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VT ination Ultimate Exam
Question 1. Which segment of the aortic arch gives rise to the left common carotid artery? A) Brachiocephalic trunk B) Subclavian artery C) Directly from the arch D) Vertebral artery Answer: C Explanation: The left common carotid artery originates directly from the aortic arch, distal to the brachiocephalic trunk. Question 2. In carotid duplex imaging, a plaque that appears uniformly hyperechoic with acoustic shadowing is most likely: A) Soft plaque B) Calcified plaque C) Ulcerated plaque D) Mixed composition plaque Answer: B Explanation: Calcified plaques are highly echogenic and produce posterior acoustic shadowing on B-mode ultrasound. Question 3. A peak systolic velocity (PSV) of 300 cm/s in the internal carotid artery (ICA) with an ICA/CCA PSV ratio >4.0 suggests: A) <30 % stenosis B) 30- 49 % stenosis C) 50- 69 % stenosis D) ≥70 % stenosis Answer: D Explanation: High PSV and an ICA/CCA ratio >4.0 are diagnostic criteria for ≥70 % ICA stenosis.
VT ination Ultimate Exam
Question 4. “Blunted” flow in the external carotid artery (ECA) on Doppler most commonly indicates: A) Proximal ICA stenosis B) ECA occlusion C) Carotid body tumor D) Normal physiological variation Answer: A Explanation: Proximal ICA stenosis can cause reduced forward flow in the ECA, producing a blunted waveform. Question 5. The middle cerebral artery (MCA) is a branch of which circle of Willis component? A) Anterior cerebral artery B) Posterior communicating artery C) Internal carotid artery D) Basilar artery Answer: C Explanation: The MCA originates from the distal internal carotid artery within the circle of Willis. Question 6. In transcranial Doppler (TCD), a mean flow velocity >120 cm/s in the middle cerebral artery after subarachnoid hemorrhage suggests: A) Normal flow B) Vasospasm C) Hyperemia D) Embolic phenomenon Answer: B Explanation: Elevated velocities (>120 cm/s) are characteristic of cerebral vasospasm following SAH.
VT ination Ultimate Exam
A) Color Doppler flow mapping B) Compression ultrasound C) Venography D) Magnetic resonance venography Answer: B Explanation: Real-time compression of the vein is the most reliable method for confirming or excluding DVT. Question 11. Acute thrombus in a deep vein typically appears on gray-scale ultrasound as: A) Anechoic, compressible, with bright walls B) Hyperechoic, non-compressible, with heterogeneous echotexture C) Isoechoic to surrounding tissue, compressible D) Completely anechoic, compressible Answer: B Explanation: Fresh thrombus is often hyperechoic and the vein is non-compressible; chronic thrombus becomes more echolucent. Question 12. In chronic DVT, the presence of collateral veins on Doppler suggests: A) Recent onset of thrombosis B) Complete resolution of the clot C) Long-standing occlusion with venous remodeling D) Arterial disease Answer: C Explanation: Collateral formation indicates the body has compensated for a chronic venous obstruction. Question 13. Phlegmasia cerulea dolens is distinguished from phlegmasia alba dolens by: A) Presence of cyanosis and edema
VT ination Ultimate Exam
B) Absence of pain C) Only arterial involvement D) Normal venous flow on Doppler Answer: A Explanation: Phlegmasia cerulea dolens presents with severe cyanosis, massive edema, and compromised arterial inflow. Question 14. A reflux duration of 1.2 seconds in the great saphenous vein (GSV) during Valsalva indicates: A) Normal valve function B) Mild reflux C) Significant venous insufficiency D) Deep vein thrombosis Answer: C Explanation: Reflux lasting longer than 1.0 second is considered pathological and signifies venous insufficiency. Question 15. In the evaluation of chronic venous insufficiency, the “augmentation test” assesses: A) Arterial pulsatility B) Valve competence in superficial veins C) Deep vein compressibility D) Lymphatic drainage Answer: B Explanation: Augmentation (or “squeeze”) evaluates whether superficial veins can transmit increased flow, reflecting valve competence. Question 16. The most common cause of upper-extremity DVT (Paget-Schroetter syndrome) is: A) Central venous catheter placement B) Repetitive overhead activity causing thoracic outlet compression
VT ination Ultimate Exam
D) Peripheral neuropathy only Answer: A Explanation: Toe arteries are less prone to medial calcification, making TBI more reliable in diabetics with non-compressible ankle vessels. Question 20. In segmental pressure testing, a pressure drop of >20 mmHg after treadmill exercise in the calf region indicates: A) Normal vascular response B) Severe arterial occlusion C) Venous insufficiency D) Neuropathy Answer: B Explanation: A post-exercise pressure drop >20 mmHg suggests flow-limiting arterial disease. Question 21. Triphasic arterial flow on spectral Doppler is characterized by: A) One forward flow component only B) Forward flow, brief reversal, then forward flow with a sharp upstroke C) Continuous forward flow without reversal D) Low-velocity monophasic pattern Answer: B Explanation: Normal peripheral arteries display a brisk systolic forward component, brief early diastolic reversal, and a late diastolic forward component. Question 22. A monophasic waveform in the dorsalis pedis artery most likely reflects: A) Normal arterial compliance B) Proximal arterial stenosis or occlusion C) Venous contamination D) Artifact from probe pressure
VT ination Ultimate Exam
Answer: B Explanation: Loss of the normal triphasic pattern indicates downstream obstruction reducing pulsatility. Question 23. In evaluating a femoral-popliteal bypass graft, a PSV >300 cm/s at the anastomosis suggests: A) Normal graft flow B) Significant graft stenosis C) Graft occlusion D) Arteriovenous fistula formation Answer: B Explanation: Elevated PSV at a graft anastomosis is a Doppler criterion for ≥70 % stenosis. Question 24. Ultrasound-guided thrombin injection is indicated for: A) Acute deep vein thrombosis B) Large arterial aneurysms C) Iatrogenic pseudoaneurysm >2 cm D) Carotid artery dissection Answer: C Explanation: Thrombin injection promotes thrombosis within a pseudoaneurysm, closing the sac. Question 25. Raynaud’s phenomenon is best evaluated with: A) Resting ankle-brachial index B) Cold-pressor test measuring digital pulse amplitude reduction C) Post-exercise segmental pressures D) Carotid duplex scanning Answer: B
VT ination Ultimate Exam
Explanation: Intervention is generally recommended when AAA diameter ≥5 cm due to rupture risk. Question 29. Type II endoleak after endovascular aneurysm repair (EVAR) originates from: A) Inadequate proximal seal B) Inadequate distal seal C) Retrograde flow from lumbar or inferior mesenteric arteries D) Graft fabric tear Answer: C Explanation: Type II endoleaks are caused by collateral retrograde flow into the aneurysm sac. Question 30. Mesenteric ischemia is best evaluated by measuring the peak systolic velocity in the superior mesenteric artery (SMA) after a patient has: A) Fasted for 12 hours B) Consumed a high-fat meal C) Performed a Valsalva maneuver D) Remained supine for 30 minutes Answer: B Explanation: Post-prandial hyperemia increases SMA flow; failure to augment suggests chronic mesenteric ischemia. Question 31. In renal artery stenosis assessment, an acceleration time (AT) >0.07 seconds on Doppler indicates: A) Normal renal artery B) Mild stenosis (<30 %) C) Moderate stenosis (30- 60 %) D) Significant stenosis (>60 %) Answer: D
VT ination Ultimate Exam
Explanation: Prolonged AT reflects delayed systolic upstroke due to hemodynamically significant stenosis. Question 32. The renal-aortic ratio (RAR) is calculated by dividing the renal artery PSV by the aortic PSV. A ratio >3.5 suggests: A) Normal renal perfusion B) Mild renal artery narrowing C) Moderate stenosis D) Severe renal artery stenosis Answer: D Explanation: High RAR values correlate with ≥60 % renal artery stenosis. Question 33. In a transplanted kidney, the resistive index (RI) measured in the interlobar arteries should normally be: A) <0. B) 0.5-0. C) 0.7-0. D) >0. Answer: B Explanation: An RI of 0.5-0.7 is typical; values >0.8 may indicate rejection or vascular complications. Question 34. Portal hypertension is most reliably identified on Doppler by: A) Decreased hepatic artery PSV B) Reversal of flow in the portal vein (hepatofugal) C) Increased renal artery flow D) Absence of splenic vein flow Answer: B Explanation: Hepatofugal (away from the liver) portal flow is a hallmark of portal hypertension.
VT ination Ultimate Exam
Question 38. The Doppler equation includes the cosine of the angle of insonation. Which statement is correct regarding angle dependence? A) At 0°, Doppler shift is maximal B) At 90°, Doppler shift is maximal C) Angles >60° should be avoided because error increases D) Angle does not affect velocity calculation Answer: C Explanation: As the angle approaches 90°, cosine approaches zero, causing large errors; ≤60° is recommended. Question 39. Spectral broadening on a Doppler waveform most often indicates: A) Laminar flow B) Turbulent flow distal to a stenosis C) Artifact from patient movement D) Low-flow state Answer: B Explanation: Turbulent flow causes a range of velocities, producing spectral broadening. Question 40. Aliasing in color Doppler occurs when: A) The pulse repetition frequency (PRF) is set too high B) The PRF is set too low relative to the velocity of flow C) The transducer frequency is too low D) The gain is excessive Answer: B Explanation: Aliasing appears when flow velocity exceeds the Nyquist limit set by the PRF. Question 41. During intra-operative carotid endarterectomy (CEA) completion scanning, a residual stenosis is diagnosed if the ICA PSV is:
VT ination Ultimate Exam
A) <125 cm/s B) 125- 200 cm/s C) 200- 300 cm/s D) >300 cm/s Answer: D Explanation: Post-CEA PSV >300 cm/s suggests residual ≥70 % stenosis requiring revision. Question 42. Pre-operative mapping for a radio-cephalic arteriovenous fistula (AVF) requires a minimum arterial diameter of: A) 1.5 mm B) 2.0 mm C) 2.5 mm D) 3.0 mm Answer: C Explanation: An arterial diameter ≥2.5 mm predicts adequate flow for AVF maturation. Question 43. Mature AVF typically exhibits a volume flow (Q) of at least: A) 200 mL/min B) 400 mL/min C) 600 mL/min D) 800 mL/min Answer: C Explanation: Successful maturation is generally defined by Q ≥ 600 mL/min. Question 44. In endovenous laser ablation (EVLA) of the GSV, the target vein diameter before treatment should be: A) ≤2 mm B) 2- 4 mm
VT ination Ultimate Exam
D) The test sensitivity decreases Answer: C Explanation: PPV is directly proportional to disease prevalence; higher prevalence yields higher PPV. Question 48. Routine phantom testing of an ultrasound system should be performed at least: A) Daily B) Weekly C) Monthly D) Annually Answer: C Explanation: Monthly phantom quality assurance checks are standard to verify resolution, depth, and Doppler accuracy. Question 49. To prevent work-related musculoskeletal disorders (WRMSD) during vascular scanning, technicians should: A) Use maximal probe pressure for better images B) Maintain neutral wrist and elbow positions, and take micro-breaks C) Stand on tiptoe to improve contact D) Keep the transducer in the same hand throughout the exam Answer: B Explanation: Ergonomic positioning and regular breaks reduce strain and risk of WRMSD. Question 50. In the lower extremity arterial exam, the posterior tibial artery is best visualized at the level of the: A) Popliteal fossa B) Medial malleolus C) Anterior tibial crest D) Lateral thigh
VT ination Ultimate Exam
Answer: B Explanation: The posterior tibial artery runs posterior to the medial malleolus, providing a reliable acoustic window. Question 51. A spectral Doppler waveform in the femoral artery that shows a sharp systolic upstroke, brief early diastolic reversal, and sustained forward flow is classified as: A) Monophasic B) Biphasic C) Triphasic D) Dampened Answer: C Explanation: This pattern reflects normal triphasic flow with high-velocity systole and diastolic components. Question 52. During an exercise stress test for PAD, a post-exercise ABI that falls below 0.90 in the affected leg indicates: A) Normal response B) Mild arterial disease C) Moderate to severe PAD D) Venous insufficiency Answer: C Explanation: A significant post-exercise drop in ABI is diagnostic of flow-limiting PAD. Question 53. In duplex scanning of the superficial femoral artery (SFA), a PSV of 250 cm/s with a post-stenotic turbulence zone suggests: A) No disease B) 30- 49 % stenosis C) 50- 69 % stenosis D) ≥70 % stenosis
VT ination Ultimate Exam
Explanation: The abdominal aorta is accessible for ultrasound; a double-lumen (intimal flap) sign indicates dissection. Question 57. The most accurate non-invasive method to assess for cerebral circulatory arrest (brain death) is: A) Carotid duplex B) Transcranial Doppler showing reverberating flow with zero diastolic velocity C) Color Doppler of the ophthalmic artery D) Pulsed-wave of the vertebral artery Answer: B Explanation: TCD demonstrates characteristic “oscillating” or reverberating flow patterns consistent with brain death. Question 58. In a patient with chronic venous insufficiency, an augmentation test that fails to increase flow velocity by at least 30 % suggests: A) Normal valve function B) Superficial vein reflux C) Deep vein thrombosis D) Lymphatic obstruction Answer: B Explanation: Lack of augmentation indicates incompetent superficial venous valves and reflux. Question 59. The “halo sign” on color Doppler of the carotid artery is indicative of: A) Plaque ulceration B) Calcified plaque C) Intramural hemorrhage within a plaque D) Normal intima-media thickness Answer: C
VT ination Ultimate Exam
Explanation: A hypoechoic halo surrounding a plaque reflects intraplaque hemorrhage. Question 60. In evaluating a patient after EVAR, a type III endoleak is most likely caused by: A) Inadequate seal at the proximal graft attachment site B) Retrograde flow from lumbar arteries C) Fabric tear or component disconnection D) Persistent aneurysm sac pressure from a missed branch vessel Answer: C Explanation: Type III endoleaks result from mechanical failure of the graft material or modular disconnection. Question 61. The “resistive index” (RI) is calculated as (PSV-EDV)/PSV. An RI of 0.85 in the renal interlobar artery most likely reflects: A) Normal renal perfusion B) Mild obstruction C) Significant renal arterial disease or acute rejection D) Venous congestion only Answer: C Explanation: RI >0.8 suggests elevated downstream resistance, often seen in renal artery stenosis or transplant rejection. Question 62. During a carotid duplex, an elevated end-diastolic velocity (EDV) in the ICA is most specific for: A) Plaque ulceration B) Moderate to severe stenosis C) Complete occlusion D) Normal age-related changes Answer: B
