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The first major branch of the aorta is the _________. - ✔✔Innominate artery. What arteries arise from the subclavian artery? - ✔✔Vertebral, Internal thoracic, internal mammary and thyrocervical trunk. The angular artery is the terminal part of what artery? - ✔✔Facial artery The arterial pulsations felt infront of the ear just aboube the zygomatic arch are from which artery? - ✔✔Superficial temporal artery. The common carotid artery divides into external and internal carotid arteries at the level of the upper border of the ___________. - ✔✔Thyroid cartilage. Name the branches of the ECA from proximal to distal. - ✔✔Superior thyroid, Ascending pharyngeal, Lingual, Facial, Occipital, Posterior Auricular, internal Maxillary, Superficial temporal Name the arteries of the Circle of Willis. - ✔✔Anterior cerebral artery (left and right) Anterior communicating artery Internal carotid artery (left and right) Posterior cerebral artery (left and right) Posterior communicating artery (left and right) The basilar artery and middle cerebral arteries, supplying the brain, are also considered part of the circle The prominence of the larynx is formed by the ___________. - ✔✔Thyroid cartilage.
The infraorbital artery is the terminal brach of what artery? - ✔✔Maxillary artery. Name the braches of the ICA proximal to distal. - ✔✔Ophthalmic artery, Supraorbital, frontal and nasal arteries What 2 arteries supply the Circle of Willis with blood? - ✔✔Carotid and vertebral arteries. What are the 2 arteries in TCD that from the temporal window have bidirectional flow with a depth of 60 - 65 mm? - ✔✔Middle and anterior cerebral arteries. What is the most common anomaly of the Circle of Willis? - ✔✔Absence or hypoplasia of one or both of the communicating arteries. What is the most common variant of the aortic arch? - ✔✔A common origin of the innominate and left common carotid artery. Name the superficial vein that supplies the 3 perfortating veins of the distal calf (Cockett). - ✔✔Posterior arch vein. Where is Boyds perforating vein located? - ✔✔Near the knee. The brachial veins connect which 2 veins? - ✔✔Axillary with the radial and ulnar veins. The term "muscle pump" refers to what? - ✔✔The calf muscles. Which vein in the antecubital fossa connect the cephalic and basilic veins? - ✔✔Median cubital vein. The brachiocephalic vein is another name for what? - ✔✔Right and left innominate veins.
The splenic artery, common hepatic artery and left gastric artery arise from what abdominal artery? - ✔✔Celiac trunk The most common anatomic variant of the renal arteries is...... - ✔✔Multiple renal arteries. What artery supplies the small intestine, right colon and transverse colon? - ✔✔SMA. What is another name for the hypogastric artery? - ✔✔Internal iliac artery. Blood supply to the vascular tissue is provided by the ____________________. - ✔✔Vaso vasorum. Which vessel layer is composed completely of endothelial cells? - ✔✔Tunica intima. What vessel layer does atherosclerosis begin in? - ✔✔Intimal layer. What are the risk factors for atherosclerosis? - ✔✔HTN, Diabetes mellitus, smoking, sndf lipoprtotein abnortmalities. What are 3 common complications of plaque ulceration? - ✔✔Embolization, thrombus, and intraplaque hemorrhage. To produce a vertebral/subvclavian steal, where must the lesion be? - ✔✔Proximal to the vertebral arteries. ____________ is the strongest risk factor for a stroke. - ✔✔Hypertension. What is the most prevalent type of stroke? - ✔✔Ischemic. T or F. the right side is most common for subclavian steal. - ✔✔False, it is the left.
Define hemiparesis - ✔✔Weakness of one side. What is the major difference between protocols for cardiac treadmill and claudication treadmill testing?
- ✔✔Speed is varied during a cardiac treadmill test to increase heartrate to a specific target level. During a treadmill test, patient complains of pain in the left arm and jaw, but denies any other pain. What is the most likely consideration? - ✔✔Angina. What is the normal diameter for the abdominal aorta? - ✔✔ 2 - 3 cm. After walking 5 minutes on treadmill, patient experiences decrease in ankle pressure of 40% on right and 15% on left. These findings suggest? - ✔✔Claudication. What is the correct setting for arterial volume recording? - ✔✔AC-coupled output. What Doppler waveform abnormality in the lower extremity arterial circulation distal to a hemodynamically significant stenosis show? - ✔✔An absent flow recersal component, blunting of the peak velocity and prolonged upslope and downslope. A normal arterial volume waveform may have all EXCEPT: Swift upstroke, sharp peak, rapid downslope bowed toward baseline, dicrotic notch or reverse flow component? - ✔✔Reverse flow component because it is part of a Doppler waveform not volume waveform. T or F- Most analog Doppler analysis is qualitative, assessing for presence or absence of characteristics. - ✔✔True. What is the normal response of ankle pressure to exercise testing? - ✔✔There should be no change if normal. With severe lower extremity arterial occlusive disease, how will distal Doppler waveforms appear? - ✔✔Markedly dampened, possibly making interpretation difficult for distal segments.
With both arterial obstructive disease and distal ischemia, what happens to vessel size and distal resistance? - ✔✔Vasodilation opens to attempt to increase nutrive blood flow to the extremity and distal resistance decreases. When you have a damped Doppler velocity waveform of the subclavian artery, where would the significant lesion be located? - ✔✔Proximal to the point of insonation. Normal values in TcPO2 are _________. - ✔✔ 60 - 80 mmHg. AAA evaluation is done pre or post prandial and why? - ✔✔Preprandial to minimize shadowing due to bowel gas. What waveforms will you likely see from CFA to tibial arteries with a superficial femoral artery occlusion?
- ✔✔Triphasic CFA and proximal SFA with monophasic at the popliteal and tibial arteries. When calculating the ABI pressure ratio, what pressures are used? - ✔✔Ankle pressure/The higher arm pressure. Which ABI would be higher between Claudication and rest pain? - ✔✔Claudication is higher (0.5-0.9) Rest pain is lower (< 0.5) What happens to a patients digital pressures when the hand is immersed in cold water if they have Raynaud's disease? - ✔✔They decrease or disappear all together. Define coarctation of the aorta. - ✔✔Coarctation of the aorta is a narrowing of the aorta most commonly found just distal to the origin of the left subclavian artery. Define compartment syndrome. - ✔✔A serious condition that involves increased pressure in a muscle compartment. It can lead to muscle and nerve damage and problems with blood flow.
What is digital subtraction arteriography? - ✔✔a method in which radiographic images of blood vessels filled with contrast material are digitized and then subtracted from images obtained before administration of the material. The method increases the contrast between the vessels and the background. Where is the usual site for percutaneous lower extremity (or any) angiography? - ✔✔Common femoral artery. The common radiologic terms "inflow", "outflow" and "runoff" refer respectively to what? - ✔✔Aortoiliac, femoropopliteal and trifurcation arteries. Contrast for arteriography is hard on what organ? - ✔✔Kidneys. What condition shows up as a "string of beads" on angiography? - ✔✔Fibromuscular dysplasia. What is FMD? - ✔✔Fibromuscular dysplasia-abnormal growth of cells in the walls of arteries that can cause the vessels to narrow or bulge. The carotid arteries,are commonly affected. Arteries within the brain and kidneys can also be affected. A characteristic "string of beads" pattern caused by the alternating narrowing and enlarging of the artery can block or reduce blood flow to the brain, causing a stroke. What is the "kissing stent" angioplasty/stent technique useful for? - ✔✔Bifurcations. What is valvulatome? - ✔✔catheter-based surgical device for cutting and disabling venous valves used by vascular surgeons to perform an in-situ bypass of the lower extremity arteries with existing veins. Most common upper extremity vein used for a arterial bypass in the leg is? - ✔✔Cephalic vein. Sometimes the basilic vein may be used. Define sympathectomy. - ✔✔surgical procedure that destroys nerves in the sympathetic nervous system to increase blood flow and decrease long-term pain in certain diseases that cause narrowed blood vessels. It can also be used to decrease excessive sweating. This procedure destroys the sympathetic ganglia, which are collections of nerve cell bodies in clusters along the thoracic or lumbar spinal cord.
When examining a patient with weight loss, postprandial pain, and an abdominal bruit, what vessel is most likely to be partly responsible? - ✔✔SMA though CA and IMA may be involved.(chronic mesenteric ischemia) Patient presents with an enlarged coronary vein with retrograde flow, what is this a finding of? - ✔✔Portal hypertension. T or F- Noninvasive diagnosis of renal artery stenosis can ve made by B-mode images of atherosclerotic plaque. - ✔✔False, It requires a duplex system with spectral analysis. What abdominal artery demonstrates higher diastolic flow postprandial? - ✔✔SMA. Normal arterial waveforms in the renal hilum are high resistance or low resistance? - ✔✔Low resistance. Proximal renal artery stenosis > than 60% is diagnosed when? - ✔✔Systolic renal/aortic velocity ratio(RAR) is >3.5. Define ischemia. - ✔✔A decrease in the blood supply to a bodily organ, tissue, or part caused by constriction or obstruction of the blood vessels. What will happen to the Doppler signal from the sublcavian vein during inspiration? - ✔✔It will augment. What will pulsatile venous Doppler from the portal vein suggest? - ✔✔Portal hypertension. T or F-In duplex assessment of the portral vein, flow is normally continuous with respiration. - ✔✔False. It is normally phasic with respiration. Is a normal spectral waveform from the hepatic veins unidirectional or bidirectional and why? - ✔✔Bidirectional because it is the result of the vessel being proximal to the right atrium and reflects right atrial pressure changes.
How is the sublcalvian vein best checked for coaptation? - ✔✔With a quick deep breath (big sniff). Doppler signal from the subclavian vein is expected to be? - ✔✔Pulsatile. (dont worry I said triphasic too) What direction is normal flow in the hepatic vein? - ✔✔bidirectional. Define TIPS. - ✔✔Transjugular intrahepatic portosystemic shunt or (TIPS) is a shunt (tube) placed between the portal vein which carries blood from the intestines and intraabdominal organs to the liver and the hepatic vein which carries blood from the liver back to the vena cava and the heart. The TIPS procedure relieves excess pressure from what abdominal abnormality? - ✔✔Portal hypertension. What is the most common cause for impotence? - ✔✔Vascular disease. When scanning a newly transplanted kidney, you see patency in both renal artery/vein.... when scanning the intrarenal arteries there is only systolic flow. What is happening? - ✔✔Absence of diastolic flow on the transplanted kidney suggests rejection. What MHz probe range would you use for Saphenous vein mapping prior to bypass surgery? - ✔✔ 7 - 10MHz. T or F- a flow rate less than 200ml/min is normal for a radial artery/cephalic vein dialysis fistula. - ✔✔False. A flow rate around 300 ml/min is required for dialysis. What is the name for a radial artery/cephalic vein dialysis fistula? - ✔✔Brescia-Cimino. T ot F- the digital/brachial systolic pressure ratio in an extremity with a dialysis fistula is about 0.5. - ✔✔False. You shouldn't take a blood pressure where there is a dialysis fistula.
What does the Valsalva maneuver due to venous flow? - ✔✔It stops/dimishes it throughout the whole body. T or F- If respiratory pressure changes are not transmitted to the lower extremity venous signals, the tech should be suspicious of proximal obstruction. - ✔✔True. What is the optimal patient position for performing lower extremity veins? - ✔✔There are 2- reverse Trendelenburg and Semi-Fowlers. Demonstration of vein wall coaptation is best performed __________________. - ✔✔In a transversse plane without color. While scanning for LEV, you notice very small venous lumen in the CFV, with bright thickened venous walls along most of the thigh. What findings is this? - ✔✔Chronic thrombosis. Thrombus that appears to be dark, homogeneous and poorly attached to the venous wall suggests? - ✔✔Acute thrombosis. What is the area in the lower extremity that is most difficult to bring about vein wall coaptation? - ✔✔Distal thigh (SFV). Pulsatile lower extremity venous Doppler signals would be associated with? - ✔✔Congestive heart failure because it increases overall venous pressure. Descending venography is used to diagnose? - ✔✔Valvular insufficiency. Venous puncture for introducing contrast in venography to assess for DVT is done at what level? what is assessing for valvular insufficiency? - ✔✔Dorsal vein on foot, CFV for insufficiency.
Acute DVT is indicated in venography as ________________. - ✔✔An area of no contrast often with "railroad track" lines along walls. What is the gold standard test for pulmonary embolism? - ✔✔Pulmonary angiography. The drug heparin can cause ____________. - ✔✔Thrombocytopenia. Heparin is a protein that can activate antibodies and it affects the partial thromboplastin time. After heparin in the hospital for treatment of DVT... What medication do they send home with the patient to use for approx. 3 months? - ✔✔Sodium warfarin or coumadin. More than 90% of infrarenal abdominal aneurysms are of what origin? - ✔✔Degenerative. A condition that causes nonatherosclerotic narrowing of brachiocephalic arteries in mostly female patients is called ___________. - ✔✔Takayasu's arteritis. The most common source of upper or lower extremity peripheral arterial embolus is - ✔✔The heart (80- 90%). Aneurysms are most often caused by? - ✔✔Congenital arterial wall weakness. An occlusive disease of medium and small arteries in the distal upper and lower limbs of primarily young male heavy smokers is? - ✔✔?Thromboangitis obliterans/Buerger's disease. What is the percentage of death from a AAA rupture? - ✔✔80%. In the lower extremities, where is the most common site of atherosclerosis? - ✔✔The arterial segment beginning in Hunters canal(adductor canal) located in the mid to lower thigh. What is the vascular disease that presents with back, abdominal or flank pain? - ✔✔AAA.
What is the most common cause of unilateral claudication in a young person? - ✔✔Popliteal artery entrapment. T or F- Raynauds phenomenon causes prolonged digital pallor ore cyanosis, fdollowed by rubor on reperfusion. - ✔✔True. The pulsatility index is defined as? - ✔✔Peak systolic to peak diastolic velocity divided by the mean velocity (Goslings pulsatility index) T or F-During intermittent claudication, there is a pressure drop distal to the obstructed segment after exercise. - ✔✔True. What change occurs inthe peripheral blood flow of limbs with obstuctive arterial disease in response to exercise(reactive hyperemia procedure)? - ✔✔Hyperemia is prolonged in obstructed limbs in comparoson to limbs with no obstruction. What is the range of ankle/arm indices in claudicating patients? - ✔✔0.5-0. The ankle/arm index is obtained by dividing? - ✔✔Ankle pressure by the higher brachial pressure. What is the key technology in arterial pneumoplethysmography? - ✔✔A pressure transducer monitoring cuff pressure over a limb. How is patency of the palmer arch determined? - ✔✔Alternately compressing the radial and ulnar arteries while listening for cjanges onthe digital artery signal. Why is assessment of the palmar arch patency useful? - ✔✔To evaluate blood flow to the digital arteries and before placement of an arteriovenous arm shunt. Name the 2 characteristics that defoine arterial stenmosis anywhere in the body include? - ✔✔Focal acceleration of velocities and distal turbulence.
What is the main difference of waveforms between the LEA's and UEA's? - ✔✔Peripheral resistance is usually lower in the upper extremity. Define Hollenhorst plaque. - ✔✔A bright yellow spot surrounded by vessels found in the eye. These patients have a 75% chance for a TIA. A unilateral symptom that ia temporary, and frequently described as a curtain or shade that blocks vision temporarily. - ✔✔Amaurosis fugax. What is the incidence of new strokes per year? - ✔✔500,000-700, What does the abbreviation TIA stand for? - ✔✔Transient Ischemic Attack. What is the length of time a TIA lasts? - ✔✔No longer than 24 hours What is the major difference between posterior and anterior cerebral circulation? - ✔✔With posterior circulation, the symptoms are bilateral/global where as anterior is unilateral. RIND, also called a stroke with recovery, lasts how long? - ✔✔24 hours-3days. Name the symptom associated with vertebrobasilar insufficiency that means difficulty with swallowing. - ✔✔Dysphagia. Distubance that effects half of the visual field in both eyes is _______________. - ✔✔Homonymous hemianopia, What is a 30 minute episode of garbled speech called? - ✔✔Dysphasia.
Name the flow resistance characteristics of the CCA, ICA and ECA. - ✔✔ICA-low resistance, ECA- high resistance, CCA-mixed resistance. T or F-The Doppler sample volume should be small to sample just from center stream. - ✔✔True. T or F- You should increase PRF to help fill in for slow flow vessels. - ✔✔False. Name the acoustic windows for TCD. - ✔✔Suboccipital, temporal, orbit of the eye, submandibular. Most common site for arterial puncture for all types of angiography is ____________. - ✔✔CFA. Name the most common complication following carotid endarterectomy. - ✔✔Hyperperfusion syndrome. What is the primary concern for patients with acute DVT? - ✔✔Pulmonary embolism. The greatest pressure of venous hypertension in secondary varicose veins occurs ______________. - ✔✔During muscle contraction, which forces blood out to the superficial veins via incompetent perforating veins. T or F- Diabetes is a risk factor for DVT. - ✔✔False. DVT is a risk factor of atherosclerosis. Name the 3 components of Virchow's triad. - ✔✔1. Intimal injury 2. Hypercoagulability 3. Stasis What percentage of PE's originate from lower extremity DVT? - ✔✔>90% What is a dilitaion of the greater saphenous vein or superficial tributary? - ✔✔Varicose vein.
A Bakers cyst is a collection of ____________. - ✔✔Synovial fluid from the knee joint. What vessel do the gastroc veins empty into? - ✔✔Popliteal vein. The soleal veins drain into the ___________and _________. - ✔✔PTV and Peroneal veins. Elevation of the extremities decreases or increases venous hypertension and pain. - ✔✔Decreases. Edema caused by DVT is characterized by? - ✔✔Selling in the legs and ankles but not feet. Bilateral pitting edema is most likely related to DVT or a Cardiac/systemic origin? - ✔✔Cardiac/ systemic origin due to CHF. Thrombus of what level would cause bilateral edema? - ✔✔IVC. Lower extremity ulcers are overwhelmingly the result of what? - ✔✔Venous disease due to chronic venous insufficiency. What is a typical finding of skin discoloration on a patient with chronic venous insufficiency is? - ✔✔Rusty brown color at ankles and calves. What is phegmasia cerulea dolens? - ✔✔Phlegmasia cerulea dolens is an uncommon, severe form of deep venous thrombosis (blood clots in the vein), usually in the upper leg. Where are chronic venous ulcerations usually found? - ✔✔On the lower third of the leg around themedial aspect of the ankle T or F-Venous ulcers are usually not painful and are located cephalad to the foot. - ✔✔True. A common physical finding in pulmonary embolism is __________. - ✔✔Tachypnea (rapid inspiration).
