VASCULAR ARDMS BOARDS DAVIES
EXAM WITH 100% CORRECT ANSWERS
2023
What's the first major arterial branch of the aorta is the? - Correct answer-Innominate
artery or brachiocephalic artery
The vertebral artery usually arises from the: - Correct answer-Subclavian Artery
The incidence of new strokes per year is: - Correct answer-from 500,000 to 700,000
The abbreviation TIA stands for: - Correct answer-Transient Ischemic Attack
A TIA of the right anterior hemisphere of the brain will likely affect: - Correct answer-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: - Correct answer-
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: - Correct answer-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: - Correct answer-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? - Correct answer-
Vertigo, dizziness, ataxia, or other bilateral or global symptoms .
What are symptoms when anterior circulation is effected? - Correct answer-Facial
Asymmetry, unilateral
What accurately defines RIND also called stroke with recovery? - Correct answer-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: - Correct answer-Stroke
because it has persisted longer than 24 hours and has not resolved completely
The infraorbital artery is a terminal branch of the: - Correct answer-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: - Correct answer-Transient Ischemic Attack
of the eye.
Dysphagia is : - Correct answer-Difficulty swallowing. Symptom associated with
vertebrobasilar insufficiency.
A binocular disturbance that disrupts vision in half the visual field of both eyes is called:
- Correct answer-Homonymous Hemianopia
Paresthesia refers to: - Correct answer-tingling sensation
A patient describes a 30-minute episode of garbled speech. This is called: - Correct
answer-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? - Correct answer-Left hemisphere . The speech area of the
cortex is in the temporal lobe of the dominant hemisphere
What is true regarding subclavian steal? - Correct answer-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: - Correct answer-more often on left side .
A hemispheric stroke usually affects: - Correct answer-The middle cerebral artery
distribution and the contralateral side of the body
Stenosis of the following vessel presents the highest risk for a TIA: - Correct answer-
Internal Carotid Artery
The vertebral arteries branch from the subclavian arteries to unite and form the: -
Correct answer-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: - Correct answer-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 is NOT true regarding carotid bruit? - Correct answer-The absence of a bruit rules
out significant stenosis.
What are bruits caused by? - Correct answer-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: - Correct
answer-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: - Correct answer-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? - Correct answer-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: - Correct answer-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? - Correct answer-
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? - Correct answer-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.
All of the following statements apply to pulsed-wave Doppler Except: - Correct answer-
The beam is continuously transmitted with intermittent reception according to vessel
depth.
How is the signal transmitted with pulsed-wave Doppler? - Correct answer-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: - Correct
answer-Flow turbulence
, What is the spectral window? - Correct answer-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).
The first intracranial branch of the internal carotid artery is the: - Correct answer-
Ophthalmic artery. Even though there is often a branch called the caroticotympanic
artery, the ophthalmic artery is regarded as the first major branch of the internal carotid
artery. It is central to indirect physiological testing.
A duplex image of the carotid bifurcation that demonstrates a goblet-like configuration of
the internal and external branches curving around a highly vascularized mass suggests:
- Correct answer-Carotid body tumor
In duplex imaging, the best arterial wall image quality is obtained when the beam is at
the following angle to the artery walls: - Correct answer-90 degrees. More echoes return
to the transducer with 90 degrees
Transcranial findings consistent with vasospasm following subarachnoid hemorrhage
would include: - Correct answer-Greatly increased mean velocities in the middle
cerebral artery.
In TCD, the normal direction of flow in the vertebral artery is: - Correct answer-away
from the beam . From the suboccipital, foramen magnum, approach, flow should
normally be away from the beam.
What is a condition that TCD might not be useful for ? - Correct answer-Temporal
Arteritis
The Doppler beam angle considered optimal for standardization of duplex carotid
studies at most vascular labs is: - Correct answer-60 degrees. It is generally accepted ,
to make consistent velocity measurements, one must be consistent about the Doppler
beam angle. Some labs insist on 60 degrees , no more and no less; other labs keep it
within the range 45 degrees to 60 degrees.
The usual instrumentation for handheld TCD includes a probe with an operating
frequency of: - Correct answer-2 MegaHertz
In Transtemporal window of TCD, the normal direction of flow in the anterior cerebral
artery is: - Correct answer-Away from the beam
A localized increase in mean velocity from 50 to 150 cm/sec at a depth of 50 mm with
the TCD transducer placed in the temporal window probably indicates: - Correct
answer-Significant stenosis of the middle cerebral artery
EXAM WITH 100% CORRECT ANSWERS
2023
What's the first major arterial branch of the aorta is the? - Correct answer-Innominate
artery or brachiocephalic artery
The vertebral artery usually arises from the: - Correct answer-Subclavian Artery
The incidence of new strokes per year is: - Correct answer-from 500,000 to 700,000
The abbreviation TIA stands for: - Correct answer-Transient Ischemic Attack
A TIA of the right anterior hemisphere of the brain will likely affect: - Correct answer-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: - Correct answer-
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: - Correct answer-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: - Correct answer-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? - Correct answer-
Vertigo, dizziness, ataxia, or other bilateral or global symptoms .
What are symptoms when anterior circulation is effected? - Correct answer-Facial
Asymmetry, unilateral
What accurately defines RIND also called stroke with recovery? - Correct answer-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: - Correct answer-Stroke
because it has persisted longer than 24 hours and has not resolved completely
The infraorbital artery is a terminal branch of the: - Correct answer-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: - Correct answer-Transient Ischemic Attack
of the eye.
Dysphagia is : - Correct answer-Difficulty swallowing. Symptom associated with
vertebrobasilar insufficiency.
A binocular disturbance that disrupts vision in half the visual field of both eyes is called:
- Correct answer-Homonymous Hemianopia
Paresthesia refers to: - Correct answer-tingling sensation
A patient describes a 30-minute episode of garbled speech. This is called: - Correct
answer-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? - Correct answer-Left hemisphere . The speech area of the
cortex is in the temporal lobe of the dominant hemisphere
What is true regarding subclavian steal? - Correct answer-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: - Correct answer-more often on left side .
A hemispheric stroke usually affects: - Correct answer-The middle cerebral artery
distribution and the contralateral side of the body
Stenosis of the following vessel presents the highest risk for a TIA: - Correct answer-
Internal Carotid Artery
The vertebral arteries branch from the subclavian arteries to unite and form the: -
Correct answer-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: - Correct answer-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 is NOT true regarding carotid bruit? - Correct answer-The absence of a bruit rules
out significant stenosis.
What are bruits caused by? - Correct answer-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: - Correct
answer-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: - Correct answer-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? - Correct answer-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: - Correct answer-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? - Correct answer-
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? - Correct answer-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.
All of the following statements apply to pulsed-wave Doppler Except: - Correct answer-
The beam is continuously transmitted with intermittent reception according to vessel
depth.
How is the signal transmitted with pulsed-wave Doppler? - Correct answer-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: - Correct
answer-Flow turbulence
, What is the spectral window? - Correct answer-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).
The first intracranial branch of the internal carotid artery is the: - Correct answer-
Ophthalmic artery. Even though there is often a branch called the caroticotympanic
artery, the ophthalmic artery is regarded as the first major branch of the internal carotid
artery. It is central to indirect physiological testing.
A duplex image of the carotid bifurcation that demonstrates a goblet-like configuration of
the internal and external branches curving around a highly vascularized mass suggests:
- Correct answer-Carotid body tumor
In duplex imaging, the best arterial wall image quality is obtained when the beam is at
the following angle to the artery walls: - Correct answer-90 degrees. More echoes return
to the transducer with 90 degrees
Transcranial findings consistent with vasospasm following subarachnoid hemorrhage
would include: - Correct answer-Greatly increased mean velocities in the middle
cerebral artery.
In TCD, the normal direction of flow in the vertebral artery is: - Correct answer-away
from the beam . From the suboccipital, foramen magnum, approach, flow should
normally be away from the beam.
What is a condition that TCD might not be useful for ? - Correct answer-Temporal
Arteritis
The Doppler beam angle considered optimal for standardization of duplex carotid
studies at most vascular labs is: - Correct answer-60 degrees. It is generally accepted ,
to make consistent velocity measurements, one must be consistent about the Doppler
beam angle. Some labs insist on 60 degrees , no more and no less; other labs keep it
within the range 45 degrees to 60 degrees.
The usual instrumentation for handheld TCD includes a probe with an operating
frequency of: - Correct answer-2 MegaHertz
In Transtemporal window of TCD, the normal direction of flow in the anterior cerebral
artery is: - Correct answer-Away from the beam
A localized increase in mean velocity from 50 to 150 cm/sec at a depth of 50 mm with
the TCD transducer placed in the temporal window probably indicates: - Correct
answer-Significant stenosis of the middle cerebral artery
