VASCULAR TECHNOLOGY DAVIES SCORECARDS

The most common anatomic variant of the aortic arch is:

a. an origin of the left vertebral from the aortic arch

b. an origin of the right subclavian from the aortic arch

c. a common origin of the innominate and left common carotid arteries

d. an origin of the right common carotid from the aortic arch

c. a common origin of the innominate and left common carotid arteries

After it crosses the lateral margin of the first rib, the subclavian artery becomes known as the:

a. brachiocephalic artery

b. axillary artery

c. brachial artery

d. vertebral artery

b. axillary artery

The common hepatic, splenic and left gastric arteries are branches arising from which abdominal artery?

a. superior mesenteric artery

b. proper hepatic artery

c. inferior mesenteric artery

d. celiac trunk

d. celiac trunk

What is the most common anatomic variant of the renal arteries?

a. retroaortic renal artery

b. multiple renal arteries

c. anterocaval course of the right renal artery

d. congenital absence of one main renal artery

b. multiple renal arteries

What is the name of the tiny infrarenal branches that arise at right angles from the interlobar arteries and course above the renal pyramids?

a. interlobar arters

b. capsular arteries

c. arcuate arteries

d. segmental arteries

c. arcuate arteries

At the inguinal ligament, the external iliac artery becomes what peripheral artery?

a. common femoral artery

b. profunda femoral artery

c.internal iliac artery

d. superficial femoral artery

a. common femoral artery

The dorsals pedis artery is a continuation of which of the following arteries?

a. posterior tibial artery

b. anterior tibial artery

c. peroneal artery

d. popliteal artery

b. anterior tibial artery

What artery supplies the small intestine, right colon and transverse colon?

a. superior mesenteric artery

b. inferior mesenteric artery

c. gastroduodenal artery

d. left gastric artery

a. superior mesenteric artery

The largest branch of the celiac trunk is the:

a. hepatic artery

b. left gastric artery

c. gastroduodenal artery

d. splenic artery

d. splenic artery

What is another name for the hypogastric artery?

a. hepatic artery

b. internal iliac artery

c. gastroduodenal artery

d. external iliac artery

b. internal iliac artery

Which of the following vessels courses along the medial aspect of the psoas muscle?

a. internal iliac artery

b. inferior mesenteric artery

c. femoral artery

d. external iliac artery

d. external iliac artery

Which of the following is usually the first branch of the external carotid artery?

a. facial artery

b. superior thyroid artery

c. superficial temporal artery

d. internal maxillary artery

b. superior thyroid artery

At what level does the vertebral artery enter the transverse foramina of the cervical spine?

a. C1

b. C2

c. C6

d. C7

c. C6

What are the three major branches of the ophthalmic artery?

a. frontal, supraorbital and nasal arteries

b. superficial temporal, angular and facial arteries

c. orbital, facial and nasal arteries

d. frontal, nasal and lacrimal arteries

a. frontal, supraorbital and nasal arteries

The basilar artery divides into the:

a. posterior communication arteries

b. posterior inferior cerebellar arteries

c. vertebral arteries

d. posterior cerebral arteries

d. posterior cerebral arteries

Via which of the following vessels does the external carotid artery provide an anastomotic link to the internal carotid artery?

a. superior thyroid artery

b. superficial temporal artery

c. internal maxillary artery

d. posterior communicating artery

b. superficial temporal artery

*ECA can supply the ICA through the periorbital circulation. ICA occlusion via retrograde flow in the ophthalmaic artery which connects the supraorbital and frontal arteries to the ECA through the superficial temporal artery.

Which of the following arteries does not arise from the intracranial internal carotid artery?

a. middle cerebral artery

b. anterior cerebral artery

c. posterior communicating artery

d. ascending pharyngeal artery

d. ascending pharyngeal artery

The ophthalmic artery is a branch of the:

a. internal carotid artery

b. anterior communicating artery

c. anterior cerebral artery

d. external carotid artery

a. internal carotid artery

In the presence of internal carotid artery occlusion, all of the following are potential collateral pathways to perfuse the ipsilateral cerebral hemisphere except:

a. contralateral internal carotid artery through reversed flow in the ipsilateral anterior cerebral artery

b. vertebrobasilar system through the posterior communicating artery

c. contralateral subclavian artery to the internal thoracic artery

d. ipsilateral external carotid artery through the orbit to the ophthalmic artery

c. contralateral subclavian artery to the internal thoracic artery

Which branch of the external carotid artery provides a collateral pathway to the vertebral artery?

a. lingual artery

b. facial artery

c. occipital artery

d. superficial temporal artery

c. occipital artery

Which vessel is most likely to be enlarged in the presence of vertebral artery occlusion?

a. ipsilateral external carotid artery

b. contralateral vertebral artery

c. ipsilateral subclavian artery

d. contralateral internal thoracic artery

b. contralateral vertebral artery

A 48 year old male presents with retrograde flow in the left vertebral artery. Which artery is most likely to be occluded?

a. right vertebral artery

b. left subclavian artery

c. right subclavian artery

d. innominate artery

b. left subclavian artery

What is the most common anomaly of the circle of Willis?

a. absence of one of the middle cerebral arteries

b. hypoplasia of the proximal segment of one of the anterior cerebral arteries

c. duplication of the posterior communicating arteries

d. absence or hypoplasia of one or both of the communicating arteries

d. absence or hypoplasia of one or both of the communicating arteries

Which of the following is not a branch of the subclavian artery?

a. vertebral artery

b. thyrocervical trunk

c. brachial artery

d. internal thoracic artery

c. brachial artery

The cervical internal artery can be differentiated from the external carotid artery by all of the following except:

a. the external carotid artery gives off multiple branches in the neck

b. there are normally no branches of the internal carotid artery in the neck

c. a bulbous area is seen at the origin of the internal carotid artery

d. the internal carotid artery is usually located anteromedial to the external carotid artery

d. the internal carotid artery is usually located anteromedial to the external carotid artery

Which of these vessels joins the brachial veins to form the axillary vein?

a. innominate vein

b. subclavian vein

c. basilic vein

d. cephalic vein

c. basilic vein

Which vein in the antecubital fossa connects the cephalic and basilic veins?

a. axillary vein

b. cephalic vein

c. median cubital vein

d. basilic vein

c. median cubital vein

Which of the following Is not a deep vein of the upper extremity?

a. cephalic vein

b. axillary vein

c. brachial vein

d. radial vein

a. cephalic vein

Where is the brachiocephalic vein found?

a. only on the right side of the neck

b. only on the left side of the neck

c. there is no such vein

d. on both the right and left sides of the neck

d. on both the right and left sides of the neck

*vein anatomy differs from arterial anatomy. the brachiocephalic vein occurs bilaterally and formed by the junction of the subclavian and internal jugular veins.

What is the longest vein in the body?

a. great saphenous vein

b. posterior tibial vein

c. basilic vein

d. femoral vei

a. great saphenous vein

Which of the following is not true regarding perforating veins?

a. they direct blood from the deep system into the superficial system

b. they have one valve each

c. they are more numerous in the calf than in the thigh

d. they are known as varicose veins when they are tortuous and dilated due to incompetent valves

a. they direct blood from the deep systems into the superficial system

*perforating veins dried blood flow form superficial into the deep system

The portal vein is formed by the junction of which of the following veins?

a. superior mesenteric and left gastric veins

b. splenic and superior mesenteric veins

c. inferior mesenteric and splenic veins

d. umbilical and splenic veins

b. splenic and superior mesenteric veins

The vein that normally courses between the superior mesenteric artery and the abdominal aorta is the:

a. portal vein

b. superior mesenteric vein

c. inferior mesenteric vein

d. left renal vein

d. left renal vein

Which statement is not true regarding the soleal veins?

a. they empty into the posterior tibial or peroneal veins

b. they connect with the superficial venous system

c. they are found deep in the calf muscle

d. they do not contain valves

b. they connect with the superficial venous system

Which veins are connected to the gastrocnemius veins by the paratibial perforating veins?

a. posterior tibial veins

b. anterior tibial vein s

c. peroneal veins

d. popliteal veins

a. posterior tibial veins

*there are 16 constant perforating veins in the leg. 8 of these drain into the PTV known as the paratibial perforators and posterior tibial perforators.

The splenic vein drains into the:

a. inferior vena cava

b. hepatic vein

c. superior mesenteric vein

d. portal vein

d. portal vein

The hepatic veins drain into the:

a. inferior vena cava

b. portal veins

c. hepatic arteries

d. superior mesenteric vein

a. inferior vena cava

All of these statements about the inferior vena cava are true except:

a. has no valves below the level of its insertion into the heart

b. formed by the confluence of the common iliac veins

c. drains into the left atrium of the heart

d. courses to the right of the abdominal aorta

c. drains into the left atrium of the heart

What is the term for the outermost layer of the arterial wall?

a. intima

b. media

c. adventitia

d. fascia

c. adventitia

What is the primary function of the vasa vasorum?

a. to regulate vasodilation of the arterioles

b. to provide nourishment to the tunica adventitia

c. to provide the major communication in arteriovenous fistulas

d. to provide auto regulation of blood flow to the brain

b. to provide nourishment to the tunica adventitia

What is the function of the bicuspid valves of the veins?

a. to maintain unidirectional flow within the venous system

b. to provide nourishment to the tunica intima

c. to prevent communication between arteries and veins

d. to direct the flow of blood away from the heart

a. to maintain unidirectional flow within the venous system

The greatest number of valves is found in which of the following veins?

a. femoral vein

b. common femoral vein

c. popliteal vein

d. great saphenous vein

d. great saphenous vein

* the GSV has 10 - 12 valves throughout its length

The bicuspid valves of the venous system are formed by folds of the:

a. adventitia

b. intima

c. media

d. smooth muscle fibers

b. intima

Which are the smallest vessels in the body?

a. arterioles

b. venues

c. capillaries

d. intimas

c. capillaries

What is demonstrated by helical flow with flow separation in the posterolateral aspect of the carotid bulb?

a. normal flow dynamics

b. dissection

c. stenosis

d. thrombosis

a. normal flow dynamics

What does the Reynolds number describe?

a. the pressure drop across a hemodynamically significant stenosis

b. the flow acceleration through a stenosis

c. the dampened flow proximal to a stenosis

d. the point at which flow becomes turbulent

d. the point at which flow becomes turbulent

This spectrum was obtained with a small sample volume from the center of the ICA. Which term can be used to the flow depicted by this waveform?

a. laminar flow

b. post stenotic turbulence

c. stenotic jet

d. tardus parvus

a. laminar

Which abdominal vein normal exhibits a pulsatile / bidirectional waveform?

a. splenic vein

b. superior mesenteric vein

c. portal vein

d. hepatic vein

d. hepatic vein

Normal blood flow in the portal vein is described as:

a. hepatofugal

b. hepatopetal

c. bidirectional

d. triphasic

b. hepatopetal

The normal waveform of the hepatic veins can be described as:

a. pulsatile

b. continuous

c. unidirectional

d. b & c

a. pulsatile

Which of the following veins is not a paired vein?

a. radial

b. posterior tibial

c. peroneal

d. cephalic

d. cephalic

The basilic vein is best described as:

a. a large single vein located near the brachial veins

b. a small vein located deep within the calf vein

c. a very small vein that joins the subclavian vein

d. a large vein coursing lateral to the cephalic vein

a. a large single vein located near the brachial veins

The renal arteries arise from the abdominal aorta approximately 1 cm distal to the:

a. inferior mesenteric artery

b. left gastric artery

c. superior mesenteric artery

d. celiac trunk

c. superior mesenteric artery

Identify and label the abdominal arteries.

a.

b.

c.

d.

e.

e.

g.

g.

i.

j

k.

l.

What is the most prevalent type of stroke?

a. ischemic

b. hemorrhagic

c. septic embolic

d. venous thrombotic

a. ischemic

Which of the following is not considered to be a risk factor for the development of stroke?

a. cigarette smoking

b. female gender

c. diabetes mellitus

d. cardiac arrhythmia

b. female gender

Where would a carotid body tumor be located?

a. within the internal jugular vein

b. medial to the origin of the external carotid artery

c. between the internal and external carotid arteries

d. in the submandibular gland

c. between the internal and external carotid arteries

What is the term for a fragment of atherosclerotic debris that courses distal through the vasculature until it lodges in a small vessel?

a. thrombus

b. dissection

c. hematoma

d. embolus

d. embolus

Which vessel or vessels provide the primary arterial supply to carotid body tumors?

a. vertebral artery

b. thyrocervical trunk

c. vasa vasorum of the internal carotid artery

d. branches of the external carotid artery

d. branches of the external carotid artery

In which of the following vessels will flow reverse secondary to innominate artery occlusion?

a. right vertebral artery

b. right common carotid artery

c. left vertebral artery

d. a and b

d. a and b

What is the biggest controllable risk factor for stroke?

a. hypercholesterolemia

b. hypertension

c. sedentary life style

d. alcohol abuse

b. hypertension

*effective control of hypertension can decrease the risk of stroke by about 42%. the higher the blood pressure, the greater the risk for stroke

All of the following statements regarding subclavian steal are true except:

a. results from severe stenosis or occlusion of the proximal vertebral artery

b. most commonly occurs on the left side

c. most patients are asymptomatic

d. lower blood pressure is seen in the affected arm

a. results from severe stenosis or occlusion of the proximal vertebral artery

* subclavian steal results from severe stenosis or occlusion of the proximal subclavian artery resulting in retrograde flow in the ipsilateral vertebral artery & flow is "stolen" from the contralateral vertebral artery.

A complication of plaque ulceration is:

a. thrombosis

b. intraplaque hemorrhage

c. embolization

d. all of the above

d. all of the above

A 35 year old female presents with Horner syndrome and left periorbital headache; she has a history of cystic medial necrosis. Duplex carotid ultrasound reveals two channels of flow within the left common carotid artery separated by a thin echogenic flap. What is the most likely diagnosis?

a. common carotid artery dissection

b. takayasu's arteritis

c. fibromuscular dysplasia

d. severe stenosis with plaque ulceration

a. common carotid artery dissection

What is the most common location in the cerebrovascular system for atherosclerosis to occur?

a. intracranial internal carotid artery

b. left subclavian artery

c. innominate artery

d. the carotid bulb

d. the carotid bulb

A 65 year old male with hypertension and diabetes presents to the vascular lab for cerebrovascular testing due to a right asymptomatic bruit. All of the following could be considered a potential source of the bruit except:

a. external carotid artery stenosis

b. subclavian artery stenosis

c. common carotid artery occlusion

d. common carotid artery dissection

c. common carotid artery occlusion

*a totally occluded vessel will not produce a bruit.

a bruit is a result of vibration in the tissue surrounding a stenosis

A patient is referred for a duplex examination to evaluate a prominent pulsatility felt in the base of the right neck. What is the most likely etiology of this physical finding?

a. excessive CCA tortuosity

b. CCA aneurysm

c. CCA dissection

d. CCA occlusion

a. excessive CCA tortuosity

Of the following, which is not one of the main collateral pathways in the event of ICA obstruction?

a. genicular to arcuate branches

b. ECA branches to ophthalmic branches

c. contralateral hemisphere

d. posterior to anterior pathways

a. genicular to arcuate branches

*genicular = knee

*arcuate =kidney

Your patient undergoes carotid endarterectomy. Six months later, angiography is performed because of symptoms referable to the other side. The angiogram reveals that the operated carotid is significantly narrowed. The most likely cause is:

a. atherosclerotic plaque recurrence

b. carotid dissection

c. neointimal hyperplasia

d. embolic activity

c. neointimal hyperplasia

*endarterectomy and angioplasty involves proliferation of smooth muscle cells in response to any trauma to an arterial wall.

An unilateral temporary vision loss associated with cerebrovascular disease is known as:

a. dysphasia

b. amaurosis fugax

c. ataxia

d. diplopia

b. amaurosis fugax

*amaurosis fugax = "a shade coming down over one eye" due to an embolic process from the ipsilateral ICA to the ophthalmic artery.

Which of the following is a symptom of vertebrobasilar insufficiency?

a. unilateral paresis

b. diplopia

c. aphasia

d. amaurosis fugax

b. diplopia

diplopia = double vision

*other symptoms of vertebrobasilar insufficiency: numbness near lips / mouth, poor coordination, dysphagia, vertigo, amnesia and ataxia

A patient presents with right arm numbness and transient loss of vision in the left eye. Which vessel is the most likely source of these symptoms?

a. right external carotid artery

b. right internal carotid artery

c. left internal carotid artery

d. left subclavian artery

c. left internal carotid artery

*unilateral symptoms involving the eye = ipsilateral ICA

*unilateral symptoms involving the body = contralateral ICA

A 56 year old male presents with transient numbness in the fingers of the left hand. Bilateral brachial systolic blood pressures are 130 mmHg on the right and 105 mmHg on the left. What is the suspected diagnosis?

a. right subclavian artery occlusion

b. innominate artery occlusion

c. left vertebral stenosis

d. left subclavian stenosis

d. left subclavian stenosis

*difference between brachial blood pressures of 15 - 20 mmHg = subclavian stenosis on the lower pressure side

Which of the following refers to neurologic symptoms that are of short duration, completely resolving in less than 24 hours?

a. CVA

b. TIA

c. HTN

d. RIND

b. TIA

*reversible ischemic neurologic deficit lasts longer than TIA & does not completely resolve.

* cerebrovascular accident = completed stroke resulting in permanent damage

A right handed patient presents with expressive aphasia and left paresis. The cause of the symptoms is most likely obstruction of which of the following vessels?

a. right internal carotid artery

b. left internal carotid artery

c. left vertebral artery

d. basilar artery

a. right internal carotid artery

*in a right handed person, the left hemisphere is dominant for speech. a lesion in the left MCA may cause dysphasia or aphasia

*unilateral paresis (weakness/paralysis) = atherosclerotic lesion on contralateral side

A 57 year old female presents with numbness in both the right leg and the left arm. These symptoms are most closely associated with:

a. left internal carotid obstruction

b. right internal carotid obstruction

c. vertebrobasilar obstruction

d. right common carotid obstruction

c. vertebrobasilar obstruction

*bilateral symptoms of weakness or numbness =.vertebrobasilar disease

*symptoms of carotid territory cerebrovascular insufficiency = unilateral

What is the name for an abnormal sound caused by flow turbulence and heard on auscultation?

a. thrill

b. bruit

c. Bernoulli

d. Poiseuille

b. bruit

What should the patient be asked to do to facilitate auscultation of the carotid artery?

a. breathe regularly and deeply

b. perform the valsalva maneuver

c. breathe quietly

d. suspend respiration

d. suspend respiration

What are Hollenhorst plaques?

a. cholesterol emboli seen on ophthalmoscopic exam within the retinal artery branches

b. complex plaques in which hemorrhage into necrotic areas has occurred

c. fibrous plaques containing an excessive amount of lips material

d. ulcerated plaques with thrombus formation

a. cholesterol emboli seen on ophthalmoscopic exam within the retinal artery branches

Neurologic exam of a patient suspected of extracranial cerebral vascular disease should include evaluation of:

a. level of consciousness

b. basic comprehension

c. orientation to time and place

d. all of the above

d. all of the above

A decreased radial pulse on one arm raises suspicion for:

a. contralateral vertebral stenosis

b. ipsilateral common carotid occlusion

c. ipsilateral subclavian artery stenosis

d. all of the above

c. ipsilateral subclavian artery stenosis

What is the purpose of obtaining bilateral blood pressures when evaluating a patient for cerebrovascular disease?

a. the systolic components from each arm are added and the average is calculated to determine the likelihood of cerebrovascular disease

b. it is necessary to know both brachial pressures to rule out the presence of hypo perfusion syndrome

c. the brachial blood pressures are compared to see if they are equal

d. both brachial blood pressures must be known to determine if hypertension is present

c. the brachial blood pressures are compared to see if they are equal

Which measurement is most commonly used in angiographic reports of carotid stenosis?

a. percentage area reduction

b. percentage diameter reduction

b. percentage diameter reduction

*easily determined from a longitudinal image while percentage area reduction is determined from a cross sectional image

In a symmetric narrowing of the carotid artery, what percentage area reduction most closely corresponds to a percentage diameter reduction of 50%?

a. 75%

b. 90%

c. 50%

d. 35%

a. 75%

*50% diameter stenosis = 75% area stenosis in a symmetric narrowing

Percentage diameter and area reduction measurements are most accurate when obtained in which imaging plane?

a. transverse

b. coronal

c. sagittal

d. oblique

a. transverse

*percentage stenosis measurements obtained in sag or coronal scan planes are over- or underestimated due to atherosclerotic plaque is typically asymmetric

Which procedure consists of the surgical removal of the atherosclerotic plaque from an artery?

a. atherectomy

b. angioplasty

c. thrombectomy

d. endarterectomy

d. endarterectomy

Which diagnostic test most readily differentiates between primary ischemic and primary hemorrhagic stroke?

a. magnetic resonance angiography

b. computer tomography of the brain

c. duplex ultrasonography

d. electrocardiogram

b. computer tomography of the brain

Which of these statement does not apply to continuous wave (CW) Doppler?

a. in the CW Doppler range-gating is applied to control vessel selection

b. the difference between the transmitted and received frequencies falls within the audible hearing range

c. CW Doppler shows greater spectral broadening than pulsed wave Doppler

d. CW Doppler requires both a transmitting and a receiving transducer

a. in the CW Doppler range-gating is applied to control vessel selection

*range gating = PW Doppler which allows signals only from a specified depth to be processed for display

*CW has no depth range or depth resolution

*CW will always have a filled in spectral window because the sample volume is large.

In a pulsed-wave Doppler studies, loss of the spectral window characterizes which type of blood flow?

a. parabolic flow

b. turbulent flow

c. laminar flow

d. all of the above

b. turbulent

What is indicated by a unilateral decrease in or absence of diastolic flow in the common carotid artery?

a. proximal disease of the aortic arch

b. distal obstructive disease

c. arteriovenous fistula

d. poor cardiac output

b. distal obstructive disease

This image is a sagittal view of the right vertebral artery origin. Both the subclavian artery and the proximal vertebral artery are demonstrated. The arrow is pointing to what vessel?

a. inferior thyroid artery

b. ascending pharyngeal artery

c. thyrocervical trunk

d. internal thoracic artery

c. thyrocervical trunk

What frequency is most commonly used for transcranial Doppler?

a. 7.5 MHz

b. 3 MHz

c. 5 MHz

d. 2 MHz

d. 2 Mz

* A low frequency transducer is required for a TCD to penetrate the temporal bone. Mean loss of power in penetrating the skull is about 80%. Higher frequencies do not provide adequate penetration for insinuating the cranial vasculature

In conventional transcranial Doppler, the angle of insonation is assumed to be:

a. 0

b. 45

c. 60

d. 90

a. 0

*actual vessel is not visualized with TCD

In evaluation of arterial vasospasm following subarachnoid hemorrhage, which testing method would be most useful?

a. CW Doppler

b. OPG - Gee

c. periorbital Doppler

d. transcranial Doppler

d. transcranial Doppler

Unilateral increased diastolic flow in the ECA is commonly seen with:

a. ECA stenosis

b. ipsilateral ICA occlusion

c. ipsilateral CCA occlusion

d. all of the above

d. all of the above

The presence of aliasing in the spectral waveform of the internal carotid artery always indicates:

a. a hemodynamically significant stenosis

b. an occlusion

c. the frequency shift exceeding 1/2 the system pulse repetition frequency

d. the wall filter is set too high

c. the frequency shift exceeding 1/2 the system pulse repetition frequency

The point at which aliasing occurs is known as:

a. Poiseuille's point

b. the Nyquist limit

c. Bernoulli's point

d. the Reynolds number

b. the Nyquist limit

Which of the following is an appropriate angle for Doppler intonation of the extra cranial vasculature?

a. 60

b. 80

c. 90

d. 70

a. 60

Which of the following parameters may not be used to determine the degree of stenosis in the internal carotid artery?

a. heart rate

b. peak frequency shift

c. PSV

d. ICA / CCA ratio

a. heart rate

Which letter in the illustration is pointing to end diastole?

a. A

b. B

c. C

d. D

e. E

e. E