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Ultrasound Vascular Registry Review Exam with 100% Correct Answers 2024/2025 What is the first branch of the aortic arch? - Correct Answer-Innominate artery/ Brachiocephalic Name the three branches of the aortic arch? - Correct Answer-a. Innominate artery/ Brachiocephalic b. Lt CCA c. Lt Subclavian artery The radial artery runs on what side of the forearm? - Correct Answer-Lateral side The radial artery branches to form what part of the palmar arch? - Correct Answer- Superficial palmar arch Where does the radial artery terminate? (Just remember that the ulnar branch and termination is opposite of the radial artery) - Correct Answer-Terminates in the deep palmar arch
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What is the first branch of the aortic arch? - Correct Answer-Innominate artery/ Brachiocephalic Name the three branches of the aortic arch? - Correct Answer-a. Innominate artery/ Brachiocephalic b. Lt CCA c. Lt Subclavian artery The radial artery runs on what side of the forearm? - Correct Answer-Lateral side The radial artery branches to form what part of the palmar arch? - Correct Answer- Superficial palmar arch Where does the radial artery terminate? (Just remember that the ulnar branch and termination is opposite of the radial artery) - Correct Answer-Terminates in the deep palmar arch What vessel is the predominate source of blood flow to the hand come from? - Correct Answer-Ulnar artery The Deep Palmar arch is a branch of the? - Correct Answer-Ulnar artery What are the three branches of the celiac trunk? - Correct Answer-a. Left Gastric artery b. Splenic artery c. Common Hepatic artery What organs does the celiac trunk supply? - Correct Answer-Stomach, Liver, Pancreas, Spleen, & Duodenum The SMA is located 1cm below the celiac trunk and supplies what? - Correct Answer- Small Intestines, cecum, and parts of colon, Is it an uncommon finding to see multiple renal arteries bilaterally? - Correct Answer-No it is not uncommon at all. What vessel runs anterior to the aorta? - Correct Answer-Left Renal vein What arises from the abdominal aorta about 3-4 cm above the bifurcation, that can act as a collateral connection? - Correct Answer-IMA (Inferior Mesenteric Artery)
What are the most distal branches of the aorta that supply blood to the pelvis, abdominal wall, and lower limbs? - Correct Answer-Common Iliac Arteries (CIA) What vessel is also referred to as the Hypogastric artery? - Correct Answer-Internal Iliac Artery What vessel runs along the medial side of the psoas mucsle and underneath the inguinal ligament? - Correct Answer-External Iliac artery What vessel becomes the CFA in the groin region? - Correct Answer-External Iliac Artery The SFA passes through an opening in what tendon to enter the popliteal fossa? - Correct Answer-Adductor Hiatus (Adductor Canal or Hunter's Canal) What is another name for the deep femoral artery? - Correct Answer-Profunda Femoris What is the region called where the SFA terminates and the popliteal artery begins? - Correct Answer-Adductor Hiatus What 3 branches is sometimes known as the trifurcation? - Correct Answer-APA, PTA, Peroneal Artery Whats the first branch off distal popliteal artery? - Correct Answer-ATA - Anterior Tibia Artery What vessel does the ATA become once it crosses the dorsum of the foot? - Correct Answer-DPA - Dorsalis Pedis Artery Wha is a major branch of the DPA (dorsalis pedis artery)? - Correct Answer-Deep Plantar Artery- penetrates the sole of foot, it unites with lateral plantar artery to complete plantar arc. How does the PTA run down the leg? - Correct Answer-Posterior and Medial side of leg What is the Tibioperoneal Trunk? - Correct Answer-Short segment between ATA branch and branches of PTA and peroneal arteries. The plantar arch in foot consists of what branch from DPA? - Correct Answer-Deep plantar artery The plantar arch in foot consists of what branch from the PTA? - Correct Answer-Lateral plantar artery, which unites with the deep plantar artery Arteries progressively decrease in size from the largest being and the smallest being ? - Correct Answer-A. Largest = Aorta
Low resistance yields what type of flow rate? - Correct Answer-High flow rate The total energy contained in moving fluid is the sum of what 3 energies? - Correct Answer-1. Potential (Pressure)
2000 is the point when laminar (stable) flow turns into turbulent (disturbed) flow
In a rigid tube, energy losses are mainly viscous; this can be described by whose principles? - Correct Answer-Poiseuille's equation What kind of flow feeds dilated vascular beds like: ICA, vertebral, renal, celiac, splenic, hepatic? - Correct Answer-Low resistance flow, which is continous (steady) flow What is one visible sign that you can differentiate a low resistant waveform from a high resistant waveform? - Correct Answer-The reversal of flow seen in high resistant waveforms. As the inflow pressure falls as a result of stenosis, what is the natural response of the periphery vessels? Vasodilate or vasoconstrict? - Correct Answer-Vasodilate Exercise should induce peripheral vasodilation, which does what to the distal peripheral resistance? Raise or Lowers? - Correct Answer-Lowers the peripheral resistance, increasing blood flow. What is the single best vasodilator of resistance vessels within skeletal muscle? - Correct Answer-Excercise What is the ability of most vascular beds to maintain constant level of blood flow over a wide range of perfusion pressures called? - Correct Answer-Autoregulation If your blood pressure rises, how will your resistance vessels responed? - Correct Answer-Resistance vessels will constriction Will your vessels be constricted or dilated if you scan a cool vs a warm extremitiy? - Correct Answer-A. Warm- Dilated B. Cool- Constricted Laminar Flow is the even distribution of frequencies at systole: where are lower frequencies found in laminar flow? where is the fastest moving flow? - Correct Answer- Slow flow is near vessel walls, with the fastest flow in the centerstream What 2 things are reduced in a significant stenosis? - Correct Answer-Volume flow and Pressure are both significantly reducted At what point in a stenosis is the flow frequencies dampened, with or without disturbance? - Correct Answer-Proximal to a stenosis At what point in a stenosis is spectral broadening and elevated velocities seen? - Correct Answer-Entering the stenosis, with the high velocity at the narrowest part of the stenosis.
What are the 2 most frequent complications of Aneursyms? - Correct Answer-1. Rupture of the aortic aneursym
b. Ankle (use PTA or DPA; peroneal A. only if necessary) c. Calf (BK) (Use PTA or DPA-that had highest pressure) d. Above knee (AK) (Same as above-may need to use pop) e. High Thigh (HT) How is the ankle/brachial index (ABI) or (Ankle/arm pressure API) calculated? - Correct Answer-ABI's are calculated by dividing the ankel pressure by the higher of the 2 brachial pressures. What value is considered normal for an ABI? - Correct Answer->1. What ABI value is seen in patients with claudication? - Correct Answer-0.5 - 0. What ABI value is seen in patients with severe arterial disease that have rest pain? - Correct Answer-< 0. What type of error will you get if a patient has a incompressible arterial vessel, when doing an ABI? - Correct Answer-An artery with an ABI >1.3-1.5 is considered incompressible and will give a falsely elevated and inaccurate pressures. Segmental pressure drop of what between 2 consecutive levels or horizontal difference, would suggests significant obstruction? - Correct Answer-> 30mmHg between 2 consecutive levels and >20-30mmHg of horizontal difference, to suggest significant obstruction A horizontal difference of > or = to 20-30mmHg suggests obstructive disease at or above the level of which leg? - Correct Answer-At or above the level in the leg with lower pressure. What segmental pressure is more reliable to use than the ankle pressure in diabtetic patients? - Correct Answer-Toe pressure At what toe pressure is it evident that a foot or toe ulcer has failed to heal? - Correct Answer-< or = 30mmHg Whats some MAJOR risks factors for atherosclerosis? - Correct Answer- Smoking, Family history, and hpyerlipidema. (Less impt factors: HTN, diabetes, sedentary (lazy/unhealth) lifestyle, and arterial wall shear/stress. In the normal patient, will the ABI increase or decrease post-exercise? - Correct Answer-In a normal patient the ABI's should increase, while in an abnormal patient ABI's will decrease. How many minutes does it take the ABI's to increase back to resting levels in a patient with single level disease? - Correct Answer-Takes 2-6 minutes
What is pledge position, in reference to upper extremity exams? - Correct Answer-Arm is at 45 degree angle from body, & externally rotated. Brescia-Cimino fistula, straight, & looped synthetic graft are all types of what? - Correct Answer-Dialysis access examples Which end of a hemodialysis access graft is stenosis more commonly seen? - Correct Answer-At venous anastomosis and outflow vein What is a "steal syndrome" in reference to hemodialysis - Correct Answer-It's when the distal arterial blood flow is reversed into the lower resistant venous circulation and can cause pain in hand/fingers on exertion, pallor and coolness of the skin distal to the shunt. What is the ideal Angle for Vasucalar studies? - Correct Answer-60 degrees, obtained centerstream, parallel to vessel walls In reference to stenotic vessels, where is the highest PSV seen? Where is turbulence usually seen? - Correct Answer-a. Narrowest part within stenosis will have highest PSV b. Post stenosis will usually have turbulenct waveform What is the mechanism for hypertension? - Correct Answer-Renal ischemia triggers the release of renin and a secondary increase in BP. Renin converts angiotensin I into angiotensin II, which causes severe vasoconstriction. Give examples of low resistive abdominal vessels? - Correct Answer-Renal, celiac, hepatic, and splenic arteries. Give examples of high resistive abdominal vessels? - Correct Answer-Aorta, as are a fasting SMA and IMA How do you calculate the renal to aorta ratio (RAR)? - Correct Answer-Divide the highest renal artery PSV by the aorta PSV. Whats considered a normal renal to aorta ratio?Abnormal? - Correct Answer-a.Normal = < 3.5. b.Abnormal = > or equal to 3. What are 2 situations that you cannot use the (RAR) renal to aorta ratio? - Correct Answer-a. If AAA is present b. If aortic PSV >90cm/s or <40cm/s Whats the normal length of the kidneys? - Correct Answer-10-12cm depending on patients body habitus. `
How do you calculate resistive index for kidneys? Whats considered normal vs abnormal? - Correct Answer-a. PSV minus EDV divided by PSV b. Normal = <0.8 and Abnormal = > or = to 0. What does an abnormal RI or RAR indicate? - Correct Answer-It indicates an increase in distal resistance. What is the dampened, weak signaled waveform called, that results from renal artery stenosis/occlusion? - Correct Answer-Tardus-parvus A patient presents w/ a history of aching and cramping abdominal pain 15-30 minutes after meals. What would you suspect to be the problem? - Correct Answer-Mesenteric ischemia or mesenteric angina; which may be due to stenosis or occlusion of the SMA, celiac, or IMA. Whats the normal velocity of the SMA? Abnormal? - Correct Answer-a.Normal = 110- 177 cm/sec b. Abnormal = >or equal 275 cm/sec (> or = 70% diameter reduction) Extrinsic compression of celiac artery origin by what ligament can cause reversible celiac artery stenosis during expiration? - Correct Answer-Median arcuate ligament of the diaphragm What vessels should be evaluated pre and post operative liver transplants? - Correct Answer-Evaluate for patency of: portal vn, hepatic veins, IVC and hepatic artery. What is the transplanted renal artery, in a renal transplant, anastomosed to? Transplanted renal vein? - Correct Answer-a. Tx Renal artery is anastomosed to either EIA or IIA. b. Tx Renal vein is anastomosed to EIV. What are signs of rejection of a renal transplant? - Correct Answer-a. Increased renal transplant size b. Increased cortical echogenicity c. Increased renal arterial resistance What is an abnormal connection between a high-pressure arterial system and a low- pressure venous system called? - Correct Answer-Arteriovenous Fistulae (AVF) If a fistula is found close to the heart, what issue is the patient at an increased risk for? - Correct Answer-Cardiac failure What 2 things predict the resistance an AVF will offer? - Correct Answer-Diameter and length of the AVF predict the resistance it offers.
What are the most common arteries used for an Angio exam? - Correct Answer-CFA (safest approach), Axillary, or Brachial arteries What are some complications that can follow an angio exam? - Correct Answer- Puncture site hematoma, pseudoaneurysm, local arterial occlusion, or possible neurologic complications What type of arterial study uses radio fequency energy and a strong magnetic field to produce images in multiple planes that quantitate blood flow and distinguish it from soft tissue without using contrast agents? - Correct Answer-MR Angiography (MRA) What is one benefit of performing and MRA study instead of and angiogram? - Correct Answer-MRA's dont require contrast agents so patients with renal failure or patients that are allergic to the contrast agents are able to have exam. What type of pharmacologic agents can be used to help treat arterial vessel issues? - Correct Answer-a.Any medication that helps decrease blood viscosity, like aspirin, which is an antiplatelet drug that decreases platelet aggregation, resulting in decreased thrombotic activitiy. b. Antihypertensive drugs may serve to decrease shearing forces against vessel walls. What is the surgical removal of atherosclerotic material, usually includes portion of intimal lining? - Correct Answer-Endarterectomy What are the 3 components that are needed to acheive a successful bypass graft? - Correct Answer-a. Good Inflow b. Conduit c. Outflow What is a PTLA (Percutaneous Transluminal Angioplasty used for and how is it done? - Correct Answer-a.Angioplasty is used to dilate focal plaque formation in a vessel. b.Same technque used as arteriography, except a balloon tipped catheter is used under fluoroscopy to region of stenosis, where the balloon is slowly inflated, pushing plaque against walls of vessl, dilating artery lumen. What is an endoleak when referring to graft complications? - Correct Answer-Endoleak is defined as a persistent blood flow outside the lumen of the endoluminal graft but within an aneurysm sac or adjacent vascular segment being treated by the device. Endoleaks are due to incomplete sealing, or exclusion of the aneurysm sac, and thus cause reflux of blood flow into the sac. The Right CCA is a branch of the? - Correct Answer-Right Innominate The Left CCA is a branch off the? - Correct Answer-Aortic Arch
The majority of the CCA's blood, flows into what vessel? - Correct Answer-Internal Carotid Artery (ICA) What is the carotid siphon and what artery originates near it? - Correct Answer-Carotid siphon is a significant curve of the ICA where the Ophthalmic artery originates What are the 2 branches of the ICA? What type of vascular beds does the ICA feed? - Correct Answer-a.Ophthalmic artery and posterior communicating artery b. Low Resistant vascular beds How many major branches does the ECA have and what is usually its first branch? - Correct Answer-a. 8 Major branches b. Superior Thyroid artery is usually 1st branch What is firts branch of the subclavian artery? - Correct Answer-Vertebral artery The vertebral arteries unite in skull to form what vessel? - Correct Answer-Basilar artery Basilar artery is formed by the confluence of what arteries? - Correct Answer-Vertebral arteries The basilar artery divides into what? - Correct Answer-Posterior cerebral arteries What is the largest intra-arterial connection (collaterl pathway) in the human body? - Correct Answer-Circle of Willis Whose principle stated that total fluid energy along a streamline of fluid flow is constant? - Correct Answer-Bernoulli's Principle What causes fleeting neurologic dysfunction, with symptoms that last less than 24 hrs and are usually caused by embolic from heart or carotid artery? What about if symptoms last more than 24hrs and complete recovery doesnt occur? - Correct Answer- a. TIA (Transient Ischemic Attack) b. CVA (Cerebrovascular Accident) How do you differentiate thrombus from embolisms? - Correct Answer-Embolism is a piece of thombus that breaks loose and travels distally until it lodges in a small vessle. What is intimal thickening from rapid production of smooth muscle cells in response to vascular injury/reconstruction, such as post carotid endarterectomy? - Correct Answer- Neointimal Hyperplasia What is Auscultation? - Correct Answer-Listening through a stethoscope What does paresthesia mean? - Correct Answer-Prickling and tingling of the skin
What are some things you can do to increase your PRF/Nyquist limit? - Correct Answer- a. Decrease baseline b. Increase Doppler scale c. Change transducer to Lower frequency d. Decrease Depth e. Alter angle of insonation or use CW Doppler What artifact can be produced from strong reflectors or by having too much gain that results in a Doppler shift above and below the baseline? - Correct Answer-Mirror Image Artifact What type of flow occurs when flow moves into a wider portion of the vessel (ex: Carotid Bulb), and the Doppler shift is seen above and below baseline differently? - Correct Answer-Helical flow What are the three acoustic windows used with transcranial Doppler? - Correct Answer- Transtemporal, Transorbital, and Transforaminal (suboccipital) What type of velocity is measure with Transcranial Doppler? Peak velocity or Time average maximum velocity (TAMV) or Mean velocity? - Correct Answer-TAMV or Mean velocity What vessels are accessed with a unilateral transtemporal approach? - Correct Answer- MCA, ACA, PCA, and terminal ICA What vessels are accessed with isilateral transorbital approach? - Correct Answer- Ophthalmic artery and Carotid siphon What vessels are accessed with transforaminal/subocciptal approach? - Correct Answer-Vertebral and Basilar arteries What is the TMVA and the mean velocity for the MCA? - Correct Answer-TMVA = 55 +/- with the mean velocity = 12cm/s What is a small terminal artery with muscular walls, that continues into the capillary network called? - Correct Answer-Arteriole What is a small blood vessel with only an endothelium membrane where the exchange of nutrients and waste occcurs called? - Correct Answer-Capillary What is a small vein that is continuous with a capillary bed called? - Correct Answer- Venule What 2 vessels supply blood to the brain? - Correct Answer-ICA and Vertebral arteries
What cranial caviity does the vertebral artery enter through? - Correct Answer- Foramen magnum What 3 main veins drain the head and neck? - Correct Answer-IJV, EJV and vertebral veins What two veins unite to form the Innominate/brachiocephalic vein? - Correct Answer- IJV and Subclavian vein The vertebral and internal mammary arteries are branch of what? - Correct Answer- Subclavian artery What artery divides into the radial and ulnar arteries? - Correct Answer-Brachial artery The ulnar artery travels distally in forearm to wrist where is becomes what? - Correct Answer-Superficial palmar arch The radial artery travels lateral & distally in forearm to wrist where is becomes what? - Correct Answer-Deep palmar arch What are the three major branches of the abdominal aorta? - Correct Answer-Celiac axis/trunk (Hepatic, splenic, and Lt gastric) SMA, and IMA What vessel courses posterior to the IVC in abdomen? - Correct Answer-Right renal artery, which is usually longer and slightly higher than left renal artery. Both renal arteries are found anteriorly or posteriorly to the renal veins? - Correct Answer-Posteriorly What 2 arteries branch anterior-lateral off aorta just below level of renal arteries? Hint: This vessel is different in each gender. - Correct Answer-Female its the ovarian arteries and in males its the testicular arteries. What does the internal iliac arteries supple? External Iliacs? - Correct Answer-A. Internal iliacs= pelvic organs B. External iliacs= BLE At the inguinal ligament, what does the external iliacs turn into? - Correct Answer- Common femoral arteries Whose law describe the steady laminar flow of Newtonian fluids or the pressure/flow relationship? - Correct Answer-Poiseuille What type of energy is represented by the velocity of moving blood? Potential or kinetic
Carrying blood from superficial veins into deep veins is acomplished by what veins? - Correct Answer-Perforators What perforators play a major role in development of venous stasis ulcers? - Correct Answer-Posterior arch vein, which has 3 perforators What is the intracranial space between the dura mater and periosteum that drains blood into the IJV called? - Correct Answer-Intracranial Venous sinuses In between what 2 muscles are the lower extremity Venous sinuses located? - Correct Answer-Soleal and gastrocnemius muscles What is formed by the confluence of axillary and cephalic veins? - Correct Answer- Subclavian vein What is formed by the confluence of brachial and basilic(superficial) veins? - Correct Answer-Axillary vein What is formed by the confluence of subclavian and IJV? - Correct Answer-Innominate vein What is formed by the confluence of rigth and left innominate veins? - Correct Answer- SVC (Superior Vena Cava), which carries blood to the right atrium List the deep veins of the upper extremity. - Correct Answer-Radial, Ulnar, Brachial, Axillary, Subclavian, Innominate, and SVC List the superficial veins of the upper extremity. - Correct Answer-Basilic and Cephalic veins List the deep veins of the lower extremity. - Correct Answer-Paired PerV & PTV, ATV, PopV, SFV, CFV, EIV, CIV, IVC List the superficial veins of the upper extremity. - Correct Answer-SSV and GSV What terminates in the right atrium and drains the head and BUE? - Correct Answer- SVC What terminates in the right atrium and drains lower half of body? - Correct Answer-IVC The confluence of what 2 veins forms the Portal vein? - Correct Answer-SMV and Splenic vein What percentage of blood flow is supplied to the liver by the portal vein? - Correct Answer-80%
Portal vein carries blood INTO (hepatopetal flow) what exact part of the liver? - Correct Answer-Sinusoids What vein carries blood FROM the liver to the IVC? - Correct Answer-Hepatic vein What veins in the body dont have valves? - Correct Answer-Soleal sinuses, IVC, SVC, Innominate, Common Iliac, Internal iliac, and the External iliac has valves 25% of the time The pressure within the vein versus pressure outside the vein is called what type of pressure? - Correct Answer-Transmural or Distention pressure What type of pressure is equivalent to the weight of a column of blood pressing against the vessels of the body? - Correct Answer-Hydrostatic pressure A dumbbell shaped vein has what type of transmural pressure? low or high? - Correct Answer-Low transmural pressure, while a circular shap vein has high transmural pressure. What you exhale where is the pressure increased and where is it decreased? - Correct Answer-Exhale forces diaphragm up = increased thoraic pressure and decreased abdominal pressure. When the valsalva maneuver is perform, what happens to the pressure within the thoracic and abdominal cavity? - Correct Answer-Pressure in both cavities is increased causing total hault of venous return. What does erythema mean? - Correct Answer-Redness seen with an inflammatory process What is induration of tissue? - Correct Answer-Edema, or fluid accumulation A lower extremity has a brownish discoloration, what can that represent? - Correct Answer-Venous statis ususally in lower leg-to-ankle area (gaiter zone) If a patient comes in for a venous study an there lower extremity has a pallor/whiteness appearance, what could be going on? What if the extremity was bluish/cyanosis color? - Correct Answer-A. Pallor color = arterial spasms secondary to extensive, acute iliofemoral thrombosis, also called phlegmasia alba dolens B. Bluish/cyanosis = severly reduced venous outflow from iliofemoral thrombosis markedly reduces arterial inflow as welll; also called phlegmasia cerulea dolens Where are venous ulcerations usually seen and how do they look? - Correct Answer- Venous ulcerations are often near the medial malleolus and are shallow, irregular