VASCULAR
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| The innominate artery is a branch of the | Aortic arch
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| When the external iliac artery passes underneath this structure, it becomes the common femoral artery | Inguinal Ligament
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| This artery passes forward above the interosseious membrane and distally comes to lie on the front of the tibia | Anterior tibial artery
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| Tunica intima refers to one of the following in the arterial wall | The inner layer
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| All of the following vessels are palpable except | Peroneal artery
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| The three branches of the aortic arch are: | Right innominate, left common carotid, left subclavian
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| According to Bernoulli what is not true about pressure/velocity relationships? | Pressure is higher at the region of stenosis
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| All of the following cause vasodilatation of a high resistance bed EXCEPT | Hyperventilation
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| a 75% area reduction equates to a | 50% diameter reduction
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| All of the following are true about post-stenotic turbulence EXCEPT | No heat loss
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| Exercise induces peripheral vasodilatation in the microcirculation which: | Decreases the distal peripheral resistance
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| All of the following are characteristics of claudication EXCEPT | Always vascular in origin
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| All of the following apply to a high resistance signal EXCEPT: | Continuous
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| All of the following are true about analog recordings EXCEPT | Displays amplitude of all frequencies
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| Utilizing Duplex Scanning, the criteria for determination of a 50-99% diameter reduction of the femoral artery is | Ratio of stenotic to pre-stenotic PSV is greater than 2:1
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| A high resistance blood flow pattern is normally NOT found in one of the following | Post prandial SMA
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| The External Carotid Artery is high resistance and the Internal Carotid Artery is low resistance. The extremity arteries are usually high resistance. | The SMA is high resistance in the fasting state, but changes to low resistance post prandial (after eating).
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| All of the following are characteristics of claudication EXCEPT | Always vascular in origin
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| One of the following statements is correct about “primary Raynaud’s" | Occurs when ischemia is due to distal arterial spasm
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| The most important differential diagnostic parameter for pseudoaneurysm is: | Communication tract between artery and aneurysm
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| A patient presenting with ischemic rest pain complains of | Foot pain when supine, relieved by standing
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| Waveforms as the result of Raynaud’s phenomena have this “unique” characteristic: | Peaked
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| The most common site of stenosis or occlusion of the hemodialysis access graft is | Outflow Vein
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| The Adson maneuver is performed for the assessment of | thoracic outlet syndrome
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| Which of the following is not a common complication of arteriography; | Nerve damage
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| Balloon agioplasty is more commonly used in all of the following arteries EXCEPT: |
gastrocnemius artery
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| All of the following are true about analog recordings EXCEPT | Displays amplitude of all frequencies
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| Which one of the following can be determined by the doppler pressure evaluation? | Be difficult to interpret in the presence of multilevel disease
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| An ABI of .65 places the patient into the category of | Claudication
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| The Allen Test is most often utilized to assess patency of these vessels | Radial artery, ulnar artery, and palmar arch
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| Vasculogenic impotence can be caused by all of the following except | Carotid artery stenosis
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| The following are characteristic of an abnormal plethysmographic waveform except: | Dicrotic notch
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| The toe pressure should be what % of the ankle pressure: | 60% - 80%
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| Waveforms as the result of Raynaud’s phenomena have this “unique” characteristic: | Peaked
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| The most common site of stenosis or occlusion of the hemodialysis access graft is | Outflow Vein
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| What is one difference between a CW Doppler and a pulsed Doppler? | A CW Doppler cannot sample flow at a discrete point
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| Arterioles assist with regulating blood flow through contraction and relaxation. (Varying the degrees of resistance.) This process is called | autoregulation
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| innermost layer in contact with blood, made of an endothelial lining. | Intima
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| muscle, elastic connective tissue, consists of smooth muscle cells | Media
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| outer layer of supporting connective tissue-provides significant portion of total strength to the arterial wall. | Adventitia(externa)
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| The adventitia layer contains the _____ which are the tiny vessels that carry blood to the walls of the arteries themselves. | vasa vasorum,
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| It divides into the right common carotid and right subclavian arteries. | The Innominate(Brachiocephalic) Artery is the first major branch of the aortic arch
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| The right vertebral artery arises from the | right subclavian artery.
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| is the next branch of the aortic arch | Left common carotid
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| is the third branch of the aortic arch. | left subclavian
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| The left vertebral artery is a branch of the | left subclavian artery.
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| Suppplies stomach,liver,pancreas,duodenum,and spleen Branches into L Gastric artery , splenic artery, and common hepatic arteries | Celiac Artery(Celiac Axis)-(CA)
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| Supplies the small intestine, cecum, parts of colon Located about one cm distal to the celiac artery There can be a common trunk of the celiac artery and the SMA** | Superior mesenteric artery (SMA)
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| Supply blood to the kidneys, suprarenal glands, and ureters. Multiple renal arteries are not uncommon | Renal Arteries
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| Supplies transverse, descending colon and part of the rectum | Inferior mesenteric artery (IMA)
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| ususally have a higher pulse amplitude than the Aorta. | The lower extremity arteries
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| At the inguinal ligament, the external iliac artery is called the | common femoral artery
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| The Femoral artery can be | palpated.
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| The popliteal artery can be | popliteal artery
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| passes above the interosseious membrane and distally comes to lie on the front of the tibia. The ATA can be palpated | anterior tibial artery
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| runs behind the bone,also terminates at the foot, but instead of being at the front of the ankle, the landmark is at the side of the foot. The posterior artery is palpated slightly behind and below the medial maleolus, or inner ankle bone. It can be palp | PTA The posterial tibal artery(PTA)
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| moves through the deep muscle compartment on the posterolateral aspect of the calf.It can not be palpated | peroneal artery
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| Is usually due to ischemia, but is not always vascular in origin. | Claudication
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| Rest pain can be relieved in part by dependency of the limb (hanging feet off bed or standing- gravity helps). | Ischemic Rest Pian
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| There is always a Communication Tract between the artery and the | aneurysm
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| Blood flow is the result of differences in energy levels. In the arterial system this energy difference is in the form of | pressure
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| The three branches of the aortic arch are: | Right innominate, left common carotid, left subclavian
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| In the cervical carotid, the internal carotid artery (ICA) can be differentiated from the external carotid artery (ECA) by all of the following except; | The ICA has only one branch
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| The ICA distributes blood to all of the following areas except; | Thyroid
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| The ECA branches into all of the following arteries EXCEPT | Basilar
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| The vertebral arteries arise from which vessels: | Subclavian
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| The circle of Willis is composed of all of the following arteries except: | Anterior choroidal arteries
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| The major branches of the ophthalmic artery that exit the orbit include all of the following except; | facial
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| Bernoulli's principle explains which phenomenon of the carotid bulb | areas of flow separation
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| A symptom of a CVA is | Aphasia for 72 hours
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| The cause of a right hemispheric infarct may be | Right ICA Occlusion
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| The ICA flow differs from ECA flow in what way? | ICA has less peripheral resistance than the ECA
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| In a carotid duplex exam, what is the most frequent reason for under-estimation of the amount of stenosis? | Improper placement of the sample volume
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| In a carotid duplex exam, overestimation of a stenosis occurs because of all of these reasons EXCEPT? | Calcification enhances amount of disease
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| The acoustic windows providing access to the intracranial vessels in TCD are; | Transorbital,transtemporal, transforaminal
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| Which artery is not routinely evaluated in a TCD exam? | Posterior communicating
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| In a TCD exam, what is the normal direction of flow in the middle cerebral artery? | antegrade
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| Utilizing duplex scanning, the criteria for determining a 80-99% diameter reduction of the ICA is | Peak >125 cm/sec
End >140cm/sec
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| stroke or cerebrovascular accident (CVA): permanent ischemic neurological deficit | (Symptoms last more than 72 hours)
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| There are eight named branches of the external carotid artery: | the superior thyroid, ascending pharyngeal, lingual, facial, occipital, posterior auricular, and the terminal branches, the superficial temporal, and the internal maxillary artery
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| The Right ICA feeds the | right hemisphere of the brain.
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| The left ICA feeds the | left hemisphere of the brain.
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| The ICA versus ECA | The ECA has multiple branches.
The ICA has no branches in the neck.
The ICA is usually more lateral while the ECA is usually more medial.
The ICA is bulbous at it’s origin.
The ICA is usually larger in diameter than the ECA
The ICA has a low resistan
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| Vertebrobasilar or Posterior portion of the circle of Willis This portion of the circle of Willis is formed by | Vertebral arteries
Basilar artery
Posterior Cerebral arteries
Posterior Communicating arteries
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| Carotid or Anterior portion of the circle of Willis,This portion of the circle of Willis is formed by | Internal Carotid Artery
Middle Cerebral Artery
Anterior Cerebral Artery
Anterior Communicating Artery
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| Middle Cerebral Arteries (MCA) | Courses laterally towards the temporal bone
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| Anterior Cerebral Arteries (ACA | Courses medially towards the midbrain
Gives rise to the anterior communicating artery
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| Basilar Artery | Formed by the confluence of the intracranial vertebral arteries
Bifurcates into the two posterior cerebral arteries (PCA)
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| Posterior Cerebral Arteries (PCA) | Perfuse the posterior hemispheres
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| Posterior Communicating Arteries | Arise from the right and left PCAs respectively
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| Transcranial Doppler | Used to evaluate the circle of Willis
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| Three windows are used to try to pass sound waves into the brain | Transtemporal
Transorbial
Suboccipital
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| Disadvantages of indirect physiologic testing | Can be difficult to interpret in the presence of multilevel disease.
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| Normal Waveforms | Slow upstroke, rounded peak, and prolonged downslope are charcteristic of abnormal waveforms. will be triphasic
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| Abnormal waveforms distal to a stenosis or occlusion will exhibit | low velocities and have a single flow component that becomes increasingly rounded and more dampened as disease severity increases.
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| Intermittent claudication | ABI .2 to 1.0
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| The toe pressure should be | 60%- 80% of the ankle pressure
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| If the patient complains of arm pain./numbness/or weakness that is related to position, perform | Thoracic Outlet Evaluation
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| Allen Test | Evaluates the integrity of the palmar arch, radial and ulnar arteries.
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| Raynaud’s Disease, Intermittent pallor, cyanosis, and rubor | that is caused solely by digital arterial spasm.
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| Autoregulation, the body will dilate its arterial capillaries and arterioles | when there is a decrease in the oxygen level in the blood,As a response to hypercapnia(too much carbon dioxide),when there is a decrease in local supply of blood (such as ischemia due to stenosis.
When tissues become ischemic (deprived of blood flow) sub
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| Factors effecting resistance to flow- | Viscosity
Vessel Diameter(Radius)
Vessel Length
Inertial Energy Loss
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| Vessel Diameter or Radius Change has the most | dramatic effect on resistance
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| When a vessel first begins to narrow, the increase in pressure gradient has the dominant effect on the flow rate. The body tries to deliver the same amount of blood across the stenotic area that it was delivering when the artery was wide open. To accompl | the flow rate has to increase
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| Poiseuille’s Law | Defines the relationship between pressure,volume flow and resistance
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| Peripheral Resistance-Low Resistance Flow | Flow-Continuous flow feeding a dilated vascular bed. Significant flow through out diastole. Example: ICA, Renal artery, Vertebral Artery, Non-fasting SMA
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| High Resistance Flow | Flow-Flow of a pulsatile nature. Characteristic flow reversals in diastole.Example;ECA, Ao
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| Spectral broadening usually represents | turbulent flow
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| Flow separations result in regions with stagnant or little movement. | These seperations are explained by Bernoulli’s principle
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| Important features of blood flow illustrated by | Spectral Analysis
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| Spectral Broadening is caused by one of following things | Doppler gain is set too high
Doppler angle is incorrect
Sample volume size is too large
Sample volume is placed incorrectly
"Turbulent flow"
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| CW can not sample flow at a | discrete point.
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| A ratio of stenotic to prestenotic PSV greater than 2:1 indicates | hemodynamically significant stenosis.
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| A stenosis causes flow abnormality or turbulent flow immediately past | the stenosis
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| Flow accerlerates through | the stenosis
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| Post stenotic turbulence | Energy is expended as heat.
There is post stenotic turbulence- Flow quality is comprised of multiple changes in direction and spectral broadening occurs. Flow is disturbed and can even be bidirectional.
Spectral broadening is present.
Disturbed flow w
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| A diameter reduction of 50% = A cross sectional area reduction | of 75%
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| 3cm distal to the stenosis | laminar flow is usually reestablished
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| According to the Bernoulli principle Pressure is lower in an area of | high velocity such as a stenosis.
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| The lower the pressure in a hurricane, | the faster the velocity of the wind.
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