Ch. 12 Lower ext arterial duplex

What waveform type presents proximal to an occlusion or near occlusion?

a. A delayed upstroke to peak systole with antegrade flow throughout diastole

b. A high-resistance pattern with only antegrade flow during systole and no flow during diastole

c. A high-resistance pattern with antegrade flow in systole and a brief reversed flow component in early diastole

d. A low-resistance pattern with antegrade flow throughout the cardiac cycle

b. A high-resistance pattern with only antegrade flow during systole and no flow during diastole

During an ultrasound examination, the following velocities are obtained: proximal to a stenosis PSV= 98, at the stenosis PSV= 233, distal to the stenosis PSV = 76. What is correct velocity ratio, Vr, for this stenosis?

a. 233/98 = 2.4

b. 233/76 = 3.1

c. 98/233 = 0.42

d. 98/76 = 1.3

a. 233/98 = 2.4

All of the following are associated with a stenosis except:

a. a color bruit may be present.

b. the color will appear uniform.

c. the color flow channel will be reduced.

d. color aliasing.

b. the color will appear uniform.

Which statement correctly describes the standard approach to scanning the deep femoral or profunda femoral artery (PFA)?

a. The PFA is followed to the adductor canal.

b. The PFA is followed through the entire length of the thigh.

c. Only the first few centimeters of the PFA is scanned.

d. The PFA is not routinely included in the lower extremity protocol.

c. Only the first few centimeters of the PFA is scanned.

Normal lower extremity arterial waveforms have all of the characteristics except:

a. a rapid deceleration.

b. a reflected wave displayed as retrograde flow in early diastole.

c. a sharp acceleration to peak systole.

d. an early systolic peak slightly before the highest peak velocity.

d. an early systolic peak slightly before the highest peak velocity.

The majority of the anterior tibial artery can be followed using what approach?

a. Medial

b. Anterolateral

c. Posterior with the patient supine

d. Posterior with the patient in a lateral decubitus position

b. Anterolateral

The presence of which of the following most increases the embolic risk of an aneurysm?

a. Size of the aneurysm

b. Calcification in the aneurysm walls

c. Length of the aneurysm

d. Thrombus within the aneurysm

d. Thrombus within the aneurysm

Which feature should be closely examined to aid in assessing the age of an occlusion?

a. The presence of collateral flow

b. The proximal peak systolic velocities

c.The adjacent vessel walls

d. The distal peak systolic velocities

c.The adjacent vessel walls

Continuous, antegrade flow through diastole in a peripheral artery can normally be observed proximal to:

a. a high-grade stenosis.

b. an arteriovenous fistula.

c. an acute arterial occlusion.

d. a peripheral embolus.

b. an arteriovenous fistula.

Examination of the femoral, popliteal, and tibial vessels generally is best performed using:

a. a linear array transducer with imaging frequencies between 4 and 7 MHz.

b. a phased array transducer with imaging frequencies between 2 and 3 MHz.

c. a compact linear array transducer with imaging frequencies between 7 and 15 MHz.

d. a curvilinear transducer with imaging frequencies between 2 and 5 MHz.

a. a linear array transducer with imaging frequencies between 4 and 7 MHz.

The use of color during arterial ultrasound examinations can do all of the following except:

a. assist with tracking the course of a vessel.

b. rapidly assess flow dynamics.

c. guide the placement of the Doppler sample volume in the area of the greatest velocity shift.

d. determine the percent stenosis.

d. determine the percent stenosis.

A patient with chronic arterial ischemia will have the following symptoms except:

a. nail thickening.

b. skin changes.

c. hair loss.

d. paralysis

d. paralysis

In addition to assessing the degree of narrowing, which of the following is least helpful prior to angioplasty and/or stent placement?

a. Plaque characteristics

b. Vessel depth

c. Artery size

d. Length of stenosis

b. Vessel depth

Which of the following is not an advantage of duplex ultrasound over contrast angiography?

a. Allows for plaque characterization

b. Can detect flow in very low-flow states

c. Waveform analysis provides a better estimation of hemodynamic significance of a stenosis.

d. Provides better visualization of collateral network

d. Provides better visualization of collateral network

Methods that can be employed to overcome the technical challenges of vessel calcification include all of the following except:

a. increasing pulse repetition frequency.

b. increasing power Doppler gain.

c. increasing persistence.

d. using multiple insonation planes

a. increasing pulse repetition frequency.

Which of the following definitions most corresponds with “duplex arteriography”?

• Ultrasound imaging of the arterial system performed to identify atherosclerotic disease and other arterial pathology, providing a detailed map of the arterial system evaluated

• The deposit of fatty material within the vessel walls, which is characteristic of atherosclerosis 

• A localized dilation of an artery involving all three layers of the arterial wall 

• A radiologic imaging technique performed using ionizing radiation to provide detailed arterial system configuration and pathology information 

• Ultrasound imaging of the arterial system performed to identify atherosclerotic disease and other arterial pathology, providing a detailed map of the arterial system evaluated

How is low-resistance blood flow characterized on a Doppler spectrum?

• Sharp downstroke in early diastole 

• Retrograde flow in systole 

• Antegrade flow in systole only

• Antegrade flow throughout diastole

• Antegrade flow throughout diastole

What characteristic will Doppler spectra in an arterial segment proximal to a hemodynamically significant stenosis or an occlusion have?

• Retrograde flow in systole 

• Retrograde flow in diastole

• No flow in systole 

• No flow in diastole

• No flow in diastole

What is the primary tool to evaluate disease of the lower extremity arteries using duplex ultrasound (at the exception of aneurysm)?

• Color display with power Doppler

• Aliasing on color Doppler

• Peak systolic velocity

• B-mode image B-mode image

• Peak systolic velocity

On a posterior approach of the popliteal fossa, what is the branch identified on the anterior aspect of the image in relation to the popliteal artery?

• The tibioperoneal trunk 

• A gastrocnemius artery

• The anterior tibial artery

• A geniculate artery

• The anterior tibial artery

A 79-year-old male presents for a consultation in vascular surgery for nonhealing ulcers on several digits of his left foot. On further examination, the patient reveals a history of rest pain, more prominent on the left than the right. Which of the following is the most likely diagnosis?

• Chronic arterial insufficiency

• Acute trauma-related vascular injury 

• Acute arterial embolism 

• Acute thrombosis with compensatory collateralization

• chronic arterial insufficiency

When assessing the appearance of a plaque on a grayscale image, what might an irregular plaque surface indicate?

• An area of necrosis 

• Thrombus formation on top of the plaque

• Stable plaque unlikely to rupture 

• An area of ulceration

• An area of ulceration

Which artery is best visualized by a posterolateral approach at the level of the calf?

• The posterior tibial artery

• The tibioperoneal trunk 

• The peroneal artery

• The popliteal artery 

• The peroneal artery

Which of the following is NOT a consideration when assessing for the possibility of treatment of an arterial lesion by angioplasty or stenting (or both)?

• Location of the stenosis

• Size of the artery 

• Length of the stenosis

• Position of branches

• Position of branches

When can a greater than 70% stenosis in any arteries of the lower extremities be safely inferred?

• The Vr is equal to or greater than 2. 

• The PSV is half distal to the stenosis. 

• The Vr is equal to or greater than 3.

• The PSV is doubled at the stenosis. 

• The Vr is equal to or greater than 3.

When using duplex ultrasound to record slow flow (<20 cm/s) in an arterial segment, which of the following adjustments would NOT be useful?

• Decrease the PRF 

• Increase the persistence of color. 

• Decrease the Doppler gain.

• Use a low wall filter. 

• Decrease the Doppler gain.