ULTRASOUND VASCULAR
REGISTRY REVIEW QUESTIONS
AND ANSWERS FINAL PAPER EXAM
Q A STUDY GUIDE WITH VERIFIED
SOLUTIONS
◉ The first intracranial branch of the internal carotid artery is the:
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: 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: Answer:
90 degrees. More echoes return to the transducer with 90 degrees
◉ Transcranial findings consistent with vasospasm following
subarachnoid hemorrhage would include: Answer: Greatly increased
mean velocities in the middle cerebral artery.
,◉ In TCD, the normal direction of flow in the vertebral artery is:
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 ? Answer:
Temporal Arteritis
◉ The Doppler beam angle considered optimal for standardization
of duplex carotid studies at most vascular labs is: 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: Answer: 2 MegaHertz
◉ In Transtemporal window of TCD, the normal direction of flow in
the anterior cerebral artery is: 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: Answer: Significant stenosis of the
middle cerebral artery
,◉ In handheld Transcranial Doppler, the angle of the beam relative
to flow is assumed to be: Answer: 0 degrees.
◉ The circle of Willis receives its blood supply from which
combination of arteries? Answer: Carotid and Vertebral arteries.
This makes possible the ability of the brain to withstand sometimes
extracranial carotid occlusion without significant symptoms
◉ You perform TCD, insonating the left anterior cerebral artery. The
flow is toward the beam. This finding suggests: Answer: Ipsilateral
carotid obstruction, with right- to- left collateralization. It suggests
flow coming across from the other hemisphere via the anterior
communicating artery.
◉ What would alter the frequency shift of the internal carotid artery
Doppler signal? Answer: Anatomic narrowing or tapering of an
artery can increase the velocity; increasing the operating or
transmitted frequency shift. Readjusting the angle-correct cursor
will change the velocity estimate for a given frequency shift, but
won't change the shift itself. The threshold sensitivity does not affect
the frequency shift.
◉ What diagnostic criteria for stenosis would be anticipated in the
presence of a 50% - 60% diameter stenosis of the internal carotid
artery? Answer: Elevation of systolic frequency with poststenotic
turbulence. The most sensitive parameter for calling this degree of
stenosis is the systolic frequency/velocity. Focal acceleration with
, distal turbulence is the hallmark of significant stenosis anywhere in
the body.
◉ The best way to prepare a transducer for intraoperative use is:
Answer: Place transducer and acoustic gel within a sterile sleeve or
bag.
◉ What would autoclaving a transducer do ? Answer: Destroy
transducers piezoelectric properties
◉ In using continuous-wave Doppler with spectral analysis to assess
the internal carotid artery, what operator induced errors would
most likely result in a falsely LOW frequency shift? Answer:
Increasing the beam angle to 70 degrees. This would create a lower
frequency shift than the proper 60 degrees angle .
◉ In continuous- wave Doppler , What would falsely higher
frequency shift? Answer: Overdriving the Doppler signal gain.
Allowing the signal beam to overlap both an artery and a vein.
Changing to a higher-frequency transducer. Leaving the wall filter
on.
◉ Of the chief advantages of continuous-wave Doppler, what is
FALSE ? Answer: It allows more precise range-gating than pulsed-
wave Doppler.
REGISTRY REVIEW QUESTIONS
AND ANSWERS FINAL PAPER EXAM
Q A STUDY GUIDE WITH VERIFIED
SOLUTIONS
◉ The first intracranial branch of the internal carotid artery is the:
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: 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: Answer:
90 degrees. More echoes return to the transducer with 90 degrees
◉ Transcranial findings consistent with vasospasm following
subarachnoid hemorrhage would include: Answer: Greatly increased
mean velocities in the middle cerebral artery.
,◉ In TCD, the normal direction of flow in the vertebral artery is:
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 ? Answer:
Temporal Arteritis
◉ The Doppler beam angle considered optimal for standardization
of duplex carotid studies at most vascular labs is: 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: Answer: 2 MegaHertz
◉ In Transtemporal window of TCD, the normal direction of flow in
the anterior cerebral artery is: 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: Answer: Significant stenosis of the
middle cerebral artery
,◉ In handheld Transcranial Doppler, the angle of the beam relative
to flow is assumed to be: Answer: 0 degrees.
◉ The circle of Willis receives its blood supply from which
combination of arteries? Answer: Carotid and Vertebral arteries.
This makes possible the ability of the brain to withstand sometimes
extracranial carotid occlusion without significant symptoms
◉ You perform TCD, insonating the left anterior cerebral artery. The
flow is toward the beam. This finding suggests: Answer: Ipsilateral
carotid obstruction, with right- to- left collateralization. It suggests
flow coming across from the other hemisphere via the anterior
communicating artery.
◉ What would alter the frequency shift of the internal carotid artery
Doppler signal? Answer: Anatomic narrowing or tapering of an
artery can increase the velocity; increasing the operating or
transmitted frequency shift. Readjusting the angle-correct cursor
will change the velocity estimate for a given frequency shift, but
won't change the shift itself. The threshold sensitivity does not affect
the frequency shift.
◉ What diagnostic criteria for stenosis would be anticipated in the
presence of a 50% - 60% diameter stenosis of the internal carotid
artery? Answer: Elevation of systolic frequency with poststenotic
turbulence. The most sensitive parameter for calling this degree of
stenosis is the systolic frequency/velocity. Focal acceleration with
, distal turbulence is the hallmark of significant stenosis anywhere in
the body.
◉ The best way to prepare a transducer for intraoperative use is:
Answer: Place transducer and acoustic gel within a sterile sleeve or
bag.
◉ What would autoclaving a transducer do ? Answer: Destroy
transducers piezoelectric properties
◉ In using continuous-wave Doppler with spectral analysis to assess
the internal carotid artery, what operator induced errors would
most likely result in a falsely LOW frequency shift? Answer:
Increasing the beam angle to 70 degrees. This would create a lower
frequency shift than the proper 60 degrees angle .
◉ In continuous- wave Doppler , What would falsely higher
frequency shift? Answer: Overdriving the Doppler signal gain.
Allowing the signal beam to overlap both an artery and a vein.
Changing to a higher-frequency transducer. Leaving the wall filter
on.
◉ Of the chief advantages of continuous-wave Doppler, what is
FALSE ? Answer: It allows more precise range-gating than pulsed-
wave Doppler.
