URR vascular: practice exam questions

What is true regarding compression techniques on a pseudo with a larger stalk

thrombin injection is more effective on pseudos with larger stalks than compressions

compressions must be done in 10 1 minute intervals with Color Doppler eval in between each compression

Rest pain is found in patients with an ABI score less than

0.5

Abnormal Allen test

when the radial artery is compressed and very little flow is seen to the hand

ulnar artery is occluded

palmar arch is not patent

Lower extremity veins that do not contain valves

IVC, Iliac veins and Soleal sinuses

Upper extremity veins that do not contain valves

SVC and innominate veins

Arteriography is the most sensitive test for arterial disease

T

_____% diameter or ____% area of a vessel is considered to be hemodynamically significant stenosis

50, 75

A double peaked wave tracing is indicative of

vasospasm due to Raynaud's syndrome

Veins that do not normally demonstrate spontaneous flow on pulse wave ultrasound exams

PTV's, peroneals, GSV

Normal PBI

greater than or equal to 0.75

Vasculogenic impotence is diagnosed with a PBI of

Why is there no aliasing on CW doppler

CW uses two elements to send and receive sound waves, PW only uses one

The ultrasound eval of a TIPS procedure should be performed within _____ hours of the operation to establish baseline values for serial exams

24

Negative Predictive Value (NPV)

number of correct neg dx / number of neg dx made

The PI of the normal aorta should be _____ than the PI of the popliteal artery

less

A PI of

5

Difference in protocol for hemodialysis graft vs hemodialysis fistula

graft- two sites of anastomosis,

fistula- one site of anastomosis (protocol is the native artery prior to anastomosis, anastomosis site, vein distal to anastomosis

When using the GSV as an in situ graft, all _______ must be marked down the leg so that they can be closed

perforators

What would cause the ECA to have reverse flow in systole?

left CCA occlusion

the flow reversal from the ECA will provide the ICA with flow because the CCA cannot

An increase in aortic sac diameter of ______ cm or greater indicates a possible endoleak

0.5

Stages of restenosis after endarterectomy procedure

first month post op- suboptimal surgical techniques

24 months post op- neointimal hyperplasia

2 years post op- progression of atherosclerotic disease

reactive hyperemia

a bright red flush on the skin occurring after pressure is relieved

Velocities are usually higher at the proximal anastomosis site of a _____ ______ ______ because the diameter of the graft increases distally

reversed in situ graft

Vasodilation will cause a triphasic waveform to become ______

monopahsic

vasodilation lessens resistance, lessened resistance causes a more monophasic waveform

PW doppler is preferred over CW to determine the location of a stenosis in a vessel because CW has no depth resolution and is preferred for higher velocities

T

Ascending venography

uses contrast that is injected at the ankle and the course is follow up the leg to assess for DVT

Descending venography

used primarily to detect and quantify reversed flow from incompetent venous valves

Flow velocity is not reported on a segmental pressures exam

T

Velocities below _____cm/s are considered normal in an AV fistula

400

The arterial inflow to an AV fistula is usually ______ resistance and very turbulent while the venous outflow is increased in pulsatility and turbulence

low

Vein of Giacomini

communicating vein between great and small saphenous veins

The _______ veins and the ______ veins are located deep within the calf tissue but are not considered deep veins

gastrocnemius and sural sinus

Describe the Adson maneuver

pt rotates head towards the involved side and extends head

therapist palpates radial pulse, extends arm and laterally rotates shoulder

(+)= absent or diminished pulse

The more _______ the ultrasound beam is to the needle during an ultrasound guided procedure, the better the reflection properties and visualization will be

perpendicular

Describe abnormal flow on a PPG waveform

low amplitude with loss of the dicrotic notch

What causes cross talk artifact

adjacent highly reflective structures

Periorbital doppler is used to visualize the _____ artery

frontal (branch of the ophthalmic)

normal flow will be seen toward the probe

A hemodynamically significant stenosis requiring intervention is what percent

70-99%

venous gangrene usually involves

The foot and all toes

arterial gangrene involves

one or two toes

Where does the DPA originate

the ATA

Where do the plantar arteries originate

from the PTA posterior to the medial malleolus

The normal pressure in the lower extremity digits is at least _____% of the brachial pressure

60

Resistance to flow ______ as blood travels distally in the aorta

increases

The higher the PI, the ______ the resistance to flow

greater

Plethysmography

determining the changes in volume of an organ part or body

pulse volume recording

type of plethysmography exam used to evaluate arterial inflow with cuffs

measures the volume changes beneath each cuff

Photoplethysmography (PPG)

uses infrared light to measure pressure in veins, for insufficiency

stab phlebectomy

multiple tiny incisions made over varicose vein sites to remove them

used in patients that cannot have endogenous ablation

A _______cm AAA or larger is considered a critical finding

5.5

ABI score for single level disease

>0.5

(

An abnormal drop of an ABI score in a serial exam would be

>0.15

_____ refill times on PPG exams for venous insufficiency indicate insufficiency

short

What control on photoplethysmography should be kept at a constant during the exam

size control

The accuracy of a test is calculated by

total number of correct diagnoses / total number of diagnoses made

Claudication is found in patients with a ______ - ______ ABI

0.5-0.9

Explain a photoplethysmography exam

a light sensor is placed on the distal calf, calf raises are performed by the patient to empty the blood from the calf, venous refill time is measured, a refill time of

Probe frequency for a TCD exam

2MHZ

If a patient coming in for a segmental pressures exam has a suspected or known DVT, what should the tech do to evaluate the patient

use waveform analysis only and obtain toe-brachial indices (TBI)

Contraindications for compression treatment of a Pseudoaneurysm

pt cannot tolerate the pain

infection of the puncture site or surrounding tissues

diameter >4cm

neck >5mm

present for more than 1 month

anticoagulants

3 cuff lower extremity segmental pressure exam is limited because there is not

2 cuffs on the thigh

When thrombin is injected into a Pseudoaneurysm, clotting should be seen within ______ post injection

5-10 seconds

The GSV is attached to the ______ aspect of the CFV

medial

Radiofrequency venous ablation requires a ______ technique

sterile

Which cerebral vessel is most commonly involved in acute occlusion and cerebral ischemia?

MCA (due to its connection to the ICA)

Laminar flow usually occurs in _______ vessels

smaller

Plug flow refers to flow that is moving at the

same speed

The recommended sample size for PW Doppler evaluation of an artery is?

1-1.5mm

Photoplethysmography for arterial disease requires the sensors to be placed where

pads of the toes

Photoplethysmography for venous insufficiency requires the sensors to be placed where

distal calf

Most common cardiac disorder associated with an arterial embolism

atrial fibrillation

Parenchymal Resistance Ratio

EDV/PSV

Describe an air photoplethysmography (APG) exam

place a large cuff around the calf, air is elevated until tracing plateaus indicating that the veins are emptied, the patient then stands and the time of venous refill is measured (>20seconds is normal)

Significant ischemic disease in the leg will lead to _______ upon elevation and _______ with dependency

pallor, rubor

Sensitivity formula

TP/(TP+FN)

Most common site of stenosis in a TIPS patient

hepatic vein anastomosis

When the velocity between two adjacent segments of an artery quadruples, there is a _____% stenosis

75

What is an abnormal response to proximal augmentation when evaluating the GSV

flow reversal begins at the onset of augmentation

Preferred probe frequency for DVT evaluation on the average patient

5-7MHz

Ultrasound performed soon after endarterectomy should be performed with

the most posterior approach possible to avoid artifacts produced by air in the graft

A thrill is a normal clinical finding with

hemodialysis fistula

PVR waveforms do not have a flow reversal component

T

A synthetic pop-fem graft should be triphasic by _____ months post op

2

A synthetic pop-fem graft may display monophasic waveforms despite being clear of stenosis due to it being _____ months post op

only 1-2

The popliteal artery courses ______ to the popliteal vein

anterior

A patient should stop their blood thinners how many days before an endogenous ablation

7

Resistive index formula

RI = PSV-EDV/PSV

Transducer frequency is directly related to

doppler velocity

increasing frequency will increase the detected doppler shift

Lower extremity arterial segmental pressure exams with exercise indicate multi level disease when the patients recovery time is

>6 minutes

Brescia-Cimino fistula

A dialysis access

Cephalic V + radial A in wrist

A Straight graft in the upper arm connects the ___ artery to the ___ vein.

radial to antecubital

Looped graft

connects brachial artery to antecubital

RI of acute allograft rejection

>0.8

The greater the doppler angle, the greater the amount of error in the calculated velocity

T

The difference between superficial and deep venous insufficiency in a PPG exam using tourniquet technique

if the venous refill time is >20 seconds after the tourniquet is applied, the insufficiency is in the superficial system

aortic regurgitation

flow of blood backward from the aorta into the heart; caused by a weak heart valve

Aortic regurgitation causes what to be seen on PW doppler

pulses biferens (double peak)

Severe aortic regurgitation causes what to be seen on PW doppler

diastolic flow reversal (water hammer pulse)

TCD cannot rule out what

AV fistula

First branch of ECA

superior thyroid artery