Clinical Rotation IV (FINAL TEST)

The portal veins carry blood from the ____ to the liver.

a. hepatic artery

b. intestine

c. splenic artery

d. peripheral venous system

b. intestine

The arterial supply to the gallbladder is via the:

a. hepatic artery

b. superior mesenteric artery

c. cystic artery

d. gastroduodenal artery

c. cystic artery

The portal vein does not drain blood:

a. out of the gastrointestinal tract from the lower end of the esophagus to the upper

end of the anal canal

b. from the pancreas, gallbladder, and bile ducts

c. from the spleen

d. from the kidneys

d. from the kidneys

The head of the pancreas, the duodenum, and parts of the stomach are supplied by the:

a. hepatic artery

b. gastroduodenal artery

c. splenic artery

d. superior mesenteric artery

b. gastroduodenal artery

Which of the following vessels passes anterior to the uncinate process of the pancreas?

a. the hepatic artery

b. the portal vein

c. the left renal vein

d. the superior mesenteric vein

d. the superior mesenteric vein

The distribution of the superior mesenteric artery is to the:

a. distal half of colon, liver

b. proximal half of colon, stomach

c. small intestine, proximal half of colon

d. large intestine, distal half of colon

c. small intestine, proximal half of colon

What vein begins at the hilum of the spleen and is joined by the short gastric and left gastroepiploic

vein?

a. the pancreatic vein

b. the portal vein

c. the superior mesenteric vein

d. the splenic vein

d. the splenic vein

What vessel passes anterior to the third part of the duodenum and posterior to the neck of the pancreas?

a. the superior mesenteric artery

b. the superior mesenteric vein

c. the inferior mesenteric vein

d. the splenic vein

b. the superior mesenteric vein

Which of these statements is false?

a. The portal vein enters the lesser omentum.

b. The portal vein is formed anterior to the pancreas.

c. The portal vein drains blood out of the gastrointestinal tract.

d. The portal vein has an anastomosis with the esophageal veins, rectal venous plexus, and superficial abdominal veins.

b. The portal vein is formed anterior to the pancreas.

The normal diameter of the aorta is less than

a. 2 mm

b. 5 mm

c. 8 cm

d. 3 cm

d. 3 cm

Budd-Chiari syndrome demonstrates thrombosis of the:

a. hepatic veins

b. hepatic arteries

c. portal veins

d. inferior vena cava

a. hepatic veins

The inferior mesenteric artery distributes blood to the:

a. left transverse colon, descending colon, sigmoid, rectum

b. ascending colon, sigmoid, rectum

c. descending colon

d. ascending colon, rectum

a. left transverse colon, descending colon, sigmoid, rectum

The right renal artery passes _____ to the inferior vena cava (IVC).

a. anterior

b. posterior

c. lateral

d. medial

b. posterior

The vessel that arises from the anterior aortic wall and takes a parallel course to the aorta is the:

a. hepatic artery

b. renal artery

c. superior mesenteric artery

d. inferior mesenteric artery

c. superior mesenteric artery

What vascular structure courses between the aorta and SMA?

a. left renal vein

b. celiac trunk

c. gastroduodenal artery

d. left renal artery

a. left renal vein

Renal arteries branch from the lateral wall of the aorta:

a. at the level of L4

b. superior to the SMA

c. superior to the hepatic arteries

d. inferior to the SMA

d. Inferior to the SMA

The IVC courses anteriorly to enter the:

a. right ventricle

b. left atrium

c. right coronary sinus

d. right atrium

d. right atrium

Which vascular structure arising from the celiac trunk passes anterior to the portal vein to enter the liver at the porta hepatitis?

a. the common bile duct

b. the hepatic artery

c. the superior mesenteric artery

d. the gastroduodenal artery

b. hepatic artery

Which of the following structures is medial to the inferior border of the pancreas?

a. the splenic artery

b. the hepatic artery

c. the superior mesenteric artery

d. the splenic vein

d. the splenic vein

The gastroduodenal artery is a branch of the:

a. right hepatic artery

b. left gastric artery

c. splenic artery

d. superior mesenteric artery

a. right hepatic artery

The most common cause of abdominal aneurysms is:

a. cystic medial necrosis

b. syphilis

c. atheroma

d. arteriosclerosis

d. arteriosclerosis

In patients with lower trunk and leg edema and a dilated IVC, a(n) _____ should be suspected.

a. rupture

b. atrioventricular fistula

c. retroperitoneal tumor

d. infection

b. atrioventricular fistula

The most common tumor to fill the IVC is:

a. islet cell carcinoma

b. renal cell carcinoma

c. venous angioma

d. nephroma

b. renal cell carcinoma

The clinical signs of leg edema, low back pain, pelvic pain, gastrointestinal complaints, and renal and liver problems may represent:

a. abdominal rupture

b. superior mesenteric thrombus

c. retroperitoneal tumor

d. IVC thrombosis

d. IVC thrombosis

Which statement is false for a patient with renal vein thrombosis?

a. Direct visualization of thrombi in the renal vein and IVC is possible.

b. There is loss of normal renal structure.

c. Renal size increases in the acute phase.

d. Doppler flow increases.

d. Doppler flow increases.

A warning sign of stroke is:

a. severe neck pain

b. loss of smell

c. temporary blindness in one eye

d. unilateral leg pain

c. temporary blindness in one eye

A difference of greater than 20 mmHg pressure between arms suggests disease of the:

a. common carotid artery

b. internal carotid artery

c. vertebral artery

d. subclavian artery

d. subclavian artery

An ultrasound finding of the Doppler signal from an external carotid artery (ECA) is:

a. low resistance

b. high resistance

c. triphasic

d. tardus parvus

b. high resistance

An ultrasound characteristic of the internal carotid artery (ICA) includes:

a. originates anterior and medial at the bifurcation

b. low-resistance Doppler signal

c. cervical branches

d. smaller lumen

b. low-resistance Doppler signal

Which of the following is not an ultrasound finding of an ICA occlusion:

a. echogenic material filling the lumen

b. lack of arterial pulsations

c. loss of diastolic flow in the common carotid artery (CCA).

d. reduced diastolic flow pattern

d. reduced diastolic flow pattern

Which of the following phrases describes a transient ischemic attack (TIA)?

a. permanent loss of vision bilaterally

b. residual neurologic deficit

c. duration less than 24 hours

d. loss of consciousness

c. duration less than 24 hours

Which of the following should be used to classify a greater than 80% diameter reduction of the origin of the ICA?

a. peak systolic velocity less than 140 cm/sec

b. peak systolic velocity greater than 140 cm/sec

c. end diastolic velocity less than 155 cm/sec

d. end diastolic velocity greater than 155 cm/sec

d. end diastolic velocity greater than 155 cm/sec

Normal vertebral arteries:

a. are asymmetrical

b. are branches of the axillary artery

c. demonstrate a high-resistance Doppler signal

d. demonstrate an alternating blood flow pattern

a. are asymmetrical

Placement of the Doppler sample volume should be parallel to the:

a. color jet

b. plaque surface

c. vessel walls

d. skin surface

c. vessel walls

The degree of stenosis at the origin of the ICA is determined by:

a. echo characteristics of the plaque

b. the presence of acoustical shadowing

c. peak systolic and end diastolic velocities

d. ICA:ECA peak systolic velocity ratio

c. peak systolic and end diastolic velocities

Approximately _____ strokes occur each year in the United States.

a. 10,000

b. 100,000

c. 700,000

d. 1,000,000

c. 700,000

The innominate artery divides into the _____ and ____ arteries:

a. right common carotid; right subclavian

b. left common carotid; left subclavian

c. right subclavian; right vertebral

d. left subclavian; left vertebral

a. right common carotid; right subclavian

The Doppler sample volume should be kept _____ during a carotid duplex imaging examination.

a. near the deep wall

b. near the superficial wall

c. large

d. small

d. small

An abnormal spectral Doppler waveform shape from the ICA suggests:

a. contralateral disease

b. arterial branches

c. proximal or distal disease/occlusion

d. venous thrombosis

c. proximal or distal disease/occlusion

A contralateral ICA occlusion may cause the ipsilateral ICA velocities to be:

a. the same

b. reversed

c. increased

d. decreased

c. increased

Which of the following ICA:CCA ratios determines a greater than 70% diameter reduction of the ICA?

a. 1.0

b. 4.0

c. 7.0

d. 10.0

b. 4.0

When determining the ICA:CCA ratio, the CCA velocity should be obtained from the:

a. proximal segment

b. mid-segment

c. distal straight segment

d. bulb

c. distal straight segment

A characteristic of a subclavian steal is:

a. reversal of blood flow in the vertebral artery

b. equal blood pressure bilaterally

c. loss of diastolic flow

d. increased pulsatility

a. reversal of blood flow in the vertebral artery

A systolic velocity recorded from the origin of the ICA that is less than 125 cm/sec suggests:

a. no plaque present

b. a stenosis less than 50% diameter reduction

c. a stenosis greater than 50% diameter reduction

a stenosis greater than 80% diameter reduction

b. a stenosis less than 50% diameter reduction

Intraoperative carotid duplex imaging identifies:

a. contralateral ICA disease

b. abnormal blood flow

c. increased blood pressure

d. the need for a carotid shunt

b. abnormal blood flow

Transient partial or complete loss of vision.

a. aphasia

b. ataxia

c. vertigo

d. amaurosis fugax

d. amaurosis fugax

The carotid body assists in regulating all except:

a. balance

b. heart rate

c. blood pressure

d. respiration

a. balance

The most commonly visualized branch of the ECA is:

a. facial

b. superior thyroid

c. lingual

d. superficial temporal

b. superior thyroid

Noise caused by tissue vibration produced by turbulent flow is:

a. boundary layer separation

b. aliasing

c. bruit

d. reverberation

c. bruit

A normal flow disturbance along the posterior wall of the bulb is:

a. a bruit

b. aliasing

c. a boundary layer separation

d. a jet

c. a boundary layer separation

When performing a transcranial color Doppler (TCD) imaging examination, the best results are obtained using a _____ transducer.

a. 10 KHz

b. 7.5 MHZ

c. 5 MHz

d. 2 MHz

d. 2 MHz

The large terminal branch of the internal carotid artery is the _____ artery.

a. anterior cerebral

b. middle cerebral

c. posterior cerebral

d. posterior communicating

b. middle cerebral

The union of the two vertebral arteries forms the ____ artery.

a. basilar

b. posterior cerebral

c. posterior communicating

d. anterior inferior cerebellar

a. basilar

A _____ degree angle is assumed when performing TCD imaging examinations.

a. 0

b. 25

c. 45

d. 60

a. 0

Intracranial arterial velocities _____ with increasing age.

a. increase

b. decrease

c. expand

d. do not change

b. decrease

A _____ Doppler transducer is used for TCD examinations.

a. pulsed

b. continuous wave

c. alternating

d. mechanical

a. pulsed

The acoustical intensity should be _____ to evaluate the carotid siphon using the transorbital approach.

a. increased

b. decreased

c. not adjusted

d. doubled

b. decreased

The ____ artery wraps around the cerebral peduncle.

a. middle cerebral

b. anterior cerebral

c. posterior cerebral

d. posterior communicating

c. posterior cerebral

Most users report ____ velocities during TCD examinations.

a. peak systolic

b. mean

c. end diastolic

d. pulsatility

b. mean

When evaluating an area of stenosis, the pulse repetition frequency (PRF) usually should be _____.

a. increased

b. decreased

c. unadjusted

d. doubled

a. increased

The interpretation of a TCD imaging examination is made from the _____.

a. gray scale image

b. color display

c. spectral waveforms

d. color bar

c. spectral waveforms

During color Doppler transcranial imaging, the middle cerebral artery (MCA) runs parallel to which bony landmark?

a. the occipital bone

b. the cerebral peduncle

c. the sphenoid wing

d. the petrous ridge of the temporal bone

c. the sphenoid wing

The anterior cerebral artery (ACA) is normally located from the ______ approach.

a. transtemporal

b. suboccipital

c. transorbital

d. submandibular

a. transtemporal

The depth of the MCA is usually _____.

a. 30-67 mm

b. 60-80 mm

c. 55-67 mm

d. 60-75 mm

a. 30-67 mm

Blood flow in the ACA is normally _____ the transducer.

a. toward

b. away from

c. bidirectional to

d. vertical to

b. away from

A low hematocrit (less than 30%) is associated with ______ intracranial arterial velocities.

a. decreased

b. increased

c. unchanged

d. turbulent

b. increased

After evaluating the MCA, the color PRF may need to be _____ to evaluate the posterior cerebral artery (PCA).

a. increased

b. decreased

c. unadjusted

d. doubled

b. decreased

A high resistance Doppler signal is normally characteristic of which artery evaluated during a TCD examination?

a. middle cerebral

b. vertebral

c. ophthalmic

d. no artery has a high resistance

c. ophthalmic

Which of the following is not a limitation of a TCD?

a. poor temporal window

b. anatomic variations

c. pulsed Doppler transducer

d. patient movement

c. pulsed Doppler transducer

The two A1 segments of the ACA are joined by the _____.

a. A2 segment of the right ACA

b. anterior communicating artery

c. A2 segment of the left ACA

d. recurrent artery of Heubner

b. anterior communicating artery

When the ophthalmic artery is being used as a collateral pathway from the external carotid artery (ECA) to the internal carotid artery, blood flows _____ the transducer.

a. toward

b. away from

c. bidirectional to

d. unchanged from

b. away from

Side-to-side differences that occur during a TCD imaging examination should be considered within

normal limits if they are less than _____ %.

a. 25

b. 50

c. 75

d. 100

a. 25

The window used to evaluate the vertebrobasilar system is:

a. transtemporal

b. suboccipital

c. transorbital

d. submandibular

b. suboccipital

Blood flow in the MCA is normally _____ the transducer.

a. toward

b. away from

c. blue on Color Doppler

d. both b and c

a. toward

Identification of normal cranial arteries is based on all except which of the following?

a. depth of sample volume

b. blood flow direction

c. blood flow velocity

d. adjacent anatomic structures

c. blood flow velocity

Blood pressure cuffs should have a width:

a. 100% less than the diameter o f the limb

b. equal to the diameter of the limb

c. 20% less than the diameter of the limb

d. 20% greater than the diameter of the limb

d. 20% greater than the diameter of the limb

The characteristics of a normal Doppler signal obtained during a lower extremity arterial imaging include all except which of the following?

a. sharp upslope

b. triphasic and reverse flow component

c. dicrotic notch

d. low velocity forward flow in late diastole

c. dicrotic notch

The most important diagnostic criterion during arterial color Doppler imaging is:

a. the color Doppler display

b. an echo-free lumen

c. decreased color filling

d. the spectral Doppler waveform

d. the spectral Doppler waveform

To obtain arterial Doppler signals during arterial color Doppler imaging, it is best to use a

a ______ imaging plane.

a. transverse

b. longitudinal

c. oblique

d. inverted

b. longitudinal

During arterial duplex imaging, Doppler signals are obtained using a _____ angle.

a. 0-degree

b. 45-degree

c. 60-degree

d. direct

c. 60-degree

Which of the following best describes ultrasound compression therapy of pseudoaneurysms?

a. It is most successful when the aneurysm is a large size.

b. It is most successful in patients who are anticoagulated.

c. It takes minimal upper body strength.

d. It usually requires 30 to 60 minutes to be successful.

d. It usually requires 30 to 60 minutes to be successful.

A difference between arms of greater than 20 mmHg pressure usually indicates disease of which of

the following arteries?

a. subclavian

b. radial

c. common carotid

d. iliac

a. subclavian

Patients complaining of intermittent claudication will have an ankle-brachial index (ABI) of:

a. 1.00

b. 0.45

c. 0.59

d. 0.35

c. 0.59

Which imaging characteristic indicates a significant (greater than 50% diameter reduction) arterial narrowing during lower extremity arterial imaging?

a. spectral broadening

b. an increase of peak systolic velocity of greater that 20% compared with the proximal adjacent area

c. an increase of peak systolic velocity of greater than 100% compared with the proximal adjacent area

d. loss of blood flow reversal in early diastole

c. an increase of peak systolic velocity of greater than 100% compared with the proximal adjacent area

The ABI on the left side is:

The following resting segmental pressure measurements (mmHg) are taken:

Right Left

Upper arm 152 110

Upper thigh 180 180

Lower thigh 100 170

Calf 100 158

Ankle 100 148

a. 0.50

b. 0.66

c. 1.35

d. 0.97

d. 0.97

The ABI on the right side is:

The following resting segmental pressure measurements (mmHg) are taken:

Right Left

Upper arm 152 110

Upper thigh 180 180

Lower thigh 100 170

Calf 100 158

Ankle 100 148

a. 0.50

b. 0.66

c. 0.91

d. 0.97

b. 0.66

The lower limb pressures suggest disease of the:

The following resting segmental pressure measurements (mmg) are taken:

Right Left

Upper arm 152 110

Upper thigh 180 180

Lower thigh 100 170

Calf 100 158

Ankle 100 148

a. right common femoral artery

b. right superficial femoral artery

c. right popliteal artery

d. left popliteal artery

b. right superficial femoral artery

The brachial pressure suggests disease of the:

The following resting segmental pressure measurements (mmHg) are taken:

Right Left

Upper arm 152 110

Upper thigh 180 180

Lower thigh 100 170

Calf 100 158

Ankle 100 148

a. innominate artery

b. right subclavian artery

c. left subclavian artery

d. right brachial artery

c. left subclavian artery

Most patients describe claudication as:

a. pain in the toes

b. pain at rest

c. cramping of the leg muscles

d. extreme leg pain when walking

c. cramping of the leg muscles

The profunda femoris artery lies _____ and ____ to the superficial femoral artery (SFA).

a. posterior; medial

b. posterior; lateral

c. anterior; medial

d. anterior; lateral

b. posterior; lateral

The major branches off the popliteal artery are the ____ and ____ arteries.

a. anterior tibial; tibial peroneal trunk

b. sural; anterior tibial

c. genicular; anterior tibial

d. sural; genicular

d. sural; genicular

The second main branch of the aortic arch is:

a. innominate artery

b. right common carotid artery

c. left common carotid artery

d. left subclavian artery

c. left common carotid artery

Segmental pressures of the lower extremity tend to _____ the extent of the disease.

a. overestimate

b. underestimate

c. equal

d. b or c

b. underestimate

A toe pressure is considered normal if it is:

a. 50 mmHg

b. 45 mmHg

c. less than 64% of brachial pressure

d. both a and c

a. 50 mmHg

The calf pulse volume waveform normally has greater amplitude than the thigh waveform because of:

a. sequential changes

b. superficial femoral disease

c. cuff artifact

d. intermittent ischemia

c. cuff artifact

Exercise testing of the lower extremity arterial system is performed on a treadmill on a _____% grade.

a. 5-10

b. 10-12

c. 12-15

d. 15-20

b. 10-12

Exercise testing of the lower extremity arterial system is performed on a treadmill at a speed of ______ mph.

a. 1.0-2.0

b. 1.5-2.0

c. 2.0-2.5

d. 2.5-3.0

b. 1.5-2.0

Ankle pressures that fall after exercise and return to baseline in five minutes suggests:

a. normal arterial system

b. multisegment arterial disease

c. single segment occlusive disease

d. lower extremity amputation

c. single segment occlusive disease

In nondiabetic patients, ischemic skin lesions are not likely to heal if ankle systolic pressure is below:

a. 55 mmHg

b. 45 mmHg

c. 80 mmHg

d. 30 mmHg

a. 55 mmHg

Which of the following veins is difficult to compress during duplex imaging?

a. subclavian

b. brachial

c. popliteal

d. posterior tibial

a. subclavian