1
Q
What happens to the size of veins as they anastomose towards the IVC?
A
Become larger
2
Q
What are the superficial vs deep veins of the upper extremities?
A
Superficial: cephalic and basilic
Deep: subclavian, axillary, brachial, radial, ulnar
3
Q
What side is the radial & ulnar vessels on in relation to the hand?
A
Radial = thumb side
Ulnar = pinkie side
4
Q
Which vein of the upper extremity is the last stop before reaching the internal jugular vein?
A
Subclavian
5
Q
The cephalic vein is more ______, while the basilic vein is more ______.
A
anterior; medial
6
Q
What is the sonographic appearance of a thrombus?
A
Gelatinous with mixed echogenicities
7
Q
What are the 3 causes of blood clots? What is this called?
A
Virchow’s triad; hyper coagulability, venous stasis, and vein wall trauma
8
Q
What are some physical causes of blood clot formation?
A
Long car trips/airplane rides, bedridden s/p surgery or illness, being elderly
9
Q
What is venous insufficiency caused by?
A
Incompetent valves leading to bidirectional flow of blood
10
Q
How is venous insufficiency diagnosed on waveform?
A
Ask patient to valsalva and if there is forward flow above baseline after, that is reflux and abnormal
11
Q
What are the effects of venous insufficiency?
A
- Varicose veins
- Decreased venous return
- Venous hypertension (increased. pressure in legs)
- Edema
- Skin staining and ulceration
12
Q
In a partially occluded vein, what waveform can we expect?
A
Steady and continuous
13
Q
What occurs in right-sided heart failure?
A
It enlarges due to accumulation of fluid and eventually causes severe tricuspid valve regurgitation
14
Q
What is the domino effect of right-sided heart failure?
A
Blood eventually backs up into the vena cava, then hepatic veins, and affects the portal venous system
15
Q
What is tricuspid regurgitation associated with?
A
Hepatic congestion and pulsatile flow in the portal vein
16
Q
At which point does the aorta become the abdominal aorta?
A
After passing the diaphragm
17
Q
What are the first 4 branches of the abdominal aorta? How are they positioned?
A
- celiac trunk (gives rise to hepatic artery, splenic artery, and left gastric artery) - anterior
- SMA - anterior
- Renal arteries - lateral
- IMA - anteriolateral
18
Q
What are the 3 kinds of aortic aneurysms?
A
- Saccular (outpouch)
- Fusiform (full dilation)
- Dissecting (flap formed due to space between arterial wall layers)
19
Q
Where are abdominal aneurysms the most common?
A
The infrarenal segment
20
Q
What is plaque localization in the aorta caused by?
A
Low flow velocity, leading to clot formation
21
Q
What are AAAs representative of?
A
A degenerative process, oftentimes attributed to atherosclerosis
22
Q
What are the repercussions of an aortic thrombus?
A
It can travel anywhere in the body, resulting in a stroke, heart attack, or kidney failure (along with overall organ death)
23
Q
What are risk factors for DVT?
A
Smoking tobacco products, medications (estrogen/OCP), obesity, recent surgery, lack of movement
24
Q
A blood clot may produce significant effects to the patient when it involves all of the following areas EXCEPT:
a. brain
b. lungs
c. superficial vein
d. heart
A
c. superficial vein
25
What are the symptoms of DVT?
Unilateral swelling, erythema, pain with standing
26
A blood clot that breaks loose and travels through the bloodstream is an...
embolism
27
Most significant blood clots form in what kind of vessels?
deep veins
28
True or false: the body is able to lyse small blood clots on its own.
True
29
The term "lyse" means to...
breakdown
30
Venous valves are composed of how many leaflets?
2
31
The purpose of the valves in both deep and superficial veins is to do what?
Keep blood flowing in a one-way direction toward the heart
32
If the vessel dilates and the valve leaflets cannot touch, the valve is...
incompetent
33
Incompetent valves can lead to all of the following EXCEPT:
a. leg swelling
b. leg pain
c. stroke
d. ulcers
c. stroke
34
Which of the following veins are essential and cannot be improved by removing them?
deep veins
35
When blood pools in the leg due to venous insufficiency and causes an increase in venous pressure, this is termed:
venous hypertension
36
Severe tricuspid valve regurgitation can lead to which of the following?
a. portal triad congestion
b. compression of the common bile duct
c. hepatic congestion
d. increased flow in the renal arteries
c. hepatic congestion
37
Valves in the deep veins of the leg that are incompetent (leak) may lead to...
stasis ulcers
38
Incompetent (leaky) valves demonstrate what kind of flow in color Doppler ultrasound?
both forward then backward flow
39
What is the most likely cause of a pulsatile portal vein?
severe tricuspid valve regurgitation
40
What does fluid responsiveness measure? Why?
The size and respiratory collapse of the IVC to identify patients with suspected hypovolemia at risk for circulatory failure
41
What is the approximate measurement of the IVC?
1.7cm
42
What is the position of the IVC in relation to the hepatic veins?
1cm distal to the hepatic veins
43
What is the normal collapsibility of the IVC upon heavy inspiration?
by 50%
44
In a patient with volume depletion secondary to dehydration, the IVC may measure less than...
1.2 cm
45
Increasing the contractility of the heart will pump more blood out, which increases ______ ________.
cardiac output
46
The term "hypovolemia" means....
below fluid volume
47
What accommodates or describes fluid expansion?
Infusion of fluid or blood
48
What is "spontaneous respiration"?
normal breathing
49
What does an inotropic agent do?
Increases the contractility of the heart
50
A tumor in the IVC would demonstrate a _______ in flow.
decrease
51
The SMA courses ________ to the intestines.
Inferiorly
52
The abdominal aorta should first be observed in which plane?
Short axis
53
Both the IVC and aorta can be visualized in the short axis. On which side of the body do they lie?
IVC to the right of midline and AO to the left of midline
54
The aorta can be distinguished from the IVC by all of the following EXCEPT:
a. pulsatility
b. color flow
c. depth in tissue
d. spectral waveform
c. depth in tissue
55
What are the distal branches of the aorta?
Iliac arteries
56
How are aneurysms measured?
From outer wall to outer wall
57
What is a landmark to identify the aorta + IVC?
Spine
58
What best describes an aneurysm?
Abnormal dilation caused by weakening of the vessel wall
59
All of the following are risk factors for aneurysms EXCEPT:
a. atherosclerosis
b. hypotension
c. infection
d. heredity
b. hypotension
60
What best describes a fusiform aneurysm?
circumferential dilation
61
What is the most common approach to measuring the aneurysm?
short axis
61
You are asked to scan the SMA. At which time would you normally find a low resistance wave form in the SMA?
After a meal / post-prandial
62
One would evaluate the aorta for all of the following types of aneurysms EXCEPT:
a. berry aneurysms
b. fusiform aneurysms
c. saccular aneurysms
d. dissecting aneurysms
a. berry aneurysms
63
If the color map is set with red above the baseline and blue below the baseline, then flow in a vessel that appears red is flowing...
toward the transducer
64
The normal waveform of the aorta is...
high resistance with clean spectral window
65
What renal vessel is anterior to the Aorta and posterior to the IVC and can be confused with the crus of the diaphragm?
right renal artery
66
The Resistive Index (RI) is often calculated when assessing the renal arteries. The measurement is a ratio of the...
peak systole and end disatole
67
An aortic thrombus can break off and cause all of the following EXCEPT:
a. stroke
b. heart attack
c. hemorrhage
d. kidney failure
c. hemorrhage
68
In a sagittal image of the IVC, which vessel can be seen anteriorly?
the portal vein
69
Congestive heart failure may lead to all of the following EXCEPT:
a. ascites
b. peripheral edema
c. venous stenosis
d. renal failure
c. venous stenosis
70
All of the following are direct branches off of the aorta EXCEPT:
a. superior mesenteric artery
b. left gastric artery
c. right renal artery
d. left renal artery
b. left gastric artery
71
The splenic vein is ______ to the SMA.
anterior
72
Which term refers to reversed flow in the portal vein?
hepatofugal
73
Which term describes blood flowing toward the liver?
hepatopedal
74
What sonographic appearance will be found when scanning the IVC of an adequately hydrated patient?
normal in size and varies with respiration
75
Varicoceles tend to occurs in young men in their ____ and _____ decade of life.
second and third
76
Varicoceles may cause what kind of symptoms?
Pain, atrophy, and/or fertility issues
77
Blood flows to the testicles via the aorta through a network of tiny vessels called the
pampiniform plexus
78
How does blood return back to the heart from the testicles?
pampiniform plexus ---> renal vein ---> IVC ---> right atrium
79
What causes a varicocele?
Incompetent valves in veins
80
Why could a varicocele cause infertility?
The enlargement of tiny veins can increase the heat within the scrotum
81
What is the sonographic appearance of varicoceles?
many anechoic structures measuring more than 2mm
82
Where are varicoceles commonly seen?
near the head of the epididymis
83
What can we ask the patient to do when evaluating for a varicocele with color Doppler?
Valsalva
84
The lobes of the thyroid gland are connected by...
the isthmus
85
Characteristic sonographic findings of torsion include all of the following EXCEPT?
a. enlargement of the testis
b. hypoechoic parenchyma
c. hyperechoic parenchyma
d. hydrocele
c. hyperechoic parenchyma
86
A 15-year-old boy presents with sudden intense right scrotal pain, nausea and vomiting. A sonogram is performed, and an enlarged hypoechoic right scrotum with decreased arterial flow is documented. The left scrotum is normal.This is most consistent with...
torsion
87
The testicular artery is a branch from the...
aorta
88
The left testicular vein drains into the...
left renal vein
89
The thyroid gland consists of how many lobes?
2
90
The role of Doppler ultrasound in the prostate is to...
identify a mass
91
Why would there be negative numbers on the velocity scale?
due to inverting the velocity scale
92
The prostate anatomy is divided into...
zones
93
The umbilical vessels are the ....
circulatory connection between mother and fetus
94
Before birth, the fetus receives. oxygen and. nutrients via the umbilical ______.
veins
95
Waste products / CO2 will travel back into the mothers circulatory system via the umbilical _______.
arteries
96
The typical umbilical cord consists of
2 arteries 1 vein
97
Where do the umbilical vessels connect?
to the placenta and fetal umbilicus on the anterior abdominal wall of the fetus
98
The umbilical artery should have what kind of waveform?
Forward flow in systole and diastole
99
What is the first step in assessing the umbilical artery?
Locate the umbilical cord where there are no other fetal body parts
100
Ectopic pregnancy is defined as...
a pregnancy outside of the uterus
101
Ectopic pregnancy most commonly occurs in the...
fallopian tube
102
Infection of the fallopian tubes is known as...
salpingitis
103
Symptoms associated with ectopic pregnancy include all of the following EXCEPT:
a. abnormal vaginal bleeding
b. pain in low back
c. fainting
d. amenorrhea
c. fainting
104
When an ectopic pregnancy ruptures, you will most likely see...
free fluid in the pelvis
105
Doppler ultrasound showing peripheral hypervascularity surrounding the extrauterine gestational sac is known as...
the ring of fire
106
In the luteal phase of the menstrual cycle, Doppler of the ovary will show...
increase in flow
107
Doppler evaluation of which of the following pregnancies would have the highest diastolic flow?
a. 12-week pregnancy
b. 35-week pregnancy
c. 19-week pregnancy
d. 26-week pregnancy
b. 35-week pregnancy
108
With each trimester, blood flow within the uterine arteries becomes more...
low resistance
109
If the blood velocity and beam/flow angle being measured combine to give a value greater than half of the PRF, you will exprience...
aliasing
110
The lateral border used to help locate the ovary is...
iliac artery
111
A hemorrhagic ovarian cyst is a finding that can mimic the
ring of fire sign as found with ectopic pregnancy
112
What is the definition of hemodynamics?
study of blood moving through the circulatory system
113
When discussing or measuring "flow", AKA "volume flow rate", one would most likely be measuring what and using which units of measure?
a. discussing the number of blood cells passing through a vessel wall and using a concrete number such as 320
b. discussing the amount of blood flow and using a volume unit such as liter
c. discussing the amount of blood flow over a specified period of time and using a volume unit such as liter divided by a unit of time such as minute
d. discussing the speed of blood flow over an hour and using an area unit such as centimeter squared and a time unit such as hour
c. discussing the amount of blood flow over a specified period of time and using a volume unit such as liter divided by a unit of time such as minute
114
Which heart valves are open during diastole?
Mitral and tricuspid valves
115
What characteristics do the CCA and ICA have in common?
constant forward flow in diastole
116
Compare pre and post-prandial waveforms.
Pre: high resistance
Post: low resistance
117
Which vessels are perpendicular (90 degrees) to to the arcuate arteries?
Interlobar
118
What is one of the most common causes of painless scrotal swelling?
Hydrocele
119
How do the ovaries appear in sagittal vs transverse views?
sag: ovular
trv: circular
120
How to measure ovarian volume:
L x W x H x 2.5
121
Which arteries supply the uterus?
Ovarian and uterine (gonadal)
122
Eventually, the. uterine and ovarian arteries...
anastomose
123
What are the main branches of the internal iliac arteries?
uterine arteries
124
In the proliferative stage of the menstrual cycle, how will the endo stripe appear sonographically?
thick and hyperechoic
125
Which arteries carry blood to the periphery of the myometrium?
arcuate arteries
126
Compare uterine artery waveform from non-gravid to gravid women.
non-gravid: high resistance
gravid: over time becomes more low resistant
127
What are the landmarks of the thyroid?
CCA and jugular; both are lateral to the lobes
trachea; posterior to the thyroid
128
Where does the descending aorta provide blood to?
The chest wall, abdominal organs, pelvic organs, lower extremities, spinal cord
129
Which vessels provide blood to the brain?
ICA and vertebral arteries
130
What is the Resistive Index (RI)?
peak systolic velocity - end-diastolic velocity) / peak systolic velocity
higher RI = higher resistance to blood flow
lower RI = lower resistance to blood flow
131
What is the pulsitility index (PI)?
(peak systolic velocity - end-diastolic velocity) / mean velocity
higher PI = higher resistance to blood flow
lower PI = lower resistance to blood flow
US Physics
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