RVT ARDMS exam review Completed with 100% Correct Answers

RVT ARDMS exam review Completed with 100% Correct Answers RVT ARDMS exam review Completed with 100% Correct Answers 3 causes of venous thrombosis also called, Virchow's Triad Venous stasis, trauma/endothelial damage, hypercoagulability Venous stasis Slowed blood flow in veins. Caused by immobility, myocardial infarction, CHF, hypotension, COPD, obesity, pregnancy, previous DVT, extrinsic compression, SVC syndrome, paraplegia, surgery associated conditions. 2 types of Trauma/endothelial damage Intrinsic and extrinsic Intrinsic trauma is Damage to the vessel wall from intravenous drugs or a catheter. Increased use of PICC line results in higher incidence of upper extremity thrombus, usually developing at most proximal portion of PICC line. Extrinsic trauma is Damage caused by an accident, which can occur at any site of the body. Hypercoagulability is associated with Pregnancy, cancer, oral contraceptives and/or hormone replacement therapy, inherited states,e.g., factor V Leiden or protein C, protein S, or Antithrombin III deficiency Sensitivity, and How to calculate? -Ability of a test to detect disease, how many tests are correctly called positive. - # of true positives divided by # of all positive tests by gold standard, or TP/TP+FN Specificity, and how to calculate? -Ability of a test to identify normality, or how many results were correctly called negative. - # of true negative divided by # of all negative tests by gold standard, or TN/TN+FP Positive predictive value, and how to calculate? -percentage of test results that accurately predict abnormality, or what % correctly predicted disease. - # of true positive test divided by # of all positive tests, or TP/TP+FP Negative predictive value, and how to calculate? - percentage of test results that accurately predict normality, or what % correctly predicted absence of disease. - # of true negatives divided by # of all negative tests, or TN/TN+FN Accuracy, and how to calculate? - % of correct tests, or how well does the test both detect and rule out disease. - total # of correct tests divided by total # of all tests, or TP+TN/TP+FP+FN+TN Brachiocephalic/ Innominate vien formed from confluence of? Subclavien and Internal jugular vein Vascular disease more common in women? Takayasu's arteritis-tennage to young women more common. FMD- younger women. Celiac band syndrome- young athletic women. Vascular disease more common in men? Obliteritis angitis(bergers disease)- younger <40 men, heavy smokers. Popliteal artery entrapment syndrome- young athletic men. Celiac artery supplies blood to what organs? Stomach, liver, pancreas, duodenum, and spleen. Celiac artery branches into? Left gastric, splenic, common hepatic arteries. SMA supplies blood to what organs? Small intestine, cecum, ascending colon, part of transverse colon. SMA location? 1cm distal to celiac artery. IMA supplies what organs? Left half of transverse colon, the descending, iliac, and sigmoid colon, and part of rectum IMA arises from? Distal abdominal aorta 3-4cm above aortic bifurcation and can act as a collateral connection. May-Thurner syndrome Compression of left common iliac vein by the right common iliac artery as the artery crosses over it, increases likelihood of left common iliac deep vein thrombosis. Paget-Schroetter syndrome -(Stress or effort thrombosis) thrombosis of subclavien or axillary vein secondary to intense, repetitive activity. -Associated with motion of upper extremity as seen with heavy lifting or strenuous throwing of a baseball or football. Nutcracker syndrome Compression of the left renal vein between the aorta and the SMA. Renal arteries supply what? Kidneys, suprarenal glands, ureters. Landmarks for renal artery and vein? Left renal vein crosses the aorta anteriorly and is superior to renal artery. Right renal artery crosses posteriorly to IVC. Two main categories for alternative diagnostic tests related to venous disease are? 1. Evaluation for possible venous thrombosis or venous reflux. 2. Evaluation of a pulmonary embolism (PE). What is a D-dimer test? D-dimer is a protien fragment produced when a blood clot dissolves in the body and is normally undetectable, but it is measurable when a clot is breaking down. With an increase of product breakdown, the level of D-dimer in blood rises. -high level of D-dimer suggests presence of thrombus. Capabilities of D-dimer test? -measurable product of thrombolysis detected on a quantitative blood assey. - can rule out thromboembolism if negative. If positive, has little specificity but points out need for additional testing to diagnose cause of hypercoagulability. Limitations of D-dimer? -there are many different methods/products to detect D-dimer in blood, causing wide variation in results obtained. -D-dimer may be elevated with pregnancy, liver disease, renal disease, cancer, or any thrombotic process, including recent surgery. -lacks specificity and positive predictive value. Two types of contrast venography (phlebography) are? 1. Ascending 2. Descending Ascending venography is? Image the veins from distal to proximal and detects venous abnormalities including DVT. Descending venography is? Image the veins from proximal to distal and assess valve function and venous reflux. Capabilities of venography? -helps evaluation of acute DVT. -evaluates congenital venous disease and/or anomalies. -assists in evaluation of chronic venous changes. -can detect and quantify reversed flow. Limitations of venography? -highly technical in technique and interpretation. -expensive -may be uncomfortable for patients -can have allergic reactions in patients with severe allergies to iodine, troublesome in patients with severe peripheral vascular occlusive disease -exposes patients to radiation How is ascending venography preformed? Requires contrast agent to be injected into a distal superficial vein and directed into the deep system. -lower extremity study, a vein on dorsum of foot is used. -upper extremity study, the basilic or cephalic may be used. -Serial x-rays are taken as contrast material passes through some of the deep veins. How is descending venography performed? -evaluates lower extremity only. -contrast agent usually injected into common femoral vein. -Serial x-rays are taken as contrast material passes through some of the deep veins. What is a lung ventilation/perfusion scan? Measures air and blood flow in the lungs and is a screening test for detection of perfusion defects of the lungs. -referred to as a V/Q scan or "ventilation quotient": a mathematical equation for calculating both air and blood flow. Capabilities of V/Q scan? Detects defects attributed to PE, usually originating from DVT, that lodges in the small vessels of the lungs and prevents adequate perfusion. -can detect poor blood flow in pulmonary vessels. Limitations of V/Q scan? Other disorders besides microembolism can cause perfusion defects like: emphysema, asthma, pneumonia, congestive heart failure, liver cirrhosis, radiotherapy, and postoperative phenomenon. -patients may have an allergic reaction to the radioisotope medium. How is a V/Q scan performed? -supine on table -hour before test, IV is placed in arm and a slightly radioactive liquid agent is injected through IV. -gamma camera sctintigraphy is used to get multiple images of chest take from different angles in order to detect radionuclide. -during Ventilation scan: half of images, patient breaths from a tube inhaling mix of air, oxygen, and radioactive version of gas, which is detected by camera, allowing airflow in different parts of lung to be measured. -during perfusion scan: other half of images, camera will track injected radionuclide in order to determine the presence of blood flow in different locations of lung. Interpretation of V/Q scan? Interpreted as representing high, moderate, or low probability of PE, or they may be intermediate. -patients with normal airflow but abnormal blood flow may have a PE. -patients with localized areas of low blood flow may have other lung diseases, like COPD. What is pulmonary angiography? Evaluating pulmonary arteries for PE What is a computed tomographic angiography(CTA)? -more often used to evaluate PE. STUDY OF CHOICE FOR PE. -uses ionizing radiation to obtain cross sectional images of vasculature. -can be performed with or without contrast agents, but it allows more discrete evaluation of the vessels, pulmonary arteries and it's branches. Limitations of pulmonary angiography? Similar to angiography -allergic reaction to contrast medium -complications like hematoma at puncture site. Limitations of computed tomographic angiography? -can have allergic reaction to contrast medium -images can be degraded by patient motion Technique for pulmonary angiography? -IV inserted -catheter is advanced through veins passing through right atrium into the pulmonary artery -contrast injected and images taken as contrast moves through Arteries in lung Technique for CTA? -Contrast injected through superficial peripheral vein (cephalic) Images obtained as contrast moves through Arteries in lung. How do you decrease risk for venous stasis? -limiting long periods of inactivity or bed rest, promoting venous drainage when inactive -leg elevation -support stockings -pneumatic compression devices -weight management What are varicose veins? Enlarged veins that appear as purple or blue and may appear twisted and/or bulging near skin surface. -very small varicosities,"spider veins(telangiectasias)", usually not medically significant. -large veins may be painful and/or symptomatic of venous disease leading to serious venous complication. What causes varicose veins? 1. Chronic ambulatory venous hypertension, or high pressure in veins due to loss of valve function or obstruction. 2. Pregnancy (increased blood volume along with increased abdominal pressure). 3. Heredity 4. Prolonged standing(pressure in legs remains elevated for long periods of time). 5. Trauma 6. Age (when veins lose Thierry elasticity and more easily stretch, allow blood to pool). 7. Obesity May be considered Most common cause of varicose veins? Incompetence of the greater saphenous vein What is venous ablation? Uses heat energy to close off the diseases vein. -if cannot be performed microphlebectomy, the surgical removal of the diseases vein, may be considered What is sclerotheraphy? The injection of a sclerosing solution, an irratant, into the vessel, resulting in its closure -larger veins may be treated with this but foam sclerotheraphy is more successful. What is foam sclerotheraphy? A solution is injected as a foam instead of a liquid. Advantages of foam sclerotheraphy? 1. Better visualization while it spreads through targeted veins 2. Ability to use smaller amounts of solution 3. Better contact inside the veins due to the foam medium (it stays longer and is not diluted by mixing with blood inside vein.) What is surface laser treatment? -Uses a precise amount of light that is pulsed through a special hand piece in order to target the vein or reddened skin area -The absorbed light causes thermocoagulation of the treated blood vessel What are reticular veins? 1-3mm in diameter vein, dilated, purple or bluish colored What are primary varicose veins? Dilated, torturous superficial veins that may be hereditary (result of congenital absence of one or more valves.) -increased venous pressure that causes primary varicose vein s is unrelated to obstruction of deep venous system What are secondary varicose veins? Caused by obstructive conditions of the deep venous system, such as previous DVT, or pregnancy; obesity May also be considered. Why would you use a vena caval interruption device? In patients with acute DVT who cannot be anticoagulated to prevent PE. -main purpose is to catch thrombus that may break loose from deep vein and embolize to heart and lungs How is interruption device inserted? Using fluroscopy, device is placed in IVC via the jugular or femoral vein Where is IVC placed in body? Just below renal veins Why would a iliofemoral venous thrombectomy be performed? In a patient with impending limb loss (due to phlegmasia cerulea dolens) if thrombolytic therapy does not dissolve the clot Chronic venous insufficiency (CVI) occurs when? The distal veins cannot maintain unidirectional blood flow proximally due to valvular incompetence. Primary cause of venous insufficiency is? Superficial and/or deep venous reflux, (resulting in chronic ambulatory venous hypertension) What is portal hypertension? Elevated pressure in portal vein, resulting from obstruction(increased resistance) of blood flow Portal vein is formed by what two veins? 1. Superior mesenteric vein 2. Splenic vein What is a transjugular intrahepatic portosystemic shunt (TIPS or TIPSS)? Is a percutaneous procedure to create a shunt/communication between the Portal and hepatic veins to decompress the portal vein. How is TIPSS accomplished? 1. Insert catheter in right internal jugular vein 2. Under fluroscopic guidance, advance catheter into right hepatic vein 3. Create bridge into portal vein (advance from hepatic vein into portal vein) 4. Support bridge with an endoprosthesis(stent) What causes portal hypertension? pathology of portal vein, Small intrahepatic portal vein radicals, Hepatic parenchyma, or the hepatic veins. 1. Cirrhosis 2. Cancer 3. Pancreatitis 4. Thrombosis 5. trauma 6. Advanced liver disease 7. Severe congestive heart failure 8. Proximal venous obstruction (hepatic vein or IVC obstruction) Budd-chiari syndrome? Results from hepatic vein occlusion, causes vary with regard to primary site of obstruction(hepatic vein level, sinusoids, or IVC) Abnormal clinical findings for Budd-chiari syndrome? 1. hepatomegaly 2. Abdominal pain 3. Sudden onset of ascites