Test 3 vascular
How can the internal and external carotid arteries be safely differentiated?
-ICA has no branches while the ECA commonly does -Waveforms may be different -You can perform a temporal tap on an ECA
during an erection to what diameter does the cavernosal artery dilate?
1.0 mm
Approximately ____ of neck bruits are related to significant stenosis of the internal carotid artery
1/3
approximately how long will contrast administered in a bolus provide enhanced visualization?
2 min
what is the typical cuff width used for a penis pressure?
2.5 cm
what is a typical rate of contrast injection for CTA?
3-5 mL/s
Which transducer is most commonly used to perform a duplex evaluation of the extra cranial cerebrovascular system?
7-4 MHz linear array
Why do Doppler waveforms in the common carotid arteries display a contour suggestive of relatively low-resistance flow?
70% of its flow supplies the ICA
the bubbles used for ultrasound contrast are typically smaller than what?
8 microns
what percent of erectile dysfunction is attributed to vascular disease?
80%`
which of the following velocities is associated with arterial insufficiency postinjection?
<25
During duplex evaluation of the carotid artery system, velocities in the external carotid artery reached 250 cm/s, the turbulence was noted just after the area of increased velocity. What do these findings suggest?
> 80% stenosis > 230 = > 70% stenosis
which of the following is considered normal for a penile brachial index?
>0.7
what velocity is typically used as an indications to revise a renal artery bypass during intraoperative assessment?
>200 cm/s
What is reactive hyperemia, a provocative maneuver used during the duplex evaluation of the extra cranial cerebrovascular system, used to demonstrate?
A change from latent or partial to complete subclavian steal
Carotid bulb
A slight dilation involving variable portions of the distal common and proximal internal carotid arteries, often including the origin of the external carotid artery. This is where the baroreceptors assisting in reflex blood pressure control are located. The carotid bulb tends to be most prominent in normal young individuals
Bruit
An abnormal "blowing" or "swishing" sound heard with a stethoscope while auscultating over an artery, such as the carotid. The sound results form vibrations that are transmitted through the tissues when blood flows through a stenotic artery
Transient ischemic attack
An episode of stroke-like neurologic symptoms that typically lasts for a few minutes to several hours and then resolves completely. This is caused by temporary interruption of the blood supply to the brain in the distribution of the cerebral artery
Spectral broadening
An increase in the "width" of the spectral waveform (frequency band) or "filling-in" of the normal clear area under the systolic peak. This represents turbulent blood flow associated with arterial lesions
Which statement on power Doppler is FALSE? A) It represents the amplitude of the Doppler signal instead of frequency shift B) It depends on the angle of insonation C) It does not give information about flow direction D) It can detect low flow states
B) It depends on the angle of insonation
If significant flow turbulence is noted in the proximal right common carotid, it becomes imperative to examine the ________
Brachocephalic (innominate)
According to the criteria developed by the University of Washington, the stenosis categories below the 50% threshold are differentiated from one another by the presence or absence of flow separation, the extent of spectral ________ and the amount of plaque visualized
Broadening
Which of the following is NOT a characteristic of normal Doppler waveform contour? A) Brisk systolic acceleration B) Sharp systolic peak C) Increased spectral broadening D) Clear spectral window
C) Increased spectral broadening
Which of the following will NOT result in symmetrical changes in the Doppler spectra? A) Aortic valve or root stenosis B) Brain death C) Subclavian steal D) Intra-aortic balloon pump
C) Subclavian steal
When qualifying the appearance of plaque by ultrasound, the use of which of the following terms is discouraged owing to poor reliability? A) Homogeneous/hetergeneous B) Smooth/irregular C) Ulcerated D) Calcified
C) Ulcerated Indentation of the intima and media
A patient presents to the vascular lab with a severe distal CCA obstruction; however, the internal carotid and external carotid artery remain patent. What is the lesion typically called?
Choke lesion
High-grade stenoses of the internal carotid arteries, as flow restricting lesions, are rarely the primary cause of neurologic symptoms because of _______
Collaterals
Which of following would affect pulsed Doppler spectrum contour in all vessels of the extracranial cerebrovascular arterial system even when no disease is present? A) Low cardiac output B) Aortic root stenosis C) Intra-aortic balloon pump D) All of the above
D) All of the above
Which of the following is NOT "sound" advice for sonographers who wish to prevent repetitive stress injuries while scanning? A) Be ambidextrous B) Arrange bed and equipment to be close to patient C) Remain well hydrated during the day D) Avoid doing stretching exercises
D) Avoid doing stretching exercises
what is the typically use of DSA in the cerebrovascular system?
DSA no longer used in this system
The use of a curved or phased array transducer is recommended for the examination of the distal internal carotid arteries, particularly in patients with tortuous vessels, fibromuscular dysplasia, or vessels that are ______ than usual
Deeper
As plaque develops and fills the carotid bulb, what change can be expected in the Doppler waveform at this level?
Disappearance of normal flow separation
In a normally hemodynamically low-resistance system or vessel, such as the internal carotid and vertebral arteries, what will a change to high-resistance pattern suggest?
Distal stenosis or occlusion
Transient symptoms manifested as a difficulty to speak are termed as _______
Dysphasia
The internal features of plaque found in the extra cranial cerebrovascular system are usually related to the _______ of plaque
Echogenicity
How should the patient's head be positioned in order to expedite a carotid-vertebral duplex examination?
Head rotated 45 degrees away from side being examined with a pillow under shoulders
Dissection of the intima, particularly in common carotid arteries, could be confused with artifacts from the wall of ________
IJV (Refraction artifact)
________ injury is defined as any adverse patient condition that is induced inadvertently by a health care provider during a diagnostic procedure or intervention
Iatrogenic
which modality is better suited for patients with iodine allergies or who are diabetic?
MRA
Doppler angle
Most commonly defined as the angle between the line of the Doppler ultrasound beam and the arterial wall (also referred to as the "angle of insonation"). This is a key variable in the Doppler equation used to calculate flow velocity
Lesions or stenoses in the internal carotid arteries can be present without ________ symptoms
Neurologic
In the presence of significant common carotid stenosis, the ICA/CCA ratio criteria are not _________
Not valid
which criterion is used most often when assessing whether to revise an infrainguinal bypass graft during intraoperative assessment
PSV > 180 and velocity > 2.5
________ Doppler is particularly helpful in detecting extremely low flow velocities, including string sign flow
Power
Neurologic deficits lasting between 24 and 72 hours are classified as ______
RIND
Flow separation can be seen in the carotid bulb and will be represented by brief flow ______
Reversal
Spectral analysis
Signal processing technique that displays the complete frequency and amplitude content of the Doppler flow signal. The spectral information is usually presented as waveforms with frequency (converted to a velocity scale) on the vertical axis, time on the horizontal axis, and amplitude indicated by a gray scale
Latent, hesitant, alternating, and complete are terms usually describing the stages of _________
Steal contours
The primary goal of an examination of the extra cranial cerebrovascular system by duplex ultrasound is to identify patients at risk for _______
Stroke
The waveform contour distal to a significant stenosis is often referred to as a _______ pattern, characterized by damped, rounded waveform with decreased velocity and delayed acceleration
Tardus parvus
There are usually two recommended methods to distinguish the internal from the external carotid artery. In one method, one would perform _______ to demonstrate oscillations on the Doppler spectrum
Temporal tap
For subclavian steal syndrome or phenomenon to occur, where does a severe stenosis or an occlusion need to be present?
The left subclavian artery or brachiocephalic artery proximal to the vertebral artery origin
What is the secondary goal of examination of the extra cranial carotid artery system by duplex ultrasound?
To document progression of disease
In order to evaluate the subclavian artery, the transducer is placed in a(n) _______ orientation at the base of the neck
Transverse
Bleeding within a plaque underneath the fibrous cap (intraplaque hemorrhage) can cause the plaque to become _______
Unstable
What is the most common technique used to identify the vertebral artery?
View the CCA and angle the transducer slightly posteriorly
What would the use of contrast enhanced ultrasound in the abdominal vasculature prove MOST helpful in?
abdominal aortic aneurysm demonstrating true and false lumen
what is the most significant advantage to CES over repeated CT for evaluation of endovasular leaks?
ability to detect leak flow
what causes a nonischemic or high flow priapism?
abnormal communication between penile arterial system and cavernosal sinusoids
which of the following can lead to complications or failure of an infrainguinal bypass graft?
all of the above
which of the following is considered the gold standard for intraoperative assessment of any type of revascularization?
arteriography
upon duplex assessment of a carotid endarterectomy site, shadowing is noted in the proximal internal carotid artery. what is the most likely cause of this shadowing?
artificial from the prosthetic path at the endarterectomy site
which of the following applications would be best suited for slow IV infusion of contrast agent?
cardiac chamber opacification
which vessels are identified near the central and medial aspects of the corpora cavernosa?
cavernosal arteries
in general when performing an intraoperative assessment which of the following imaging techniques is best?
combination of grayscale, color and spectral doppler
what are the two masses of erectile tissue composed of multiple sinusoidal chambers?
corpora cavernosa
what technique is achieved by obtaining a mask image before injection of contrast and then postinjection image obtained of just the contrast filled vessel?
digital subtraction angiography
during intraoperative duplex assessment of a lower extremity bypass graft, turbulent flow is noted in the mid thigh with elevated diastolic flow noted in the proximal thigh. what are these findings consistent with?
dissection
What is a benefit of MRA compared to CTA?
does not require contrast
what is recommened all patients with peyronie disease have prior to preforming invasive treatmemts?
duplex doppler ultrasound with intracavernosal injections
why may intraoperative duplex ultrasound evaluation of renal artery bypass be preferred over angiography?
duplex ultrasound avoids the use of contrast in a renal compromised patient
what is a common venous procedure in which intraoperative monitoring is routinely used?
endovenous laser therapy
after the microbubbles are ruptured how are the shell particles removed from the body?
exhalation
which of the following is a limitation of CTA when trying to determine stenosis verus occlusion, especially in small vessels?
extravasation of contrast
during grayscale imaging of the corpora cavernosa a thickened hyperechoic area is noted on the tunica albuginea. shadowing is noted as well. what does this likely represent?
fibrous plaque with calcification
during a superior mesenteric artery bypass intraoperative evaluation an intimal flap is discovered and velocities were 300 what would likely occur with this graft?
graft revision would be indicated
which duplex ultrasound system requirement would be best suited for intraoperative assessment
gray scale system with high frequency transducers
when using contrast injections with either CT or MR what must the patient do when images need to acquired?
hold their breath
which of the following duplex ultrasound findings is not associated with platelet aggregation?
hypoechoic or anechoic material adjacent to vessel wall
where does the arterial vascular supply to the penis originate?
internal iliac artery
how is the ultrasound contrast agent administered?
intravenous
why is intraoperative duplex ultrasound not used in aortailiac reconstruction?
large amounts of bowl gas make imaging impossible
in a cardiac application what would the use of saline contrast study help diagnose?
left to right shunting VSD
which of the following is NOT an ultrasound system necessary for successful are use of contrast agents?
low mechanical index
what is a benefit of MRA compared to CTA?
no exposure to ionizing radiation
what is the primary role of the vascular tech during intraoperative procedure?
operation of the ultrasound system as the vascular surgeon manipulates the transducer
all of the following are measured both pre and post injections except
penile length
how do normal penile systolic pressures compared to brachial systolic pressure?
penile pressure are less than brachial pressure
what is a connection of veins that drains the dorsal veins of the penis into the internal iliac or internal pudendal vein?
periprostatic plexus
what is the microbubble shell in definity?
phospholipids
which of the following is NOT a characteristic of a viable contrast agent?
size greater than 8 microns
what type of UCA would best serve a patient/sonographer when the diagnosis is DVT and vessels are difficult to visualize?
thrombus-specific agent
what is the purpose of the intracavernosal injection?
to induce and maintain an erection
what is a major benefit of angiography in the intraoperative assessment of carotid endarterectomy?
unable to visualize the intracranial carotid artery
which of the following is not a disadvantage of using saline as a contrast agent?
unstable or fragile
in which situation is duplex sonography least effective in evaluation of organ transplant?
urinary or bile obstruction
which of the following situations would most likely be enhanced with the use of contrast ultrasound agent?
vessels with slow flow identified by power doppler
Where is MRA the least accurate?
visceral vessels
