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Question 1. Which vessel supplies the anterior portion of the cerebral hemispheres and is a component of the Circle of Willis? A) Middle Cerebral Artery B) Anterior Cerebral Artery C) Posterior Cerebral Artery D) Basilar artery Answer: B Explanation: The Anterior Cerebral Artery (ACA) originates from the internal carotid artery and supplies the medial and superior surfaces of the frontal and parietal lobes, forming the anterior part of the Circle of Willis. Question 2. In a duplex scan of the common carotid artery, a peak systolic velocity (PSV) of 250 cm/s most likely corresponds to which NASCET stenosis grade? A) <50 % B) 50- 69 % C) 70- 79 % D) ≥80 % Answer: D Explanation: According to NASCET criteria, a PSV ≥230 cm/s is indicative of ≥80 % stenosis. Question 3. Which of the following is the most common anatomical variant of the aortic arch? A) Bovine arch (common origin of the left common carotid and brachiocephalic trunk) B) Right-sided aortic arch C) Isolated subclavian artery D) Aberrant right subclavian artery Answer: A Explanation: The bovine arch, where the left common carotid shares a common origin with the brachiocephalic trunk, occurs in ~15- 20 % of the population and is the most frequent variant.
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Question 4. During lower-extremity arterial duplex, a loss of the triphasic waveform at the dorsalis pedis artery most likely indicates: A) Normal aging change B) Proximal arterial stenosis ≥50 % C) Venous insufficiency D) Deep vein thrombosis Answer: B Explanation: Triphasic waveforms become monophasic or biphasic when there is significant proximal arterial narrowing that dampens the high-frequency components. Question 5. Which vein is the primary conduit for cerebral venous drainage to the right atrium? A) Internal jugular vein B) Subclavian vein C) Superior vena cava D) Brachiocephalic vein Answer: A Explanation: The internal jugular vein collects blood from the dural sinuses and drains into the brachiocephalic vein, forming the main pathway for cerebral venous outflow. Question 6. The calf muscle pump primarily assists which of the following functions? A) Arterial blood delivery to the foot B) Venous return from the lower leg C) Lymphatic drainage of the thigh D) Oxygen exchange in capillaries Answer: B Explanation: Contraction of the gastrocnemius and soleus muscles compresses deep veins, propelling blood proximally toward the heart.
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Question 10. The most sensitive sonographic sign for acute deep vein thrombosis (DVT) in the femoral vein is: A) Increased venous diameter B) Loss of compressibility C) Hyper-echogenic clot visualized within the lumen D) Absence of respiratory variation in flow Answer: B Explanation: In acute DVT, the vein becomes non-compressible under probe pressure, which is the primary diagnostic criterion on compression ultrasound. Question 11. In the CEAP classification for chronic venous disease, the “C” component refers to: A) Clinical severity B) Etiology C) Anatomy D) Pathophysiology Answer: A Explanation: CEAP stands for Clinical, Etiology, Anatomy, and Pathophysiology; the “C” denotes the observable clinical presentation (e.g., C2 – varicose veins). Question 12. A post-carotid endarterectomy duplex shows a PSV of 380 cm/s at the surgical site. This most likely indicates: A) Normal postoperative flow B) Residual stenosis ≥70 % C) Hyperdynamic flow due to low downstream resistance D) Technical error in angle correction Answer: B Explanation: PSV >350 cm/s after carotid endarterectomy suggests significant residual or recurrent stenosis, warranting further evaluation.
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Question 13. Which of the following is a characteristic finding of Buerger’s disease on arterial ultrasound? A. Diffuse atherosclerotic plaque in the aorto-iliac segment B. Segmental occlusions with cork-screw collaterals in distal tibial arteries C. Uniform arterial wall thickening in the femoral artery D. Large aneurysmal dilation of the popliteal artery Answer: B Explanation: Buerger’s disease (thromboangiitis obliterans) commonly presents with segmental occlusions and tortuous collateral vessels, especially in distal extremities. Question 14. The ankle-brachial index (ABI) is considered normal when: A) ≤0. B) 0.91-1. C) 1.01-1. D) >1.30 indicates normal arterial flow Answer: C Explanation: An ABI of 1.01-1.30 reflects normal arterial perfusion; values ≤0. suggest peripheral artery disease, while >1.30 may indicate non-compressible arteries. Question 15. Which of the following best describes an endoleak type II after EVAR? A) Inadequate seal at the proximal graft attachment site B) Persistent flow from lumbar or inferior mesenteric arteries into the aneurysm sac C) Graft fabric tear leading to direct sac filling D) Retrograde flow from the femoral artery into the sac Answer: B Explanation: Type II endoleaks arise from retrograde filling of the aneurysm sac via collateral branches such as lumbar or inferior mesenteric arteries.
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Question 19. Which of the following describes the typical spectral Doppler waveform of a healthy superficial femoral artery (SFA) in a supine adult? A) Monophasic, low-resistance pattern B) Triphasic with a brief diastolic reversal component C) Continuous flat waveform D) Polyphasic with multiple peaks per cardiac cycle Answer: B Explanation: A normal peripheral artery exhibits a triphasic waveform: forward systolic flow, brief early diastolic reversal, and late diastolic forward flow. Question 20. The “bovine” arch variant can affect ultrasound assessment of which vessel? A) Left subclavian artery B) Right vertebral artery C) Left common carotid artery D) Innominate (brachiocephalic) trunk Answer: C Explanation: In a bovine arch, the left common carotid shares a common origin with the innominate trunk, altering its usual anatomical course and requiring careful identification. Question 21. Which of the following is the most appropriate initial sonographic technique for evaluating suspected popliteal artery entrapment syndrome? A) Transverse B-mode imaging of the popliteal fossa at rest B) Dynamic duplex scanning with the knee in extension and flexion C) Color Doppler at the femoral artery level D) Spectral Doppler of the tibial posterior artery only Answer: B Explanation: Popliteal artery entrapment is best demonstrated by dynamic imaging that shows arterial compression or kinking during knee flexion.
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Question 22. A 55-year-old smoker presents with claudication after walking 150 m. Duplex shows a PSV of 210 cm/s in the superficial femoral artery. According to the AHA criteria, the degree of stenosis is: A) <30 % B) 30- 49 % C) 50- 69 % D) ≥70 % Answer: C Explanation: For the superficial femoral artery, a PSV of 200- 300 cm/s corresponds to a 50- 69 % stenosis. Question 23. Which of the following statements about the renal artery Doppler waveform in a healthy adult is correct? A) Continuous low-velocity flow throughout the cardiac cycle B) High-resistance pattern with a sharp systolic peak and minimal diastolic flow C) Low-resistance pattern with forward flow throughout diastole D) Triphasic pattern with diastolic reversal Answer: C Explanation: Renal arteries normally exhibit a low-resistance waveform, reflecting continuous forward flow during both systole and diastole. Question 24. In the assessment of a venous pseudoaneurysm, which sonographic feature is pathognomonic? A) “To-and-fro” flow at the neck on spectral Doppler B) Absence of color flow within the sac C) Hyper-echogenic clot filling the cavity D) Uniform expansion of the vein wall Answer: A Explanation: The “to-and-fro” (bidirectional) flow at the pseudoaneurysm neck is characteristic and confirms communication with arterial blood.
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Question 28. In a duplex exam of the great saphenous vein (GSV), reflux lasting longer than 1.0 second is considered abnormal. This threshold is based on: A) Venous pressure gradient B) Valve leaflet length C) Normal physiologic venous flow timing D) Standardized CEAP criteria Answer: C Explanation: Normal venous valves close within 0.5 seconds; reflux >1.0 second indicates valvular incompetence. Question 29. Which of the following is the most accurate method for calculating volumetric flow in an arterial access site? A) Measuring PSV alone B) Using the formula Q = π × r² × Vmean C) Adding systolic and diastolic velocities D) Estimating from color Doppler area only Answer: B Explanation: Volumetric flow (Q) equals the cross-sectional area (πr²) multiplied by the mean velocity (Vmean) obtained from spectral Doppler. Question 30. The “string sign” on duplex ultrasound of the carotid artery is most indicative of: A) Severe atherosclerotic plaque with >90 % stenosis B) Dissection with an intimal flap C) Chronic total occlusion with a narrow residual lumen D) Pseudoaneurysm formation Answer: C Explanation: The string sign refers to a thin residual channel seen in chronic total occlusion, suggesting near-complete blockage.
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Question 31. Which of the following is true regarding the relationship between Reynolds number and blood flow? A) Low Reynolds number indicates turbulent flow. B) High Reynolds number (>2000) suggests the potential for turbulence. C) Reynolds number is independent of vessel diameter. D) It is calculated using Poiseuille’s law. Answer: B Explanation: Reynolds number = (ρ × v × D)/μ; values >2000 generally indicate transition from laminar to turbulent flow. Question 32. In a patient with chronic mesenteric ischemia, which mesenteric artery is most commonly affected? A) Celiac trunk B) Superior mesenteric artery (SMA) C) Inferior mesenteric artery (IMA) D) Renal artery Answer: B Explanation: The SMA supplies the majority of the small intestine and right colon; atherosclerotic disease here is the most frequent cause of chronic mesenteric ischemia. Question 33. The term “ectasia” differs from “aneurysm” primarily by: A) Presence of a true lumen B) Diameter less than 1.5 times the normal vessel size C) Absence of a thrombus D) Location in the intracranial circulation only Answer: B Explanation: Ectasia refers to a mild dilatation (<1.5× normal diameter), whereas an aneurysm is defined as ≥1.5× normal diameter. Question 34. Which of the following is the recommended angle of insonation for accurate Doppler velocity measurement?
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B) Distal limb ischemia due to diversion of arterial blood into the fistula C) Recurrent thrombosis of the fistula D) High-output heart failure from the fistula Answer: B Explanation: Steal syndrome occurs when the AV fistula diverts too much arterial blood away from the distal extremity, leading to ischemic symptoms. Question 38. The most common site of atherosclerotic plaque formation in the carotid artery is: A) Bifurcation (carotid bulb) B) Mid-common carotid artery C) Internal carotid artery distal to the skull base D) External carotid artery Answer: A Explanation: Hemodynamic turbulence at the carotid bifurcation predisposes to plaque development in the bulb region. Question 39. In a duplex of the popliteal vein, an elevated augmentation index (AI) after calf compression suggests: A) Normal venous compliance B) Deep vein thrombosis C) Venous reflux D) Superficial thrombophlebitis Answer: C Explanation: An increased AI indicates that the vein fills rapidly after compression, a sign of valvular incompetence and reflux. Question 40. Which of the following statements about the ALARA principle in ultrasound safety is correct? A) It stands for “As Low As Reasonably Achievable” and dictates minimizing exposure time, output, and mechanical index.
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B) It applies only to ionizing radiation, not ultrasound. C) It requires the use of contrast agents in all vascular studies. D) It is a guideline for increasing thermal index to improve image quality. Answer: A Explanation: ALARA is a fundamental safety concept for all imaging modalities, including ultrasound, emphasizing the reduction of acoustic output and exposure duration. Question 41. The “wall-motion artifact” seen on color Doppler is most commonly caused by: A) Patient movement B) High PRF settings C) Low gain D) Incorrect transducer frequency Answer: A Explanation: Patient or probe motion can produce apparent movement of the vessel wall on color flow images, mimicking pathology. Question 42. In a duplex scan of the lower extremity, a monophasic waveform with a prolonged diastolic component in the posterior tibial artery suggests: A) Normal aging change B) Proximal arterial stenosis of ≥50 % C) Distal venous thrombosis D) Arterial aneurysm Answer: B Explanation: Loss of the triphasic pattern and presence of a dampened, monophasic waveform indicates upstream arterial narrowing. Question 43. Which of the following is considered a high-risk feature for rupture in a thoracic aortic aneurysm? A) Diameter 4.0 cm
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C) To measure venous pressure D) To assess muscle perfusion Answer: B Explanation: Spectral broadening reflects a range of velocities, typical of turbulent flow that occurs distal to significant stenosis. Question 47. During a transcranial Doppler (TCD) study, a mean flow velocity of 120 cm/s in the middle cerebral artery (MCA) is most consistent with: A) Normal flow B) Severe vasospasm C) Hyperemia D) Embolic occlusion Answer: A Explanation: Normal MCA mean velocities range from 30- 80 cm/s; values up to ~120 cm/s can be seen in hyperemic states but are generally considered within normal limits if no clinical signs. Question 48. Which of the following is the most appropriate management for a small (≤2 cm) asymptomatic abdominal aortic aneurysm in a 68-year-old male smoker? A) Immediate open surgical repair B) Endovascular repair within 6 months C) Surveillance with ultrasound every 6 months D) No follow-up required Answer: C Explanation: Small AAAs (<3 cm) are managed with periodic imaging surveillance; intervention is generally deferred until the diameter reaches ≥5.5 cm or rapid growth occurs. Question 49. In a duplex evaluation of the internal jugular vein, the presence of “spontaneous echo contrast” (SEC) is most indicative of: A) Acute thrombosis
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B) High venous pressure and sluggish flow, predisposing to clot formation C) Normal venous flow D) Valvular incompetence Answer: B Explanation: SEC appears as swirling, low-level echoes caused by red-cell aggregation in slow, stagnant blood, signaling increased thrombosis risk. Question 50. Which of the following best describes the effect of increasing the transducer frequency on axial resolution? A) Improves axial resolution B) Decreases axial resolution C) No effect on axial resolution D) Improves lateral resolution only Answer: A Explanation: Higher frequencies produce shorter wavelengths, enhancing axial (and lateral) resolution, albeit at the cost of reduced penetration. Question 51. A 45-year-old female presents with a painless, compressible swelling in the thigh. Duplex shows a tubular structure with venous flow and valves oriented proximally. This structure is most likely: A) Superficial femoral artery aneurysm B) Great saphenous vein varix C) Deep vein thrombosis D) Lymphatic cyst Answer: B Explanation: The great saphenous vein runs superficially; compressibility, venous flow, and proximal valve orientation are typical of a varix. Question 52. Which of the following Doppler settings will most likely reduce aliasing in a high-velocity carotid stenosis? A) Decrease PRF and increase wall filter
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B) Triphasic waveform throughout the graft C) Absence of any spectral broadening D) Continuous color flow without turbulence Answer: B Explanation: A triphasic waveform throughout the conduit suggests normal arterial flow and graft patency; loss of triphasic pattern may herald stenosis. Question 56. In a duplex of the hepatic veins, a pulsatile flow pattern synchronous with the cardiac cycle is expected because: A) Hepatic veins are low-pressure vessels B) They receive direct arterial blood flow C) They are directly influenced by right atrial pressure changes D) Portal hypertension eliminates pulsatility Answer: C Explanation: Hepatic venous flow mirrors right atrial pressure fluctuations, producing a characteristic triphasic pattern. Question 57. Which of the following is the most appropriate sonographic criterion for diagnosing a high-grade (>70 %) stenosis in the external iliac artery? A) PSV > 150 cm/s and EDV > 40 cm/s B) PSV > 300 cm/s with a turbulent color signal C) PSV < 100 cm/s with normal waveform D) Absence of color flow at the lesion Answer: B Explanation: High-grade external iliac stenosis typically yields PSV >300 cm/s and turbulent color flow due to accelerated jet. Question 58. A 70-year-old man with known PAD undergoes a treadmill test. His post-exercise ABI falls from 0.92 to 0.55. This drop is most consistent with: A) Normal physiological response B) Critical limb-ischemia
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C) Moderate peripheral arterial disease D) Acute arterial occlusion Answer: C Explanation: A post-exercise ABI reduction >0.15–0.20 indicates PAD; a fall to 0. reflects moderate disease. Question 59. Which of the following statements about the “spectral Doppler envelope” in a normal common femoral artery is correct? A) It displays a narrow, high-velocity peak only in systole B) It shows a broad, low-velocity diastolic component C) It is triphasic with a sharp systolic upstroke, brief reversal, and forward diastolic flow D) It is flat throughout the cardiac cycle Answer: C Explanation: Normal peripheral arteries demonstrate a triphasic envelope reflecting forward systolic flow, early diastolic reversal, and late diastolic forward flow. Question 60. In the context of ultrasound physics, the Reynolds number is calculated using which of the following variables? A) Frequency, wavelength, and speed of sound B) Velocity, diameter, density, and viscosity C) Pressure gradient and radius D) Angle of insonation and PRF Answer: B Explanation: Reynolds number = (ρ × v × D)/μ, incorporating fluid density (ρ), velocity (v), vessel diameter (D), and viscosity (μ). Question 61. Which of the following is the most common cause of a type III endoleak after EVAR? A) Graft fabric tear B) Persistent flow through lumbar arteries
