VASCULAR ARDMS BOARDS DAVIES
COMPLETE DETAILED CASE STUDY
h 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
The abbreviation TIA stands for: - Transient Ischemic Attack
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 is NOT true regarding carotid bruit? - The absence of a bruit rules out significant stenosis.
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 hof hthese hconditions his hleast hlikely hto hcause ha hbruit hin hthe hneck? h- hCritical hpreocclusive
hstenosis hof hthe hinternal hcarotid hartery. hBruits hoften hdisappear hwhen hthe hstenosis his hvery hhigh-
grade hor hpreocclusive.
Why hare hbrachial hblood hpressures hobtained hbilaterally hwhen hevaluating ha hpatient hfor
hcerebrovascular hdisease? h- hThe hbrachial hblood hpressures hare hcompared hto hsee hif hthey hare hequal. hIf
hone hpressure his h15-20mmHg hless hthan hthe hother, hsubclavian hsteal his hsuspected hon hthe hside hof hthe
hlower hpressure.
All hof hthe hfollowing hstatements happly hto hpulsed-wave hDoppler hExcept: h- hThe hbeam his hcontinuously
htransmitted hwith hintermittent hreception haccording hto hvessel hdepth.
How his hthe hsignal htransmitted hwith hpulsed-wave hDoppler? h- hIn hshort hbursts hor hpulses, hand hthe
htransducer h"listens" hfor hthe hreflected hsignal hin hbetween hthe htransmitted hpulses.
Loss hof hthe hspectral hwindow hwith hpulsed hDoppler hultrasound hoccurs hwith: h- hFlow hturbulence
What his hthe hspectral hwindow? h- hIs hthe hblank harea hunderneath hthe hsystolic hpeak hon hthe hspectral
hwaveform. hIt his hfilled hin hor h"lost" hwhen hturbulent hflow hcreates hspectral hbroadening. hOther hreasons
hfor hloss hof hthe hspectral hwindow hinclude hoveruse hof hDoppler hgain hand hincorrect hpositioning hof hthe
hsample hvolume houtside hof hthe hcenter hstreamline h(depicting hsignals hfrom hthe hvessel hwall hor
hadjacent hslower hmoving hblood hflow).
The hfirst hintracranial hbranch hof hthe hinternal hcarotid hartery his hthe: h- hOphthalmic hartery. hEven hthough
hthere his hoften ha hbranch hcalled hthe hcaroticotympanic hartery, hthe hophthalmic hartery his hregarded has
hthe hfirst hmajor hbranch hof hthe hinternal hcarotid hartery. hIt his hcentral hto hindirect hphysiological htesting.
A hduplex himage hof hthe hcarotid hbifurcation hthat hdemonstrates ha hgoblet-like hconfiguration hof hthe
hinternal hand hexternal hbranches hcurving haround ha hhighly hvascularized hmass hsuggests: h- hCarotid hbody
htumor
COMPLETE DETAILED CASE STUDY
h 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
The abbreviation TIA stands for: - Transient Ischemic Attack
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 is NOT true regarding carotid bruit? - The absence of a bruit rules out significant stenosis.
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 hof hthese hconditions his hleast hlikely hto hcause ha hbruit hin hthe hneck? h- hCritical hpreocclusive
hstenosis hof hthe hinternal hcarotid hartery. hBruits hoften hdisappear hwhen hthe hstenosis his hvery hhigh-
grade hor hpreocclusive.
Why hare hbrachial hblood hpressures hobtained hbilaterally hwhen hevaluating ha hpatient hfor
hcerebrovascular hdisease? h- hThe hbrachial hblood hpressures hare hcompared hto hsee hif hthey hare hequal. hIf
hone hpressure his h15-20mmHg hless hthan hthe hother, hsubclavian hsteal his hsuspected hon hthe hside hof hthe
hlower hpressure.
All hof hthe hfollowing hstatements happly hto hpulsed-wave hDoppler hExcept: h- hThe hbeam his hcontinuously
htransmitted hwith hintermittent hreception haccording hto hvessel hdepth.
How his hthe hsignal htransmitted hwith hpulsed-wave hDoppler? h- hIn hshort hbursts hor hpulses, hand hthe
htransducer h"listens" hfor hthe hreflected hsignal hin hbetween hthe htransmitted hpulses.
Loss hof hthe hspectral hwindow hwith hpulsed hDoppler hultrasound hoccurs hwith: h- hFlow hturbulence
What his hthe hspectral hwindow? h- hIs hthe hblank harea hunderneath hthe hsystolic hpeak hon hthe hspectral
hwaveform. hIt his hfilled hin hor h"lost" hwhen hturbulent hflow hcreates hspectral hbroadening. hOther hreasons
hfor hloss hof hthe hspectral hwindow hinclude hoveruse hof hDoppler hgain hand hincorrect hpositioning hof hthe
hsample hvolume houtside hof hthe hcenter hstreamline h(depicting hsignals hfrom hthe hvessel hwall hor
hadjacent hslower hmoving hblood hflow).
The hfirst hintracranial hbranch hof hthe hinternal hcarotid hartery his hthe: h- hOphthalmic hartery. hEven hthough
hthere his hoften ha hbranch hcalled hthe hcaroticotympanic hartery, hthe hophthalmic hartery his hregarded has
hthe hfirst hmajor hbranch hof hthe hinternal hcarotid hartery. hIt his hcentral hto hindirect hphysiological htesting.
A hduplex himage hof hthe hcarotid hbifurcation hthat hdemonstrates ha hgoblet-like hconfiguration hof hthe
hinternal hand hexternal hbranches hcurving haround ha hhighly hvascularized hmass hsuggests: h- hCarotid hbody
htumor
