VAS test

Acute thrombus is soft and may be easily compressed to a certain extent; chronic thrombus A. is not compressible to any extent B. may be easily compressed to a certain extent C. will easily compress completely D. with some difficulty (pressure) will compress completely

A

Blood movement in concentric layers with the highest velocity in the center of the vessel that creates a parabolic flow profile is A. laminar flow B. disorganized flow C. boundary layer separation D. turbulent flow

A

Deep vein thrombus can originate anywhere in the venous system, but studies have shown the single most common site to be A. soleal sinusoids B. PTV C. Ilio-femoral vein D. saphenous-femoral junction

A

Embolism is A. sudden blocking of artery by clot or foreign material B. atherosclerotic plaque formation C. trauma to an artery with resulting occlusion D. dissection of an artery caused by trauma

A

If the transmitted frequency is raised, the Doppler shift A. increases B. decreases C. remains the same D. will not be detected

A

Lower extremity venous examination for patency includes A. compression and augmentation at each landmark site B. proximal compression at each landmark site C. spectral analysis at each landmark site D. color flow Doppler at each landmark site

A

The Doppler effect creates A. change in frequency of Doppler shift when the reflector moves relative to the transducer B. increase in frequency as the reflector moves away from the transducer C. maximum frequency shift at 90 degrees D. requires angle correction for frequency measurements

A

The GSV of the lower extremities have two primary tributary veins in the legs, the first one joining at the knee (posterior arch and anterior veins of the legs) and the second one at the foramen ovale, includes all veins listed below except A. superficial external pudendal vein B. superficial epigastric veins C. deep external pudendal veins D. superficial iliac circumflex

A

The innominate or brachiocephalic vein lies anterior and lateral to the innominate artery, and receives all the veins below except A. brachiocostal vein B. vertebral vein C. interal mammary vein D. inferior thyroid

A

The normal route of venous flow in the lower extremity is A. superficial veins to perforator veins to the deep veins B. deep veins to the perforator veins to the superficial veins C. deep veins to superficial veins to perforator veins D. superficial veins to the deep veins to perforator veins

A

The superficial veins of the lower extemities can be demonstrated sonographically within 1-2 cm of the skin surface, they lie A. within the subcutaneous fat B. within the connective tissue sheath C. just below the subcutaneous fat D. just above the deep fascia

A

The turbulence in the blood flow distal to a narrowing of the vessel is A. poststenotic turbulence B. velocity jet C. laminar flow D. dampened flow

A

The veins in the sole of the foot form the planter cutaneous arch, which drains into the medial and lateral marginal veins, which in turn empty into A. greater and lesser saphenous veins B. anterior and posterior tibial veins C. ATV and LSV D. GSV

A

The venus valves are found in the A. tunica intima B. tunica media C. tunica adventitia D. A and C

A

There are no valves present in which of these veins? A. innominate veins B. axillary vein C. external jugular vein D. internal jugular vein

A

To determine reflux in the vein, manual compression is performed A. proximal to the transducer and vein in question B. distal to the transducer and vein in question C. at the level of the transducer and vein in question D. in 5-minute intervals at the level of the transducer

A

US cannot accurately detect thrombosis in which LE veins? A. calf veins B. superficial veins C. deep veins D. perforating veins

A

Venous stasis leads to chronic venous insufficiency, which is characterized clinically by everything, listed below except A. no leg pain B. varicose veins C. chronic swelling of the leg D. cutaneous hyperpigmentation

A

Which artery is present only on the right side of the upper extremity? A. brachiocephalic B. subclavian C. thyrocervical D. costocervical

A

Which vein arises from the medial side of the dorsal venous arch, runs along the ulnar aspect of the forearm and upper arm, finally penetrating the deep fascia to unite with the brachial vein to form the axillary vein? A. basalic vein B. cephalic vein C. median cubital vein D. radial vein

A

Which vein arises medial to the lateral malleolus of the ankle, then in the lower two thirds of the leg follows the medial surface of the fibula, finally in the upper third it turns to join the posterior tibial vein? A. peroneal vein B. anterior tibial vein C. posterior tibial vein D. LSV

A

Collateralization caused by obstruction may be confusing for the examiner and may be mistaken for a patent vessel. They exhibit all the characteristics below except A. continuous in nature B. pulsatile in nature C. abnormally located D. difficult to compress

B

Continuous wave Doppler has how many crystals in the transducer? A. 1 B. 2 C. 3 D. 4

B

Duplex scanning on the deep venous system of the LE is usually performed with A. the patient placed in the supine position with the leg straight B. the patient placed in the supine position with the leg externally rotated C. the patient placed in the supine position with the leg internally rotated D. the patient placed in the prone position with the leg internally rotated

B

Each toe has two dorsal digital and two plantar veins that unite to form the dorsal metatarsal veins that join to form the A. dorsal metatarsal venous arch B. superficial dorsal venous arch C. deep dorsal venous arch D. planter-dorsal venous arch

B

Respiration plays a major role on the venous flow patterns. During inspiration, the intra-abdominal venous pressure increases A. blood flows smoothly throughout the body, at the moment of exhalation the valves close, then quickly reopen again B. decreasing blood flow from the LE while increasing the flow from the upper part of the body C. increasing blood flow from the LE while decreasing the flow from the upper part of the body D. respiration does not play a big role in the venous flow pattern

B

Spectral broadening seen on the spectral analysis means A. normal arterial waveform B. increased bandwidth caused by disturbed flow C. decreased bandwidth caused by disturbed flow D. increased bandwidth caused by laminar flow

B

The cephalic vein communicates with the basilic vein in the cubital fossa at the elbow through the A. lateral cubital vein B. median cubital vein C. inter cubital vein D. inferior cubital vein

B

The condition for chronic venous insufficiency of the extremity that continues to deteriorate with progressive leg pain described as an aching or bursting sensation with prolonged walking is called A. Young syndrome B. venous claudication C. Ryan syndrome D. arterial claudication

B

The only location where a spontaneous venous signal may normally not be heard in the LE veins is the A. external iliac vein B. PTV C. profunda or DFV D. peroneal vein

B

The popliteal vein is formed from the posterior tibial and anterior tibial veins at the knee, then extends upward through what to become the SFV? A. profunda hiatus B. adductor canal (Hunter's) C. Scarpa's triangle D. flexor hallucis longus

B

The primary clinical concern in deep vein thrombosis (DVT) is the complication of A. claudication B. pulmonary embolism C. valve competency D. loss of extremity

B

There are several causes of chronic venous insufficiency that result in venous stasis. Which one listed below is incorrect? A. varicose veins B. surgery C. post thrombotic syndrome D. chronic recurrent thrombosis

B

Thrombosis of the axillary and subclavian veins is an uncommon primary disorder, occurring in fewer than 2% of cases of acute thrombophlebitis of deep vein of the extremities. The low frequency of this disorder may be attributable to everything listed below except A. rapid emptying of blood from the arm B. fewer veins C. a shorter course of blood flow D. increased quantity of clot resolving enzymes

B

To ensure sonographic visualization of low frequency venous flow A. a high wall filter setting is used B. a low wall filter setting is used C. the same setting is used for arterial and venous flow D. a medium wall filter setting is used

B

Using US duplex scanning to look at the venous system, a partial obstruction will present as A. partial fixed lumen that is very easy to compress, with complete closure B. partial fixed lumen that is very hard to compress, with limited closure C. complete fixed lumen that is very easy to compress, with complete closure D. complete fixed lumen that is very hard to compress, with limited closure

B

Varicose veins with competent deep vein valves and incompetent superficial veins are termed A. secondary varicose veins B. primary varicose veins C. fist varicose veins D. thigh varicose veins

B

What type of pain is present during exertion and disappears upon cessation of activity? A. rest pain B. claudication pain C. trauma pain D. normal exercise

B

When performing a Doppler US exam of the venous system, the normal response to a distal aug is A. a rapid increase in frequency followed by an abrupt cessation of the signal, and then a normal return to phasicity B. a rapid increase in frequency followed by a slow decay, and then a normal return to phasicity C. a slow increase in frequency followed by an abrupt cessation of the signal, then a normal return to phasicity D. no response is heard with aug

B

Which vein is a continuation of the dorsalis pedis and lies btw the tibia and fibula on top of the interosseous membrane? A. popliteal vein B. ATV C. LSV D. peroneal vein

B

Which vein is not part of the superficial venous system? A. GSV B. SFV C. LSV D. basilic vein

B

Which veins arise from and drain the plantar venous arch and superficial venous net of the foot? A. ATV B. PTV C. GSV D. LSV

B

Which vessels distal landmark is the area btw the medial malleolus and the Achilles tendon, near the skin surface? A. ATV B. PTV C. LSV D. GSV

B

Varicose veins are the most common form of venous disease. These veins also A. affect approximately 45% of the human population B. are equally prevalent in both men and women C. are not of genetic predisposition D. are usually caused by absence of valves

B (Varicose veins are equally prevalent in men and women. They also affect approximately 15% of the population, are genetic predisposition and are usually caused by functional failure of the valves rather than absence of them.)

A functioning valve is competent if A. it simultaneously opens and closes B. it allows both forward and reverse venous flow C. it will not allow reversal of venous blood flow D. it stays open continuously allowing continuous venous flow

C

After an episode of deep vein thrombosis, the venous valves are destroyed and become incompetent. This is termed A. thrombophlebitis B. Raynaud's phenomenon C. postphlebitic syndrome D. phlegmasia cerulea dolens

C

After the deep vein muscular pump activates (contracts) the leg muscles and valves, everything listed below happens except A. blood is forced out of the deep veins up the leg B. once the blood is pumped into the thigh, the valves close at the popliteal vein to hold it there C. the perforating veins will open to fill the superficial veins D. blood flows from the superficial system into the deep system

C

After thrombus fills the vein and adheres to the wall of the vessel, it will then contract, and recanalization will begin. This generally takes A. about 10 days B. about 3 days C. about 5 days D. about 12 days

C

As sympathetic stimulation is increased, the smooth muscle of the artery contracts and narrows the vessel lumen. This is called A. vasodilation B. vascular narrowing C. vasoconstriction D. vasospasm

C

Compression of the venous system by external pressure often compromises the flow of the vessel. Which of the following cannot compromise the flow? A. Baker's cyst B. lymph nodes C. varicose veins D. hematomas

C

Normal veins exhibit all the characteristics below except A. spontaneous flow B. phasic flow C. pulsatility D. compressibility

C

Pathologic conditions can mimic deep vein thrombosis but can be easily demonstrated by US. Which one of the answer listed below is not a pathologic condition? A. enlarged lymph nodes B. hematomas C. cast on broken bone, causing swelling D. popliteal (Baker's) cyst

C

Primary varicose veins normally affect the superficial system. Their exact cause is unknown. Listed below are what is believed to be a few of the contributing factors. Which one is incorrect? A. abnormal wall weakness B. increased distending force C. large arteriovenous fistulas D. multiple arteriovenous fistulas

C

Several abdominal organs do not pour their blood directly into the IVC; they send their blood to the liver by means of the hepatic portal vein. Which one of the organs listed below does not go through the portal vein? A. spleen B. GB C. renal D. pancreas

C

The communicating veins or perforators are located throughout the leg, in most legs there are A. more than 50 B. more than 1000 C. more than 100 D. more than 500

C

The expansion and contraction of arteries after each systole of the left ventricle creates a pressure wave termed A. cycle B. waveform C. pulse D. mean

C

The longest vein in the body is the A. cephalic vein B. SFV C. GSV D. IVC

C

The physiology of circulation is called A. fluid dynamics B. circulatory system C. hemodynamics D. coronary circulation

C

The soleus plexus veins in the posterior calf drain the soleus muscle and empty into the A. LSV B. peroneal vein C. PTV D. GSV

C

The the lower extremity what provides the energy required to circulate blood during strenuous exercise? A. soleus sinusoids B. gastroc sinusoids C. musculovenous pump D. venous pressure changes

C

The vein wall is very thin and is comprised of three layers; the outermost layer is called A. tunica media B. tunica intima C. tunica adventitia D. tunica endothelium

C

The veins serve as the passageway of blood flow to the heart, pulmonary veins carry A. deoxygenated blood from the heart back to the lungs B. blood from the portal system to the heart C. oxygenated blood from the lungs to the heart D. blood from the IVC to the heart

C

What determines the Doppler shift frequency? A. flow toward the transducer B. flow away from the transducer C. difference btw the reflected and transmitted frequency D. the velocity of the moving particles toward the transducer

C

What is the most common symptom of lower extremity arterial disease? A. ulceration B. absence of pulses C. claudication D. cyanosis

C

Which vessel arises from the medial end of the dorsal venous arch at the foot and ascends in the ankle in front of the medial malleolus of the tibia, and after ascending up the calf it crosses behind the medial condyle of the femur at the knee? A. LSV B. PTV C. GSV D. ATV

C

A large series of veins drain into what sinuses to form the main collecting chambers of the calf muscle pump? A. gastrocnemial sinuses B. medial calf sinuses C. peroneal sinuses D. soleal sinuses

D

As venous thrombus ages, it becomes everything listed below except A. echogenic B. the vein distends C. the vein doesn't compress D. anechoic

D

Blood pressure is A. volume of blood flowing through the vessel B. average pressure throughout the cardiac cycle C. pulse pressure in circulatory system D. pressure exerted by blood on the wall of a blood vessel

D

Calf pain on passive dorsiflexion of the foot is the nonspecific sign suggesting the diagnosis of deep vein thrombosis known as A. Sullivan's sign B. Rich-Durbin's sign C. Madison's sign D. Homans sign

D

Composition of the arteries does not include A. intima B. media C. adventitia D. internal capsule

D

Deep vein thrombosis of teh upper extremity is becoming more frequent because of A. Increased number of patients having radiation therapy and complications B. Increased incidence of trauma patients with complications C. Increased incidence of thoracic outlet syndrome D. increased used of central venous catheters

D

Following an episode of deep vein thrombosis, the venous valves have probably become irreversibly incompetent. This results in continual high venous pressure which causes everything listed below except A. chronic edema B. dilated incompetent perforators C. development of varices D. calf is cold to the touch

D

If flow is toward the transducer the frequency shift will be A. lower B. same C. variable D. higher

D

Posterior to the neck of the pancreas, what two veins join to form the portal vein? A. splenic vein and hepatic vein B. hepatic vein and SMV C. hepatic vein and celiac vein D. splenic vein and SMV

D

The only point in the body (in any position) where the arteriovenous pressure gradient remains the constant (83 mm HG) is the hydrostatic indifferent point which is located A. at the external jugular B. at the hip C. at the aorta bifurcation D. just below the diaphragm

D

The perforating veins of the lower extremities do everything listed below except A. connect the superficial veins to the deep veins B. penetrate the deep fascia C. allow blood to flow from the superficial to the deep veins D. connect the anterior arch of the GSV with the deep veins

D

The right ovarian vein drains directly into the IVC. The left ovarian vein drains into A. the right ovarian vein B. the left internal iliac vein C. the IVC D. the left renal vein

D

There are a number of variables that are associated with an increase in the likelihood of developing deep vein thrombus, one that decreases the chances is A. obesity B. the use of oral contraception C. over 60 age group D. smoking

D

Venous Doppler evaluation of the LE is highly accurate in the detection of A. differentiating intrinsic from extrinsic causes of obstruction B. partial obstructions that do not cause changes in the venous flow pattern C. detect thrombosis confined to the calf veins D. detecting hemodynamically significant obstruction of the pop, superficial femoral and common femoral veins

D

What arises from the dorsal venous system that is formed by the digital and metacarpal veins? A. the venous arch B. radial and ulnar veins C. innominate vein D. cephalic and basilic veins

D

Which of the following is not true of the spectral analysis? A. mathematical display of the frequency components in the Doppler signal B. computer using the fast fourier transform method C. demonstrates the presence, direction and characteristics of blood flow D. Does not provide measurements of the blood flow

D

Which one of the following is not used to augment veins? A. distal compression of the vein B. coughing C. Valsalva D. compression of the vein with the transducer probe

D

Which statement is not true about aliasing? A. velocities exceed the Nyquist limit B. wraparound of the waveform C. higher velocities appear on the negative side of the baseline D. not controlled by the pulse repetition rate

D

Which vein receives both the superficial and deep venous systems of the upper extremity? A. innominate vein B. cephalic vein C. brachial vein D. subclavian vein

D

Within 15 minutes of standing still, what percentage of the body's total volume of blood may be pooled to the lower extremity veins? A. 20-30 B. 10-15 C. 30-40 D. 15-20

D (15-20% of the body's total blood volume may be pooled in the LE veins with 15 min of standing absolutely still. This accounts for the well known example of soldiers fainting after standing at attention for extended periods of time.)

When scanning the subclavian vein toward the shoulder, what branch does it give off just before becoming the axillary vein? A. Costocoracoid vein B. basilic vein C. cubital vein D. cephalic vein

D (As soon as the subclavian vein gives off the cephalic vein branch it changes its name to the axillary vein. This happens at the outer border of the first rib. Usually, only one valve is found in the axillary vein.)

What percentage of blood in the body can be found within the venous system? A. 60-65 B. 50-65 C. 70-75 D. 75-80

D (the veins act as a storage site for blood)

Normal veins characteristics do not include the following A. phasicity B. spontaneity C. compressibility D. augmentation E. continuous signal without respiratory movements

E

Predisposing factors for arterial disease does not include A. smoking B. aging C. diabetes D. family history of arterial disease E. hypertension F. bradycardia

F

A normal venous signal is described as being A. continuous B. phasic C. pulsatile D. oscillating

B

The GSV enters the CFV in the groin region just below the inguinal ligament at the A. foramen ovale B. foramen Penn C. foramen Adcock D. foramen fascial

A (The GSV ascends along the medial aspect of the leg then enters the CFV at the foramen ovale, just below the inguinal ligament.)

All deep veins of the lower leg are usually paired, communicate with the superficial vein system and contain at least how many valves? A. 10 B. 7 C. 15 D. 5

A (all deep veins contain at least 10 valves. As many as 10-15 may be present in each vein. They are usually paried and communicate with the superficial system.)

Veins differ from arteries in all the ways listed below except A. veins have thicker walls with very little muscles B. veins are distensible C. veins are collapsible D. veins can be divided into deep and superficial systems

A (veins have thinner walls)

A pathological condition, which can mimic a deep vein throbosis is A. aortic aneurysm B. Baker's cyst C. phlegmasia cerulea dolens D. decreased skin temperature

B

Maximum Doppler shift frequency occurs at A. 90 degrees B. 180 degrees C. 0 degrees D. 75 degrees

C (A perpendicular or 90 angle results in no detected Doppler shift. Because zero degree is not feasible in most clinical applications; we avoid the 90 angle and maintain a 30-60 for clinical applications)

Virchow's triad places the risk factors for venous thrombosis into three categories. All of the following are correct except A. changes or injury to the vessel wall B. hypercoagulability of blood C. immobility of extremity D. stasis or slowing of blood flow

C (Immobility is not one of the categories of Virchow's triad but it is a risk factor.)

The pressure within a vein is A. indirectly proportional to the cardiac output B. equal to the arterial pressure C. directly proportional to the force that is exerted on the vein wall by the blood volume within it D. directly proportional to the rate of respiration and pulmonary status

C (The transmural pressures are governed by the pressure-volume relationship. The difference in pressure btw the intraluminal pressure trying to expand the vein and the outside tissue pressure trying to collapse the vein is called transmural pressure. If this pressure is increased, the volume of blood within the vein increases due to the flexibility of the vein wall.)

In the acute stage, fresh venous thrombus A. is usually echogenic B. vein is usually compressible C. is usually anechoic D. Collateral veins usually start to appear adjacent to the vessel

C (in acute stages, fresh thrombus is usually anechoic. The vein will not compress. Collateral veins can appear as the recanalization begins.)

The two major muscle plexus veins are the soleus and gastroc in the lower legs. The gastroc plexus drains the blood from the gastrocnemius muscle and empties into the A. PTV B. ATV C. popliteal vein D. peroneal vein

C (the gastroc empties into the pop vein. The soleus plexus veins empty into the PTV)

Which veins make up the superficial venous system in the upper extremity? A. axillary vein B. subclavian vein C. brachial vein D. cephalic vein E. basilic vein F. A, B and C G. D and E H. all of the above

H