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Question 1. Which extracranial artery gives rise to the internal carotid artery? A) Subclavian artery B) Common carotid artery C) Vertebral artery D) Brachial artery Answer: B Explanation: The internal carotid artery branches directly from the common carotid artery at the carotid bifurcation. Question 2. In a normal Doppler waveform of the femoral artery, which pattern is expected? A) Triphasic B) Biphasic C) Monophasic D) Flat Answer: A Explanation: Peripheral arteries in healthy individuals exhibit a triphasic waveform reflecting forward flow, brief reversal, and diastolic flow. Question 3. According to Poiseuille’s law, which factor most strongly influences flow through a vessel? A) Vessel length B) Blood viscosity C) Vessel radius D) Pressure gradient Answer: C
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Explanation: Flow is proportional to the fourth power of the radius; small changes in radius cause large changes in flow. Question 4. Which of the following best describes laminar flow? A) Chaotic eddies and vortices B) Parallel layers of blood moving in an orderly fashion C) Turbulent flow with audible bruit D) Flow that reverses during diastole Answer: B Explanation: Laminar flow consists of smooth, parallel layers with minimal mixing, typical in normal vessels. Question 5. A 65-year-old male has a carotid plaque that is predominantly echogenic with acoustic shadowing. What type of plaque is this? A) Soft plaque B) Calcified plaque C) Ulcerated plaque D) Mixed plaque Answer: B Explanation: Echogenic material with posterior acoustic shadowing indicates heavy calcium deposition. Question 6. Which Doppler artifact occurs when the displayed color changes direction despite true flow being unidirectional? A) Aliasing B) Mirror image artifact C) Blooming
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B) 0.
C) 0.
D) 0.
Answer: D Explanation: An RI approaching 1 indicates minimal diastolic flow, reflecting high resistance. Question 10. Which of the following best describes a true aneurysm? A) Dilatation involving all three layers of the arterial wall B) A contained rupture limited by surrounding tissue C) A focal outpouching of the intima only D) An arterial dissection with a false lumen Answer: A Explanation: True aneurysms involve dilation of the intima, media, and adventitia. Question 11. The ankle-brachial index (ABI) is most useful for detecting which condition? A) Venous insufficiency B) Peripheral arterial disease C) Deep vein thrombosis D) Lymphedema Answer: B Explanation: ABI compares ankle systolic pressure to brachial pressure to assess arterial perfusion of the lower extremities.
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Question 12. Which of the following veins contains valves that prevent retrograde flow? A. Inferior vena cava B. Common femoral vein C. Popliteal vein D. External iliac vein Answer: C Explanation: The popliteal vein, like most deep veins of the lower extremity, has multiple bicuspid valves to assist venous return. Question 13. In the Circle of Willis, which artery supplies the posterior cerebral territories? A) Anterior cerebral artery B) Middle cerebral artery C) Posterior communicating artery D) Posterior cerebral artery Answer: D Explanation: The posterior cerebral artery (PCA) originates from the basilar artery and supplies occipital and inferior temporal lobes. Question 14. During a duplex exam of the subclavian artery, a high-velocity jet with a post-stenotic turbulent signal is noted. What is the most likely cause? A) Venous thrombosis B) Atherosclerotic stenosis C) Arteriovenous fistula D) External compression from a cervical rib Answer: B
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D) Detection of arterial aneurysm in the brachial artery Answer: B Explanation: Duplex can quantify flow through the fistula; excessive flow may cause distal ischemia (steal). Question 18. The presence of a “to-and-fro” waveform in a peripheral artery most likely suggests: A) Normal triphasic flow B) Severe proximal stenosis C) Distal arterial occlusion with collateral flow D) Venous reflux Answer: C Explanation: Collateral vessels can produce a bidirectional waveform when the main artery is occluded downstream. Question 19. Which of the following is a common cause of subclavian steal syndrome? A) Proximal subclavian artery stenosis B) Distal brachial artery thrombosis C) Internal carotid artery dissection D) Vertebral artery aneurysm Answer: A Explanation: Stenosis of the proximal subclavian artery reverses flow in the ipsilateral vertebral artery to supply the arm. Question 20. During a vascular ultrasound, the mechanical index (MI) is kept below 1.0. This is primarily to: A) Reduce thermal heating of tissue
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B) Minimize acoustic cavitation C) Increase image resolution D) Enhance Doppler sensitivity Answer: B Explanation: The MI reflects the likelihood of cavitation; keeping it low protects tissues from mechanical bioeffects. Question 21. Which of the following vessels is most commonly used for a femoral-popliteal bypass graft? A) Saphenous vein B) Femoral artery C) Popliteal artery D) Inferior vena cava Answer: A Explanation: The great saphenous vein is the preferred autogenous conduit for femoral-popliteal bypasses. Question 22. In an abdominal aortic aneurysm (AAA) surveillance scan, which finding warrants immediate surgical referral? A) Diameter 3.5 cm B) Diameter 4.0 cm with rapid growth >0.5 cm in 6 months C) Presence of mural thrombus only D) No change in size over 2 years Answer: B Explanation: Rapid expansion (>0.5 cm in 6 months) or size >5.5 cm in men signals high rupture risk and requires repair.
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Explanation: Low-level disinfection of the transducer between patients eliminates pathogens and complies with infection control standards. Question 26. In the context of Doppler physics, the Nyquist limit is determined by: A) The transducer frequency only B) The pulse repetition frequency (PRF) C) The depth of imaging D) The gain setting Answer: B Explanation: The Nyquist limit equals half the PRF; exceeding it causes aliasing. Question 27. Which artery is most commonly evaluated for carotid endarterectomy planning? A) External carotid artery B) Common carotid artery C) Internal carotid artery D) Vertebral artery Answer: C Explanation: The internal carotid artery supplies the brain; stenosis here is the primary target for endarterectomy. Question 28. Which of the following is a typical sonographic feature of a pseudoaneurysm? A) Uniform wall thickening B) “To-and-fro” flow at the neck (yin-yang sign) C) Continuous laminar flow throughout the sac
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D) Absence of any Doppler signal Answer: B Explanation: A pseudoaneurysm has a narrow neck with bidirectional flow creating the characteristic yin-yang pattern. Question 29. In a duplex study of the popliteal vein, reflux is defined as flow lasting longer than: A) 0.2 seconds B) 0.5 seconds C) 1.0 seconds D) 2.0 seconds Answer: C Explanation: Venous reflux is considered pathologic when retrograde flow persists >1 second. Question 30. Which of the following statements about the pulsatility index (PI) is correct? A) PI = (PSV – EDV) / Mean velocity B) PI = (PSV + EDV) / PSV C) PI = (PSV – EDV) / PSV D) PI = (Mean velocity) / (PSV – EDV) Answer: A Explanation: PI = (Peak systolic velocity – End-diastolic velocity) divided by the mean velocity; it reflects downstream resistance. Question 31. The primary purpose of an ankle-brachial index (ABI) in diabetic patients with non-compressible vessels is to: A) Diagnose venous thrombosis
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Question 34. Which of the following is a typical finding in chronic deep vein thrombosis on ultrasound? A) Uniformly compressible vein B. Presence of a hyperechoic “cobweb” sign within the lumen C. Absence of any echoic material D. Hyperdynamic arterial flow adjacent to the vein Answer: B Explanation: Chronic DVT often displays echogenic fibrous strands (“cobweb” sign) and may be partially compressible. Question 35. In a patient with suspected thoracic outlet syndrome, which provocative maneuver is commonly used during duplex scanning? A) Valsalva maneuver B. Adson’s maneuver C. Romberg test D. Allen test Answer: B Explanation: The Adson’s maneuver (head rotation and deep inspiration) can exacerbate subclavian artery compression, revealing flow changes. Question 36. The term “turbulent flow” on color Doppler is most likely to appear as: A. Uniform color fill B. Random, speckled color pattern with aliasing C. No color signal at all D. A single color hue throughout the vessel Answer: B
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Explanation: Turbulence creates chaotic velocities exceeding the Nyquist limit, resulting in aliasing and a speckled color appearance. Question 37. Which of the following vessels is most frequently involved in an acute lower-extremity DVT? A) Common femoral vein B) Popliteal vein C) Great saphenous vein D) Inferior vena cava Answer: B Explanation: The popliteal vein is a common site for acute DVT due to stasis and valve incompetence. Question 38. In an arterial duplex exam, which parameter is primarily used to grade the severity of stenosis? A) End-diastolic velocity (EDV) B) Peak systolic velocity (PSV) C) Resistive index (RI) D) Pulsatility index (PI) Answer: B Explanation: PSV increases proportionally with the degree of narrowing; thresholds are set for mild, moderate, and severe stenosis. Question 39. Which of the following best explains why the renal arteries demonstrate a low resistive index? A) High downstream resistance in the glomeruli B) Presence of arteriovenous fistulas C) Low resistance renal parenchymal perfusion
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B) Uniformly echogenic wall thickening C) Absence of color flow in the entire artery D) Presence of a pseudoaneurysm sac adjacent to the artery Answer: A Explanation: Dissection creates a true lumen and a false lumen separated by an intimal flap, seen as a double-lumen on B-mode. Question 43. In a duplex scan of the lower extremity, a “tardus-parvus” waveform distal to a stenosis is characterized by: A) Increased PSV and early systolic upstroke B) Decreased PSV and delayed systolic rise C) Normal triphasic pattern with high diastolic flow D) Continuous flat-line signal Answer: B Explanation: “Tardus-parvus” (slow and weak) indicates downstream dampening of flow due to proximal narrowing. Question 44. Which of the following is a key component of the ALARA principle in ultrasound? A) Maximizing output power at all times B) Using the lowest possible mechanical index consistent with diagnostic quality C) Avoiding Doppler altogether to reduce exposure D) Performing scans only on in-patient settings Answer: B Explanation: ALARA (As Low As Reasonably Achievable) mandates using the minimal acoustic output needed for adequate imaging.
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Question 45. Which of the following arteries supplies the lateral aspect of the forearm? A) Radial artery B) Ulnar artery C) Brachial artery D) Subclavian artery Answer: A Explanation: The radial artery courses laterally along the forearm, providing blood to the lateral compartments. Question 46. In a patient with severe peripheral arterial disease, the ankle-brachial index is most likely: A) >1. B) 0.9-1. C) 0.5-0. D) 0.2-0. Answer: D Explanation: Advanced PAD often yields a very low ABI (<0.4), indicating critical limb ischemia. Question 47. Which of the following is the most accurate method for measuring volume flow (Q) in an AV fistula? A) Calculating from PSV alone B) Using the cross-sectional area and time-averaged mean velocity (TAMEAN) C) Estimating from the diameter of the feeding artery only D) Measuring the resistive index Answer: B
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D. Bilateral symmetrical flow patterns Answer: B Explanation: Subclavian steal reverses vertebral flow to supply the arm distal to a proximal subclavian stenosis. Question 51. Which of the following statements about the hepatic portal vein is correct? A) It carries oxygenated blood from the liver to the intestines. B) It receives blood from the superior and inferior mesenteric veins. C) It is a branch of the hepatic artery. D) It is a high-pressure arterial system. Answer: B Explanation: The portal vein is formed by the confluence of the superior mesenteric and splenic veins (and contributions from the inferior mesenteric vein). Question 52. In a duplex study of the lower extremity, an elevated pulsatility index (>2.0) in the dorsalis pedis artery most likely indicates: A) Proximal arterial stenosis B) Venous insufficiency C) Normal physiologic variation D) Deep vein thrombosis Answer: A Explanation: A high PI reflects increased downstream resistance, often due to proximal arterial narrowing. Question 53. Which of the following is the primary purpose of a “compression” technique when evaluating for DVT?
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A) To increase blood flow velocity for better Doppler signals B) To assess the elasticity of the vein wall C) To demonstrate the inability of a thrombus-filled vein to collapse D) To differentiate arterial from venous structures Answer: C Explanation: A thrombus prevents the vein from compressing; this is the cornerstone of compression ultrasonography for DVT. Question 54. Which of the following is a common cause of a false-negative ABI in patients with medial arterial calcification? A) Overly high cuff pressure B) Non-compressible arterial wall leading to artificially high pressures C) Use of a Doppler probe instead of a sphygmomanometer D) Measuring at the wrong anatomical site Answer: B Explanation: Calcified arteries do not compress, yielding falsely elevated ankle pressures and a misleadingly normal ABI. Question 55. In the context of vascular ultrasound, “gain” primarily affects: A) The depth of penetration B) The amplitude of the returned echo signal C) The frequency of the transmitted wave D) The angle of insonation Answer: B Explanation: Gain amplifies the received echo signal, influencing image brightness.
