1.
When scanning in the transverse plane, the ECA is usually ________ to the ICA
Correct Answer
A. Medial
Explanation
When scanning in the transverse plane, the ECA is usually medial to the ICA. This means that the external carotid artery (ECA) is located closer to the midline of the body compared to the internal carotid artery (ICA).
2.
What does tapping of the temporal artery branch do to the ECA waveform?
Correct Answer
B. Causes changes in the diastolic flow pattern
Explanation
Tapping of the temporal artery branch causes changes in the diastolic flow pattern. This means that the flow of blood during the diastolic phase of the cardiac cycle is altered when the temporal artery branch is tapped. This tapping may result in changes in the velocity or direction of the blood flow during diastole, which can be observed in the waveform of the external carotid artery (ECA). It is important to note that tapping the temporal artery branch does not have any effect on the ECA during systole or on the diastolic flow in the internal carotid artery (ICA).
3.
A phenomenon associated with pulsed Doppler, which is a misrepresentation of the Doppler shift in a negative direction, and occurs when the Doppler shift frequency exceeds one-half the PRF is called
Correct Answer
D. Aliasing
Explanation
Aliasing is a phenomenon associated with pulsed Doppler where the Doppler shift is misrepresented in a negative direction. This occurs when the Doppler shift frequency exceeds one-half the Pulse Repetition Frequency (PRF). In other words, when the Doppler shift is too high, it wraps around and appears as a negative value, causing aliasing. This can lead to incorrect interpretation of blood flow direction and velocity. Hence, the correct answer is aliasing.
4.
What are the typical color assignments for blood flow in relation to the transducer?
Correct Answer
A. RED = Blood Flow Towards BLUE = Blood Flow Away
Explanation
The typical color assignments for blood flow in relation to the transducer are red for blood flow towards and blue for blood flow away. This color scheme is commonly used in medical imaging, such as Doppler ultrasound, to represent the direction of blood flow. Red is used to indicate blood flowing towards the transducer, while blue is used to indicate blood flowing away from the transducer. This color coding helps healthcare professionals visualize and interpret the direction of blood flow in real-time.
5.
The Doppler Shift is a function of what variables?
Correct Answer
C. Operating frequency, speed, and angle of measurement
Explanation
The Doppler Shift is a phenomenon that occurs when there is relative motion between a source of waves and an observer. It causes a change in the observed frequency of the waves. The variables that affect the Doppler Shift include the operating frequency of the waves, the speed of the source or observer, and the angle at which the measurement is being taken. These variables determine the amount and direction of the frequency shift, allowing for the calculation of the velocity of the source or observer.
6.
X-Ray visualization of blood vessels in the brain using contrast material that is opaque to X-Rays is called
Correct Answer
B. Cerebral Angiography
Explanation
Cerebral angiography is the correct answer because it is a procedure that involves the use of contrast material that is opaque to X-rays to visualize blood vessels in the brain. This technique allows for the identification of abnormalities, such as blockages or aneurysms, in the blood vessels of the brain. MRI, nuclear medicine imaging, and cerebral ultrasound do not specifically involve the use of contrast material to visualize blood vessels in the brain.
7.
Does the ECA have a highly or lowly resistive flow level?
Correct Answer
A. Highly
Explanation
The ECA (Electronic Control Assembly) has a highly resistive flow level. This means that there is a high level of resistance to the flow of electricity within the ECA. This could indicate that the ECA is designed to limit or control the flow of electricity in a specific way, such as regulating the voltage or current. A highly resistive flow level can be beneficial in preventing damage or overload to the electrical components connected to the ECA.
8.
The major branches of the ophthalmic artery that exit the orbit, include all of the following EXCEPT
Correct Answer
D. Facial
Explanation
The major branches of the ophthalmic artery that exit the orbit include the supraorbital, frontal, and nasal arteries. However, the facial artery does not exit the orbit.
9.
The most common site for plaque formation in the head and neck is
Correct Answer
B. At the bifurcation of the internal and external carotid arteries
Explanation
Plaque formation refers to the buildup of fatty deposits in the arteries, which can lead to various cardiovascular diseases. The bifurcation of the internal and external carotid arteries is a common site for plaque formation in the head and neck. This is because the carotid arteries supply blood to the brain and face, making them susceptible to plaque buildup. Plaque in this area can restrict blood flow to the brain, potentially leading to a stroke or other complications. Therefore, it is important to monitor and manage plaque formation in this region to maintain proper blood flow and prevent cardiovascular issues.
10.
What is the primary cause of extracranial cerebrovascular disease?
Correct Answer
C. Atherosclerosis
Explanation
Extracranial cerebrovascular disease refers to the narrowing or blockage of blood vessels outside the brain that supply blood to the brain. Atherosclerosis is the primary cause of this condition. Atherosclerosis is a condition where plaque builds up inside the arteries, causing them to become narrow and stiff. This plaque is made up of cholesterol, fat, calcium, and other substances. Over time, the plaque can rupture, leading to the formation of blood clots that can block the blood flow to the brain. This can result in a stroke or transient ischemic attack (TIA), which is a temporary interruption of blood flow to the brain. While conditions like diabetes and primary hypertension can contribute to the development of atherosclerosis, they are not the primary cause of extracranial cerebrovascular disease.
11.
The right carotid artery originates from which vessel?
Correct Answer
B. Brachiocephalic artery
Explanation
The right carotid artery originates from the brachiocephalic artery. The brachiocephalic artery is a major branch of the aorta and is responsible for supplying blood to the right arm, head, and neck. It divides into the right common carotid artery, which further branches into the internal and external carotid arteries. The internal carotid artery supplies blood to the brain, while the external carotid artery supplies blood to the face and neck. Therefore, the brachiocephalic artery is the correct vessel from which the right carotid artery originates.
12.
The ________ artery is the first major branch of the Internal Carotid Artery.
Correct Answer
A. Ophthalmic artery
Explanation
The ophthalmic artery is the first major branch of the Internal Carotid Artery. It supplies blood to the structures of the eye, including the retina, choroid, and optic nerve. This artery plays a crucial role in maintaining the health and function of the eye.
13.
The right vertebral artery originates from
Correct Answer
A. The right subclavian artery
Explanation
The right vertebral artery originates from the right subclavian artery. The subclavian artery is a major branch of the brachiocephalic artery, which is also known as the innominate artery. Therefore, option B and C are both correct.
14.
Calculate the approximate percentage of stenosis when the following values exist. The original lumen diameter is 9 cm. The residual lumen diameter is 3 cm.
Correct Answer
B. 66%
Explanation
The approximate percentage of stenosis can be calculated by finding the difference between the original lumen diameter and the residual lumen diameter, and then dividing it by the original lumen diameter. In this case, the difference is 9 cm - 3 cm = 6 cm. Dividing 6 cm by 9 cm gives a result of 0.6667. Multiplying this by 100 gives approximately 66%, which is the answer.
15.
Whe peak systolic velocities in the carotid arteries exceed 250 cm/sec, the diameter stenosis correlates with
Correct Answer
A. 80-99% diameter reduction
Explanation
When the peak systolic velocities in the carotid arteries exceed 250 cm/sec, it indicates a high flow rate through the arteries. This high flow rate is typically seen in cases of severe stenosis, where there is a significant reduction in the diameter of the arteries. Therefore, the diameter stenosis correlates with an 80-99% diameter reduction.
16.
Three layers make up the arterial walls. Which layer is most invovled in atherosclerotic disease?
Correct Answer
C. Intima
Explanation
The intima layer is most involved in atherosclerotic disease. Atherosclerosis is a condition characterized by the build-up of plaque in the arteries, which narrows and hardens them. This plaque primarily forms in the intima layer, which is the innermost layer of the arterial walls. It consists of a single layer of endothelial cells and is in direct contact with the blood flow. The accumulation of cholesterol, fatty deposits, and inflammatory cells in the intima layer leads to the development of atherosclerotic plaques, causing the progression of the disease.
17.
Factors that can affect the peak systolic and end diastolic velocities in a stenotic lesion during pulsed wave Doppler examinations include all of the following EXCEPT
Correct Answer
C. Glucose level
Explanation
The peak systolic and end diastolic velocities in a stenotic lesion during pulsed wave Doppler examinations are influenced by various factors. Blood pressure, cardiac output, and peripheral resistance are all factors that can affect these velocities. However, glucose level is not directly related to the velocities in a stenotic lesion. Therefore, glucose level is the exception among the given factors.
18.
Why is vascular laboratory accreditation of importance and needed?
Correct Answer
D. To minimize variance in performance of ultrasound exams
Explanation
Vascular laboratory accreditation is important and needed to minimize variance in performance of ultrasound exams. Accreditation ensures that the laboratory meets certain standards and guidelines, ensuring consistency and accuracy in the performance of ultrasound exams. This helps to improve patient care and outcomes by reducing errors and ensuring that all sonographers are following standardized protocols. Accreditation also provides assurance to patients and referring physicians that the laboratory is reliable and trustworthy.
19.
The Doppler shift ________ as the Doppler angle increases toward 90 degrees.
Correct Answer
A. Decreases
Explanation
As the Doppler angle increases towards 90 degrees, the Doppler shift decreases. This is because the Doppler angle represents the angle between the direction of the sound waves and the direction of the motion of the source or observer. When the angle is close to 90 degrees, the component of the motion in the direction of the sound waves becomes smaller, resulting in a smaller Doppler shift.
20.
When examining large arterial vessels, the cursor size should be kept small, and velocity samples should be taken
Correct Answer
C. In the middle of the vessel in Long
Explanation
When examining large arterial vessels, it is recommended to place the cursor in the middle of the vessel in the Long view. This is because the Long view provides a longitudinal section of the vessel, allowing for better visualization of the blood flow. Placing the cursor in the middle of the vessel ensures that velocity samples are taken from the center of the blood flow, giving a more accurate measurement of the velocity. This approach helps in accurately assessing the blood flow dynamics and detecting any abnormalities in the arterial vessels.
21.
In scanning the arteries of the legs, the ______ view is more imporant because of the importance of the Doppler waveform in the study.
Correct Answer
B. Longitudinal
Explanation
In scanning the arteries of the legs, the longitudinal view is more important because it allows for a better visualization of the Doppler waveform. The Doppler waveform is a crucial component in the study as it provides information about blood flow and any abnormalities in the arteries. The longitudinal view allows for a clearer and more detailed examination of the waveform, making it the preferred view in this context.
22.
All of the following vessels can be palpated as pulse points with the EXCEPTION of the
Correct Answer
A. Peroneal artery
Explanation
All of the vessels listed in the options can be palpated as pulse points except for the peroneal artery. Palpating a pulse point involves feeling the pulsations of the artery, which indicates the flow of blood. The common femoral artery, posterior tibial artery, and popliteal artery are all easily accessible and can be palpated to assess the pulse. However, the peroneal artery is not typically used as a pulse point for palpation.
23.
Surgical interventions between the femoral and popliteal arteries (grafts) would be unsuccessful without adequate inflow from the aorta-iliac arteries
Correct Answer
A. True
Explanation
Without adequate inflow from the aorta-iliac arteries, surgical interventions between the femoral and popliteal arteries would be unsuccessful. This is because the aorta-iliac arteries are responsible for supplying blood to the lower extremities. If there is insufficient blood flow from these arteries, the grafts placed between the femoral and popliteal arteries would not receive enough oxygen and nutrients, leading to the failure of the surgical interventions. Therefore, the statement is true.
24.
After the superficial femoral artery passes through the adductor hiatus (Hunter's Canal), it becomes the
Correct Answer
C. Popliteal artery
Explanation
After passing through the adductor hiatus (Hunter's Canal), the superficial femoral artery continues its course and becomes the popliteal artery. The popliteal artery is located behind the knee and is responsible for supplying blood to the lower leg and foot. It is an important artery in the lower limb and is a continuation of the femoral artery.
25.
The pain of intermittent claudication occurs as a response to lack of blood flow to the muscles during exercise. Cladication pain occurs ______ the level of stenosis
Correct Answer
B. Below
Explanation
The pain of intermittent claudication occurs below the level of stenosis. This is because intermittent claudication is caused by a lack of blood flow to the muscles during exercise, and stenosis refers to the narrowing of blood vessels. Therefore, the pain occurs below the level of stenosis where the blood flow is restricted, leading to muscle ischemia and pain.
26.
The greater risk factors for the development of primary varicose veins is
Correct Answer
D. Genetic predisposition
Explanation
Genetic predisposition is the correct answer because primary varicose veins are primarily caused by inherited weaknesses in the vein walls and valves. People with a family history of varicose veins are more likely to develop them themselves. Standing on the feet too long, valve stiffening, and previous thrombotic episodes can contribute to varicose veins, but they are not the primary risk factors.
27.
The primary function of the venous valves is to
Correct Answer
B. Assure antegrade flow
Explanation
The primary function of the venous valves is to assure antegrade flow. Venous valves are one-way valves that prevent the backflow of blood in the veins. They ensure that blood flows in the correct direction, towards the heart, by closing when blood tries to flow backward. This helps to maintain a steady flow of blood and prevents pooling or congestion in the veins. Therefore, the venous valves play a crucial role in assuring the forward flow of blood in the venous system.
28.
When a patient is standing in the erect position, the venous pressure in the lower extremities
Correct Answer
B. Increases
Explanation
When a patient is standing in the erect position, the force of gravity pulls blood downwards, causing an increase in venous pressure in the lower extremities. This is because the blood has to work against gravity to return to the heart, leading to an increase in pressure in the veins of the legs.
29.
Venous valves are extensions of the ______ layer, forming structures that allow the blood to flow in only one direction.
Correct Answer
C. Intimal
Explanation
Venous valves are extensions of the intimal layer, forming structures that allow the blood to flow in only one direction. The intimal layer is the innermost layer of blood vessels and is responsible for maintaining the integrity and function of the vessel walls. The presence of valves in veins helps prevent the backflow of blood and ensures that it flows in the correct direction towards the heart. Therefore, the correct answer is intimal.
30.
The three deep veins of the calf are
Correct Answer
B. Posterior Tibial Vein, Peroneal Vein, Anterior Tibial Vein
Explanation
The correct answer is Posterior Tibial Vein, Peroneal Vein, Anterior Tibial Vein. These three deep veins are located in the calf region. The Posterior Tibial Vein runs along the back of the leg, the Peroneal Vein runs along the outer side of the leg, and the Anterior Tibial Vein runs along the front of the leg. Together, these veins play a crucial role in carrying deoxygenated blood back to the heart from the lower leg and foot.
31.
The superficial venous system of the lower extremities consists of
Correct Answer
B. The Greater and Lesser Saphenous Veins
Explanation
The correct answer is the Greater and Lesser Saphenous Veins. The superficial venous system of the lower extremities includes these two veins. The Greater Saphenous Vein is the longest vein in the body and runs along the inside of the leg, while the Lesser Saphenous Vein runs along the back of the leg. These veins are responsible for draining blood from the skin and superficial tissues of the lower extremities.
32.
Which of the following are associated with Chronic arterial disease affecting the lower extremities
Correct Answer
E. All of the above
Explanation
Chronic arterial disease affecting the lower extremities is associated with various symptoms. Trophic nail changes occur due to inadequate blood supply to the nails, resulting in thickened, brittle, and discolored nails. Hairlessness is a common symptom as reduced blood flow hinders hair growth. Shiny skin is another characteristic as the lack of blood supply makes the skin appear smooth and glossy. Deep regular ulcers on the bony prominences of the foot are also associated with chronic arterial disease in the lower extremities. Therefore, all of the above symptoms are linked to this condition.
33.
A patient presents at the vascular lab with a history of sudden onset of right upper extremity pain and swelling, and in order to perform duplex ultrasound imaging of the right arm to rule out thrombus. The Doppler venous signal of the arm normally differs from that of the leg in the following way(s).
Correct Answer
D. All of the above
Explanation
The correct answer is "all of the above". This means that all of the statements mentioned in the options are true for the Doppler venous signal of the arm compared to the leg. The arm has increased flow during inspiration, while flow from the leg decreases with inspiration. Additionally, the subclavian veins may be pulsatile and non-compressible. Therefore, all of these characteristics help differentiate the venous signal of the arm from that of the leg during duplex ultrasound imaging.
34.
A 65 year old female patient comes to the vascular lab because of a non-healing ulcer on the medial aspect of the left malleolus. In addition, a brownish discoloration can be seen on the left ankle extending to the lower calf. This lesion is most likely
Correct Answer
B. A venous ulcer
Explanation
Based on the description provided, the most likely explanation for the non-healing ulcer on the medial aspect of the left malleolus, along with the brownish discoloration extending to the lower calf, is a venous ulcer. Venous ulcers typically occur due to impaired venous circulation, leading to pooling of blood in the lower extremities. This causes increased pressure in the veins, resulting in tissue damage and ulceration. The brownish discoloration is a common characteristic of venous ulcers, known as hemosiderin staining, caused by the breakdown of red blood cells and deposition of iron pigment in the skin.
35.
During an examination of the veins of the lower extremities, the patient complains of extreme pain in both legs and cannot tolerate any compression of the calf veins. All veins above the knee compress completely and show spontaneous and phasic signals. The report of the sonographer may contain all of the following statements EXCEPT
Correct Answer
D. No evidence of DVT
Explanation
The patient's complaint of extreme pain in both legs and inability to tolerate compression of the calf veins, along with the findings of complete compression and spontaneous and phasic signals in the veins above the knee, suggest the presence of deep vein thrombosis (DVT). Therefore, the statement "no evidence of DVT" would not be included in the sonographer's report.
36.
All of the following mechanisms assist in the return of venous flow from the lower extremities to the heart EXCEPT for
Correct Answer
A. Inspiration
Explanation
Inspiration refers to the act of inhaling or taking in air. During inspiration, the diaphragm contracts and moves downward, creating a negative pressure in the chest cavity. This negative pressure helps to pull blood towards the heart, assisting in the return of venous flow from the lower extremities. Therefore, inspiration is not an exception and actually contributes to the return of venous flow, making it the correct answer.
37.
The most worrisome sequela of deep venous thrombosis is
Correct Answer
C. Pulmonary embolism
Explanation
Pulmonary embolism is the most worrisome sequela of deep venous thrombosis. It occurs when a blood clot from the veins, usually in the legs, travels to the lungs and blocks the blood flow. This can be life-threatening as it can cause difficulty in breathing, chest pain, and even death in severe cases. Prompt medical intervention is necessary to prevent further complications and manage the condition effectively. Venous ulcers, phlegmasia cerulea dolens, and valvular destruction are also potential complications of deep venous thrombosis, but pulmonary embolism is considered the most concerning.
38.
What organization is responsible for the accreditation of vascular laboratories in the United States?
Correct Answer
B. ICAVL
Explanation
ICAVL, or the Intersocietal Commission for the Accreditation of Vascular Laboratories, is the organization responsible for accrediting vascular laboratories in the United States. They set standards and guidelines for the quality of care provided by these laboratories, ensuring that they meet the highest standards of patient care and diagnostic accuracy. Through their accreditation process, ICAVL helps to promote quality improvement and patient safety in the field of vascular medicine.
39.
The confluence of the splenic and superior mesenteric veins form from the following vessel.
Correct Answer
C. Portal vein
Explanation
The confluence of the splenic and superior mesenteric veins form the portal vein. The portal vein is responsible for carrying blood from the digestive organs, such as the spleen and intestines, to the liver. This allows the liver to process and filter the blood before it is returned to the heart. The hepatic vein carries blood from the liver to the inferior vena cava, the inferior vena cava carries deoxygenated blood from the lower body to the heart, and the left renal vein carries blood from the left kidney to the inferior vena cava.
40.
In venous duplex scanning for deep venous thrombosis, all of the following characteristics are of diagnostic value to rule out acute DVT EXCEPT
Correct Answer
A. Venous reflux
Explanation
Venous reflux is not a characteristic of diagnostic value to rule out acute deep venous thrombosis (DVT). Venous reflux refers to the backward flow of blood in the veins, which is commonly seen in conditions such as varicose veins but is not specific to DVT. On the other hand, the other characteristics listed - augmentation with distal compression, echogenicity of the venous lumen, and wall compressibility - are all useful in diagnosing or ruling out DVT.