RVT ARDMS EVALUATION EXAM 2O26 QUESTIONS AND
SOLUTIONS RATED A+
✔✔May-Thurner syndrome - ✔✔Compression of left common iliac vein by the right
common iliac artery as the artery crosses over it, increases likelihood of left common
iliac deep vein thrombosis.
✔✔Paget-Schroetter syndrome - ✔✔-(Stress or effort thrombosis) thrombosis of
subclavien or axillary vein secondary to intense, repetitive activity.
-Associated with motion of upper extremity as seen with heavy lifting or strenuous
throwing of a baseball or football.
✔✔Nutcracker syndrome - ✔✔Compression of the left renal vein between the aorta and
the SMA.
✔✔Renal arteries supply what? - ✔✔Kidneys, suprarenal glands, ureters.
✔✔Landmarks for renal artery and vein? - ✔✔Left renal vein crosses the aorta
anteriorly and is superior to renal artery.
Right renal artery crosses posteriorly to IVC.
✔✔Two main categories for alternative diagnostic tests related to venous disease are? -
✔✔1. Evaluation for possible venous thrombosis or venous reflux.
2. Evaluation of a pulmonary embolism (PE).
✔✔What is a D-dimer test? - ✔✔D-dimer is a protien fragment produced when a blood
clot dissolves in the body and is normally undetectable, but it is measurable when a clot
is breaking down. With an increase of product breakdown, the level of D-dimer in blood
rises.
-high level of D-dimer suggests presence of thrombus.
✔✔Capabilities of D-dimer test? - ✔✔-measurable product of thrombolysis detected on
a quantitative blood assey.
- can rule out thromboembolism if negative. If positive, has little specificity but points out
need for additional testing to diagnose cause of hypercoagulability.
✔✔Limitations of D-dimer? - ✔✔-there are many different methods/products to detect D-
dimer in blood, causing wide variation in results obtained.
-D-dimer may be elevated with pregnancy, liver disease, renal disease, cancer, or any
thrombotic process, including recent surgery.
-lacks specificity and positive predictive value.
✔✔Two types of contrast venography (phlebography) are? - ✔✔1. Ascending
2. Descending
, ✔✔Ascending venography is? - ✔✔Image the veins from distal to proximal and detects
venous abnormalities including DVT.
✔✔Descending venography is? - ✔✔Image the veins from proximal to distal and assess
valve function and venous reflux.
✔✔Capabilities of venography? - ✔✔-helps evaluation of acute DVT.
-evaluates congenital venous disease and/or anomalies.
-assists in evaluation of chronic venous changes.
-can detect and quantify reversed flow.
✔✔Limitations of venography? - ✔✔-highly technical in technique and interpretation.
-expensive
-may be uncomfortable for patients
-can have allergic reactions in patients with severe allergies to iodine, troublesome in
patients with severe peripheral vascular occlusive disease
-exposes patients to radiation
✔✔How is ascending venography preformed? - ✔✔Requires contrast agent to be
injected into a distal superficial vein and directed into the deep system.
-lower extremity study, a vein on dorsum of foot is used.
-upper extremity study, the basilic or cephalic may be used.
-Serial x-rays are taken as contrast material passes through some of the deep veins.
✔✔How is descending venography performed? - ✔✔-evaluates lower extremity only.
-contrast agent usually injected into common femoral vein.
-Serial x-rays are taken as contrast material passes through some of the deep veins.
✔✔What is a lung ventilation/perfusion scan? - ✔✔Measures air and blood flow in the
lungs and is a screening test for detection of perfusion defects of the lungs.
-referred to as a V/Q scan or "ventilation quotient": a mathematical equation for
calculating both air and blood flow.
✔✔Capabilities of V/Q scan? - ✔✔Detects defects attributed to PE, usually originating
from DVT, that lodges in the small vessels of the lungs and prevents adequate
perfusion.
-can detect poor blood flow in pulmonary vessels.
✔✔Limitations of V/Q scan? - ✔✔Other disorders besides microembolism can cause
perfusion defects like: emphysema, asthma, pneumonia, congestive heart failure, liver
cirrhosis, radiotherapy, and postoperative phenomenon.
-patients may have an allergic reaction to the radioisotope medium.
✔✔How is a V/Q scan performed? - ✔✔-supine on table
SOLUTIONS RATED A+
✔✔May-Thurner syndrome - ✔✔Compression of left common iliac vein by the right
common iliac artery as the artery crosses over it, increases likelihood of left common
iliac deep vein thrombosis.
✔✔Paget-Schroetter syndrome - ✔✔-(Stress or effort thrombosis) thrombosis of
subclavien or axillary vein secondary to intense, repetitive activity.
-Associated with motion of upper extremity as seen with heavy lifting or strenuous
throwing of a baseball or football.
✔✔Nutcracker syndrome - ✔✔Compression of the left renal vein between the aorta and
the SMA.
✔✔Renal arteries supply what? - ✔✔Kidneys, suprarenal glands, ureters.
✔✔Landmarks for renal artery and vein? - ✔✔Left renal vein crosses the aorta
anteriorly and is superior to renal artery.
Right renal artery crosses posteriorly to IVC.
✔✔Two main categories for alternative diagnostic tests related to venous disease are? -
✔✔1. Evaluation for possible venous thrombosis or venous reflux.
2. Evaluation of a pulmonary embolism (PE).
✔✔What is a D-dimer test? - ✔✔D-dimer is a protien fragment produced when a blood
clot dissolves in the body and is normally undetectable, but it is measurable when a clot
is breaking down. With an increase of product breakdown, the level of D-dimer in blood
rises.
-high level of D-dimer suggests presence of thrombus.
✔✔Capabilities of D-dimer test? - ✔✔-measurable product of thrombolysis detected on
a quantitative blood assey.
- can rule out thromboembolism if negative. If positive, has little specificity but points out
need for additional testing to diagnose cause of hypercoagulability.
✔✔Limitations of D-dimer? - ✔✔-there are many different methods/products to detect D-
dimer in blood, causing wide variation in results obtained.
-D-dimer may be elevated with pregnancy, liver disease, renal disease, cancer, or any
thrombotic process, including recent surgery.
-lacks specificity and positive predictive value.
✔✔Two types of contrast venography (phlebography) are? - ✔✔1. Ascending
2. Descending
, ✔✔Ascending venography is? - ✔✔Image the veins from distal to proximal and detects
venous abnormalities including DVT.
✔✔Descending venography is? - ✔✔Image the veins from proximal to distal and assess
valve function and venous reflux.
✔✔Capabilities of venography? - ✔✔-helps evaluation of acute DVT.
-evaluates congenital venous disease and/or anomalies.
-assists in evaluation of chronic venous changes.
-can detect and quantify reversed flow.
✔✔Limitations of venography? - ✔✔-highly technical in technique and interpretation.
-expensive
-may be uncomfortable for patients
-can have allergic reactions in patients with severe allergies to iodine, troublesome in
patients with severe peripheral vascular occlusive disease
-exposes patients to radiation
✔✔How is ascending venography preformed? - ✔✔Requires contrast agent to be
injected into a distal superficial vein and directed into the deep system.
-lower extremity study, a vein on dorsum of foot is used.
-upper extremity study, the basilic or cephalic may be used.
-Serial x-rays are taken as contrast material passes through some of the deep veins.
✔✔How is descending venography performed? - ✔✔-evaluates lower extremity only.
-contrast agent usually injected into common femoral vein.
-Serial x-rays are taken as contrast material passes through some of the deep veins.
✔✔What is a lung ventilation/perfusion scan? - ✔✔Measures air and blood flow in the
lungs and is a screening test for detection of perfusion defects of the lungs.
-referred to as a V/Q scan or "ventilation quotient": a mathematical equation for
calculating both air and blood flow.
✔✔Capabilities of V/Q scan? - ✔✔Detects defects attributed to PE, usually originating
from DVT, that lodges in the small vessels of the lungs and prevents adequate
perfusion.
-can detect poor blood flow in pulmonary vessels.
✔✔Limitations of V/Q scan? - ✔✔Other disorders besides microembolism can cause
perfusion defects like: emphysema, asthma, pneumonia, congestive heart failure, liver
cirrhosis, radiotherapy, and postoperative phenomenon.
-patients may have an allergic reaction to the radioisotope medium.
✔✔How is a V/Q scan performed? - ✔✔-supine on table
