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Question 1. Which artery supplies the ophthalmic artery via collateral flow in cases of internal carotid artery occlusion? A) Middle cerebral artery B) External carotid artery C) Vertebral artery D) Basilar artery Answer: B Explanation: The external carotid artery (ECA) can provide collateral flow to the intracranial circulation through the ophthalmic artery when the internal carotid artery (ICA) is occluded. Question 2. In the lower extremity deep venous system, which vein is the first tributary of the common femoral vein? A) Profunda femoris vein B) Popliteal vein C) Great saphenous vein D) Peroneal vein Answer: A Explanation: The profunda femoris (deep femoral) vein drains the deep thigh musculature and joins the femoral vein to form the common femoral vein. Question 3. According to Poiseuille’s law, which factor most strongly influences blood flow through a vessel? A) Vessel length B) Blood viscosity C) Vessel radius D) Pressure gradient
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Answer: C Explanation: Flow is proportional to the fourth power of the radius; small changes in radius dramatically affect flow. Question 4. What is the typical peak systolic velocity (PSV) threshold on carotid duplex that indicates ≥70 % stenosis of the internal carotid artery? A) 125 cm/s B) 150 cm/s C) 200 cm/s D) 250 cm/s Answer: C Explanation: A PSV ≥200 cm/s in the ICA correlates with ≥70 % stenosis per SRU consensus criteria. Question 5. Which of the following best describes a true aneurysm? A) Involves all three layers of the arterial wall B) Contains only a hematoma within the adventitia C) Results from a penetrating injury D) Is always saccular in shape Answer: A Explanation: True aneurysms involve dilation of the intima, media, and adventitia; pseudoaneurysms involve only a breach of the wall with surrounding tissue forming the sac. Question 6. In venous duplex, what finding confirms deep vein thrombosis (DVT) in the compressible segment of the femoral vein? A) Absence of respiratory phasicity B) Persistent compressibility
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A) Monophasic B) Biphasic C) Triphasic D) Flat Answer: C Explanation: A triphasic waveform (forward systolic, brief reverse flow, and forward diastolic) indicates normal arterial compliance and resistance. Question 10. In the cerebrovascular circulation, which artery forms the posterior communicating artery? A) Anterior cerebral artery B) Middle cerebral artery C) Posterior cerebral artery D) Basilar artery Answer: C Explanation: The posterior communicating artery connects the posterior cerebral artery (PCA) to the internal carotid system. Question 11. Which of the following best describes the effect of a 50 % arterial stenosis on pressure gradient according to Bernoulli’s principle? A) No change in pressure B) Small pressure drop of ~5 mmHg C) Moderate pressure drop of ~15 mmHg D) Large pressure drop of >30 mmHg Answer: C Explanation: A 50 % diameter reduction creates a moderate pressure gradient (≈15 mmHg) due to increased velocity and turbulence.
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Question 12. The most common cause of abdominal aortic aneurysm (AAA) in adults is: A. Traumatic injury B. Atherosclerosis C. Infection D. Connective-tissue disease Answer: B Explanation: Atherosclerotic degeneration of the aortic wall is the predominant etiology of AAA in the adult population. Question 13. Which of the following veins is most commonly used for creation of an arteriovenous fistula (AVF) for dialysis access? A) Small saphenous vein B) Cephalic vein C) Basilic vein D) Femoral vein Answer: B Explanation: The cephalic vein in the forearm is frequently anastomosed to the radial artery to form a radio-cephalic AVF. Question 14. In duplex imaging of the lower extremity, a reflux duration of >0.5 seconds after Valsalva indicates: A) Normal venous function B) Deep vein thrombosis C) Venous insufficiency D) Arterial occlusion Answer: C
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Answer: B Explanation: FMD produces a “string-of-beads” pattern due to alternating medial fibromuscular hyperplasia and normal segments. Question 18. In the setting of a carotid endarterectomy, which duplex criterion suggests residual stenosis >50 % at the surgical site? A) ICA PSV <125 cm/s B) ICA/CCA PSV ratio <1. C) ICA PSV 125–200 cm/s D) ICA PSV >250 cm/s Answer: D Explanation: An ICA PSV >250 cm/s post-CEA is indicative of residual or recurrent stenosis exceeding 50 %. Question 19. Which of the following best describes the “steal syndrome” after creation of a high-flow AVF? A) Increased arterial pressure in the distal limb B) Decreased perfusion to the hand due to diversion of blood into the fistula C) Venous hypertension in the limb D) Development of arterial aneurysm at the anastomosis Answer: B Explanation: Steal syndrome occurs when the AVF diverts arterial flow away from the distal extremity, causing ischemic symptoms. Question 20. Which of the following is the primary determinant of the mechanical index (MI) on an ultrasound system? A) Frequency of the transmitted wave B) Peak rarefactional pressure
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C) Thermal index D) Gain setting Answer: B Explanation: MI = peak negative pressure (in MPa) / √(frequency in MHz); it reflects the potential for cavitation. Question 21. The most reliable method for confirming a diagnosis of acute deep vein thrombosis (DVT) in the calf veins is: A) Color flow mapping alone B) Spectral Doppler waveform analysis C) Compression ultrasonography with real-time probe pressure D) Measurement of vein diameter Answer: C Explanation: Real-time compression is the gold standard; failure to compress the vein confirms thrombus presence. Question 22. Which of the following arteries supplies the majority of blood to the small intestine? A) Celiac trunk B) Superior mesenteric artery (SMA) C) Inferior mesenteric artery (IMA) D) Renal artery Answer: B Explanation: The SMA provides arterial inflow to the duodenum, jejunum, and ileum. Question 23. In a patient with a suspected abdominal aortic aneurysm, which ultrasound finding indicates a “contained rupture”?
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Question 26. Which of the following statements about the calf muscle pump is correct? A) It functions only during passive leg movement B) Valves in the deep veins prevent retrograde flow during contraction C) It decreases venous return to the heart D) It is independent of arterial inflow Answer: B Explanation: The calf muscle pump compresses deep veins, and competent valves prevent backflow, enhancing venous return. Question 27. In the evaluation of mesenteric ischemia, which duplex finding is most suggestive of significant stenosis of the superior mesenteric artery (SMA)? A) PSV <100 cm/s B) PSV >275 cm/s with a low end-diastolic velocity C) High resistance index (>1.0) D) Absence of flow on color Doppler Answer: B Explanation: An SMA PSV >275 cm/s is a widely accepted threshold for ≥70 % stenosis. Question 28. Which of the following is the most appropriate angle of insonation for accurate Doppler velocity measurement? A) 0° B) 30° C) 60° D) 90° Answer: C
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Explanation: Angles ≤60° minimize error; 60° is the maximum recommended angle for Doppler calculations. Question 29. In a patient with chronic venous insufficiency, which duplex maneuver is used to quantify reflux time? A) Compression-augmentation test B) Valsalva maneuver C) Respiratory phasicity assessment D) Color flow mapping only Answer: B Explanation: The Valsalva maneuver provokes reflux; the duration of reverse flow is measured to assess valve competence. Question 30. Which of the following best describes the effect of atherosclerotic plaque on arterial compliance? A) Increases compliance B) No effect on compliance C) Decreases compliance, making the vessel stiffer D) Converts the artery to a venous system Answer: C Explanation: Plaque deposition reduces arterial elasticity, decreasing compliance and increasing pulse wave velocity. Question 31. Which of the following veins is most commonly involved in May-Thurner syndrome? A) Left common iliac vein compressed by the right common iliac artery B) Right common iliac vein compressed by the left common iliac artery C) Inferior vena cava compressed by the aorta
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A) Double lumen sign B) Uniformly thickened aortic wall without lumen dilation C) Circumferential dilation of the aortic lumen with intact adventitial wall D) Presence of an arterial dissection flap Answer: C Explanation: True AAAs involve all three layers, resulting in a circumferentially dilated lumen while preserving the outer wall. Question 35. Which of the following best describes the “string-of-beads” appearance on renal artery duplex? A. Atherosclerotic plaque B. Fibromuscular dysplasia C. Dissection flap D. Thrombotic occlusion Answer: B Explanation: Fibromuscular dysplasia produces alternating areas of stenosis and aneurysmal dilation, creating the classic “string-of-beads” pattern. Question 36. In a peripheral arterial disease (PAD) study, a segmental pressure drop of >20 mmHg between two adjacent sites suggests: A) Normal arterial flow B) Severe arterial stenosis or occlusion C) Venous insufficiency D) Artifact from probe pressure Answer: B Explanation: A pressure gradient >20 mmHg across a segment is indicative of a clinically significant arterial lesion.
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Question 37. Which of the following Doppler artifacts occurs when the sample volume is placed too deep relative to the transducer? A) Aliasing B) Mirror image C) Range ambiguity D) Phase wrap-around Answer: C Explanation: Range ambiguity (or range ambiguity artifact) arises when the depth exceeds the transmitted pulse-repetition interval, causing misplacement of echoes. Question 38. Which of the following is the most common location for an arteriovenous fistula (AVF) creation in the upper extremity? A) Brachial artery to basilic vein B) Radial artery to cephalic vein C) Ulnar artery to median cubital vein D) Subclavian artery to axillary vein Answer: B Explanation: The radio-cephalic AVF (radial artery to cephalic vein) at the wrist is the preferred first-choice access for hemodialysis. Question 39. In the context of ultrasound safety, the ALARA principle stands for: A) As Low As Reasonably Achievable B) Acoustic Limits Are Reduced Always C) Automatic Low-Amplitude Reducing Algorithm D) All Levels of Acoustic Radiation Applied Answer: A
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C) Lymphatic obstruction D) Hypercoagulable state Answer: A Explanation: Damage to venous valves during thrombosis leads to chronic reflux and the clinical features of post-thrombotic syndrome. Question 43. In a duplex study of the carotid bifurcation, an ICA/CCA PSV ratio of 2.5 suggests: A) Normal flow B) 30 % stenosis C) 50 % stenosis D) >70 % stenosis Answer: D Explanation: An ICA/CCA PSV ratio >2.0 is associated with ≥70 % stenosis. Question 44. Which of the following veins is most commonly used for harvesting a great saphenous vein (GSV) bypass graft in lower extremity revascularization? A) Small saphenous vein B) Cephalic vein C) Great saphenous vein D) Basilic vein Answer: C Explanation: The GSV is the conduit of choice for infra-inguinal bypass due to its length and diameter.
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Question 45. Which of the following best explains why a high-resistance arterial waveform is seen in the tibial arteries of a patient with severe peripheral arterial disease? A) Increased downstream compliance B) Proximal arterial occlusion reducing forward flow C) Venous congestion D) Hyperdynamic cardiac output Answer: B Explanation: Severe proximal stenosis limits systolic flow, resulting in a high-resistance, monophasic waveform distally. Question 46. The “turbulent flow” that leads to a spectral broadening on Doppler is most likely to occur when: A) Flow velocity is low and laminar B) Reynolds number exceeds the critical threshold (~2000) C) The transducer frequency is below 2 MHz D) The angle of insonation is 0° Answer: B Explanation: Turbulence arises when Reynolds number >~2000, causing chaotic flow and spectral broadening. Question 47. Which of the following is a characteristic finding of a “pseudoaneurysm” on color Doppler? A) Uniform anechoic sac with internal flow swirl (to-and-fro) at the neck B) Complete absence of flow within the lesion C) High-velocity monophasic flow throughout the sac D) Constant color fill without any spectral waveform Answer: A
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D) RI = (PSV-EDV)/PSV
Answer: D Explanation: RI = (PSV − EDV)/PSV; values >0.7 may indicate parenchymal disease, not necessarily stenosis. Question 51. In a patient with suspected subclavian steal syndrome, which duplex finding is most diagnostic? A) Increased PSV in the vertebral artery during arm exertion B) Reversal of flow in the ipsilateral vertebral artery during arm exercise C) Absence of flow in the subclavian artery at rest D) Uniform triphasic flow in the subclavian artery Answer: B Explanation: Subclavian steal is characterized by retrograde flow in the vertebral artery when the subclavian artery is stenosed. Question 52. Which of the following is the most common location for an aortic dissection entry tear? A) Ascending aorta B) Descending thoracic aorta distal to the left subclavian artery C) Abdominal aorta at the renal bifurcation D) Aortic arch at the origin of the brachiocephalic trunk Answer: B Explanation: Most spontaneous dissections begin in the descending thoracic aorta just distal to the left subclavian artery. Question 53. Which of the following best describes the effect of a high-flow arteriovenous graft (AVG) on the arterial waveform distal to the anastomosis?
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A) Increased systolic peak and normal triphasic shape B) Diminished systolic upstroke with a monophasic pattern C) No change in waveform morphology D) Reversal of flow direction Answer: B Explanation: High flow through an AVG reduces resistance downstream, flattening the arterial waveform to monophasic. Question 54. Which of the following is the most reliable sonographic sign of an acute arterial occlusion? A) Presence of a color flow signal within the lumen B) Absence of any Doppler signal and non-compressibility of the artery C) Normal spectral waveform with low velocity D) Increased PSV at the site of occlusion Answer: B Explanation: Acute occlusion eliminates flow; the artery becomes non-compressible and shows no color or spectral signal. Question 55. In a duplex study of the upper extremity, which vein is most commonly involved in thrombosis after a long-lasting peripheral IV line? A) Cephalic vein B) Basilic vein C) Axillary vein D) Subclavian vein Answer: A Explanation: The cephalic vein is frequently accessed for peripheral IVs and is prone to thrombosis.
