ARDMS RVT Vascular Sonography Certification Exam 2026:
Comprehensive Professional Practice Test — Cerebrovascular
Imaging, Peripheral Arterial & Venous Disease, Abdominal Vascular
Studies, Doppler Hemodynamic & Clinical Assessment — 200
Multiple-Choice Questions with Answers & Detailed Rationales
Section 1: Cerebrovascular and Extracranial Arterial Examination
Question 1
A patient presents with amaurosis fugax in the right eye. Which vessel is the most likely
source of the embolus?
A. Right external carotid artery
B. Right ophthalmic artery
C. Right internal carotid artery
D. Right vertebral artery
Correct Answer: C
Explanation: The ophthalmic artery is the first branch of the internal carotid artery, and
amaurosis fugax is often a symptom of emboli originating from the ipsilateral ICA.
Question 2
During a carotid duplex examination, you note a velocity of 150 cm/s in the proximal left ICA
with post-stenotic turbulence and a "jet" appearance. What is the most likely diagnosis?
A. Normal ICA
B. <50% stenosis
C. 50-69% stenosis
,D. >70% stenosis
Correct Answer: D
Explanation: Velocities exceeding 125-140 cm/s in the ICA, especially with post-stenotic
turbulence, are highly suggestive of a hemodynamically significant stenosis (>70%).
Question 3
Which of the following findings on a carotid duplex is most indicative of a near-occlusion
(string sign)?
A. High-resistance flow in the common carotid artery
B. A very high peak systolic velocity in the ICA
C. A low-velocity, high-resistance signal in the ICA
D. Reversed flow in the ipsilateral vertebral artery
Correct Answer: C
Explanation: A near-occlusion or "string sign" presents with markedly reduced flow velocities
and a high-resistance Doppler waveform in the ICA due to extremely low flow volume.
Question 4
A patient with a history of transient ischemic attacks (TIAs) undergoes a carotid ultrasound.
The image shows a heterogeneous plaque with a large, anechoic area within it. What does
this finding suggest?
A. A calcified, stable plaque
B. A fibrous, stable plaque
C. An intraplaque hemorrhage or ulceration
,D. A normal intima-media thickness
Correct Answer: C
Explanation: An anechoic or lucent area within a plaque is characteristic of intraplaque
hemorrhage or a lipid-rich core, which are features of an unstable, high-risk plaque.
Question 5
What is the primary purpose of using color Doppler in a carotid examination?
A. To measure the intima-media thickness
B. To identify the presence and direction of flow
C. To calculate the resistive index
D. To differentiate plaque from the vessel wall
Correct Answer: B
Explanation: Color Doppler provides a real-time, two-dimensional map of blood flow,
allowing for rapid identification of vessels, flow direction, and areas of abnormal flow.
Question 6
The vertebral artery normally arises from which vessel?
A. The common carotid artery
B. The subclavian artery
C. The aortic arch
D. The external carotid artery
, Correct Answer: B
Explanation: In the vast majority of cases, the right and left vertebral arteries originate from
the respective subclavian arteries.
Question 7
A patient has a known history of right subclavian steal syndrome. What flow pattern would
you expect to see in the right vertebral artery?
A. Antegrade flow throughout the cardiac cycle
B. Retrograde flow throughout the cardiac cycle
C. A "bunny rabbit" waveform
D. A high-resistance waveform
Correct Answer: B
Explanation: In subclavian steal, a stenosis or occlusion in the proximal subclavian artery
causes a pressure gradient that reverses flow in the ipsilateral vertebral artery to supply the
arm.
Question 8
What is the normal direction of flow in the ophthalmic artery?
A. Antegrade (towards the eye)
B. Retrograde (away from the eye)
C. Bidirectional
D. It is normally not detectable
Correct Answer: A
Comprehensive Professional Practice Test — Cerebrovascular
Imaging, Peripheral Arterial & Venous Disease, Abdominal Vascular
Studies, Doppler Hemodynamic & Clinical Assessment — 200
Multiple-Choice Questions with Answers & Detailed Rationales
Section 1: Cerebrovascular and Extracranial Arterial Examination
Question 1
A patient presents with amaurosis fugax in the right eye. Which vessel is the most likely
source of the embolus?
A. Right external carotid artery
B. Right ophthalmic artery
C. Right internal carotid artery
D. Right vertebral artery
Correct Answer: C
Explanation: The ophthalmic artery is the first branch of the internal carotid artery, and
amaurosis fugax is often a symptom of emboli originating from the ipsilateral ICA.
Question 2
During a carotid duplex examination, you note a velocity of 150 cm/s in the proximal left ICA
with post-stenotic turbulence and a "jet" appearance. What is the most likely diagnosis?
A. Normal ICA
B. <50% stenosis
C. 50-69% stenosis
,D. >70% stenosis
Correct Answer: D
Explanation: Velocities exceeding 125-140 cm/s in the ICA, especially with post-stenotic
turbulence, are highly suggestive of a hemodynamically significant stenosis (>70%).
Question 3
Which of the following findings on a carotid duplex is most indicative of a near-occlusion
(string sign)?
A. High-resistance flow in the common carotid artery
B. A very high peak systolic velocity in the ICA
C. A low-velocity, high-resistance signal in the ICA
D. Reversed flow in the ipsilateral vertebral artery
Correct Answer: C
Explanation: A near-occlusion or "string sign" presents with markedly reduced flow velocities
and a high-resistance Doppler waveform in the ICA due to extremely low flow volume.
Question 4
A patient with a history of transient ischemic attacks (TIAs) undergoes a carotid ultrasound.
The image shows a heterogeneous plaque with a large, anechoic area within it. What does
this finding suggest?
A. A calcified, stable plaque
B. A fibrous, stable plaque
C. An intraplaque hemorrhage or ulceration
,D. A normal intima-media thickness
Correct Answer: C
Explanation: An anechoic or lucent area within a plaque is characteristic of intraplaque
hemorrhage or a lipid-rich core, which are features of an unstable, high-risk plaque.
Question 5
What is the primary purpose of using color Doppler in a carotid examination?
A. To measure the intima-media thickness
B. To identify the presence and direction of flow
C. To calculate the resistive index
D. To differentiate plaque from the vessel wall
Correct Answer: B
Explanation: Color Doppler provides a real-time, two-dimensional map of blood flow,
allowing for rapid identification of vessels, flow direction, and areas of abnormal flow.
Question 6
The vertebral artery normally arises from which vessel?
A. The common carotid artery
B. The subclavian artery
C. The aortic arch
D. The external carotid artery
, Correct Answer: B
Explanation: In the vast majority of cases, the right and left vertebral arteries originate from
the respective subclavian arteries.
Question 7
A patient has a known history of right subclavian steal syndrome. What flow pattern would
you expect to see in the right vertebral artery?
A. Antegrade flow throughout the cardiac cycle
B. Retrograde flow throughout the cardiac cycle
C. A "bunny rabbit" waveform
D. A high-resistance waveform
Correct Answer: B
Explanation: In subclavian steal, a stenosis or occlusion in the proximal subclavian artery
causes a pressure gradient that reverses flow in the ipsilateral vertebral artery to supply the
arm.
Question 8
What is the normal direction of flow in the ophthalmic artery?
A. Antegrade (towards the eye)
B. Retrograde (away from the eye)
C. Bidirectional
D. It is normally not detectable
Correct Answer: A
