ARDMS Vascular Board

Which of the following vessels will be abnormally dilated with significant portal HTN?

main portal vein and left gastric vein

Which renal arteries are evaluated with Doppler in an ultrasound exam that is used to perform an indirect evaluation for renal artery stenosis?

segmental and parenchymal arteries

________ is caused by emboli reaching the small digital arteries and causing obstruction/ischemia.

Blue toe syndrome

Blue Toe Syndrome is a complication typically seen with which of the following?

Abdominal aortic aneurysm

_________ is a genetic disorder that negatively affects collagen formation.

The reduction in collagen will result in less rigid arteries and increased risk of aneurysm formation.

Ehler-Danlos syndrome

A patient is referred for an ultrasound of the aorta due to a history of Ehler-Danlos syndrome. What are you looking for on the exam?

Aneurysm

A 55yr old with a history of alcoholism, jaundice and cirrhosis is referred for a liver Doppler exam. Which of the following is an expected abnormal finding?

increased resistance in the hepatic artery

The most common reason for underestimation of arterial stenosis is:

improper sample volume location

Which of the following sonographic characteristics is most suggestive of renal vein thrombosis?

reduced diastolic flow in the renal arteries

All of the following terms refer to the areas of flow separation seen distal to a stenosis, except:

autoregulation

How do the microbubbles in an ultrasound contrast agent change the image?

increase the reflectivity of flowing blood

According to the Bernoulli Principle, where will you find the lowest pressure in a vessel with stenosis?

at the site of stenosis

A damped waveform with low velocity turbulent systolic flow will be found:

distal to a significant stenosis

Which of the following is a Doppler indication of acute renal vein thrombosis?

resistive index >0.7 in the cortex

CREST syndrome

also known as limited cutaneous systemic sclerosis, is an autoimmune disease causing excess collagen production and tissue hardening. The acronym stands for its five primary features: Calcinosis, Raynaud's phenomenon, Esophageal dysfunction, Sclerodactyly, and Telangiectasia

Which of the following is least likely to be associated with renal artery stenosis?

May Thurner syndrome

Nutcracker syndrome is defined as:

abnormal compression of the left renal vein by the SMA and aorta

tardus parvus

a Doppler ultrasound finding indicating significant arterial narrowing proximal to the measurement site. It is characterized by a slow, delayed systolic upstroke ("tardus") and a diminished, rounded systolic peak ("parvus").

What is caput medusae?

tortuous vessels around the umbilicus caused by portal HTN

Bandwidth refers to ________.

the difference between the highest and lowest frequencies in the pulse

Laminar flow has a ________ bandwidth of reflected signals because the blood cells are all moving at relatively the same speed.

narrow

With turbulent flow, the blood cells are moving at many different velocities. This produces a _______ bandwidth of reflected signals and the spectral window fills in.

broad

Which of the following is associated with spectral broadening?

increased bandwidth

If the mesenteric - aortic ratio exceeds ______, a significant stenosis is present.

3.0

Which of the following indicates a significant SMA stenosis?

dilated inferior mesenteric artery that is easily visualized sonographically

The renal-aortic ratio is invalid in patients with:

abdominal aortic aneurysm

Type I endoleak

Occurs when there is an inadequate seal at the top or bottom attachment sites of the graft, allowing blood to flow directly into the aneurysm sac

Type II endoleak

The most common type, where blood flows backward (retrograde flow) into the aneurysm sac from small branching arteries, such as the lumbar or inferior mesenteric arteries

Type III endoleak

Caused by mechanical failure or a structural defect in the graft, such as a tear in the fabric or a separation between the modular components of the stent

Type IV endoleak

Blood seeps through the actual walls of the graft due to the porosity of its fabric

Type V endoleak

The aneurysm sac continues to expand without any visible leak or identifiable source on imaging tests

Which of the following describes the most common flow pattern seen in a Type Il endoleak?

bidirectional

The majority of abdominal aortic aneurysms form in what part of the vessel?

Infrarenal

Which of the following is an indirect sign of an unstable AAA sac with an endoleak?

Echolucent areas within the sac

Which of the following terms would be used to describe flow within an abdominal aortic aneurysm?

non-laminar flow

Anemia will ________ blood flow velocities detected on Doppler evaluation.

increase

Renal artery stenosis is considered hemodynamically significant when it is greater than ________

60%

The bilateral presentation of renal stenosis in a pediatric patient is most likely due to

a diffuse disorder of congenital or idiopathic nature.

The aorta should be measured from _______ wall.

outer wall to outer

________ has been shown to infiltrate the renal vein and IVC causing mass and thrombus formation within. It is the most common type of tumor with IVC/renal vein invasion.

Renal carcinoma

Obstruction of the IVC will cause flow in the iliacs to become _______.

continuous

Continuous flow in an extremity vein typically indicates a _______ obstruction is present.

proximal

Which of the following is true regarding scrotal varicoceles?

usually occurs on left side

The diagnosis of AAA is made once the aorta AP or width dimension exceeds ____

3.0cm

Which of the following is most suggestive of renal transplant rejection?

oliguria

Where is the Doppler cursor placed in the aorta to obtain the velocity used in the renal aortic ratio?

at the level of the renal artery origins

The Bernoulli principle explains the:

decrease in pressure seen with increased blood flow velocity

Bernoulli's principle states that:

in a steadily flowing fluid (liquid or gas), an increase in the fluid's speed occurs simultaneously with a decrease in its static pressure. Put simply: faster-moving air or water exerts less outward pressure than slower-moving air or water

If a patient has a history of

_______, they have an increased risk for carotid dissection.

Marfan syndrome

A patient with RUQ abdomen pain and bloating is referred to rule out Budd Chiari syndrome. What vessels will be evaluated for this diagnosis?

Hepatic veins

Which of the following is an autosomal dominant disorder that can lead to arteriovenous malformation in the liver?

Hereditary Hemorrhagic Telangiectasia

Hereditary Hemorrhagic Telangiectasia

a rare genetic disorder that causes fragile, direct connections between arteries and veins, bypassing capillaries

Klippel-Trenaunay syndrome

a rare congenital disorder defined by a triad of symptoms: a port-wine stain birthmark, varicose veins, and soft tissue or bone overgrowth affecting one or more limbs

Paget Schroetter syndrome

also known as "effort thrombosis", is a type of upper-extremity deep vein thrombosis (DVT). It occurs when a blood clot forms in the axillary or subclavian veins, typically triggered by vigorous, repetitive overhead arm motions—such as in weightlifting, pitching, or wrestling

Stanford Classification (aortic dissections) type A:

dissections that involve the ascending aorta and arch (proximal to the origin of the left subclavian artery)

Stanford Classification (aortic dissections) Type B:

dissections that involve the aorta from the left subclavian artery to the iliac bifurcation

DeBakey Classification (aortic dissections) Type I:

dissections that involve the ascending and descending aorta (= Stanford A)

DeBakey Classification (aortic dissections) Type Il:

dissections that involve only the ascending aorta (= Stanford A)

DeBakey Classification (aortic dissections) Type III:

dissections that involve the descending aorta only, starting after the origin of the left subclavian artery (= Stanford B)

While performing an aortic duplex exam, you identify an intimal flap that begins just below the renal arteries and measures 2.5cm in length. According to the Stanford Classification, this is a _________ and the DeBakey Classification calls it a ________.

Type B dissection, Type Ill dissection

Leriche syndrome

also knowon as aortoiliac occlusive disease. It is a form of peripheral artery disease caused by plaque buildup blocking the abdominal aorta. It classically causes a triad of symptoms: thigh or buttock cramping, erectile dysfunction, and absent/weak pulses in the groin area

A patient presents with a script that requests an aortic Doppler evaluation due to Leriche syndrome.

What are you looking for on the exam?

extensive diffuse atherosclerotic disease causing obstruction of the distal aorta

The type of plaque that carries the greatest risk of embolization is

soft

Which of the following procedures can be performed on a patient in renal failure?

Duplex ultrasound

Median arcuate ligament syndrome involves compression of which vessel during respiration?

celiac axis

Which of the following vessels are a common source for a Type Il endoleak?

inferior mesenteric artery and lumbar arteries

The most common site for renal artery stenosis is:

at the origin of the renal artery

if thrombus accumulation is present within the AAA, the true lumen is ________.

the anechoic space in the middle of the vessel

if thrombus accumulation is present within the AAA, the total AP dimension of the AAA size is

the distance between the actual vessel walls.

Which of the following correctly describes the symptoms associated with median arcuate ligament syndrome?

abdominal pain that is relieved by deep inspiration

A tardus parvus waveform is the result of:

significant proximal arterial stenosis

Hemodynamically significant stenosis of the celiac axis is diagnosed with the PSV greater than?

2.0m/s

If a patient complains of a recent onset of uncontrollable systemic HTN with average BP readings exceeding 170/90mmHg, what vascular cause should be suspected?

renal artery stenosis

Which of the following is not a characteristic of a high-grade stenosis?

Laminar flow just distal to the site of stenosis

Congestive heart failure causes increased pulsatility in the:

iliac veins and portal veins

When scanning a patient with a history of renal cell carcinoma, you identify a hypochoic mass within the IVC lumen near the renal veins. What is the best way to determine if this is tumor invasion or thrombus formation?

Apply color Doppler to assess internal vascularity of the mass.

Which of the following is a congenital vascular abnormality that commonly causes decreased ankle pressures bilaterally?

Coarctation of the aorta

What term refers to the phenomenon of a PW Doppler tracing displaying a wider distribution of the velocity of blood cells with varying degrees of arterial blockage?

Spectral broadening

A patient complains of bilateral pain and color changes in the legs. When he lies down, both legs become pale. When he sits up on the edge of the bed, both legs become reddened. These clinical findings are most suggestive of:

significant aortic stenosis

Flow distal to a significant stenosis will exhibit which of the following characteristics?

lower resistance flow

Which of the following is NOT a potential acute complication of a liver transplant?

cirrhosis

Which of the following correctly describes an aortic aneurysm?

The AP diameter is considered the most reliable dimension for diagnosis of a AAA

Which renal arteries are evaluated with Doppler in an ultrasound exam that is used to perform a direct evaluation for renal artery stenosis?

main renal artery

When evaluating a liver transplant, you must use angle correction during Doppler evaluation of:

hepatic arteries and portal veins

Which of the following describes the proper way to measure an abdominal aortic aneurysm?

outer wall to outer wall

Which type of aortic aneurysm is associated with an infection of the arterial wall?

Motic

Increased resistance in a renal artery can indicate:

distal stenosis or kidney disease

Which of the following correctly describes an IVC aneurysm?

Most IVC aneurysms are saccular

Why is aspirin prescribed for patients with atherosclerotic arterial disease?

to reduce blood viscosity

Which of the following calculations is necessary to accurately diagnose renovascular HTN?

renal-aortic ratio

Aneurysm formation affects the ________, while atherosclerotic disease affects the _________.

media and adventitia layers of the vessel wall, intimal layer of the vessel wall

An aortic aneurysm is diagnosed when the diameter of the aorta exceeds ________, and a popliteal aneurysm is diagnosed when the diameter of the popliteal artery exceeds ________.

3cm, 1cm

Hemodynamically significant stenosis of the SMA is diagnosed when the peak systolic velocity is greater than?

2.75 m/s

Renal artery stenosis > 60% is indicated when ________

the PSV is greater than 2.0m/s and the renal aortic ratio is over 3.5.

A ______% stenosis is considered significant and treatment is required.

60

true or false: There are no other diagnostic criteria used to stage RAS at 75% and 85% stenosis etc.

true

According to the Bernoulli principle, the velocity increases at an area of stenosis. What happens to the pressure at the site of stenosis?

decreases

An abnormal renal-aortic ratio would be a ratio

>3.5

Which of the following can lead to systolic flow reversal in the hepatic veins?

significant tricuspid regurgitation

The Doppler tracing of the flow in a vessel just distal to a stenosis will demonstrate ________ than at the stenosis.

greater bandwidth