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85 Cards in this Set
- Front
- Back
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What causes the flow below the baseline with a triphasic waveform?
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Breif diastolic reversal caused by elastic recoil of artery(winkessel effect)
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HOw does changing to a higher frequency probe affect the amount of aliasing?
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it increases the amount of aliasing
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Is PRF dependant on image depth? why
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yes, deeper fields of view require longer time delay btw sound pulses
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What might cause random color assignment? What pathological process can produce these findings?
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soft tissue vibration(bruit);
-stenosis -aneurysm -AV fistula |
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HOw can you distinguish true flow reversal from aliasing on color doppler?
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true flow reversal will be blue to red or red to blue, but with aliasing, flow goes to the color on the opposite side of the color scale.
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HOw can artifact be elimiated on color doppler?
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-increase the doppler angle(closer to 90)
-increase scale -decrease transmitted frequency |
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What is the doppler frequency shift dependant on?
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-angle
-velocity -transmitted frequency -speed of sound |
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Is the RI dependant on doppler angle?
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no, because when the doppler angle changes, both PSV, and EDV change proportionally. This is true with PI as well.
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Is acceleration time dependant on doppler angle?
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yes
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What parameter is displayed on the verticle axis of the spectral waveform?
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Velocty(doppler frequency shift)
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Is mirror image artifact more common on grayscale or color doppler?
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color doppler, becaue color is encoded on mean doppler shift
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how can pulsed doppler help in confirming mirror image artifact vs. duplication.
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mirror image artifact will be similar, but will have a lower amplitude waveform.
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WHat happens to the doppler flrequency shift when the doppler angle approaches 0?
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the frequecy shift increases
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What would you consider if you saw a tardus parvus waveform in multiple abdominal and peripheral arteries?
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aortic stenosis, or coarctation
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What would you consider if you saw a tardus parvus waveform in the lower pole of the kidney, but a normal waveform was seen in the upper pole?
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stenosis of accessory artery of the lower pole
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What does color priority adjust?
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-color is suppressed on any pixel that has a grayscale above the line(adjusted on color scale)
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It what situation would you want to increase the color priority? why?
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testicular examination in order to increase your chance of seeing flow.
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other than blood flow velocity, what determines color shading?
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-doppler angle
-transmitted frequecy -amount of filtering of low frequency shifts |
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how do you deterimine when the portal vein becomes too pulsitile?
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If waveform hits, or falls below the baseline
-this is caused by Rt heart dysfunction or TR |
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Where does the umbilical vein originate? Which direction wll it be flowing?
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originates from the ascending poriton of the left portal vein, and will be travelling away from the liver with portal hypertension.
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HOw does the blood flow from the umbilcal vein travel back to the heart?
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-by travelling inferior to the liver along the abdominal wall
-umbilical vein should not exceed 3mm |
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What effect does deep inspiration have on the hepatic vein waveform?
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-causes a decrease in velocity
-causes blunting(not sharp) |
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Which portal vein is flow reversal more often seen in?
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RPV
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If you see transient, high amplitude signal spikes on the spectral doppler of the portal vein, and echogenic contenets within the portal vein, what might this indicated?
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Most consistant with portal vein gas, and may indicate ishemic bowel
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What would cause a large difference in the velocities of the upper and lower poles of segmental arteries in a single kidney? How might the patient present?
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AV fistula
flank pain hematuria |
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Where will the lt gastric vein be seen in transverse? What is another name for it?
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seen draped over the celiac axis
aka coronary vein |
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What is normal flow like in the coronary vein?
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normally flows toward the splenic vein, and is <6mm
-when it is away from the splenic vein, this indicates portal hypertension |
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Which side is easier to see renal vein thrombosis?
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the right side because the renal vein is shorter and can use liver a window
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Bland renal vein thrombosis
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what we classify as "normal" thrombosis
-just another term to remember |
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what is a normal value for early systolic acceleration of the kidney
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>3m/s2
-renal artery stenosis has to be 70-80 percent before distal acceleration decreases |
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how common is it to see a retroaortic left renal vein?
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2% of the population has them/
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Differentiate tumor thrombus vs. bland thrombus
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Tumor thrombus=may or may not see blood vessels, expands lumen, can see cystic spaces
Bland thrombus=no blood vessels, rarely expands the lumen or has cystic spaces |
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With cavernous transformation fo the portal vein, where do the blood vessels lie, and what direction are they going?
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anterior to portal vein and hepatic artery, and are flowing hepatopedal
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what is the treatment of choice for renal artery stenosis?
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angioplasty
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what happens to the portal vein velocity after a successful tips shunt?
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increases
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what happens to the flow in the right and left portal veins after a successful tips shunt?
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flow reverses towards the stent
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what are the differential diagnosis when to-fo flow is seen after a renal transplant?
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-renal vein thromosis
-severe rejection -tense subcapsular hematoma |
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what may cause a to-fo flow pattern when dopplering at some point in the body?
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-psdudoanrysms-@ neck
-type 1 and 2 aortic endoleaks -partial subclavian steel -normal penile artery in an erect penis -lymph nodes replaced by metastatic disease |
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when there is renal vein thrombosis of a kidney, why would the arterial flow exibit reversed diastolic flow?
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because this is the only way for blood to get out during diastole
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can you see changes in a PVD study as the result of AAA?
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no
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What are reasons that would cause a pt. to have an ABI of 0?
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1. patient has synthetic graft al the way down the leg(would be able to obtain TBI in this case)
2. Acute embolic occlusion(toe and ABI's are O)-usually occurs from cardiac thrombus |
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T/F there is better collateral capabilities in the legs than the arms?
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false
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What would cause an elevated dicrotic notch?
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raynaud's disease; will be more prominent distally(closer to fingers)
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What are the numbers for normal and abnormal venous refill?What is the pupose of the touniquet in this test?
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normal>20sec(usually around 45 seconds)
abnormal<20sec tourniquiet is used to differentiate btw superficial and deep |
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With the venous refill test, what would be indicated by a refill time of 10 seconds before the tourniquet is used, and 19 seconds after?
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venous insufficiency of deep venous system
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with a venous refill study, what would be indicated by a venous refill time of 18 before the tourniquet, and 25 after the tourniquet is used?
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abnormal superficial valves
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Ohm's law
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V=IR
voltage=Current x resistance |
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What are the different coupling modes that can be used for Plethsmography?
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DC coupling-used for very slow flow
AC coupling-alternating current used for arterial flow |
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HOw does an analog Plesthmography waveform display frequency shift?
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displays it as average frequency shift
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What are the most commonly used Plethsmographes?
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PPG and strain guage
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Explain arterialPneumoplethsmography
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-aka air, volume
-generates PVR waveform -good because it's not affected by calcified arteries -65mmHg cuff inflated at the thigh to approx. 400cc's -65mmHg @ calf and ankle inflated to approx 75cc's. |
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Explain arterial SPG?
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-measures circumferential difference
-based on electrical impedence |
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PPG
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rely's on feflected light off of RBC's
-not a true plethsmography device |
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WIth a venous ouflow study, what would be an indication of thrombus?
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-decreased outflow
-decreased calf volume expansion |
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For venous plethsmography, what parameters can be used? Which one is used that is not used in arterial plethsmography>
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-Can use Air, IPG, and SPG.
IPG is not an arterial parameter |
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What coupling setting should IPG be set to
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-DC mode
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HOw could pneumoplethsmography be helpful in a venous study?
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-used for varicose veins and venous ulcers
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In a venous volume test, how many ml of increased venous volume would indicated functional venous valves? What would indicate venous insufficency?
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100-150ml of increased venous volume indicates functional venous valves
100-350ml increase in leg volume indicates venous insufficency |
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What parameter relates Ohm's law?
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IPG
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With IPG, there are 2 methods. Name them both, and explain which one is better?
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2 wire method-rarely used
4wire-more accurate |
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With IPG, how does electrical resistance affect venous impenence?
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as electrical resisstance increases, venous impedience increases
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What is consdidered normal for MVO(max venous ouflow) on IPG? As MVO increases, how does this affect the chance for DVT?
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NOrmal MVO=<3sec
Increased MVO decreased the liklihood for DVT |
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What is normal MVO on a venous PVR?
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determined from 1 second of outflow
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What PPG is reflective of venous incopitence?
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<20sec
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Which of the following arteries does not come off of the subclavian artery?
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vertebral
superior thyroid internal thoracic thyrocervical trunk internal mammary |
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what is the infraorbital artery a terminal branch of?
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maxillary
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if the probe is positioned anterior and medial in the neck, then which carotid vessel is superficial?
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ECA
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If the probe is positioned posterior and laterally for a carotid exam, which vessel will be seen anteriorly?
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ICA
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If you have one subclavian with an abnormal waveform, and one with a normal waveform, would the SVC be normal or abnormal?
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normal-if it was abnormal, it would affect both subclavian veins
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What is the significance of seeing flow reversal of the right and left internal mammory veins?
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indicates collateral flow owing to the central venous system, usually the SVC
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what is the difference in treatment btw patients with total occlusion, and partial occlusion?
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total-not endartectomy candidates
partial-can have endartectomies |
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what might cause a patent ICA to appear totally occluded?
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-subtotal occlusion with slow flow
-shadowing from calcifications -very deeply situated ICA |
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where are baker's cysts located
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-fluid collection in the bursa between the medial head of the gasctrocnemious and the semimembranous tendon
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t/f bakers cysts typically communicate with the joint?
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true
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when should you suspect rupture of a baker's cyst?
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inferior aspect of cyst converts from round to pointed appearance
-detectable fluid tracking fom inferior portion of cyst |
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Are AV fistulas more commonly seen above or below the femoral bifercation?
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below
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how often are thrombin injections successful?
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>90%
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Name the window, normal depth, velocity, and flow direction when doing a TCD test of the MCA?
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TRANSTEMPORAL
30-60MM 55+/-12 TOWARD |
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Name the window, normal depth, velocity, and flow direction when doing a TCD test of the ACA?
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TRANSTEMPORAL
60-80MM 50+/-11 AWAY |
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Name the window, normal depth, velocity, and flow direction when doing a TCD test of the PCA?
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TRANSTEMPORAL
60-70MM 39+/-10 TOWARD |
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Name the window, normal depth, velocity, and flow direction when doing a TCD test of the TERMINAL ICA?
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TRANSTEMPORAL
55-65MM 55+/-12 BIDIRECTIONAL |
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Name the window, normal depth, velocity, and flow direction when doing a TCD test of the ICA?
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TRANSORBITAL
60-80 47+/-14 PARASELLAR-TOWARD SUPRACLINOID-AWAY GENU-BI |
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Name the window, normal depth, velocity, and flow direction when doing a TCD test of the OPTHALMIC?
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TRANSORBITAL
40-60 21+/-5 TOWARD |
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Name the window, normal depth, velocity, and flow direction when doing a TCD test of the VERTEBRAL?
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TRANSFORAMENAL
60-90 38+/-10 AWAY |
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Name the window, normal depth, velocity, and flow direction when doing a TCD test of the BASILAR?
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TRANSFORAMINAL
80-120MM 41+/-10 AWAY FROM TRANSDUCER |
