficial temporal artery
occipital artery (think its closer to the back of the neck)
thump artifact
occurs when ICA is occluded
thrill
palpable vibration felt outside of the body
TIA is characterized by
paralysis (focal weakness), paresthesia (numbness), amaurosis fugax (TIA of the eye), and aphasia (difficulty speaking)
Which description represents the type of waveform morphology demonstrated in this image? a) Pre-steal b) To and Fro c) Pulsus Bisferiens d) Tarvus-Parvus
pre-steal
tardus parvus waveform in distal ICA suggests:
proximal occlusion
waveform proximal to occlusive DVT
pulsatile venous flow (unless patient has CHF in which pulsatile venous flow occurs bilaterally)
a non-invasive test that can be used to augment a subclavian steal from hesitant stages to complete stages so it can be more easily recognized
reactive hyperemia
progression of arterial disease
reduced claudication, toenail thickening, discolored and scaly skin
distal CCA occlusion can cause
retrograde flow in ECA and dampened monophonic waveforms in the ICA
what type of artifact will mimic an artery dissection
reverberation
Calculate ABI if: right left brachial artery 152 146 posterior tibial artery 112 158 dorsalis pedis artery 108 154
right ABI: 0.74 left ABI: 1.0
basilar artery divides into
right and left posterior cerebral arteries
Brachiocephalic artery divides into
right common carotid artery and right subclavian artery
if you see retrograde or "hesitant" flow in the right vertebral artery, what side of of the subclavian is affected?
right subclavian (ipsilateral side)
a patient with mild claudication has a normal ABI of 1.09, what should you perform next?
stress test
Via which of the following vessels does the external carotid artery provide an anastomotic link to the internal carotid artery?
superficial temporal artery
what is a contraindication for pseudoaneurysm closure?
the width of the pseudoaneurysm neck is 2 - 3 cm
an ulcer on the medial malleolus indicates what
venous insufficiency
