Deck 29: Vascular Technology

Question 1

Which is NOT a characteristic of a normal peripheral artery Doppler spectral waveform?

A) Narrow systolic Doppler spectral bandwidth
B) Reversed diastolic flow
C) Systolic window
D) Blunted systolic peak

Answer 1

D
The Doppler spectral waveform from a normal peripheral artery exhibits rapid systolic upstroke, sharp systolic peak, rapid deceleration to a reverse flow component and, most often, forward diastolic flow.

Question 2

Which statement is NOT true?

A) The resistance to blood flow in the small tibial arteries should be greater than that in the aorta.
B) Normally, at rest no significant pressure gradient is seen between the aorta and the distal tibial arteries.
C) With normal arterial wall compliance, the Doppler spectral waveform from the peripheral arteries of the extremities should be triphasic.
D) During systole and left ventricular contraction, the arterial pulse pressure wave is transmitted through the aorta and into the high-resistance peripheral arterial bed.

Answer 2

B
Resistance to blood flow in the small-diameter tibial arteries is greater than in the wide-diameter aorta. This results in a pressure gradient between the aorta and the tibial arteries. At rest, ankle pressures normally are equal to or slightly higher than the systemic pressure. All other statements are accurate with respect to the high-resistance peripheral arterial system.

Question 3

Which statement best differentiates indirect noninvasive vascular test procedures from direct noninvasive vascular procedures?

A) Indirect test procedures provide morphologic information that allows evaluation of the severity of a lesion.
B) Indirect test procedures are physiologic and indicate the presence of significant occlusive disease by demonstrating pressure or limb volume changes downstream from the site of the lesion, whereas direct procedures evaluate the disease at the site where it is located
C) Indirect test procedures use continuous wave Doppler as well as plethysmographic testing.
D) Indirect test procedures detect lesions that are not yet hemodynamically significant, whereas direct test procedures give information only on disease that is flow reducing.

Answer 3

B
Indirect noninvasive test procedures demonstrate the functional effects of flow-reducing lesions distal to the site of the obstruction. They are nonimaging modalities based on changes in segmental pressures and the volume of blood in the tissues that result from significant hemodynamic stenosis (greater than 50% to 60% diameter reduction) or occlusion. They cannot demonstrate lesions that are not severe enough to cause a pressure-flow gradient. They define the segment of the limb where arterial blockage is present. In contrast, direct test procedures (duplex and CW Doppler) are able to define the precise location of disease, quantify its hemodynamic significance, and describe the morphology of the lesion based on its acoustic properties.

Question 4

Which of the following is NOT a branch of the internal carotid artery?

A) Middle cerebral artery
B) Posterior cerebral artery
C) Anterior cerebral artery
D) Ophthalmic artery

Question 5

The common carotid artery supplies approximately ____ of the blood flow to the internal carotid artery.

A) 50%
B) 80%
C) 60%
D) 40%

Question 6

Which change is NOT normally found in Doppler spectral waveforms from elderly patients?

A) Loss of the reverse diastolic flow component
B) A reduction in the peak diastolic forward velocity
C) A decrease in the peak systolic velocity
D) A decrease in vessel wall elasticity

Question 7

Which statement does NOT accurately define the left common iliac artery?

A) The vessel lies posterior to the ureter and anterior to the peritoneum.
B) The left common iliac vein is posterior to the artery.
C) The psoas magnus muscle borders the artery laterally.
D) The vessel is the first segment of the peripheral arterial tree distal to the aorta.

Question 8

Which is NOT part of the deep venous system of the lower extremities?

A) Perforator vein
B) Profunda femoris vein
C) Femoral vein
D) Anterior tibial vein

Question 9

Which vessel is NOT part of the cerebrovascular system?

A) Common carotid artery
B) Vertebral artery
C) Internal carotid artery
D) Internal iliac artery

Question 10

The Doppler spectral waveform from the normal common carotid artery is characterized by all of the following except

A) rapid systolic deceleration.
B) systolic window.
C) spectral broadening.
D) constant forward diastolic flow.

Question 11

Which is NOT a component of the Doppler equation?

A) Doppler peak diastolic frequency
B) Angle of the Doppler beam with respect to the path of blood flow
C) Speed of sound in soft tissue
D) Velocity of blood flow

Question 12

Indirect vascular laboratory evaluations are best defined as

A) B-mode imaging combined with Doppler velocity spectral analysis.
B) physiologic test procedures that demonstrate pressure and/or volume changes in vessels distal to the location of the disease.
C) tests that examine blood vessels at the site of the disease.
D) duplex evaluations that examine the velocity spectral patterns distal to the location of the disease.

Question 13

Which statement is incorrect?

A) Venous flow from the legs is under the control of the calf muscle pump.
B) During exercise, venous pressure at foot level exceeds 40 mm Hg.
C) The direction of venous flow normally is from the superficial venous system to the deep venous system.
D) Veins can withstand tremendous volume change with little change in transmural pressure because of the small amount of elastin found in the venous wall.

Question 14

Which statement is NOT true about the vertebral arteries?

A) They arise as the first branch of the subclavian arteries.
B) They course toward the brain by passing through the upper four cervical vertebrae.
C) They pass superior to the atlas, wind around the lateral mass of the atlas, and enter the vertebral canal superior to the spinal cord.
D) They enter the skull through the foramen magnum to form the basilar artery, which supplies the structures in the posterior fossa.

Question 15

In a normal abdominal aorta, the peak systolic velocity averages ____cm/sec; in the popliteal artery, an average peak systolic velocity of _____cm/sec normally is found.

A) 60/80
B) 80/50
C) 100/50
D) 90/60

Question 16

Which of the following is NOT an element of the Doppler equation?

A) Carrier Doppler frequency
B) Angle of insonation with respect to the path of blood flow
C) Constant for the speed of sound in blood
D) Velocity of red cell movement

Question 17

Which is NOT part of the femoral-popliteal arterial system?

A) Internal iliac artery
B) Profunda femoris artery
C) Popliteal artery
D) Common femoral artery

Question 18

Which statement best describes boundary layer separation in the carotid bulb?

A) Flow moves forward on the wall opposite the flow divide between the internal and external carotid arteries.
B) Both forward and reverse flow patterns are present as a result of dilatation of the carotid bulb and the presence of a pressure-flow gradient on the posterolateral wall of the bulb.
C) Forward flow is seen on the wall opposite the flow divide, whereas reverse flow is seen on the anterolateral wall of the bulb.
D) Disordered flow patterns are seen in the carotid bulb as a result of thickening of the arterial intima.

Question 19

The Doppler spectral waveform from the low-resistance internal carotid artery can be characterized by

A) high peak systolic velocity and low diastolic flow.
B) rapid systolic upstroke and rapid deceleration to low diastolic flow.
C) slow systolic rise time, rapid deceleration, flow reversal in late systole, and low diastolic flow.
D) cephalad flow throughout the cardiac cycle.

Question 20

Which statement is NOT true about the anterior tibial artery?

A) Proximally, it lies close to the inner side of the neck of the fibula.
B) It lies on the fibula and anterior ligament of the ankle join in the lower third of the leg.
C) It becomes the dorsalis pedis artery distal to the ankle joint.
D) It is almost always accompanied by two anterior tibial veins.

Question 21

Which statement is NOT true about the peripheral veins?

A) They can undergo remarkable volume changes with little change in transmural pressure.
B) The percentage of smooth muscle found in the walls of veins varies with their location.
C) The venous wall is only half as thick as the arterial wall and is composed primarily of elastin fibers.
D) The venous pressure in the feet of an exercising adult usually is less than 25 mm Hg.

Question 22

Which is NOT part of the circle of Willis?

A) Posterior cerebral artery
B) Anterior communicating artery
C) Middle cerebral artery
D) Anterior cerebral artery

Question 23

Which is NOT considered a normal Doppler spectral flow pattern found in the peripheral venous system?

A) Spontaneous flow
B) Respirophascity
C) Antegrade flow
D) Pulsatility

Question 24

In the absence of peripheral arterial occlusive disease, the systolic pressure is greater in the tibial arteries than in the abdominal aorta. ____

Question 25

Which of the following is NOT one of the four segments of the internal carotid artery?

A) Petrous segment
B) Cavernous segment
C) Cerebral segment
D) Clinoid segment

Question 26

The transcranial approach is commonly chosen for interrogation of the ophthalmic artery. ____

Question 27

Intracranial arteries are identified during a noninvasive vascular examination based on all the following factors except

A) pulsatility.
B) peak systolic velocity.
C) depth.
D) flow direction.

Question 28

The goal of the vascular diagnostic laboratory is to answer the following questions using an array of indirect and direct noninvasive evaluations: Is vascular disease present? Where is it located? How severe is the disease process? What are the therapeutic options? Has revascularization been successful? ____

Question 29

Duplication commonly is associated with all these veins except the

A) popliteal vein.
B) common iliac vein.
C) greater saphenous vein.
D) femoral vein.

Question 30

The internal carotid artery supplies the high-resistance vascular beds of the brain and eye. ____