Vascular Board Questions

1. Name 4 Vascular Emergencies:

2. Predisposing Factors for DVT:

(Causes)

3. _____________ results in stasis of blood flow & venous dilatation. 4. _______________results in a decreased Doppler signal and

___________________ results in increase visualized flow.

5. With unilateral swelling the most common diagnosis is:

6. With unilateral swelling the least common diagnoses would be:

7. With bilateral swelling most common diagnosis is ________ & least

common diagnoses are:

8. Predisposing Factors of UE DVT:

9. Axillary & Subclavian veins are usually ____________ to arteries. 10. For subclavian artery to compress try ____________ maneuver. 11. Testicular torsion is most common in ____________ &

________________boys.

12. _______________ ________________ may occur in a normal ovary

or ovary with pre-existing ovarian cyst or __________mass. Occurs more on the __________ and there is an increased risk with pregnancy. 13.Symptoms of Ovarian Torsion:

14. Aortic _______________ is considered a vascular emergency caused

by a defect in the intima but is usually asymptomatic and caused by trauma, HTN, pregnancy & ________________Syndrome. 15. 4 types of Arterial Testing:

16. When performing PVRs, always evaluate the _______________,

________________, & ______________ of the waveform.

17. A normal PVR waveform has a ___________upstroke, &

_______________ wave.
18. Severe arterial disease shows a ____________ waveform that

eventually becomes _________.

19. Patients who are symptomatic but have normal PVRs need

____________ ____________.
20. When performing a carotid study, the head is to the ______of the

screen. 21.When performing a carotid study, with an anterior approach the ECA is at the _______ of the screen and with a posterior approach the ECA is at the ________ of the screen.

22.Clinical Indications for Carotids:

23. The thicker the _______________ ______________along the post

wall, the higher the risk for heart disease.

24. The ECA has an early diastolic notch and a ____________ in

diastole during temporal tapping. 25. If a patient has a normal PVR and is symptomatic and cannot do exercise testing, have pt. do _____ ________ for 1 min. and do post pressures. 26.If you get a high PSV and see no stenosis, other things to think of:
27. If you see lots of plaque and the PSV is not as high as youd expect,

Think of:

28. Proximal to a high-grade stenosis or occlusion, you may see a low

PSV with little or no ___________ flow representing a ___________ waveform.

29. A delayed upstroke with a rounded systolic peak distal to a high

grade stenosis/occlusion is known as __________ ___________.

30. Decreased PSVs in the CCAs bilaterally think of:

31. The CCAs & Subclavian on the right branch from the

_____________ Artery and on the left the CCAs & Subclavian branch from the ____________. 32.Increased PSVs bilaterally in the CCAs think of:

33.When you see a decreased PSV with a more pronounced flow reversal in diastole throughout CCA that worsens as you reach the distal CCA & eventually becomes a knocking waveform, think of: 34.If you see a tardus parvus waveform in the CCAs bilaterally, most likely ______________ ______________.
35. If you see tardus parvus waveform throughout RT. CCA & ICA with

reversed flow in the vert. this is most likely stenosis of _____________ _______________ & if you see the same on the lt. it is most likely stenosis of the ________________ ______________. 36.If you see a bilateral knocking waveform in CCAs and it gets worse in the ICAs, then most likely _____________ stenosis.
37. If you see a waveform that look like the ICA (low-resistant) in the

ECA then you know this is an ______________ ___________.

38. If you see reversed diastolic flow in the proximal CCAs bilaterally,

think of:
39. If you are doing a caroitid on a young patient with a stroke and no

obvious neurologic symptoms are present ad you see a bizarre, variable waveform with a decreased PSV, think of:
40. Subclavian Steal is more common on the _________ side and there

is ____________ blood pressure in that affected arm. 41.A common phenomenon following any injury to an arterial wall, including endarterectomy or angioplasty, involving proliferation of smooth muscle in response to injury is called ______________.
42. Temporary shading of the vision of one eye is called ______________

while double vision is known as ____________ and is a symptom

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of ____________________ __________________. 43.Increased PSV in the proximal subclavian with a tardus parvus in the Distal subclavian, most likely ____________ ______________. 44.If you see a sharp systolic peak with a more rounded second peak in the vertebral artery with preservance of the antegrade flow, this is known as the : _______________ waveform. 45.Arteritis of the Carotids with cocentric thickening of the wall can be caused by:

46.With Carotids we use the equation for Flow: 47.When you see a decreased PSV (30-40cm/sec) in any artery or graft, this is most likely due to a nearly ______________ vessel. 48.When you see a bisferiens waveform when doing carotids, most likely a diagnosis of:
49. If a patient present with vertebrobasilar symptoms and arm ischemia,

______________ ________________ is most suspected and most commonly occurs in the ______vert and it is larger than the _______.
50. Vertigo or bilateral ocular symptoms are related to the

____________________ system.
51. ______________ ________________on the ipsilateral side with a

pre-bunny waveform can convert an incomplete steal to a complete steal. 52.A neurologic ischemic deficit that resolves completely after 24 hours is known as:
53. A _______________ waveform in the vert. represents a 5

significant steal while a _____________ flow signal represents a complete steal. 54. Condition caused by restricted blood flow to the heart causing edema to the face & arms is referred to as: 55. ________________ _______________ is considered the Gold Standard method for evaluating disease of great vessels including subclavian steal. 56. ___________________ is the most common cause of subclavian steal. 57. Symptomatic patients with a greater than _______ % stenosis is warrant consideration for carotid endarterectomy. 58. Carotid endarterectomy or ______________ is done for pts. with Carotid stenosis or more conservatively, ________________are given to the patient. 59. Symptoms seen with ICA lesion:

60. The ____________ ____________ is the most common place for ICA stenosis. 61. Risk Factors for ICA disease:

62. Bilateral blood pressure difference of >30 mmHg in UEs suggests stenosis of >50% of _______________ or _______________ artery. 63. The proximal end of this very superficial vein is at about the level of the very distal axillary artery: 64. This artery is found just superior to the left renal vein:

65. This artery runs post. to the tibia along most of its course.(Whos buried in Grants tomb?) ________ __________ artery 66. Compression of the neurovascular bundle which may contain brachial plexus, subclavian artery & subclavian vein is called _____________ _______________ _______________. 67. When doing penile plethysmography, Doppler velocity signals are taken of the ________, ________, & _______. 68. Poor arterial inflow to ___________ _____________ due to proximal obstruction may affect penile arterial flow. 69. Congenital narrowing or stricture of the thoracic Aorta is known as ________________ of the Aorta. 70. This calf artery is found along the soleal muscular septum near the tibia: 71. The proximal limit of this vein is the popliteal vein: 72. This calf artery is found along the intersosseous membrane between the tibia and the fibula: 73. The renal arteries are __________ to the lt. renal vein. 74. A normal Penile/Brachial Index is > or equal to _________ & ________ consistent with vasculogenic incompetence. 75.Most common location of true aneurysm is _________________ _____________. 76. An increase in dorsal vein velocity could suggest a ____________ ___________. 77. PPGs are mainly used for the __________ and __________ vessels. 78. __________________ , in combination with ________________ __________________, helps differentiate between true claudication from pseudoclaudication.
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79. Large, sinusoid, saccular veins that drain into the post. tibial and peroneal veins and located deep within the calf muscles are called: 80. Plethysmography cannot differentiate b/t major ____________ and _______________ branches and tracing reflects all arterial flow beneath cuff. 81. Both volume and photo plethysmograpy are evaluated using _____________ criteria and not _________________. 82. Volume changes beneath cuff are converted to ___________ pressure changes within the air-filled cuff bladder. 83. The venous sinuses are dilated vessels in the ____________ & ___________ muscles of the calf that serve as reservoirs for venous blood. 84. _____________________ measures the change in skin blood volume using a small light probe placed on the skin just above the ankle and used measurement of the efficiency of the _________ __________ of the lower leg. (venous insufficiency) 85. PPG detects ____________ blood flow rather than truly measuring volume changes. 86. Diode transmits ____________ _____________ into subcutaneous tissue with backscattered light reflected back to the adjacent photosensor. 87. With Photo PPGs, the cutaneous blood flow determines the _______________ . Increased blood flow results in _____________ _______________. 88. With ________ _________________, as arterial flow moves under the cuff, momentary volume changes in the limb segment occur.
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89. Photo-plethysmography (PPG), uses a _____________ that consists of a light-emitting ________ and photo-sensor. 90. Ascends medially following the tibia bone and along the medial surface of the thigh: 91. With PPGs, blood attenuates __________ in proportion to its content in tissue. 92. With _________ machine performs a self-calibration when activated. 93. PPGs are used for venous reflux testing and consists of a transducer, ____________ and __________ ____________ _______________. 94. PPGs measure ____________ _____________flow while PVRs measure ____________ ___________. . 95. Abnormal waveforms on PPGs and PVRs always reflect significant disease _____________ to level of tracing . 96. PVRs look at the ___________ and ______________of waveform. 97. The more significant the disease on PVRs, the more ____________ the waveform until it eventually becomes _____________. 98. A normal PVR wavefrom displays a __________ __________ upstroke, ___________ systolic peak with _____________ wave. 99. With mild and moderate arterial disease, PVR displays an absent ______________ ____________. 100. An almost normal waveform quality may accompany abnormal segmental pressures because ____________can underestimate significance of obstruction. 101. When performing PVRs, AC mode is used for ___________ studies & DC mode is used for ___________ studies. 102. Blood flow in the body starts at the ____ __________ & ends at the
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______ _____________. 103. Expect to see Spectral Broadening at these sites:

104. Name 4 types of emergency vascular masses:

105. 2nd largest artery in the body: ______________ artery. 106. LE Arterial Duplex Criteria for 50% stenosis: 107. A Hemispheric Index of ____ and a PSV of ______ cm/sec. indicates vasospasm of the MCA. 108. ____________ ________________ ___________________is accurate for detecting changes in limb volume and is measured by the height of the water in the chimney. 109. _____________ ______________as well as the ___________ surface are measured and used for calculation of transient changes in limb volume when performing water displacement plethysmography. 110. With __________ plethysmography, cuffs applied too tightly, can obliterate or diminish the pulse wave forms. With __________ plethysmography improper contact with skin surface will cause poor results. 111. With digital plethysmography, a ____________ is placed on the plantar side of toe using double-stick tape or velcro and pulses are recorded on __________. 112. Following cold immersion, abnormal cold sensitivity is likely if the amplitude fails to return to baseline level with ___ minutes.

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114. The presence of artifactually high ankle pressures from arterial calcinosis usually requires a _________________ __________. 115. Normal UE digit Finger/brachial indices should be _____-____ Normal LE digit Toe/brachial indices should be ____-_____ 116. ________________ ______________ determines wound healing & amputation level by measuring the oxygen level of tissue beneath the skin. 117. The oxygen that escapes through the skin is measured by a sensor in an electrode affixed to a fixation ______when performing _________. 118. The electrode converts a chemical reaction to a current reading which is converted to pO2 (partial pressure of oxygen in blood) reading in ________. 119. TcPO2 readings: Healing should occur with a pO2 reading of ____-___ mmHg. Non-healing levels are ____-____ mmHG. 120. _________ are larger in diameter than _________. ____________ are more elastic & muscular. 121. Contraction or relaxation of a muscle changes the size of the lumen & controls ____________ ____________ in a vessel. 122. Organic disease is ___________ obstructive disease & Functional disease is ________________ disease. 123. A Transcranial Doppler study utilizes ____________ Doppler.
124. ______________ _____________is a characteristic seen in digit pulse

contours in patients with Raynauds phenomena. 125. Evaluate Dialysis grafts as follows:

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126. Artifact displayed as on Spectral Analysis as above & below the baseline cause by very strong reflectors, e.g. (bone), or from too much gain: 127. 2 types stents: which is self employed and which is balloon expandable?

128. A TIPS shunt in the liver is created b/t the PV & HV with the _____________ v. being the outflow end & ____________ v. being the inflow end. 129. Other causes than DVT for leg swelling: (6)

130. 3 types of AV Fistulas:

131. ______________ means cause by trauma, medical exam (post

biopsy) or treatment.
132. Straight grafts include Brachial artery to: (3)

133. ______________ grafts can be used immediately after implantation

whereas ______________ grafts take 3-4 wks, to mature before you can use it. 134. U-Shaped synthetic grafts are established as loops from _____________ artery at elbow to ____________ or _______________ veins.
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135. Theraputic grafts are used for:

136. An AV fistula is a direct communication b/t an artery and vein that bypasses the ______________ bed.
137. Under-estimation of disease process may include:

138. Suitable volume for hemodialysis fistulas is _____-______ml. min. 139.

Factors that may produced flow other than stenosis:

140.

A Brescia-Cimino graft is the connection of the ______________ _________ to the _____________ _____________. ____________ and its mean flow velocity by using equation:

141. Shunt flow is determined by the ____________of the feeding

142. ________________ _______________artifact and _____________

__________________ are common artifacts in shunts/fistulas.

143. Feeding artery of dialysis graft has _____________flow with a

large ______________ component.

144. The draining vein of a dialysis graft displays an ______________

profile with pronounced _______________. . 145. In a dialysis graft, if arterial flow is _______ cm/sec, there is a > 75% diameter reduction. 146. _______________ is a sign of reduced shunt flow.
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147. Vasospastic disorder occurring in women approx 20-50 and is brought on by emotional stress and cold weather and causes cyclic color changes in the hand/digits is called _________________ ________________. 148. Excessive shunt flow, >1200 ml/min. can lead to ___________ _______________ causing ______________ in the hand digits. 149. Stenosis in a graft predominantly develops in the _____________ anastamotic area or along the access __________.

150. If stenosis is excluded in a graft and there is inadequate flow, look for ___________ _______________that reduce fistula flow rate and need to be ligated surgically. 151. Stenosis/Obstruction or compression of venous outflow, monophasic flow becomes _____________ , ______ -resistant with loss of ______________ component. 152. Direct criteria for shunt stenosis:

153. The Allen test is used to detect patency of the radial artery for

use as a _____________ artery bypass graft. 154. We do ultrasound of fistulas/graft to determine ______ _______ and look for complications such as: 155. Inverse damping factor should always be close to _____ for each segment of the limb and if less than significant disease is present. 156. Use a ________ PRF for high velocities in fistula and a lower gain
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to prevent ___________artifacts. 157. Most perforating veins are found in the __________ __________ aspect of the leg.
158.

Hemodynamic complications of excessive fistula flow, over 1600 ml/min. are: an increased risk of ____________ _______________ or _____________ _______________(ischemia dst. to shunt.) The most accurate method for determining the shunt volume is to calculate the difference of flow rates of feeding artery____________ and ______________ of the shunt which is the same as before _________________ & after _____________. Most common sites of stenosis in a hemodialysis access graft? Retrograde arterial flow is often observed in the native artery at the distal anastamosis of a __________ graft. Successful bypass grafts include: (HINT:GOD)

159.

160. 161. 162.

163.

7 types of LE bypass grafts:

164.

Low PSV obtained in access graft could indicate _____________ ________________ problems. A ___________ _______________ is a typical graft puncture complication that develops as a result of blood escaping into a subcutaneous hollow space. A __________ aneurysm, especially common after infection, is a type of false aneurysm that appears on US as a perivascular space with pulsatile flow.

165.

166.

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167.

The _____ vertebral is usually smaller than the _____ . Occurs only with LE in-situ bypass grafts: An almost completed thrombosed graft will have reduced, ______________ waveform with a ______ PSV presented on US as a ____________ waveform. 170. Caused by a fracture of the penis where fibrous tissue develops under the skin causing curvature of the penis is called: 171. A ____________ ___________ consists of rectus abdominus muscle, sub-q fat, arteries, perforators & overlying skin & is used for breast reconstruction. 172. 4 Complications that can occur after an angiographic procedure: 173. Cerebrovascular collaterals:

168.

169.

174. A ______________ occurs when veins of the pampiniform plexus

become extremely enlarged.

175. A normal Penile/Brachial Index (PBI) is between _____-______ and

______ is considered abnormal.

176. After full erection is achieved, ____________ velocities should

decrease significantly & sometimes even reverses in direction.

177. ________________ have the highest resistance in the Circulatory

system. 178. In the arterial system, total blood flow may be normal in an extremity at rest, even when there is a significant stenosis or
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occlusion of a vessel, due to ______________.

179. __________________ causes arterioles to be _______-resistant &

_____________ at rest.
180. The Pulsatility Index should be > ____in a healthy blood vessel.

181. Name the 4 main visceral arterial branches:

182. The celicac artery branches:

183. The SMA supplies:

184. The celiac supplies: (HINT: Pan lives splendid stomachs duo)

185. What branches form the palmar arch? (RSD: UDS)

Radial artery teminates into the ___________ Palmar arch Ulnar artery terminates into the ___________ Palmar arch
186. What branches form the plantar arch?

187. The dorsalis pedis artery originates from the ___________

___________ artery.
188. The deep and lateral plantar artery arise from the ____________

____________ artery. 189. Calf artery medial to the fibula?

190. The EIA travels along the medial side of the __________ _________

muscle.

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191. The ___________ ____________ are tiny vessels that carry blood to

the walls of the larger arteries. 192. A contralateral pathway in the Circle of Willis is retrograde flow in the ECA along branches of the _______________ artery. 193. The ___________ ____________ arteries & veins are paired and anterior to the tibia. 194. The _________ ___________ arteries & veins are paired and post. to the tibia. 195. Pseudo-claudication mimics vascular symptoms and is usually _____________ or ____________ in origin. 196. If bilateral buttock pain then most likely there is ______-________ disease but if unilateral then iliac artery occlusive disease. 197. If calf pain only then most likely there is _______________occlusive disease. 198. If there is thigh disease then most likely there is __________&/or ____________ occlusive disease. 199. With Primary Raynauds disease, ___________ digital ischemia occurs due to digital arterial spasm brought on by emotional stress, exposure to cold or other factors. (vasospasm) 200. Secondary Raynauds suggested to be the 1st manisfestation of _____________ disease and happens when the normal vasoconstrictive responses of the arterioles are superimposed on an already _________ arterial obstruction. 201. The waveform qualities of PPGs help to distinguish between _______________ and ____________ claudication.
202. Vasospastic disorders are considered _____________ while arterial

obstruction is considered ________________.

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203. 3 major risk factors of Atherosclerotic disease: Other Factors:

204. A ___________ aneurysm is diffuse circumferential dilatation whereas a ___________ aneurysm is a localized outpouching. 205. Name 3 Collagen Vascular diseases: 206. 4 places that can be auscultated with a stethoscope:

207. _________ is paleness (white) _________ is redness _________ is bluish 208. The analog Doppler is easily affected by ________and is less _____________ than spectral analysis. 209. Arteries that carry low resistant blood flow are those that provide blood to a _____________ dilated arterial vascular bed. 210. The thickest layer of the wall of the veins is the tunica __________. 211. As blood travels from the aorta to the capillaries _______________ increases. 212. Difference b/t the systolic and diastolic pressures is known as the ___________ pressure. 213. The tunica media contains concentric layers of ____________ _____________. 214. As depth of respiration increases, venous return ____________.

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215. As heart rate decreases, diastolic pressure will ___________. 216. _______ % of the blood volume is contained within the veins. 217._________________ is not a red blood cell disease. 218. A hemispheric stroke is usually affects the ______________ ______________ artery and the ______________ side of the body. 219. Veins carry _________________ blood back to the heart. 220. As resistance of blood flow through the artery increases, the pressure drop across the artery will ___________. 221. The vessel ____________ is the principal determinant of resistance. 222. When performing a preoperative scan of the radial artery for a CABG, another test must be performed: 223. The flow rate within vessel in is affected by 3 things: (Same as factors affecting blood flow within the body) 224. Fluid along the tube is proportional to the: 225. When there is a ___________ ____________ along the length of an artery, there is a corresponding loss of energy. 226. There is more energy lost when the vessel is ____________, ____________ is higher and blood is more ____________. 227. Flow rate is proportional to the ____________ ____________. 228. Flow characteristics of pulsatile flow reveal a sharp rise in velocity during systole which is the ____________ phase and a decrease in velocity during diastole which is the ____________ phase.

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229. Upon inspiration, the diaphragm descends causing an UE veins to ____________ and LE veins to ___________. 230. The end point of venous flow is at the _______ __________. 231. _________ walls have more collagen fibers than ___________. 232. ____________control oxygen to the legs and _________control the rate of blood return back to the heart thereby regulating cardiac output. 233. ____________increases when either flow or resistance increases. (THINK OF A HOSE) 234. In the vascular system, an increase in volume results from an increase in ___________ ______________. 235. When collateral blood flow develops resistance at the level will ________________.
236. When a patient with a stenotic lesion is exercised, the pressure

gradient at the site of a stenosis will _____________.

237. Total volume of blood in the circulatory system, of an average

person, is ____________.
238. ________________ is the most common complication of

catheterization or iatrogenic trauma to a vessel. Other complications include:

239. Leg pain upon elevation is intermittent ____________claudication

and pain when legs are dependent because of blood pooling at ankles is ____________claudication. 240. Name some symptoms of PVD:

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241. Venous ulcers are a result of high blood pressure in the veins of

your legs caused by ____________ _________________.

242. With ____________ insufficiency you must NEVER elevate the

legs or use compression hose as you would with ___________ insuffiency.

243. An artery with a larger pulse wave amplitude means that it has a

____________ ____________ peak.

244. A pulse with a rapid upstroke, rapid downstroke, high amplitude

and short duration is known as a ____________ __________ pulse and seen with aortic incompetence.
245. ____________ulcers form between the toes and outer ankles while

venous ulcers occur above the ankle on the side of the leg or shin.
246. Almost always there will be ____________ with venous ulcers and

is usually the 1st thing you will find. (HINT: why legs must be elevated).
247. _______________ ulcers are much deeper and irregular than

_______________ulcers which makes them more severe.

248. Venous ulcers ________ while arterial ulcers cause little

_____________.
249. An ____________ pulse is prolonged with a low amplitude and

prolonged duration usually seen in aortic stenosis.

250. ____________means twice beating meaning that this phase of the

arterial pressure pulse should have a 2nd smaller wave or notch.

251. _________ ____________ is a pulse with two peaks where

upstroke is sharp and rises high to the 1st peak, falls again & rises to a 2nd peak.
252. Heat causes _____________ of vessels and cold & stress causes

________________ of vessels. (THINK: Raynauds)

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253. Risk factors for AAA:

254. Arteries used for a TRAM flap for breast reconstruction are:
255. Portal vein is formed by the __________ vein & ________ .

256. _____________ ________________ is caused by an increased

impedance of flow through the liver.

257

A measurement of > ________ mm of the portal vein diameter with _____________ flow indicates portal hypertension.

258. When evaluating liver for portal hypertension, you must also evaluate the ________ for obstruction and the hepatic veins for ____________ _____________syndrome. 259. Stenosis or obstruction of hepatic veins may be caused by: (HINT: HAS) 260. When performing the Allen test for palmar arch if flow reverses after radial artery compression then it is a(n) ____________arch, if flow does not reverse after compression then a(n) ____________ arch. 261. _______________ US is performed to direct hepatic resection in an avascular plane during donor hepatectomy. 262. Injuries unique to balloon angioplasty/stenting include: ____________ ________________ & _________________.

263. MCA lesions affect the ________ while ACA lesions affect the
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___________. 264. A stenosis that reduces the vessel ____________ by 50% is equivalent to a 75% ____________ reduction. 265. The Adson maneuver is performed for assessment of ____________ _____________ _________________. 266. When evaluating a bypass graft an abnormal flow pattern is from ______________ to _________________. 267. ________________ _______________is known as the pulseless disease of the aorta and its branch arteries & also affects the CCA & subclavian arteries. 268. If intraluminal pressure exceeds tissue pressure then vein _______ . 269. Transmural pressure is the difference between ____________ & _____________ pressure. 270. An indirect sign of severe significant transplant renal artery stenosis displaying a delayed increase of systolic signal is called a ________ sign. 271. A renal transplant ultrasound cannot exclude ____________ . 272. Most common complication post biopsy is : ______________. 273. After renal transplantation normal flow is ______________ if biphasic then there is __________________. 274. When evaluating bypass grafts, compare results with previous studies & observe for changes such as: reduced _________ in smallest graft diameter that were previously higher decrease of ______ cm/sec in any graft segment decrease in ABI of ________. 275. Intraoperative monitoring of grafts is done to check patency of
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________________ sites, __________ __________ sites, & any suspicious stenotic or ______________ areas. 276. In a _____________ vein bypass graft branches are ligated. 277. The Doppler Equation: Df =

278. Propagation speed in equation above (in soft tissue) is _____m/s. 279. In reversed LE vein bypass graft velocity will be higher ______________ because vein is reversed and small end is ____________. 280. In an _______________ LE bypass graft, valves are broken up and branches are ligated. 281. _____________ ______________ is the predominant underlying factor that leads to chronic venous insufficiency. 282. ____________ is currently the GOLD STANDARD for diagnosis of aortic dissection. 283. If you see a tardus parvus waveform in the distal vert., then there is stenosis where: 284. Other branches of ECA:

285. When standing, normal venous pressure in the deep veins in the legs is ___ mmHg and ____ mmHg in the superficial veins. 286. First branch of ECA is ___________ ______________ artery. 287.Name the different types of ICA plaque:
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288. _________________ plaque has the highest potential for embolism in the ICA while ______________ plaque has the lowest potential. 289. With increasing arterial disease, the waveform loses ____________ & ______________wave. 290. Aortic ______________ is considered a vascular emergency caused by a defect in the intima but is usually asymptomatic and caused by trauma, HTN, pregnancy & _____________ Syndrome. 291. Evaluate Dialysis grafts as follows:

292. Rule of thumb; open sample volume gate _____ the size of the vessel. 293. Thrombangitis obliterans is also known as __________ Disease. 294. Retrograde flow in rt. vertebral usually indicates ___________ artery obstruction. 295. Retrograde flow in left vertebral artery usually indicates ________ obstruction. 296. Subclavian steal is more common in the _________ (larger) vertebral. 297. With subclavian steal, there is a ____-____ mmHg difference in BP and the side with the _________BP is the affected side. 298. When significant disease is present in proximal subclavian or brachiocephalic artery, blood must course up the contralateral
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__________ cross the ____________ artery, cross down ____________of affected side to ______________ to perfuse arm. 299. With subclavian steal you will see _____________ flow in ipsilateral vert. & _____ resistance in contralateral vert.
300. In a partial steal you will see _____________ flow that can be

converted to a ____________ steal by having patient exercise hand or placing a blood pressure cuff on arm for few minutes and releasing.
301. With severe CCA disease, flow not only in vert. may reverse but

also in ___________artery.
302. _____________ _____________ _______________is caused by an

extra rib in thorax or scalene muscles causing extrinsic compression on distal subclavian or proximal axillary arteries.
303. Testing for TOS consists of recording waveform in ___________

_____________. 304. in different positions using these maneuvers: (military position) (arms out, palms up) (hand on lap, 90 or 120 degrees)
305. The ______________ artery is imagined for TOS in the

supraclavicular & infraclavicular positions and flow velocities recorded.

306. With vertebral disease, tardus parvus is consistent with proximal

vert. artery obstruction and an resistance seen with distal _____________or ____________ obstruction. .
307. Peripheral artery aneurysm _______ usually requires surgery. 308. Thickest layer of the walls of veins is the tunica __________

308. As blood flows from the aorta to the capillaries, its velocity of
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flow will ____________. 309. Surgical procedures for PVD:

310. Risk factors for DVT:

311. 3 things associated with Virchows Triad:

312. The tunica _________ is composed of concentric layers of smooth muscle. 313. The tunic _________ is composed of endothelial cells. 314. The tunica _____________ is composed of collagenous & elastic fibers. 315. Network of mnute (my nute) blood vessels that perfuse tissues is called ___________ ______________. 317. An exchange of nutrients & waste products b/t blood & cells of tissue takes place in the __________________. . 318. _______________ account for of the total resistance to blood flow. 319. Blood Pressure ~ __________ ___________ 320. _____________ ____________ demonstrates that a change in diameter of a blood vessel affects resistance the most.

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321. When collaterals develop gradually, there is _______ resistance across the region of stenosis. 322. Resistance to flow across the __________stenosis or occlusion will be higher than resistance to flow across a ___________stenosis or occlusion. 323. The vessel ____________ is the most principal determinant to control resistance. 324. _______________ _______________is the principal factor for determining arterial blood pressure. 325. Resistance in the blood vessels is affected by three parameters:

326. _______________ ______________ describes the relationship between pressure & velocity. 327. The volume of blood moving through a given area in a given time is the ____________ ___________. 328. Also called the fibular artery: _____________ artery. 329. The proximal limit of the ___________ artery is the thoracic outlet. 330. The ____________ artery originates at the insertion of the teres major muscle in the proximal arm. 331. The ___________ artery is medial to the fibula. 332. The _________begins at the inguinal ligament and the ________ ends at the inguinal ligament. 333. The ________ is just superior to the left renal vein. 334. Calf artery found along the intersosseous membrane between the tibia & fibula is the ___________ ____________artery.

29

335. First 3 main branches off the aortic arch:

336. A _________ aneurysm involves all 3 layers of the wall of an artery while __________________ does not primarily involve such distortion of the vessel. 337. _________ __________ is proportional to the 4th power of the vessel radius. 338. ______ (________________ _______________ ____________) is a procedure done by passing a balloon catheter into a vessel and inflated pressing outward against vessel walls to relieve arterial stenosis. 339. Prominent _____________ ____________post renal transplant usually indicates acute renal failure. 340. ___________ flow in the iliac artery post renal transplant is normal. 341. _________ is an important cause of hypertension in transplant patients. 342. An acute emergency post renal transplantation is acute __________ ______________. 343. You will see __________ flow in a pt. with acute venous thrombosis post renal transplantation. 344. A PSV of > _______ cm/s in the renal artery post transplant indicates a >50% stenosis. 345. If the transplant is from a live donor there is no _______ patch. 346. A RAR (renal artery ratio) of _______ indicates RAS. 347. An acceleration time of ______in renal artery is considered normal. 348. Upon reaching renal hilum, main renal artery branches into
30

_____________ arteries which in turn give rise to the____________ arteries. 349. The interlobar arteries branch into the _____________arteries at the cortico-medullary junction. 350. ______________ arteries course alongside the renal pyramids toward periphery of kidney while the _________arteries travel across the top of the renal pyramids. 351. When scanning longitudinally, the head is always to the ______ of the screen & when transverse, head is to _______ of screen. 352. _________________ results from inadequate blood supply to the muscles. 353. Diagnostic Criteria for stenosis of LEs:

354. Re= q stands for _________n stands for _________ 355. 2 types of Autologous vein grafts:

356. _______________ skin discoloration occurs with venous disease. 357. In an autologous vein graft, a change in flow from ____________to ______________ and a change in the shape of the high resistant waveform signals impending failure or occlusion.

358. Occlusions in post-op bypass grafts are caused by: Immediate:

31

Within 1st year: Later: 359. In an in-situ graft, there is a possibility of non-ligated side branches being left in which leaves a risk of an ______ ________ forming. (because they can communicate with the deep system). 360. ____________ _____________ ______________, also known as milk leg, and common in pregnant women due to compression of the iliofemoral v. 361. Main complication of endovascular intervention, following trauma, or vascular surgery is development of a(n) __________________. 367.The ___________ ___________represents the interruption of smooth flow due to the brief backflow of blood that closes the aortic semilunar valve. 363. Tests to diagnose venous incomptetence:

364. Klippel-Trenaunay-Weber Syndrome is congenital absence or artresia of _________ ____________. 365. __________ _____________ ______________is when the lt. common iliac vein courses posterior to rt. CIA. 366. Most severe form of limb thrombosis (DVT), usually in the upper leg, caused by occlusion of the major and collateral veins and is known as blue leg is called ____________ ____________ ______________. . 367. Plegmasia _________ dolens comes before plegmasia ___________ dolens. 368. Plegmasia alba dolens is distinguished clinically from plegmasia alba dolens in that there is no ___________with alba ___________.
32

369. If no spontaneous flow, & only augmented flow, at CFV, FV or pop v, obstruction at or _________ to site you are evaluating. 370. If no augmented flow with distal compression, obstruction at site you are evaluating or more _____________. 371. _________________ is a non-invase test used to diagnose venous insufficiency. 372. ___________ __________uses transducer that transmits, receives, and quantitates light. 373. Analog Doppler is displayed on a strip chart recorder that incorporates a ___________ __________ _____________. 374. With increasing proximal stenosis of the lower extremity the ___________ _____________ component is lost. 375. The medial malleolus to mid calf is known as the ___________ ___________. 376. Cardiac output, radius & resistance all have a directly proportional relationship with ____________ _____________. 377. With renal transplant rejection, you might see ___________ areas in the parenchyma. 378. A renal transplant is preferred more on the rt. than the left due to the __________ renal vein. 379. With renal transplantation, often with ___________donors a Carrell patch (small portion of surrounding aorta), is acquired and anastamosed to the ___________ _________ artery. 380. Post renal transplant fluid collections may contain ________, __________, ____________ or __________. (HINT: plub) 381. __________ ____________ ____________ occurs in the immediate post renal transplant period as a result of ischemia and more
33

commonly seen in

____________ transplants.

382. Signs & Symptoms of IVC obstruction: (HINT:HAP)

Most severe: 383. The normal response of a vein below the point of obstruction will be ___________, but above the obstruction the vein should remain _____________ in diameter. 384. An IVC filter is made of nickel ___________(nitinol). 385. With deep inspiration, venous blood flow ___________ and the IVC ___________. 386. When performing PVRs, the 4-cuff method is better at differentiating _________ disease from __________ artery disease. 387. The most common cause of IVC obstruction is ________- _______ heart failure. 388. Bad plaque is _______________ & ______________.
389. Normal Transcutaneous Oximetery readings are between ___-___

mmHg and non-healing is ____-_____ mmHg. 390. When performing a Valsalva maneuver, venous return is blocked & flow temporarily ___________ in the IVC causing it to _________. 391. Sonographically, an enlarged renal vein is ________ cm. 392. ____________ ____________ is the transient increase in organ blood flow that occurs following a brief period of ischemia.

34

393. The ability of most vascular beds to maintain a constant level of blood flow over a wide range of perfusion pressures is known as __________________. 394. In genereal, the ability of an organ to display ____________ ______________ , is similar to its ability to display autoregulation.
395. Hyperemia occurs during the period of ____________& tissue

hypoxia (no oxygen to tissues) dilates arterioles (causing vasodilation) and ____________ vascular resistance.
396. After reactive hyperemia, when perfusion pressure is restored

(occlusion released), flow becomes __________ because of the reduced vascular resistance. ( resistance = blood flow).
397. In Portal HTN, there is isolated ________ involvement.

398. When does an AV malformation occur?

399. Reactive hyperemia produces _____________and _______________ distal to the occluding cuffs. 400. A normal toe-brachial-index falls between _____-______ Significant disease: __________ Normal finger indexes are ____-_____
401. Symptoms seen with an ICA lesion: (HINT: U- PAPA?)

Symptoms are_____________.

402. Post exercise ABIs should ____ abnormal if ___.

403. Bad plaque is _____________ & ______________. 404. Only eye symptom associated with ICA disease is ___________
35

_____________. 405. ________ lesions affect the arms and _______ lesions affect the legs.
406. Symptoms seen in MCA lesion: (HINT: BAD CHAF)

407. Symptoms with ACA lesion: (HINT: MIL)

408. Symptoms seen with a PCA lesion: (HINT: DC)

409. Resistance is proportional to ____________ and inversely proportional

to __________.
410. Blood volume is proportional to ___________ ____________,

therefore, hemorrhage causes a _ in blood volume so blood pressure _

411. _____________ _______________states velocity & pressure are

inversely proportional so therefore as velocity pressure .

412. ______________ _____________is ptosis (drooping) of the upper

eyelid with sinking in of the orbit & constriction of the pupil. 413. A normal TcPo2 reading is ____-____ mmHg and non-healing levels are ____-____ mmHg. 414. _________ _________ velocities should not increase post paparavine injection in penis for vasculogenic impotence.
415. A PSV of _____ cm/sec & a RAR of > ____indicates a RAS of

>60% .

36

416. Posterior circulation consists of the _________ & _________. 417. Diameter of cavernous arteries should _________ post-injection. 418. ___________ __________ velocities should not increase post paparavine injection in penis for vasculogenic impotence.
419. If dorsal vein velocities increase post injection, indicates

___________ ____________. 420. Endarterectomy vein patches are susceptible to __________ while prosthetic patches are susceptible to ____________. 421. Diagnostic test that overestimates stenosis: 422. __________ is most frequently used in cerebrovascular disease. 423. _____________ ________________to monitor the MCA during cerbrovacular & cardiovascular surgeries. 424. The MCA is _____-_____ mm deep. 425. When doing TCDs. what angle of insonation is used? 426. TCDs: transtemporal window used for :. 427. TCDs: transorbital window used for: 428. TCDs: transforaminal (transoccipital) window used for: 429. What vessels exhibit antegrade flow in the brain?

430. What vessels exhibit retrograde flow in the brain?

37

431. ____________ pressure is the maximum amount of pressure exerted by the blood against the artery walls. 432. __________ ________________is a technique that allows the measurement of limb volume changes with different maneuvers. 433. ____________ pressure is the result of ventricular relaxation and _____________ pressure is the result of ventricular contraction. 434. __________ pressure is the difference between systolic & diastolic pressure. 435. 2 limb-threatening colors associated with venous disease: _____________ & _____________. 436. These tests are used to diagnosis venous insufficiency by ________________ venous reflux. 437. PPGs ________ ________ w/light emitting diode & photo sensor _________ transmits infrared light into tissue _________ coupling (AC or DC) APGs ____________ transducer measures limb volume changes _________ strip chart recorder

438. With PPGs, increased blood flow results in ____________ reflection. 439. _________ cannot be calibrated volumetrically like _________. 440. _______ coupling detects fast changes in blood content & is used for arterial studies. 441. With PPGs, the normal VRT is _______ sec. without tourniquet. 442. If VRT is _______ sec. it means that it is filling too quick because the
38

valves are not working. 443. A VRT of < 20 sec. without tourniquet signifies ________________ system incompetence. 444. A VRT of < 20 sec. with & without tourniquet signifies _________ system incompetence. 445. The strip chart runs at a slow speed of ___ mm/sec. and uses _______ sensitive paper. 446. The Asymptomatic Carotid Atheroscleosis Study determined that the therapeutic benefit of endarterectomy in symptomatic patients with > ___ % diameter reduction of the ICA. 447. Diagnostic Interpretation of APGs consist of using 3 things:

448. ____________ ______________ is considered to be the gold standard for evaluation of acute & chronic DVT & other venous anomalies. 449. 2 types of Contrast Venography: ___________: for DVT & other venous anomalies ___________ : to quantify reversed flow from incompetent venous valves.
450. For ________________ venography, contrast media is injected into

the dorsum of foot. 451. For ________________ venography, contrast media is injected into the CFV. 452. Pharmacologic (anticoagulant) treatment for DVT: 453. Surgical & Endovascular treatment for DVT:
39

454. For chronic venous insufficiency, a vein ____________of incompent perforators is performed or ____________ reconstruction. 455. Varicose vein treatment:

456. ________________ is the ability of a test to identify normalcy. 457. _________________ is the ability of a test to detect disease. 458. ______________ tells how good a test is. 459. ____________ _______________ __________ tells how often negative study is correct. 460. ____________ ____________ ____________tells how often a positive study is correct. 461. Specifity: _________________________ 462. Sensitivity: _______________________ 463. Approach for inserting TIPS is into the Rt. IJV to IVC to ______ ___________ vein. 464. In a TIPS shunt, the ___________ vein is the outflow end & the __________ vein is the inflow end. 465. AB.
40

CHINT: TF (Tommy Fallon) 466. Accuracy 467. Sensitivity = _______ ______

D. FT (Fallon, Tommy)

468. Normal flow through a TIP should not have a PSV of higher than _______ cm/sec. 469. An Inverse Damping Factor should be close to _____for each segment of the limb & the Pulsatility Index should be > ___ in a healthy vessel 470. In LEs during Resting blood vessel is _____________ & should exhibit ___________ flow and after exercise blood vessel is ________________ and should exhibit ___________ flow. 471. Normal toe pressures are between ____-____and < ____ indicates significant occlusive disease. 472. Fistulas/Grafts: PSV > _____cm/sec = > __% stenosis PSV > _____cm/sec = > __% stenosis 473. Sensitivity & Specifity are ___________. 474. Pos. Predictive Value & Neg. Predictive Value are ____________. 475. With Analog Doppler, the vertical axis (y) represents __________ while the horizontal axis represents (x) ________. 476. Limitations of Analog Doppler:

477. Spectral Analysis uses _______ method & makes it possible to display individual frequencies.

41

478. Spectral Analysis displays information related to the __________ of a spectrum with a narrow spectrum for _________ flow and spectral broadening for ___________ flow with wide range of frequencies. 479. Most common variant of the Circle of Willis is a ______________ _______. 480. A PI of >5.0 and an Inverse Damping Factor of ____ indicates a healthy vessel. 481. Gastrocnemius vein drains into the ____________ vein. 482. The GSV drains into the ___________ v. & the LSV drains into the ___________ v. 483. The GSV is _________ and the LSV is ________ in the leg. 484. When doing ABIs/PVRs, the 1st sign of abnormality is absence of the ___________ ___________. 485. Distal to more significant occlusions, the slope of both the ascending & descending segments of the trace ___________ and ___________ of the systolic peak is noted. As obstruction increases, waveforms become ___________. . 486. When there is stenosis in the LEs, ___________ can help form collaterals. 487. Treatment options for LE arterial disease: 488. Nonlateralizing and less specific carotid symptoms:

489. Long term consequences of varicose veins: (HINT: PUBE)

42

490. The most important diagnostic criteria during duplex examination of the lower extremity arterial system is: 491. The normal Doppler spectral arterial waveform of the lower arterial system does not include a _________ notch. 492. Utrasound compression therapy of a pseudoaneuryms usually requires ____-____ minutes to be successful. 493. Surveillance programs of lower extremity bypass graft will benefit by beginning it within ________ after the operation. 494. What is the best benefit of using arterial duplex imaging to evaluate the arterial stenosis of the lower extremity? 495. Digit plethysmography differentiates fixed arterial obstruction from ______________. 496. __________________is done to measure gas volume changes in the lungs and to determine if there is pulmonary artery obstruction. 497. ____________ pressure is the lowest pressure in the artery. 498. __________ flow is caused by the friction (resistance) between the blood & the vessel walls. 499. _________________ is the process by which organs & tissues of the body self-regulate blood delivery. 500. The exchange of materials (nutrients) between tissue cells & the blood take place in the ______________ . 501. A false negative ABI result can be due to 2 things? 502. Pts. with moderate disease of the _________ __________ or _________ artery may have normal arterial circulation at rest but
43

when exercised demonstrate a decrease in ankle pressures. 503. A normal PVR waveform exhibits a ________upstroke, ________ downstroke and prominent __________ ____________. 504. With increasing severity of PAD, the waveforms become more _____________ and virtually absent waveforms. 505. A treadmill exercise test following PVRs requires walking at a speed of __mph, at a ___% incline at a max of ___ minutes. 506. A >50% stenosis in the lower extremities will show a _________ (>_____ %) of PSV compared to the proximal segment & reduced systolic velocity _________ to the stenosis.
507. The tunic adventita (outermost layer) of a vein is composed of

_____________ tissue.
508. The tunica media (middle layer) of a vein is made of ___________

muscle. 509. The tunica intima (innermost layer) is made up of __________ cells.
509. The ___________ ____________ vein has its own hidden fascial

compartment in the thigh and exits the fascia only near the knee. 511. __________ are also called capacitance vessels. 512. The ___________ veins are the ones affected by varicosities. 513. Varicose vein symptoms: (HINT: HALTS)

514. Lifestyle Causes of varicose veins: (anything that puts pressure one the LEs from the abdomen down):

44

515. _________ are known as blood reservoirs. 516. If ________ return decreases, heart will not be able to pump blood. 517. The ____ turns into the femoral artery from the groin. 518. The _____ divides into the medial & lateral plantar arteries & the _____ branches into the DPA. 519. When evaluating bypass grafts, if the ratio of the PSV within a stenotic segment relative to the normal segment proximal to a stenosis is >2, this suggests a ___%- ___% diameter reduction & EDV >____cm/s suggests a >75% stenosis. 520. The Gold Standard for carotids is _________ ____________. 521. Surveillance of bypass grafts should be done within 7 days of formation, then again in __ _________, then at __ -month intervals. 522. The development of a stenosis on a graft surveillance study should prompt consideration of _______________. 523. Complications of arteriography include:

524. The tunica __________ smooth surface decreases its resistance to blood flow. 525. ______ supplies distal half of large intestine. 526. ______ supplies most of small intestine.

45

527. _________ join to form the IVC. 528. The splenic vein supplies what 3 organs?

529. A ___________waveform is displayed in a well-functioning in-situ bypass graft. 530. Pseudoaneurysms are commonly found involving the _____. . 531. A normal, well-functioning synthetic bypass graft displays a ____________ waveform (no 3rd forward component-just the 1st 2 of a triphasic waveform on a picture) or __________ waveform. 532. A ________( ______) graft is currently the graft of choice for femoro-popliteal bypass grafts. 533. A _________ _________ s a small piece of vein that is used to patch or expand a biologic graft in an area of anatomic narrowing or at the site of a focal stenosis. 534. The GSV drains into the _________ vein & the LSV drains into the __________ vein. 535. The most common cause of CCA/ICA disease is ____________ & the 2 most common symptoms are: _________ & _____________. (whichever one is an answer on the boards) 536. ICA divides into the _______ & _______. . 537. The systemic arterial pressure waveform results from the ejection of blood from the ________ ___________ into the aorta during systole. 538. ___________ artery occlusive disease is the most commonly treated of the great vessel lesions with __________ ___________ artery occlusive disease the least encountered.

46

539. ____________ _____________ is the 2nd most encountered great vessel occlusive disease in the U.S. 540. Lateralizing symptoms of carotid artery disease: (3)

541. Non-lateralizing symptoms of carotid artery disease:

542. Subclavian (or innominate) artery occlusive disease symptoms:

543. Inverted champagne bottle refers to what disease? 544. ____________ ____________ will help to reduce the risk of further ulcers from venous insufficiency. 545. The presence of ____________ venous reflux represents a significant factor in the development of venous reflux disease in the GSV. 546. The _________ areas in the leg are the areas where skin changes & venous stasis ulcers are more likely to occur. 547. Perforator veins & their locations: (3)

548. Lateral calf perforators called the ____________perforators connect the LSVs to the _________ veins & are also called Bassis veins. 549. Clinical indications for Mesenteric Arterial Duplex: (5)
47

550. Clinical indications for Venous Duplex of UEs & Les: (8)

551. Clinical indications for Renal Duplex US: (5)

552. Clincal indications for Peripheral Arterial Study:

553. _________ ________ perforating veins are commonly associated severe chronic venous insufficiency (ulcerations) 554. __________________ is a non-invasive test used to diagnose pulmonary artery obstruction. 555. _____ ___________ & _____________ _____________ noninvasive tests are particularly important in performing in pts. with falsely elevated ABIs due to calcified vessels. 556. Clinical Indications for performing Arterial Plethysmography rather than Duplex Doppler examination: (3)

557. Normal toe pressures are ___ mmHg and < ___ mmHg it is unlikely that the ulcer will heal.
48

558. If patient has an ankle pressure < ____ mmHG it is unlikely that the foot/ankle ulcer will heal. 559. If there is a _____ difference b/t indices compared to previous study this indicates significant change. 560. On PVR studies, the ________ of the wave is more reliable than the _________ of the wave. 561. Tests for lower extremity PAD & GOLD STANDARD ( Italics)(7)

562. Tests for Carotid Artery Disease & GOLD STANDARD (Italics)(5)

563. For possible pseudoclaudication ______ with ________ is done. 564. Tests for AAA & GOLD STANDARD (in Italics) (4)

565. Tests for Cerbrovascular disease & GOLD STANDARD(Italics)(2)

566. Tests for Venous Insufficiency & GOLD STANDARD (Italics) (4)

567. Tests for DVT & GOLD STANDARD (in Italics) (5)

49

568. 2nd largest vein in the body is the : _________ 569. With venous Plethysmography normal venous filling times should be _____ sec. 570. With Arterial Plethysmography, cuffs are inflated to ____mmHg. 571. With Venous Plethysmography, the effects of ____________ on venous volume are evaluated. 572. __________ of changes during respirations with Venous Plethysmography testing indicates thrombotic occlusion. 573. _____________ _______________ is used for the diagnosis of valvular incompetence & varicose veins. 574. The number of venous valves ___________ in the veins from proximal to distal. 575. APG measurements includes: (HINT: REV)

576. ____________ _______________means corresponding veins

which are paired, deep veins of the calf that follow their corresponding arteries. 577. Major part of calf muscle pump & drains blood into the PTV & peroneal veins are called the _________ ___________.
578. Empties the lateral hand & forearm: ________ veins 579. Formed by the digital veins: __________ vein.

580. _____________ venous _____________ is the most common form

of venous disease.
581. Veins without valves: 50

582. _________-____________ ___________is stress effort thrombosis

& involves the axillary or subclavian vein.

583. With _______ syndrome flow to the UE remains the same during

inspiration (remains continuous).

584. ____________ __________is RBCs arranged like rolls or coins&

moving very sluggish very likely meaning an outflow problem. 585. Phasic, bi-directional (pulsatile) Doppler signals are seen in these abdominal veins: (HINT: HIR)

586. If there is no augmentation with proximal release, consider a more _____________ obstruction.
587. Ascites related to __________ ___________ syndrome is caused by

occluded or thrombosed ____________ veins.

588. ______________ plaque can cause a TIA which is considered a

vascular emergency. 589. Resistance is proportional to _________ and inversely proportional to __________. 590. The _______ turns immediately to course parallel to the Aorta. 591. The proximal limit of the ______ artery is at the adductor hiatus. 592. Symptoms frequently seen with vertebrobasilar lesion:

51

593. __________ _________ velocities should not increase post paparavine injection in penis for vasculogenic impotence. 594. Penile plethysmography is performed to determine whether impotence is related to ___________ ____________ ___________. 595.Doppler velocities are obtained of the _______, _______, & ______ to calculate penile-brachial index. 596. The __________ arteries supply the skin of the penis and the glans. 597. ABI ratio: _____________ _____________. 598. Any drop in pressure after exercise testing indicates _____________ ____________ __________. 599. Low ABI pressures before and after exercise testing are _________. 600. Post exercising ABIs for single level & multi-level disease: Single level Disease takes ___-___ min. to increase back to resting state & Multi-level Disease takes ___-___ min. to increase back to resting state. 601. If Reactive Hyperemia done instead of exercise testing with ABIs, Single level disease shows _____drop in ankle pressures Multi-level disease shows _____ drop in ankle pressures 602. When performing TCDs, diagnosis of vasospasm is most accurate in the _____ and occlusion is most accurate in the ____& ______. 603. Severe vasospasm in the MCA is indicated with a PSV of ____cm/s 604. 4 causes of impotence in men:

52

605. LE Arterial Duplex Criteria for Stenosis:

606. An analog display employs a _______ _________ ____________ ____________ to display signals graphically on a strip chart recorder.
607. The rt. & lt. innominate veins unite to form the:

608. If overall graft velocity is < ____ cm/sec, signifies impending graft failure. 609. When comparing ABI indices to a previous study, if _____ then this indicates a significant change. 610. _______________of PVR waveform is a less reliable indicator of vascular disease than the ________ of the wave. 611. Hemodialysis access can be performed through either a __________ graft or surgically created _______ and can be ___________ or _____________. 612. A __________graft matures quicker than an ______ graft and has fewer initial complications, however, once an _______ graft matures, lasts longer. 612. Graft failure < 1month is usually due to_____________complications and >1month most commonly occurs secondary to progressive stenosis from _____________ ________________. 613. Treatment for stenosis in a graft or AVF:

614. Indications for graft failure:

53

615. Also known as the pulseless disease: ____________ disease 616. A ___________ _ __________ __________ helps control respiration by sensing changes in oxygen tension of blood. 617. A reasonable guideline is that a ___-___ increase in graft velocities suggests a 50% stenosis and a ___-___ fold increase suggests a >75% stenosis. 618. Graft Complications:

619. Normal dialysis graft waveforms in the supplying arteries are , and ______-resistant with PSVs from __________cm/sec and EDVs of _____ - _____ cm/sec. 620. The draining veins in a graft have arterial pulsations with PSVs of ______ - ______ cm/sec. 621. With PTFE grafts, stenosis and subsequent thrombosis usually occur at the _____________ anastomosis site. 622. ___________ ___________ is defined as retrograde flow in the native artery distal to the graft anastomosis. 623. Posterior circulation of the brain is mainly supplied by the Rt. & Lt. ______ via the ____________ artery and the anterior circulation is fed by the _________. 624. Thrombangitis obliterans is caused by inflammation of the arteries and always starts in the __________ or ____________vessels & proceeds centrally and prevents collaterals from forming. 625. Occurs from increased pressure in the calf due to DVT, hemorrhage,
54

or serous fluid not allowing the fascia to expand: _______________ _________________. 626. ________ overestimates stenosis & _________ has risk of stroke. 627. Anterior Circulation in the brain consist of : ________, _________, & __________ while the __________, ____________, & ___________ involves the Posterior Circulation of the brain. 628. Clinically, shunts are recognized by a ____________ ____________ and a more or less persistent high frequency ________ throughout the cardiac cycle. 629. In a graft/fistula, normal flow is _____________ in the feeding artery and the draining vein shows an arterialized flow pattern with pronounced ______________. 630. Determination of flow rate in the ____________ ____________ has been found to be the most reliable measure for estimating the fistula flow rate. 631. The volume flow rate is calculated from the _________ velocity & the __________________ ______________of the vessel. 632. The fistula flow rate is determined by comparing the value measured in the feeding artery with the _______ _______ artery on the contralateral side or by subtracting the blood flow in the artery the blood flow in the artery ___________ to the shunt. 633. Clinical Indication for Hemodialysis Graft/Fistula Exam: (HINT: 5 Ps & LI)

634. The ___________ _____________ vein continues up the thigh as the Giacomini vein & terminates into the mid/dst SFV. 635. A frequent complication of AAA aneurysm is _____________ & a
55

frequequent complication of peripheral artery aneurysm is distal _______________. 636. When doing PVRs the __ cuff method is more accurate. 637. When doing PVRs, the width of cuff should be ___ % greater then diameter of limb. 638. When doing PVRs, with 3-cuff technique, the high thigh pressure should be __________ to the highest brachial pressure & the 4-cuff technique pressure should be _____________to the highest brachial pressure. 639. ______________ testing is better than ____________ ___________ testing in that it helps to differentiate between true & pseudo claudication. 640. The _______________ ______________ is based on the fact that the arterial obstruction prox. to the Doppler probe results in a slowing of the time between the onset of systole & the point of max. systolic peak. 641. The _______ & ________helps differentiate inflow from outflow disease. 642. ____________ PPG waveforms & __________ ___________testing is done on pts., who present with cold sensitivity of fingers, for vasospastic disease. 643. ______________ obstructive disease has abnormal tracings while ______________obstructive disease has normal Doppler, pressures, PPG tracings. 644. __________________ helps differentiate true claudication from neurogenic (false) claudication and also locate the level of obstruction. 645. ______________________ does not actually record flow volume changes rather it detects cutaneous blood flow.

56

646. When taking simultaneous blood pressures at 4 different sites, this must involve a ______________ cuff on the same extremity. 647. When collateral vessels are present and ___________________ is used alone, the degree of obstructive disease may be underestimated. 648. An _________________ _____________is a device that can monitor a signal distal to a pressure cuff in order to obtain a pressure reading. 649. Name 4 such devices:

650. Limitations of Plethysmography (air or photo):

651. A slower than normal upslope culminating in a sharp anacrotic notch is seen in patients with _______________ disease. 652. The 2 main capabilities of TcP02 are to determine whether healing can occur at a ___________ ____________ or _________________ ______________. 653. The unique step for setting up TcP02 test is ______________ _______________. 654. 2 most common sites for stenosis in a Dialysis graft are: 655. Sites above are so vulnerable to stenosis due to the introduction of increased ____________ pressure into the ___________ _______. 656. ________ can occur due to placement of a hemodialysis graft due to increased venous return to the heart. (The closer the access to the heart the access graft, the higher the likelihood). 657. When comparing 2 VEIN bypass graft studies, you must check to see
57

if flow in any graft segment has decreased by ___ cm/sec or if the ABIs have decreased more than _______. 658. Intraoperative monitoring during a LE vein graft is very useful in order to check patency of _______________ sites & evaluate suspicious _____________ or turbulent areas. 659. Indirect criteria for dialysis shunt stenosis are ____________ flow in the feeding artery & a decrease in shunt flow to <_____ ml/min. 660. RAR for >60% stenosis: 661. With proximal high grade stenosis or occlusion, the distal Doppler signal does not change its resistance, just its ____________. 662. The 2 main criteria used to determine whether resistance has in the kidney &/or renal artery are the: 663. Most common complications after liver transplantation: (4)

664. The number 2 in the Doppler equation represents that RBC is 1st an ____________ of a stationary US field then it acts as a ___________ source when wave scatter from its surface. 665. Other conditions that can cause Renal Artery Resistance other than after Renal transplantation: 666. The Superior Epigastric artery branches off the ____________ _____________ artery & the Inferior Epigastric artery branches off ______________ ______________ artery. 667. The ____________ ___________ is where the Superior Epigastric & Inferior Epigastric artery anastamose. 668. 4 arteries that are preoperatively mapped using Duplex Doppler:
58

669. Blue Toe Syndrome is caused by: (4 things) (HINT: 4 As)

670. 3 veins often mapped for bypass grafts:

59

60