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The vascular disease that presents as back, abdominal, or flank pain is: - ✔✔Abdominal aortic aneurysm The circle of Willis receives its blood supply from which combination of arteries? - ✔✔Carotid and Vertebral arteries 2 of the major branches of the External Carotid arteries include the: - ✔✔Superficial Temporal and Facial arteries What is the most common anomaly of the Circle of Willis - ✔✔Absence or Hypoplasia of 1 or both of the communicating arteries. The Brachial veins connect the: - ✔✔Ulnar and radial veins to the axillary vein Which vein in the antecubital fossa connects the cephalic and basilic veins? - ✔✔Median cubital vein. The axillary artery connects the: - ✔✔Brachial artery to the subclavian artery The renal arteries arise from the aorta: - ✔✔laterally In a cross section of the aorta and the surrounding regions the vein that is visualized superficial to the aorta and the origins of the right and left renal arteries in deep to the superior mesenteric artery is the: - ✔✔Left Renal Vein The splenic common hepatic and left gastric arteries arise from this abdominal artery: - ✔✔Celiac Trunk The smallest vessels in the body are: - ✔✔capillaries
The term Tunica Intima denotes: - ✔✔The inner lining of the arterial wall The layer of arterial or venous wall composed entirely of endothelial cells is the: - ✔✔Tunica Intima A venule contains which vessel layers: - ✔✔Tunica media and Tunica Intima Atherosclerosis is a disease the begins in the: - ✔✔Intima A disease that affects primarily the Intima and may extended into the media is: - ✔✔Atherosclerosis In the cerebrovascular system, atherosclerosis occurs my commonly in the: - ✔✔Carotid Bulb The NASCET (north American symptomatic carotid endarterectomy trial) used the following arterial graphic criteria/criterium to classify internal carotid artery disease: - ✔✔Diameter percentage stenosis calculated by diving the minimal diameter by the diameter of the unstenosed distal internal carotid artery. A patient complains of temporary shading of the vision in 1 eye, this symptom is called: - ✔✔Amaurosis Fugax A Transient Ischemic attack: - ✔✔Resolves within 24 hours The abbreviation TIA stands for: - ✔✔transient ischemic attack Subclavian steal occurs: - ✔✔more often on the left side Why are brachial blood pressures obtained bilaterally when evaluating a patient for cerebrovascular disease? - ✔✔The brachial blood pressures are compared to see if they are equal. Lose of the spectral window with pulsed Doppler ultrasound occurs with: - ✔✔Flow Turbulence
✔✔A. The stenosis is long and smooth, changing its doppler character compared to that of a shorter lesion. B. Only 1 plain of visualizing was used for angiography. C. Poor angle correction with the duplex, creating artificially low velocity estimates. D. Acoustic shadowing prevented doppler assessment of the maximal narrowing.
- E. Color flow PRF set to low creating aliasing and over estimation of velocities. The acoustic windows through which ultrasound may pass in performing TCD and Trans cranial imaging include all except: - ✔✔A. The temporal bone
- B. The medial part of the frontal bone C. The orbit of the eye D. The sub-occipital window E. The sub-mandibular area Major complications of cerebrovascular angiography include all of the following except: - ✔✔A. Death B. Stroke *C. Inadvertent venous puncture D. arterial occlusion at the access site E. Renal Failure Angiography is generally considered only when the information is necessary for surgery or other urgent patient management because of all these factors except: - ✔✔A. Expensive B. Carries risk of stroke C. Carries risk of anaphylactic complications
- D. It is often non-diagnostic E. It is an invasive procedure
The most common medical treatment of acute ischemic stroke consist of: - ✔✔rtPA (Recombinant Tissue Plasminogen Activator) The primary concern in patient with acute deep venous thrombosis: - ✔✔Pulmonary embolism may occur The greatest pressure of venous hypertension in secondary varicose veins occurs: - ✔✔during muscle contraction A varicose vein is most often: - ✔✔A dilation of the greater saphenous vein or superficial tributary. A bakers cyst is a collection of: - ✔✔Synovial fluid from the knee joint 2 weeks after the fractur of the femur a 33 year old female is seen for swelling of the calf of the same leg. The preliminary diagnosis, prior to any performance noninvasive testing should include: - ✔✔DVT & Popliteal entrapment (2 of the above) Patients suspected of having venous disease may complain of pain that is: - ✔✔relieved by elevation Edema caused by DVT is characterized by: - ✔✔Swelling in the ankles and legs but not the feet. (Usually swelling is not found in the feet in venous disease. ) A patient with chronic venous insufficiency complains of sudden onset of edema and pain in the affected leg, this maybe related to: - ✔✔reoccurrence of acute DVT Patients with a swollen limb who have just returned from a country where filariasis is endemic may be suspecting: - ✔✔lymphedema Filariasis is a nematoad that takes up residence in the lymph system and can cause lymphedema. This would be a somewhat obscure differential diagnosis for deep venous thrombosis.
Pulsatile lower extremity venous doppler signals would be associated with: - ✔✔Congestive heart failure The examiner listens w/ CW Doppler to the superficial femoral vein at mid thigh and performs a calf compression. The compression maneuver augments the signal. This finding suggests: - ✔✔This is a normal finding Of the following techniques, which would be the least effective in detecting significant DVT: Photoplethysmography Duplex Ultra sound Impedance plethysmography Strain gauge plethysmography - ✔✔Photoplethysmography A Vascular maneuver - ✔✔Slows down of stops venous flow everywhere in the body Which of the following is NOT one of the commonly assessed characteristics of CW venous doppler? Spontaneity Gaiety Augmentation Competence Phaticity - ✔✔Gaiety The optimal patient position for imaging of the lower extremity veins is: - ✔✔Semi fowlers position and reverse Trendelenburgs position The examiner scans the femoral veins and notes a very small venous lumen, with bright, thickened venous walls along most of the thigh, these finding suggest: - ✔✔Chronic thrombosis The examiner scans a patient with pain and swelling in the calf. A large, dark area is noted in the medical popliteal space, and no vascular communication to it is found. This most likely represents: - ✔✔Bakers cyst
The most common source of lower or upper extremity peripheral arterial embolus is: - ✔✔The heart Continuous wave doppler assessments of the posterior tibial level reveals nonspontaneous flow that augments with foot compression. This finding: - ✔✔Is within normal normal limits in a cold patient Contrast venography is: - ✔✔invasive
- very sensitive and specific test, some hazard, diagnostic w/ suspected DVT The venous puncture for introducing contrast in venography to asses for deep venous thrombosis is done at what level? - ✔✔Dorsal vein on the foot The "gold standard" test for pulmonary embolus, though it carries its own risk for compromised patients is: - ✔✔Pulmonary angiography The drug heparin: - ✔✔Can cause thrombocytopenia (diminished blood platelet count)
- its a protein so it can activate antibodies in sensitive Pts, has significant complication rate and can produce (diminished blood platelet count) The following are all possible complications of heparin EXCEPT Thrombocytopenia Formation of antiplatelet antibody Decreases activated partial thromboplastin time Intraabdominal bleeding platelet aggression - ✔✔Intraabdominal bleeding The agent of choice in the initial management of pulmonary embolism is - ✔✔Heparin More than 90 % of infrarenal abdominal aneurysms are of: - ✔✔Degenerative origin
B. Absent pulse 3. Subclavian artery occlusion C. Foot rubor 1. Aortoiliac + SFA occlusion D. Right side weakness 4. Left carotid artery occlusion E. Edema 2. Deep venous thrombosis Patients presenting with symptoms of claudication complain of: - ✔✔Cramping pain in calf, thigh, or buttocks w/ exercise and relieved by rest Patients found to have ulcerating lesions or gangrene may have which of the following diseases? Arterial insufficiency Neuropathy Vasospasm Venous disease All of the above - ✔✔All of the above Patients w/ advanced peripheral arterial vascular occlusive disease exhibit which of the following skin changes? Shiny, Scaly skin Dependent rubor Pallor elevation Stasis pigmentation All except D - ✔✔All except D A pulsatile mass in the groin after catheterization of a cardiac patient most likely will be: - ✔✔A false aneurysm of the femoral vein Rest pain is characterized by: - ✔✔Pain at night in the forefoot or foot that may go away w/ leg dependency
- nocturnal forefoot pain relieved by dependency or exercise common complaint
A vibration noted while palpating pulses is called: - ✔✔A thrill Rubor is defined as: - ✔✔Red skin color. (examples are the cherry-red color of digits in a Raynaud's patient when the digital arteries reopen after prolonged spasm, or the bright red foot in dependency after elevation in a patient with advanced arterial occlusive disease.) Delayed return of the capillary blush after pressure on the pulp of the digit is a sign of: - ✔✔Advanced ischemia The absence of bruit at the common femoral level - ✔✔Cannot rule out significant stenosis at that level. (Bruits heard on physical examination are useful: Although the absence of a bruit does not rule out significant arterial obstruction, the presence of a bruit does suggest stenosis.) Unilateral claudication in the calf and foot of a young individual suggests: - ✔✔Popliteal artery entrapment A pulsatility index is defined as: - ✔✔Peak systolic to peak diastolic velocity divided by the mean velocity (Goslings pulsatility index) Which one of the following conditions will cause an increase in the pulse amplitude of the arterial pressure wave? An increase in peripheral resistance A decrease in left ventricular function Vasodilation secondary to heating Young age Mild atherosclerosis - ✔✔An increase in peripheral resistance Ankle/arm indices in claudicating patients are usually - ✔✔In range 0. 5 - 0. When assessing a digital artery with doppler, patency of the palmar arch can be determined by: - ✔✔Alternately compressing the radial and ulnar arteries while listening for changes in the digital artery signal
Right proximal superficial femoral obstruction - ✔✔Aortic obstruction Normal diameter of the abdominal aorta is: - ✔✔ 2 - 3 cm A patient with a history of rest pain, 100 foot calf and thigh claudication, and an ulcer on the great toe of the left foot has a left ankle pressure of > 300 mmHg. This result is: - ✔✔Erroneous due to probable arterial calcification After walking for 5 minutes on the treadmill, a patient experiences decreases in ankle pressure of 40 % on the right and 15 % on the left. These findings: - ✔✔Are typical for patients with claudication Right arm 180 / 100 mmHg Left arm 120 / 60 mmHg Right PTA 100 mmHg Left PTA 90 mmHg The left Ankle/Brachial index is: - ✔✔ 0. 50 ( 90 / 180 ) A patient walks on a treadmill until forced to stop at 3 minutes due to left calf and thigh pain. The right leg was asymptomatic throughout the course of the testing. The following results were obtained: Pre- exercise Right arm: 150 Right PTA: 120 Left PTA: 120 Post exercise Right arm: 150 Right PTA: 75 Left PTA: 50 - ✔✔Which of the following statements are true: *There is arterial disease in both legs *The left leg has worse disease than the right The patient has aortoiliac arterial disease Retesting the patient in 30 mins should result in a shorter walking time The arm pressure normally increases after treadmill testing, raising questions of the validity of these results
Parameters usually assessed with exercise testing include all EXCEPT: Changes in thigh-to-ankle index Time required for recovery to pre-stress pressure level Patient complaint of leg pain during exercise Length of time of exercise Magnitude of pressure drop - ✔✔Changes in thigh-to-ankle index The most widely used interpretive technique for analog doppler waveform is: - ✔✔A qualitative approach or pattern recognition A normal response of ankle pressure to exercise testing (such as treadmill) is: - ✔✔No change Possible error(s) that can occur when recording a Femoral arterial waveform using continuous-wave Doppler include: Insonating an artery other than the intended one Recording two vessels simultaneously using an improper probe frequency - ✔✔All of the above With severe lower extremity arterial occlusive disease, the Doppler waveforms distally: - ✔✔Will appear markedly dampened, possibly making interpretation difficult for distal markings The usual cuff pressure used in arterial volume recording is: - ✔✔ 65 mmHg Distal to an aortoiliac occlusion, the common femoral artery signal is typically: - ✔✔Low pitched and monophasic Diastolic flow reversal: - ✔✔May be absent in vasodilated limbs Audible Doppler venous signals typically are low-frequency and vary with respiration, whereas normal arterial signals in the legs and arms are: - ✔✔Relatively high frequency with pulsatile components
d. ABI < 0. 50 - ✔✔ 1 - C 2 - D In a study of the upper extremities, pulse volume recording show lack or dicrotic notch at all levels of a patient with warm hands and fingers bilaterally. The patient: - ✔✔Is vasodilated A clenched fist will change the following parameter in the brachial artery doppler waveform: - ✔✔Increase the pulsatility index Which of the following is a significant problem with digital subtraction angiography? Longer than normal procedure time Increase in contrast dosage single view filming technique Patient cooperation Inability to provide sequential images - ✔✔Patient cooperation The usual site of puncture for percutaneous lower extremity (or any) angiography is: - ✔✔Common femoral artery Arteriography would be contraindicated or approached very cautiously in a patient with: - ✔✔Renal Failure Compared to patency rates in the iliac arteries, patency rates for angioplasty of the infrainguinal arteries are: - ✔✔Worse The upper extremity vein most commonly used for an arterial bypass in the leg is the: - ✔✔Cephalic vein A 64 year old male complains of hailf block left thigh and calf claudication w/o symptoms on the right. Physical examination reveals that the left femoral pulse is absent; pulses on the right are normal, w/o
bruit. Treadmill testing results are abnormal on the left, normal on the right. Duplex reveals an occulated iliac artery on the left. This patient may be an ideal candidate for: - ✔✔Femorofemoral bypass The five year risk for rupture of abdominal aortic aneurysms of 4 cm is approx.: - ✔✔< 10 % The most effective lytic treatment for acute arterial thrombosis is: - ✔✔Urokinase or streptokinase You are preforming a doppler exam on a patient with suspected renovascular hypertension. Which diagnostic parameter is the best indicator of renovascular disease? Pulsatility index A/B ratio Renal/aortic ratio Systolic/diastolic ratio - ✔✔Renal/aortic ratio What is the most common location of atherosclerotic disease of the renal artery? - ✔✔Proximal In a patient with portal hypertension, the most likely result of increased portal venous pressure would be: - ✔✔Enlarged coronary vein in the United States the most common cause of portal hypertension is - ✔✔Cirrhosis To evaluate blood flow within the splanchnic arteries, you should examine the following vessels: - ✔✔Celiac artery, superior mesenteric artery, inferior mesenteric artery The patient with advanced chronic mesenteric ischemia is most likely to be: - ✔✔Malnourished A common manifestation of portal hypertension is: - ✔✔Bleeding esophageal varices Noninvasive diagnosis of RENAL ARTERY stenosis: - ✔✔Requires a duplex system with spectral signal analysis
The probability that a positive non-invasive test reveals actual disease (as diagnosed by the gold standard test) is called: - ✔✔Positive predictable value Given the following information, overall accuracy can be: Sensitivity = 91. 3 % Specificity = 83. 4 % Positive predictive value = 94. 3 % Negative predictive value = 80. 7 % - ✔✔ 85 % Overall accuracy must fall between sensitivity/specificity and positive/negative predictive values The calculation the has as its denominator the total number of normal noninvasive tests is: - ✔✔Negative predictive values In kappa statistics, if there is no relationship between the two variables being compared, the kappa value is: - ✔✔Zero Your patient begins to fall while getting off the examination table. What should you do? - ✔✔Guide the fall, protecting their head overall accuracy denominator: - ✔✔The total number of tests performed (all four boxes in the 2 x2 table) Specificity denominator - ✔✔all those without the condition regardless of whether they were identified correctly (True negatives + False positives, a sum that always equals the number of negative gold standard results) Sensitivity denominator - ✔✔all those with the condition regardless of whether they were identified correctly (True positives + False negatives, a sum that always equals the number of positive gold standard results)
positive predictive value denominator - ✔✔The total number of abnormal non invasive studies, whether true or not (True positives+ False positives) Negative predictive denominator - ✔✔The total number of negative noninvasive studies (True negatives + False negatives)
