Vascular lecture Final test 3

the assumed angle of intonation in a transcranial doppler(TCD) exam is____?

0 degrees

at what point does the portal vein size becomes abnormal

13mm

which of the following is the threshold for an abnormal renal artery to aortic ration (RAR)?

3.5

in reference to chart 1, fill in the missing information at the cell labeled A, they typical depth of the sample volume is :

30-60mm

from the transorbitial view, the ophthalmic artery will be typically at a depth of ______ mm.

40-60

in reference to chart 1, fill in the missing information at the cell labeled B , they typical depth of the sample volume is :

55-65mm

in reference to chart 1, fill in the missing information at the cell labeled C , they typical depth of the sample volume is :

55-65mm

in reference to chart 1, fill in the missing information at the cell labeled E , they typical depth of the sample volume is :

60-70mm

from the trans orbital view, the ICA will be typically be at a depth of ______ mm

60-80

in reference to chart 1, fill in the missing information at the cell labeled D , they typical depth of the sample volume is :

60-80mm

the MCA's carry ____% of the ICA flow?

75-80

normal adult kidney length is:

9-12cm

Normal low resistance index (R) for the renal artery is typically:

<0.75

the transorbital doppler examination has limitations that include

All of the above; requires considerable skill to perform only diagnostic with hemodynamically significant lesions it cannot differentiate an occlusion from a tight stenosis

when evaluating the ophthalmic artery during a transorbital doppler exam, the normal flow pattern in the artery should be

Antegrade

In reference to diagram 3; identify the structure labeled as A

Common hepatic artery

there are normally 3 major branches of the hepatic veins that drain blood into the superior vena cava

False

in reference to diagram 4; identify the structure labeled as B

Genu segment

in reference to diagram 2, the structure labeled as E is identified as:

Main renal arteries

normal high flow velocity in the renal artery is typically:

PSV 100 cm/sec

what is the criteria threshold for an SMA >70% stenosis?

PSV of 275 cm/sec

the criteria for a greater than 70% stenosis in the celiac artery is :

PSV> 200cm/sec with post stenotic turbulence

the criteria for a greater than 70% stenosis in the superior mesenteric artery is:

PSV> 275 cm/s with post stenotic turbulence

a neurological deficit that damages brain tissue but does reserve itself is classified as a :

RIND

what relationship does the right renal artery (RRA) have to the inferior vena cava (IVC)

RRA passes posterior to the IVC

a normal doppler signal in the SMA post-prandial should be

a low resistance waveform with a peak systolic velocity of 250 cm/sec

in reference to diagram 2, the structure labeled as B is identified as:

accurate arteries

Mrs.hh is complaining of visual problems. which of the following is associated with a stenosis of an internal carotid artery?

amaurosis fugax

Crossover collateralization occurs when __________ flow is evident in the ipsilateral anterior cerebral artery.

antegrade (toward the transducer)

in a normal or functioning circle of willis, intracranial cross-filling often occurs in which of the following vessels in the presences of an occluded ICA?

anterior communicating artery

In reference to diagram 3; identify the structure labeled as E

aorta

in reference to diagram 5; identify the PW waveform in image 5B as being

aortic artery flow distal to the renals

in reference to diagram 5; identify the PW waveform in image 5A as being

aortic artery flow proximal to the renals

in reference to chart 1, fill in the missing information at the cell labeled I , the typical flow direction (with respect to the transducer)

away

in reference to chart 1, fill in the missing information at the cell labeled H , they typical depth of the sample volume is :

bi-directional

flow at the MCA/ACA junction should appear on the display as

bidirectional

in reference to diagram 4; identify the structure labeled as E

cavernous segment

which of the following is not a cause of portal hypertension

celiac artery stenosis

which of the following is the first branch of the abdominal aorta?

celiac axis

in reference to diagram 4; identify the structure labeled as F

cervical segment

__________ is the size of a fifty cent piece and lies at the base of the brain connecting the anterior and posterior circulatory system

circle of willis

TCD findings of retrograde flow in the ipsilateral ophthalmic artery is found in:

external-to-internal collaterization

extrenal-to-internal collateralization is evident when there is reversal of flow direction in raw anterior cerebral artery (A1) ipsilateral to the proximal stenosis or occlusion

false

if a TCD study is performed without imaging, vessels can be accurately indenified in spite of the lack anatomic landmarks

false

normal hepatic vein flow is hepatopetal

false

the supra orbital and facial arteries arise from the ophthalmic artery

false

when performing a transorbital doppler study the patient is optioned prone with eyes closed

false

flow direction into the liver is called:

hepatopeal flow

renal fibromuscular dysplasia (FMD) usually occurs in what vessel segment

in the mid to distal main renal artery

the most common place for an aneurysm to occur is:

infrarenal aorta

in reference to diagram 2, the structure labeled as A is identified as:

interlobular arteries

in reference to diagram 2, the structure labeled as C is identified as:

interlobular arteries

the ophthalmic artery is a branch off of the

internal carotid artery

as you proceed to evaluate the SMA in sagittal/ longitudinal orientation, you know that one of the the following is least likely to occur:

it takes off deep to the arota

with occlusion of the proximal left internal carotid artery (ICA) perfusion to the left hemisphere would leased likely occur from which of the following collateral pathways

left ECA to distal ICA via occipital artery

In reference to diagram 3; identify the structure labeled as D

left gastric artery

the splenic and hepatic arteries should normally exhibit a _______ waveform pattern

low resistance

abdominal pain that develops 15-30 minutes after eating is sometimes called "fear of food" syndrome. which of the following is a possible cause?

mesenteric ischemia

although vasospasm can occur in the other cerebral arteries, which artery is mentioned in the text as the first one to identify and interrogate?

middle cerebral

mr.mj is brought to the emergency room with a sudden onset of aphasia, right hemiparesis (more severally affecting the face and arm than the leg) and behavioral changes. which artery is the most likely cause of these signs and symptoms

middle cerebral artery

a transcranial doppler system usually uses a _____ transducer:

none of the above; 2.0KHz 3.0MHz !.5MHz

all of the following are branches of the ECA except:

ophthalmic

in reference to diagram 4; identify the structure labeled as A

ophthalmic artery

in reference to diagram 4; identify the structure labeled as C

parasellar segment

which artery courses through the petrous portion of the temporal bone?

petrous ICA

which of the items below describes the course go the left renal vein

posterior to the SMA and arteries to the aorta to enter the IVC

what happens to the doppler waveform in the celiac axis when the patient eats

remains the same

to calculate the percentage stenosis on the basis of vessel diameter, subtract from 1 the diameter of the ______ lumen divided by the diameter of the ______ lumen then multiply by 100.

residual; true

external to internal collateralization is evident when there is _______ flow in the ipsilateral ______ artery

retrograde; ophthalmic

in reference to diagram 2, the structure labeled as D is identified as:

segmental arteries

a 75 y/o patient with a history of recent TIA's, hypertension, and hyperlipidemia arrives in the ICU with symptoms of acute right sided weakness and aphasia. the most likely cause of these symptoms is:

severe internal carotid artery stenosis

In reference to diagram 3; identify the structure labeled as C

splenic artery

the portal vein is formed by the confluence of which two veins?

splenic vein, superior mesenteric vein

a trades parvus waveform in a segmental renal artery suggests what conditions?

stenosis or occlusion of the main renal artery

the vertebral/ basilar arteries can be seen from a ______ approach

suboccipital

In reference to diagram 3; identify the structure labeled as B

superior mesenteric artery

in reference to diagram 4; identify the structure labeled as D

supraclinoid segment

which of the following becomes an extra cranial to intracranial collateral route in the presence of significant ICA disease?

supraorbital and ophthalmic arteries via the ECA branches

as you evaluate the distal aorta, which of the following is true?

the aorta normally tapers at its bifurcation

which vessel(s) will you find just distal to the SMA?

the renal arteries

mr.fg is complaining of a 20 minute episode of left vision loss. what does this sign/symptom suggest to you?

this TIA is most likely related to a blockage in the left ICA

as you perform the TCD the transducer is the trans temporal window with a sample volume approximately 55-65 mm deep. what is the most likely significance of the bi-directional flow detected (almost identical flow patterns appearing above and below the baseline)

this is an expected finding

in reference to chart 1, fill in the missing information at the cell labeled F , the typical flow direction (with respect to the transducer)

toward

in reference to chart 1, fill in the missing information at the cell labeled G , the typical flow direction (with respect to the transducer)

toward

n reference to chart 1, fill in the missing information at the cell labeled J , the typical flow direction (with respect to the transducer)

toward

in a transtemporal window, flow direction should be ______ the transducer in the MCA

towards

the three acoustic "windows" used during doppler exam include transtemporal, trans occipital (suboccipital) and ______?

transoribital

in transcranial doppler, the MCA is accessed through _______ "window" and typically demonstrate flow direction _____ the transducer

transtemporal; towards

diminished rounded waveforms may be seen distal in the presence of a stenosis that represents a tardus parvus waveform

true

poststenotic turbulence (PST) is a characteristic of the stenosis profile

true

stent placement in the liver parenchyma between the portal vein and the hepatic vein is called a trans jugular intrahepatic portosustemic shunt (TIPS)

true

the direct technique for evaluating the renal artery includes both visualization of the renal artery as well as the vasculature of the kidney itself

true

the increased diastolic flow in the celiac artery refects decreased end-organ resistance of hepatic and splenic circulation

true

transcranial doppler (TCD) is capable of detecting intracranial stenoses and occlusions

true

transcranial doppler is not useful in evaluating intracranial arteriovenous malformations

true

a major complication accounting for one third of permanent neurologic deficit is:

vasospasm

a patient presents to the vascular lab with symptoms of vertigo, bilateral visual disturbances and ataxia. you should suspect:

vertebral-basilar insufficiency

from a trasformenal or sub occipital view the two arteries that can be most often seen are the _______ and _________

vertebral; basilar

a cerebral angiogram documents may regularly- shaped areas of narrowing in the distal ICA. (like a string of pearls) what is the most likely explanation for this finding?

you suspect fibromuscular dysplasia

your next patient has a transcranial doppler study (TCD) ordered. which of the following statements about that procedure is not correct

you will be using 2MHZ continuous wave doppler