VASCULAR ARDMS BOARDS 2023 with 100% correct questions and answers

What's the first major arterial branch of the aorta is the? Innominate artery or brachiocephalic artery The vertebral artery usually arises from the: Subclavian Artery The incidence of new strokes per year is: from 500,000 to 700,000 A TIA of the right anterior hemisphere of the brain will likely affect: The left side of the body - affects the side of the body opposite that of the ischemic hemisphere Amaurosis Fugax related to an internal carotid lesion will cause: Temporary blindness or shadowing of the ipsilateral eye. affects same side since thromboembolic activity from ulcerated ipsilateral carotid atheroma is suspected A transient ischemic attack: Resolves within 24 hours. TIA often last just a few minutes Simultaneous bilateral ocular symptoms in the patient with suspected cerebrovascular disease generally originate form: The vertebrobasilar arteries . usually originate in the posterior circulation , as the visual cortex is in the occipital lobe. The specific binocular symptom of homonymous hemianopia results from obstruction of a middle cerebral artery branch, not the vertebrobasilar system What are symptoms when vertebrobasilar circulation is effected? Vertigo, dizziness, ataxia, or other bilateral or global symptoms . What are symptoms when anterior circulation is effected? Facial Asymmetry, unilateral What accurately defines RIND also called stroke with recovery? A neurologic ischemic deficit that resolves completely after 24 hours. Describes an intracranial ischemic event that does not resolve within 24 hours but thereafter completely resolves. A 56- year old patient reports loss of vision in her left eye two days ago, with total resolution in 10 minutes. Yesterday morning she developed weakness and numbness in her right hand and was unable to hold her coffee cup. This afternoon her hand strength is about 90% normal, with normal sensation. Clinically she has: Stroke because it has persisted longer than 24 hours and has not resolved completely The infraorbital artery is a terminal branch of the: Maxillary Artery . It creates one of the potential anastomoses with orbital branches that can provide collateral pathways in the even of carotid obstruction Amaurosis Fugax can be interpreted as a: Transient Ischemic Attack of the eye. Dysphagia is : Difficulty swallowing. Symptom associated with vertebrobasilar insufficiency. A binocular disturbance that disrupts vision in half the visual field of both eyes is called: Homonymous Hemianopia Paresthesia refers to: tingling sensation A patient describes a 30-minute episode of garbled speech. This is called: Dysphasia . Aphasia is widely used as well but technically this is incorrect, since it means "absence of speech." A right-handed patient experiences a 30-minute episode of dysphasia. Which area of circulation is suspect? Left hemisphere . The speech area of the cortex is in the temporal lobe of the dominant hemisphere What is true regarding subclavian steal? It is usually a harmless hemodynamic phenomenon. It is caused by arterial obstruction proximal to the origin of the vertebral artery. This creates an abnormal pressure gradient that pulls or "steals" flow from the vertebral artery to perfuse the ipsilateral upper extremity. Subclavian steal occurs: more often on left side . A hemispheric stroke usually affects: The middle cerebral artery distribution and the contralateral side of the body Stenosis of the following vessel presents the highest risk for a TIA: Internal Carotid Artery The vertebral arteries branch from the subclavian arteries to unite and form the: Basilar Artery . This system is called the vertebrobasilar system and is responsible for the circulation to the posterior portion of the brain . A decreased pulse at mid neck is suggestive of: Common Carotid stenosis if the contralateral pulse is normal. Sometimes the right neck pulse can feel reduced because of the larger muscles overlying the carotid. Occasionally the right neck feels stronger due to tortuosity of the common carotid Artery. What are bruits caused by? Turbulent flow. Presence of a bruit is significant, since there is turbulent flow for some reason. The absence of a bruit does not rule out stenosis; severe stenosis may not cause a bruit. Bruits heard bilaterally, loudest low in the neck, are most likely caused by: Aortic Valve Stenosis. Aortic murmurs radiate distally, frequently into the low carotids. A stronger pulse is palpated in the right neck than on the left. This could result from all the following except: Innominate occlusion which would be expected to make the right carotid pulse weaker, not stronger. What is true regarding the clinical detection of a bruit? It means that turbulent flow exists. It may be indicative of valvular dysfunction in the heart. This finding may be normal in parts of some vessels and during periods of enhanced flow. During ordinary auscultation of a carotid bifurcation, the detection of a bruit that extends into diastole is: Highly significant for carotid artery stenosis or for any other arterial location. Perhaps this is related to the fact that elevated end-diastolic velocities are suggestive of severe stenosis. Which of these conditions is least likely to cause a bruit in the neck? Critical preocclusive stenosis of the internal carotid artery. Bruits often disappear when the stenosis is very high-grade or preocclusive. Why are brachial blood pressures obtained bilaterally when evaluating a patient for cerebrovascular disease? The brachial blood pressures are compared to see if they are equal. If one pressure is 15-20mmHg less than the other, subclavian steal is suspected on the side of the lower pressure. How is the signal transmitted with pulsed-wave Doppler? In short bursts or pulses, and the transducer "listens" for the reflected signal in between the transmitted pulses. Loss of the spectral window with pulsed Doppler ultrasound occurs with: Flow turbulence What is the spectral window? Is the blank area underneath the systolic peak on the spectral waveform. It is filled in or "lost" when turbulent flow creates spectral broadening. Other reasons for loss of the spectral window include overuse of Doppler gain and incorrect positioning of the sample volume outside of the center streamline (depicting signals from the vessel wall or adjacent slower moving blood flow).