Vascular Registry CCI Exam Questions With complete solutions Latest 2024 (100% Verified)

Vascular Registry CCI Exam Questions With complete solutions Latest 2024 (100% Verified)Abdominal Aorta waveform(s) - correct answer Low resistance proximal, Higher resistance beyond renals Celiac Artery supplies - correct answer Liver, spleen, stomach, & proximal small bowel Branches of the Abdominal AO - correct answer 1st major-Celiac artery (trunk/axis) 2nd major-SMA Renals 3rd major-IMA (after renals) Celiac Axis - correct answer Branches into Common Hepatic (to right), Splenic, & Left Gastric (off left) Common Hepatic Arteries - correct answer Gives rise to the Gastroduodenal artery in PANC head & divides into Rt & Lt Hepatics Splenic Artery - correct answer Branches left and posteriosuperior to PANC body/tail SMA/IMA waveforms - correct answer High resistance preprandial/Low resistance postprandial SMA supplies - correct answer Bowel from duodenum to prox small bowel IMA supplies - correct answer Bowel descending & rectosigmoid colon Right Renal Artery - correct answer Branches anterolateral, posterior to IVC Left Renal Artery - correct answer Branches posterolateral Renal Artery waveform - correct answer Low resistance Portal vein is usually formed by the confluence of - correct answer SMV & Splenic veins *It also receives blood from the inferior mesenteric, gastric, and cystic veins Portals walls/waveforma - correct answer echogenic walls & phasic waveforms Renal veins are formed by - correct answer renal tributaries Vascular Registry CCI Exam Review Questions With complete solutions Latest 2023/2024 | 100% Verified Left Renal Vein - correct answer Longer than Rt.; Receives suprarenal/Gonadal vein Left Renal pathway - correct answer Anterior to AO; Posterior to SMA Right Renal Vein - correct answer No tributaries; shorter Hepatic Veins - correct answer Hepatofugal flow; from liver to IVC Patient status for Abdominal Vascular Imaging - correct answer NPO 8-12 hours Ectasia - correct answer Local diameter increase with small bulge (20% increase for Ao 3cm) AAA growth rate - correct answer 1-2mm/year until 3-4cm; 5 mm/yr 4cm Aneurysm classification - correct answer 2-3cm; 3-4cm for AAA AAA Intervention - correct answer 5.5cm (high risk for rupture-catastrophic) Fusiform - correct answer Concentric enlargement; All 3 layers intact Saccular - correct answer Eccentric enlargement; All 3 layers compromised; Less common (1%); Usually in Thoracic Ao Types of Saccular AAA - correct answer 1-Cannula Placement 2-Mycotic aneurysm (bacterial infection Ao wall) 3-Vasculitis (Inflammatory process) 4-Penetrating ulcer rupture into media Vasculitis/Aortitis - correct answer Inflammatory process in wall of Ao beginning with outer (adventitia) layer and moving inward; ie: Takayasu's Dissection - correct answer Intimal wall compromised resulting in 2 lumens falsetrue; flow reversal Type 1 (a/b) endoleak - correct answer Leak in anastamosis of graft at (a) prox or (b) distal end Type 2 endoleak - correct answer Aorta branch vessel; exhibits retrograde flow; more dangerous b/c internally bleeding Type 3/4 endoleak - correct answer (3) Junction of modular components; (4) Trans graft flow-graft defect Chronic Mesenteric Ischemia - correct answer "Fear of Food" 95% of Bowel Ischemia cases Atherosclerotic stenosis/occlusion in main mesenteric arteries: 70% stenosis in 2/3 of principle mesenteric arteries Ischemia diagnosis criteria via Moneta - correct answer Celiac 200cm/s SMA 275cm/s Median Arcuate Ligament Syndrome (MALS) - correct answer Arch impedes on Celiac during EXPIRATION (non-compressed during inhalation) Measurement(s) of Splenic Vein - correct answer 7-17 cm long; 5-10mm diameter Portal vein diameter - correct answer 13mm Blood supply to liver - correct answer 75% from Portal VEIN; 25% from Hepatic ARTERY Portal vein carries ____________ to the liver - correct answer Nutrients Hepatic artery carries ______________ to the liver - correct answer Oxygen Portal Hypertension - correct answer Extrahepatic, Hyperdynamic, Intrahepatic (more common) Extrahepatic Portal HTN - correct answer Prehepatic (Portal/splenic vein thrombus, Extrinsic compression of Potral vein) Posthepatic (IVC/Hepatic vein obstruction) Hyperdynamic Portal HTN - correct answer AV malformation causing arterial portal fistulas Intrahepatic (within liver) - correct answer Presinusodial (less common) Postsinusoidial (more common) Cirrhosis/Venoclusive disease Small liver, large spleen, ascites LaPlace's law - correct answer Larger vessel radius, larger wall tension to compensate for extra pressure Hydrostatic pressure - correct answer Gravitational Large vessels serve as - correct answer Pressure reservoirs Vasodilation - correct answer Stretch to absorb Vasoconstriction - correct answer shrink/squeeze Energy and stenosis - correct answer Prox- PE↑, KE↓(highest total energy) Within-PE↓, KE↑ (lower TE, Bernouille's) Distal-PE↑, KE↓ (lowest total energy) A-Early Systole (Forward flow to periphery) B-Peak Systole (Store PE) C-Late Systole (Temporary reversal-Peripheral resistance) D-Early Diastole (Forward-reduced resistance) E-Late Diastole (Vessel Recoil/Vasoconstrict/PE turns KE) - correct answer Brain - correct answer Supplied by ICA & Vertebrals 2% of Body's weight 15% CO 20% Total blood supply 3-8 minutes of oxygen deprivation results in - correct answer cellular death Bovine Arch - correct answer Common origin of Lt. CCA and Innominate ICA - correct answer Terminates into MCA/ACA and feeds the brain, forehead, eyes, & nose-70-80% from CCA ECA - correct answer Does not feed brain unless needed as collateral circulation ECA supplies - correct answer Neck, face, scalp ECA Branches - correct answer Superior Thyroid Ascending Pharyngeal Lingual Facial Occipital Posterior Auricular Maxillary Superficial Thyroid Vertebral supply - correct answer Medulla/Inferior cerebellum Basilar supply - correct answer Pons/superior anterior cerebellum Circle of Willis has atleast ____ variations with the most common being ___________________ - correct answer 9; the absence of one or both communicating arteries What portion of the population has an incomplete CofW? - correct answer 50% What portion of the population has a complete Cof W? - correct answer 20-25% Anatomic interrogation - correct answer B-mode/2D best Physiologic/hemodynamic interrogation - correct answer Spectral/Doppler best Hemorrhagic Stroke - correct answer Bleed; HTN Ischemic Stroke - correct answer Oxygen interruption; Blood clot/emboli from Atherosclerosis Which stroke is known to be the 3rd leading cause of death? - correct answer Ischemic Stroke Small perforating artery obstruction - correct answer Occurs in elderly/diabetics Transient Ischemic Attack (TIA) - correct answer HTN; Up to 24 hours; Unilateral symptoms-Contralateral hemipharesis Reversible Ischemic Neurological Defects (RIND) - correct answer Atherosclerosis; more then 24 hours; Unilateral symptoms-Contralateral hemipharesis Vertebrobasilar Insufficiency (VBI) - correct answer Obstruction of posterior circulation; Elderly/diabetic/poorly controlled HTN; Bilateral symptoms (DROP ATTACKS) Cerebrovascular Accident (CVA) - correct answer Complete stroke with permanent lasting neurological deficits Plaque descriptions - correct answer 1-Fatty streak 2-Fibrous (soft) plaque 3-Complicated lesions 4-Ulcerative 5-Intraplaque Hemorrhage Fatty Streak - correct answer Homogenous/thin lipid Fibrous (soft) Plaque - correct answer Homogenous/lipid, collagen, elastic fibers Complicated Lesions - correct answer Heterogenous/fibrous, collagen, calcium, cell debris Ulcerative - correct answer Deteriorating smooth "craterlike" embolis? Intraplaque hemorrhage - correct answer High rupture risk NASCET - correct answer Distal/Residual ECST - correct answer Bulb/Residual Bisferious waveform in Carotid exam - correct answer Double peak waveform signifying severe AI If the CCA is occluded - correct answer Verterbrals supply ECA and ECA supplies ICA through retrograde flow What is the most common referral for asymptomatic cervical bruit? - correct answer Fibromuscular Dysplasia (FMD) Neointimal Hyperplasia - correct answer 6-24months post endarterectomy Takayasu's - correct answer Pulselessness (AI) Vasculitis that affects large arteries Temporal Arteritis - correct answer Halo/edema Low velocity/low resistance - correct answer Proximal/inflow Low velocity/high resistance - correct answer Distal/outflow Arterial Palpitations - correct answer Carotid Superficial temporal Subclavian Axillary Brachial Bow Hunter's syndrome - correct answer Compression from bony spine with change in head or neck position Subclavian steal phenomenon - correct answer Asymptomatic Subclavian steal syndrome - correct answer VBI First sign of subclavian steal - correct answer change of flow in vertebral (bunny waveform) Segments of the ICA - correct answer Cervical Petrous Cavernous Cervical ICA - correct answer Bifurcation through petrous canal Petrous ICA - correct answer Petrous of temporal bone Cavernous ICA - correct answer Carotid Siphon (genu, parasellar, supraclinoid) Supraclinoid - correct answer Ophthalmic, distal MCA - correct answer Longer and more lateral; 75-80% from ICA ACA - correct answer Medial/midbrain Basilar - correct answer 3cm long TCD - correct answer Freehand, 2MHz PW XDR at 0° TCI - correct answer 1.8-2.5MHz XDR with transtemporal & suboccipital windows Carotid plaque is mostly found in the - correct answer bifurcation Most common cause for stenosis - correct answer Plaque in bifurcation Most common region stenosis - correct answer Prox ICA after bifurcation To be truly at the center of the artery you - correct answer should visualize intimal lining very clearly ICA/CCA ratio - correct answer Fastest ICA/Distal CCA Trickle flow - correct answer 95% stenosis Carotid Body Tumors - correct answer AKA Chemodactoma/Paragangliomas; more common at higher altitudes Hollenhurst Plaque - correct answer Ulceration in ICA causing negative affects in retinal artery Distal carotid dissections - correct answer are very narrow and have no visible plaque Physiologic/Arterial Doppler - correct answer Indirect approach Duplex Imaging - correct answer Direct approach All segmental pressures - correct answer should be equal or slightly greater than brachial with 20-30mmHg change in pressures ABI - correct answer Highest of brachials and highest DPA/PTA of each leg A/B=I Reactive Hyperemia - correct answer Pump 20-30 above brachial to occlude for 3-5min (normal=90% return after a min) Complicated Lesions - correct answer Heterogenous/fibrous, collagen, cal Complicated Lesions - correct answer ICA - correct answer Terminates into MCA/ACA and feeds the brain, forehead, eyes, & nose-70-80% from CCA ICA - correct answer What is the first branch of the aortic arch? - correct answer Innominate artery/ Brachiocephalic Name the three branches of the aortic arch? - correct answer a. Innominate artery/ Brachiocephalic b. Lt CCA c. Lt Subclavian artery The radial artery runs on what side of the forearm? - correct answer Lateral side The radial artery branches to form what part of the palmar arch? - correct answer Superficial palmar arch Where does the radial artery terminate? (Just remember that the ulnar branch and termination is opposite of the radial artery) - correct answer Terminates in the deep palmar arch What vessel is the predominate source of blood flow to the hand come from? - correct answer Ulnar artery The Deep Palmar arch is a branch of the? - correct answer Ulnar artery What are the three branches of the celiac trunk? - correct answer a. Left Gastric artery b. Splenic artery c. Common Hepatic artery What organs does the celiac trunk supply? - correct answer Stomach, Liver, Pancreas, Spleen, & Duodenum The SMA is located 1cm below the celiac trunk and supplies what? - correct answer Small Intestines, cecum, and parts of colon, Is it an uncommon finding to see multiple renal arteries bilaterally? - correct answer No it is not uncommon at all. What vessel runs anterior to the aorta? - correct answer Left Renal vein What arises from the abdominal aorta about 3-4 cm above the bifurcation, that can act as a collateral connection? - correct answer IMA (Inferior Mesenteric Artery) What are the most distal branches of the aorta that supply blood to the pelvis, abdominal wall, and lower limbs? - correct answer Common Iliac Arteries (CIA) What vessel is also referred to as the Hypogastric artery? - correct answer Internal Iliac Artery What vessel runs along the medial side of the psoas mucsle and underneath the inguinal ligament? - correct answer External Iliac artery What vessel becomes the CFA in the groin region? - correct answer External Iliac Artery The SFA passes through an opening in what tendon to enter the popliteal fossa? - correct answer Adductor Hiatus (Adductor Canal or Hunter's Canal) What is another name for the deep femoral artery? - correct answer Profunda Femoris What is the region called where the SFA terminates and the popliteal artery begins? - correct answer Adductor Hiatus What 3 branches is sometimes known as the trifurcation? - correct answer APA, PTA, Peroneal Artery Whats the first branch off distal popliteal artery? - correct answer ATA - Anterior Tibia Artery What vessel does the ATA become once it crosses the dorsum of the foot? - correct answer DPA - Dorsalis Pedis Artery Wha is a major branch of the DPA (dorsalis pedis artery)? - correct answer Deep Plantar Artery- penetrates the sole of foot, it unites with lateral plantar artery to complete plantar arc. How does the PTA run down the leg? - correct answer Posterior and Medial side of leg What is the Tibioperoneal Trunk? - correct answer Short segment between ATA branch and branches of PTA and peroneal arteries. The plantar arch in foot consists of what branch from DPA? - correct answer Deep plantar artery The plantar arch in foot consists of what branch from the PTA? - correct answer Lateral plantar artery, which unites with the deep plantar artery Arteries progressively decrease in size from the largest being __ and the smallest being ___? - correct answer A. Largest = Aorta B. Smallest = Arterioles Arterioles are considered what type of vessels and assist in regulating what? - correct answer a. Arterioles are considered resistance vessels b. They assist in regulating blood flow through contraction and relaxation. Where does the exchange of nutrients and waste products between blood and tissue take place? - correct answer Capillaries What is the inner thin layer of the arterial wall called? - correct answer Tunica intima, which consists of smooth endothelium and connective tissue What layer of the arterial wall is thickest and made up largely of elastic type of smooth mucsle and connective tissue? - correct answer Tunica media / intermediate layer Which layer of the arterial wall is made up of fibrous connective tissue? - correct answer Tunica externa / outer layer (adventitia) What layer of the arterial wall contains the vasa vasorum? What is the vasa vasorum? - correct answer The vasa vasorum tiny vessels found in the adventitial layer of the arterial wall, that carry blood to the walls of the largest arteries. Proximal to aortic arch, what are the first branches of the ascending aorta? - correct answer Coronary Arteries What events lead up to the beginning of cardiac contractions? - correct answer 1. Pressure in left ventricle begins to rise 2. Left ventricle pressure exceeds that in the aorta 3. Aortic valve opens; blood is ejected, blood pressure rises What generates the pressure wave to move the blood? - correct answer Pumping Heart What governs the amount of blood that enters the arterial system? - correct answer Cardiac output What determines the amount of blood that leaves the arterial system? - correct answer Arterial pressure and total peripheral resistance Where is pressure greatest in the arterial system? - correct answer Pressure is greatest at the heart, gradually decreasing as blood moves further away. What 2 things is required for movement of any fluid medium between 2 points? - correct answer 1. Pathway for fluid to flow 2. Pressure difference / Energy gradient Low resistance yields what type of flow rate? - correct answer High flow rate The total energy contained in moving fluid is the sum of what 3 energies? - correct answer 1. Potential (Pressure) 2. Kinetic 3. Gravitational What type of energy is stored energy and is the major form of energy for circulation of blood? - correct answer Pressure (Potential) Energy, measured in mmHg. What form of energy id equivlent to the weight of the column of blood extending from the heart to the level where pressure is measured? - correct answer Gravitational energy or Hydrostatic Pressure (HP) What is the tendency of a fluid to resist changes in its velocity? - correct answer Inertia What 2 things affect the movement of fluid? - correct answer 1. Physcial properties of the fluid 2. What the fluid is moving through Internal friction within a fluid is measured how? - correct answer It's measured by its Viscosity What is an example of something that would increase blood viscosity? Decrease blood viscosity? - correct answer 1. Elevated hematocrit increases viscosity 2. Severe anemia would decrease viscosity Viscosity measures what of a fluid? - correct answer Viscosity measures the thickness of a fluid. What type of energy loss is due to increased friction between molecules and layers? - correct answer Viscous energy loss What type of energy loss occurs with deviation from laminar flow, due to changes in direction and / or velocity? - correct answer Inertial energy loss Whose equation define the relationship between: pressure, resistance, and volume flow? - correct answer Poiseulle's Equation: Q = P/R ; it helps answer the question of how much fluid moves through a vessel What can occur due to geometry change with or without intra-luminal disease and becuase of curves in vessels? - correct answer Pressure gradients (Flow separation), they occur in areas with stagnant or little movement. What predicts when fluid becomes unstable? - correct answer Reynolds Number (Re)- 2000 is the point when laminar (stable) flow turns into turbulent (disturbed) flow In a rigid tube, energy losses are mainly viscous; this can be described by whose principles? - correct answer Poiseuille's equation What kind of flow feeds dilated vascular beds like: ICA, vertebral, renal, celiac, splenic, hepatic? - correct answer Low resistance flow, which is continous (steady) flow What is one visible sign that you can differentiate a low resistant waveform from a high resistant waveform? - correct answer The reversal of flow seen in high resistant waveforms. As the inflow pressure falls as a result of stenosis, what is the natural response of the periphery vessels? Vasodilate or vasoconstrict? - correct answer Vasodilate Exercise should induce peripheral vasodilation, which does what to the distal peripheral resistance? Raise or Lowers? - correct answer Lowers the peripheral resistance, increasing blood flow. What is the single best vasodilator of resistance vessels within skeletal muscle? - correct answer Excercise What is the ability of most vascular beds to maintain constant level of blood flow over a wide range of perfusion pressures called? - correct answer Autoregulation If your blood pressure rises, how will your resistance vessels responed? - correct answer Resistance vessels will constriction Will your vessels be constricted or dilated if you scan a cool vs a warm extremitiy? - correct answer A. Warm- Dilated B. Cool- Constricted Laminar Flow is the even distribution of frequencies at systole: where are lower frequencies found in laminar flow? where is the fastest moving flow? - correct answer Slow flow is near vessel walls, with the fastest flow in the centerstream What 2 things are reduced in a significant stenosis? - correct answer Volume flow and Pressure are both significantly reducted At what point in a stenosis is the flow frequencies dampened, with or without disturbance? - correct answer Proximal to a stenosis At what point in a stenosis is spectral broadening and elevated velocities seen? - correct answer Entering the stenosis, with the high velocity at the narrowest part of the stenosis. At what point in a stenosis is flow reversals, flow separation, and vortices / eddy currents seen? - correct answer Exiting the stenosis, post-stenotic turbulence. What is pain in muscles usually occurin during exercise; subsides with rest? - correct answer Claudication What arterial condition has symptoms of the 6 P's: pain, pallor (white), pulselessness, paresthesia, paralysis, and polar; it may result from thrombus, embolism, or trauma? - correct answer Acute Arterial Occlusion What coniditon exists when symptoms of intermittent digital ischemia occur in response to cold exposure or emotional stress? - correct answer Raynaud's phenomenon What form of Raynaud's is seen as ischemia due to digital arterial spasm and is commonly seen in young women? - correct answer Primary Raynaud's What form of Raynaud's is also known as obstructive Raynaud's syndrome and may be the first manifestation of Buerger's disease? - correct answer Secondary Raynaud's What word (color) results from deficient blood supply; skin pale? - correct answer Pallor What word (color) suggests dilated vessels secondary to reactive hyperemia; skin is reddened? - correct answer Rubor What word (color) results from a concentration of deoxygenated hemoglobin, causing bluish discoloration? - correct answer Cyanosis Name a few areas where palpable pulses can be felt. - correct answer Aorta, femoral, popliteal, DPA, PTA What is most common arterial pathology? - correct answer Thickening, hardening, loss of elasticity of the artery wall What syndrome occurs in males and is caused by obstruction of the aorta, resulting in fatigue in the hips, thighs, and calves during exercise, absense of femoral pulse, and impotence? - correct answer Leriche Syndrome What are 2 examples of types of true aneurysms? - correct answer 1. Fusiform 2. Saccular What is a common location for a dissecting aneurysm to occur? - correct answer Thoracic Aorta What is most common location for a true aneurysm? - correct answer Infrarenal What are the 2 most frequent complications of Aneursyms? - correct answer 1. Rupture of the aortic aneursym 2. Embolization of the peripheral aneurysms What is a non-atherosclerotic lesion, with Buerger's disease (thromboangitis obliterans) as a form of the condition, which is when LE arterial vessels become inflammed and lead to thrombosis of the vessels - correct answer Arteritis What is a congential anomalie of the arterial system that is seen as congential narrowing or stricture of thoracic aorta called? - correct answer Coarctation of the aorta What layer of the aortic wall develops a tear, which allows for blood to leak through and form a false lumen? - correct answer Intimal layer tears and allows blood to leak into the media layer which weakens the media layers. What occurs when the frequency of the wave received is different from the transmitted wave, which is relative motion between the source (blood) and the receiver of sound (transducer)? - correct answer Doppler shift What Doppler method uses individual frequencies displayed by FFT (Fast Fourier Transform) method? - correct answer Spectral analysis What 5 arterial vessels in upper extremities are evaluated in arterial study? - correct answer Subclavian, axillary, brachial, radial, and ulnar. Analog Doppler are not capable of portraying velocities less than what cm/sec? - correct answer No velocities 6cm/sec What are somethings you can do to reduce noise on a spectral trace? - correct answer 1. Decrease gain 2. Increase wall filter 3. Turn machine on/off 4. Try another wall plug What is the difference between the 4 cuff method vs the 3 cuff method? - correct answer 3 cuff method only has one cuff on thigh while the 4 cuff method has 2, high thigh and above knee (low thigh). The 3 cuff method provides more accurate pressure readings. What frequency probe and what Doppler angle should you have for arterial studies? - correct answer 8-10 MHz probe with a Doppler angle 45-60 degrees to the skin. What percentage should the width of cuff used in arterial segmentals be greater than the limb? - correct answer 20% What order is segmental pressures taken? - correct answer a. Brachial (upper arm) b. Ankle (use PTA or DPA; peroneal A. only if necessary) c. Calf (BK) (Use PTA or DPA-that had highest pressure) d. Above knee (AK) (Same as above-may need to use pop) e. High Thigh (HT) How is the ankle/brachial index (ABI) or (Ankle/arm pressure API) calculated? - correct answer ABI's are calculated by dividing the ankel pressure by the higher of the 2 brachial pressures. What value is considered normal for an ABI? - correct answer 1.0 What ABI value is seen in patients with claudication? - correct answer 0.5 - 0.9 What ABI value is seen in patients with severe arterial disease that have rest pain? - correct answer 0.5