URR: Physiologic Flashcards by Allison Lockwood

Which of the following is considered a limitation of the three cuff lower extremity segmental pressure exam?

a. there is no way to differentiate groin and ankle arterial disease
b. there is no way to differentiate proximal and distal calf artery disease
c. the single thigh cuff normally overestimates the thigh pressure
d. there is no way to differentiate lower thigh and popliteal arterial disease

d. there is no way to differentiate lower thigh and popliteal arterial disease

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The following pressure readings from a segmental pressure evaluation were obtained in a patient suffering from low back and thigh pain. What is the ABI for each leg?
Lt Ankle 136
Rt Ankle 128
Lt Arm 124
Rt Arm 120

A. Rt = 1.07, Lt = 1.10
B. Rt = 1.03, Lt = 1.13
C. Rt = 0.94, Lt = 0.91
D. Rt = 1.03, Lt = 1.10

D. Rt = 1.03, Lt = 1.10

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Which of the following is a contraindication for a lower extremity segmental pressure exam?

a. ulceration on the distal calf
b. ulceration on the 3rd and 4th toes
c. diabetes mellitus
d. current anticoagulant treatment

a. ulceration on the distal calf

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Venous PG tracings are obtained. The right side demonstrates a venous refill time of 30 seconds. The left side demonstrates a refill time of 23 seconds. Which of the following describes the next step in evaluation?

A. A tourniquet will be applied to the left leg at the thigh level and the VRT assessment will be repeated.
B. A tourniquet will be applied to both legs at the thigh level and the VRT assessment will be repeated.
C. The results are normal. No further evaluation is necessary.
D. A tourniquet will be applied to the right leg at the thigh level and the VRT assessment will be repeated.

C. The results are normal. No further evaluation is necessary.

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Which method is preferred to evaluate suspected popliteal entrapment?

A. PPG tracing of the digits at rest and during dorsiflexion
B. segmental pressures before and after treadmill exercise
C.PPG tracing of the digits at rest and during treadmill exercise
D. pulse volume recordings of the leg arteries with the patient supine and standing

A. PPG tracing of the digits at rest and during dorsiflexion

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A segmental pressure exam demonstrates the following pressures:
right arm: 142mmHg
right leg:
proximal thigh 140mmHg
distal thigh 126mmHg
calf 116mmHg
ankle 112mmHg.
Which of the following could explain these results?

A. infrapopliteal disease
B. pelvic mass
C. pelvic mass or mid femoral artery stenosis
D. medial calcification

B. Pelvic mass

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Which of the following would cause the systolic pressure reading obtained from the below knee cuff to be falsely elevated?

A. reading obtained with the patient supine
B. cuff placement over the tibial tubercle
C. cuff is too large
D. the patient suffers from congestive heart failure

B. cuff placement over the tibial tubercle

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Which of the following correctly describes normal results for an air plethysmography (APG) exam?

A. low ejection fraction, low residual venous fraction and venous filling index
B. high ejection fraction and residual venous fraction with low venous filling index
C. high ejection fraction, with low residual venous fraction and venous filling index
D. low ejection fraction and low residual venous fraction with high venous filling index

C. high ejection fraction, with low residual venous fraction and venous filling index

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How should you prepare the patient to start the examination used to assess the venous refill time using photoplethysmography?

A. Seated at the edge of the table with lower legs dangling, sensor placed at medial malleolus
B. Standing with the sensor at the medial malleolus
C. Supine legs elevated with sensor at the medial malleolus
D. Supine legs elevated with pressure cuff on thigh

A. Seated at the edge of the table with lower legs dangling, sensor placed at medial malleolus

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Subcutaneous blood supply to the digits can be evaluated using which non-invasive plethysmography technique?

A. Photoplethysmography
B. Impedance plethysmography
C. Strain gauge plethysmography
D. Pulse volume recording

A. Photoplethysmography

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Which of the following correctly describes a PVR waveform?

A. The patient should be standing for the waveform recording
B. The diastolic flow reversal component is exaggerated on a PVR waveform
C. Hemodynamic changes due to stenosis will be displayed as a deepng of the dicrotic notch and increased amplitude of the wave
D. The amplitude of the waveforms from the calf should be higher than the amplitude of the waveforms from the thigh in normal patients

D. The amplitude of the waveforms from the calf should be higher than the amplitude of the waveforms from the thigh in normal patients

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A. perform digital pressures on at least one more digit on the right hand
B. end the exam and report left palmar arch disease
C. end the exam and report right palmar arch disease
D. perform digital pressures on at least one more digit on the left hand

D. perform digital pressures on at least one more digit on the left hand

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It is important to wait at least one minute before repeating what measurement?

A. ankle blood pressure
B. volume flow in a hemodialysis graft
C. MCA mean velocity
D. brachial pressure on an arm with a hemodialysis graft

A. ankle blood pressure

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The following pressures were obtained in a patient during a segmental pressure exam. Where is the disease, if any?
Right: PTA 136mmHg, DPA, 130mmHg, Calf 136mmHg, Low Thigh 144mmHg, High Thigh 160mmHg, Brachial 130mmHg
Left: PTA 98mmHg, DPA 85mmHg, Calf 100mmHg, Low Thigh 114mmHg, High Thigh 128mmHg, Brachial 126mmHg

A. iliac disease left leg, normal right leg
B. normal left leg, medial calcification right leg
C. left calf artery disease, normal right leg
D. aortic disease or left iliac disease

A. iliac disease left leg, normal right leg

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When the Allen test is performed with significant abnormal findings, what happens to the digit PPG tracings with radial artery compression?

A. amplitude increases by at least 4 times the original amplitude
B. dicrotic notch moves to the top of the peak amplitude
C. amplitude increases by at least 50%
D. amplitude significantly decreases

D. amplitude significantly decreases

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Treadmill exercise is normally performed:

A. until symptoms are intolerable or up to 5 minutes
B. up to 5 minutes
C. until symptoms are intolerable
D. up to 12 minutes or until symptoms are intolerable

A. until symptoms are intolerable or up to 5 minutes

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A patient presents with a history of recurrent upper extremity DVT due to Paget Schroetter syndrome. The referring physician ordered a PVR exam of the upper extremities instead of a venous Doppler exam of the upper extremities. Why?

A. rule out Raynaud’s syndrome
B. to rule out a subclavian steal
C. to rule out associated atherosclerotic disease
D. to rule out thoracic outlet syndrome

D. to rule out thoracic outlet syndrome

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What can be done to inhibit light from the exam room from causing artifact on an upper extremity PPG tracing?

A. increase the room temperature
B. perform the exam with all lights off and windows covered
C. cover the patient’s hand with a towel or sheet
D. place acoustic gel between the PPG sensor and the skin

C. cover the patient’s hand with a towel or sheet

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A patient presents for penile Doppler and segmental pressure exam due to impotence. The ABl is >1.0 bilaterally. The PBI is 0.8. What should be done next to evaluate this patient?

A. Use papaverine to assess for decreased venous outflow
B. Use papaverine to assess for increased venous outflow
C. Have the patient perform 5 minutes of exercise on the treadmill at 7% grade
D. Write the results as normal with no explanation of impotence

B. Use papaverine to assess for increased venous outflow

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When using the rapid cuff inflator to evaluate the great saphenous vein in the distal thigh, where should you place the pneumatic cuff?

A. upper calf
B. ankle
C. foot/metatarsals
D. distal thigh

A. upper calf

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Lower extremity arterial segmental pressure exam results in a post exercise basal pressure recovery time of 2 to 6 minutes which suggests:

A. Thoracic outlet syndrome
B. Multi-level stenosis
C. Iliac Disease
D. Single level stenosis

D. Single level stenosis

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If the systolic brachial pressure is 116mmHg, what is the minimum toe pressure that would be considered normal?

A. 80mmHg
B. 60mmHg
C. 100mmHg
D. 70mmHg

D. 70mmHg

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Which of the following could cause a false reduction in ankle pressure on an average sized patient?

A. medial calcification of the calf vessels
B. using the 12cm cuff for the ankle
C. cuff is loosely wrapped around the arm
D. evaluating the pressure with the patient seated in a chair

B. using the 12cm cuff for the ankle

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Which of the following patients would benefit from an exercise segmental pressure exam?

A. Patient with rest pain and resting ABI 0.4
B. Patient with COPD and resting ABl of 0.9
C. Patient with claudication and resting ABI 0.6
D. Patient with claudication and a resting ABI of 0.95

D. Patient with claudication and a resting ABI of 0.95

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A segmental pressure exam is performed for a patient who is experiencing rest pain in the right leg. An ABI of 0.42 was found on the right leg. Which of the following statements is true regarding the findings? A. The patient will be referred to a vascular surgeon for intervention. B. Exercise testing will provide additional diagnostic information for this patient. C. A PVR exam will provide additional diagnostic information for this patient. D. A tourniquet will be applied to the upper thigh and the ankle pressure repeated.

A. The patient will be referred to a vascular surgeon for intervention.

A patient presents with a script for an upper extremity PPG exam to rule out Raynaud syndrome. How will you perform the exam? A. Place PPG sensors on the wrists before and after cold sensitivity testing. B. Place the PPG sensors at the antecubital fossa and apply tourniquets at multiple levels on the arm to assess changes in flow. C. Place PPG sensors on the tips of the fingers before and after cold sensitivity testing. D. Raynaud syndrome cannot be evaluated with PPG techniques.

C. Place PPG sensors on the tips of the fingers before and after cold sensitivity testing.

Flow velocity in a lower extremity arterial bypass graft is considered abnormal once it falls below A. 40cm/s B. 60cm/s C. 30cm/s D. 50cm/s

A. 40cm/s

Pulse volume recording: A. will demonstrate waveforms that are nearly identical to the analog Doppler waveforms in a normal patient B. readings should be taken beginning with the distal cuff and moving proximally C. is commonly performed with a segmental pressure exam D. is used to assess arterial insufficiency and DVT

C. is commonly performed with a segmental pressure exam

Which of the following techniques can be used to assess the presence and timing of reflux in multiple vessels simultaneously? A. PW Doppler B. color Doppler C. Real time 2D imaging D. CW Doppler

B. color Doppler

Which of the following disorders would demonstrate normal digital pressures in the upper extremity? A. Raynaud disease B. Buerger disease C. Thoracic outlet syndrome D. SVC syndrome

D. SVC syndrome

Increased peripheral resistance will lead to _____ amplitude in PVR tracings. A. increased B. decreased C. little change in D. the formation of a second dicrotic notc

A. increased

The 12cm blood pressure cuffs are missing from the lab. You perform the 3 cuff method lower extremity segmental pressure exam with the 10cm cuffs on a patient that is 5'5" 150lbs. What information that you will report will be invalid? A. brachial pressure only B. calf pressure only C. thigh pressure only D. brachial pressure, calf pressure and ankle pressure

C. thigh pressure only

A ___cuff is usually used to assess wrist pressure and a ____ cuff is usually used to assess digit pressure. A. 2.5cm, 1 cm B. 10cm, 7cm C. 7cm, 2.5cm D. 12cm, 2.5cm

C. 7cm, 2.5cm

Which of the following describes the appearance of a significantly abnormal arterial PPG waveform? A. low amplitude with loss of the dicrotic notch B. high amplitude with prominent of the dicrotic notch C. high amplitude with loss of the dicotic notch D. low amplitude with prominent dicrotic notch

A. low amplitude with loss of the dicrotic notch

You are evaluating a patient with suspected Raynaud disease using PPG. After obtaining a baseline tracing, you place the hand in cold water for 2 minutes. Once the hand is removed, PPG sensors are reapplied to the fingertips. Which of the following correctly describes normal results for this exam? A. waveform amplitude increases to at least 4X the original B. waveform amplitude increases to at least 2X the original C. waveforms return to baseline within 7 minutes after removing the hand from the cold water D. waveforms return to baseline within 5 minutes after removing the hand from the cold water

D. waveforms return to baseline within 5 minutes after removing the hand from the cold water

When performing a lower extremity venous Doppler for insufficiency, A. the intensity of the Doppler signal indicates the severity of the reflux B. a minimum of 30 seconds between augmentation maneuvers is recommended C. augmentation pressure is applied quickly, held for at least 15 seconds, and released quickly D. the GSV should be evaluated with patient bearing weight on the leg

B. a minimum of 30 seconds between augmentation maneuvers is recommended

When a patient performs exercise on a treadmill what will be the normal change in arterial flow in the legs? A. increased antegrade flow in diastole B. increased peripheral resistance C. decreased antegrade flow in diastole D. unchanged flow pattern

A. increased antegrade flow in diastole

What is the primary purpose of using a tourniquet during a venous PPG exam of the leg? A. to evaluate the perforators for reflux B. to determine if thrombus is confined to the superficial system C. to determine if venous insufficiency is confined to the superficial system D. to determine if thrombus is present in the deep or superficial system

C. to determine if venous insufficiency is confined to the superficial system

When performing a treadmill test for PAD, exercise is normally performed _____. When performing a reactive hyperemia exam for PAD, the cuffs are inflated _____. A. for up to 5 minutes, for up to 5 minutes B. for up to 10 minutes, for up to 5 minutes C. with the patient supine, with the patient standing D. with the patient standing, with the patient supine

A. for up to 5 minutes, for up to 5 minutes

A 65yr old male presents with mild left calf pain after walking 10 blocks. The pain is relieved by sitting and resting. On a resting arterial exam with ABI, the left ABl is 1.04. These findings are most suggestive of: A. An exercise arterial should be performed to re-evaluate the ABI of the left leg before a diagnosis is made. B. The patient is most likely experiencing an orthopedic or neurogenic problem and an MRI may be warranted. C. The venous system should be evaluated for thrombosis. D. The venous system should be evaluated for possible insufficiency.

A. An exercise arterial should be performed to re-evaluate the ABI of the left leg before a diagnosis is made.

When performing a PVR exam of the lower extremity arteries, how are the waveforms obtained? A. Starting at the ankle on the right leg, proceed up through the right thigh before repeating the process with the left leg B. Starting at the right thigh cuff and moving toward the right ankle cuff, then repeating the process with the left leg C. Starting at both ankles and moving up through the cuffs on both legs simultaneously D. Starting at both thighs and moving down through the cuffs on both legs simultaneously

D. Starting at both thighs and moving down through the cuffs on both legs simultaneously

Which of the following will increase the amplitude of a digital PPG tracing? A. adjust the baseline of the tracing B. adding more gel between the skin and the sensor C. increase sweep speed of the recorder D. warming the patients foot and toes

D. warming the patients foot and toes

Why should a segmental pressure exam be performed with the patient supine? A. To eliminate the influence of hydrostatic pressure on the ankle pressures B. To provide the most comfortable position for the patient during the lengthy exam C. To increase the pressure in the venous system and reduce the pressures in the arterial system D. To eliminate the influence of hydrostatic pressure on the brachial pressures

A. To eliminate the influence of hydrostatic pressure on the ankle pressures

A patient presents for a bilateral segmental pressure exam of the lower extremities. The chart lists a history of a bilateral mastectomy in 1980. How will this affect your exam? A. The pressure indices cannot be calculated and the exam will be limited to waveform analysis only B. If the surgical procedure was performed more than 15 years ago, the exam should be completed using the standard protocol C. A wrist pressure must be obtained instead of a brachial pressure and this number will be used to calculate the pressure indices D. The patient must be evaluated in the standing position for the pressure measurements

A. The pressure indices cannot be calculated and the exam will be limited to waveform analysis only

A patient presents with a history of HTN, diabetes and claudication. The arterial Doppler evaluation demonstrates monophasic flow in all calf vessels but the ABI values are LT 1.36 and RT 1.32. Which of the following correctly describes the findings? A. The exam is normal and additional testing should be performed to rule out extrinsic vessel compression due to popliteal entrapment syndrome. B. The ABI values are abnormally elevated due to a diabetic complication called medial calcification. C.The most likely diagnosis is thromboangitis obliterans, which leads to medial calcification of the calf vessels. D. The exam is normal and additional testing should be performed to rule out extrinsic vessel compression due to median arcuate ligament syndrome.

B. The ABI values are abnormally elevated due to a diabetic complication called medial calcification.

The 10cm blood pressure cuffs are missing from the lab. You perform the 3 cuff method lower extremity segmental pressure exam with the 12cm and 14cm cuffs on a patient that is 5'5" 150lbs. What information that you will report will be invalid? A. calf pressure only B. brachial pressure only C. thigh pressure only D. brachial pressure, calf pressure and ankle pressure

D. brachial pressure, calf pressure and ankle pressure

Which of the following screening techniques for peripheral arterial disease can distinguish between a stenosis and an occlusion in a vessel? A. Segmental pressure evaluations B. Doppler evaluations C. Pulse Volume Recording D. Photoplethysmography

B. Doppler evaluations

Upon cessation of exercise, the ankle pressures in a normal patient will: A. increase to normal levels in less than 5 minutes B. decrease to normal levels in less than 5 minutes C. decrease to normal levels in less than 10 minutes D. increase to normal levels in less than 10 minutes

B. decrease to normal levels in less than 5 minutes

A double peaked waveform obtained during PPG evaluation of the digits of the left hand is indicative of: A. Thoracic outlet syndrome B. Subclavian stenosis C. Raynaud syndrome D. palmar arch stenosis

C. Raynaud syndrome

A diabetic patient with a history of chronic renal failure and dialysis treatment presents with leg pain with walking. Which of the following is a potential complication for performing a segmental pressure exam on this patient? A. The arm without the dialysis port is the only brachial pressure used in the evaluation. B. Medial calcification may lead to overestimation of the ankle pressures. C. Dialysis patients cannot be placed in the supine position for more than a few minutes, so the segmental exam will need to be performed with the patient seated in a chair. D. More than one of the above

D. More than one of the above

A patient complains of left arm numbness and pain that increases in severity when it is cold outside. An upper extremity arterial duplex exam demonstrates a >50% stenosis in the distal subclavian artery. The PPG exam demonstrates additional decrease in digital flow with cold exposure. What explains these findings? A. Buerger Disease B. Thoracic Outlet Syndrome C. Primary Raynaud Syndrome D. Secondary Raynaud Phenomenon

D. Secondary Raynaud Phenomenon

If the blood pressure in the ankle is obtained with the patient's legs in the dependent position: A. the pressure will be underestimated B. it will be the same as if the patient is evaluated in the supine position C. the ankle will demonstrate the same response as if an exercise exam was just performed D. the pressure will be falsely elevated

D. the pressure will be falsely elevated

While performing an arterial Duplex exam, you obtain a triphasic waveform in the proximal femoral artery but the rest of the leg arteries demonstrate a monophasic waveform. The brachial pressure is 140mmHg. Which of the following lists the correct expected pressures from the four cuff segmental exam on the same patient? A. Upper Thigh 155mmg, Distal Thigh 155mmHg, Popliteal 120mmHg, PTA 110mmHg B. Upper Thigh 155mmg, Distal Thigh 125mmHg, Popliteal 160mmHg, PTA 155mmHg C. Upper Thigh 175mmg, Distal Thigh 120mmHg, Popliteal 110mmHg, PTA 95mmHg D. Upper Thigh 120mmg, Distal Thigh 120mmHg, Popliteal 110mmHg, PTA 100mmHg

C. Upper Thigh 175mmg, Distal Thigh 120mmHg, Popliteal 110mmHg, PTA 95mmHg

When a patient performs exercise on a treadmill what will be the normal change in the ankle brachial indices? A. unchanged or mild decrease B. increased by more than 0.3 C. decreased by less than 0.3 D. unchanged or mild increase

D. unchanged or mild increase

A 9 year old presents with chronic fatigue and decreased palpable femoral pulses. The ankle brachial index is performed with the following results. Lt arm 168mmHg Lt ankle 95mmHg Rt arm 174mmHg Rt ankle 86mmHg; Which of the following is the most likely explanation of the findings? A. There is most likely a coarctation of the descending aorta. B. There is most likely atherosclerotic vascular disease present in both lower extremities. C. There is most likely a subclavian steal present. D. The bilateral ABIs are normal.

A. There is most likely a coarctation of the descending aorta.

Which of the following is a major limitation of a lower extremity segmental pressure exam when compared to a Doppler evaluation? A. The segmental pressure technique is only valid for evaluating obstructive disease below the knee. B. The segmental pressure technique is only valid for evaluating obstructive disease above the knee. C. The segmental pressure technique cannot differentiate external iliac from common femoral stenosis/occlusion. D. The segmental pressure technique cannot evaluate obstructive disease in the feet.

C. The segmental pressure technique cannot differentiate external iliac from common femoral stenosis/occlusion.

A patient presents with HTN, DM and left lower extremity pain that occurs only as he walks. He usually begins to have pain after he walks to his mailbox with increasing pain as he returns to the house. The pain is relieved by resting his legs for a few minutes. What would the predicted ABl value be for the left leg? A. 0.9 B. 0.6 C. 0.4 D. above 1.0; these symptoms are most likely unrelated to arterial disease

B. 0.6

When performing a photoplethysmography exam for arterial insufficiency, where should you place the sensor? A. distal pad of the great toe B. groin C. medial distal calf D. dorsal aspect of the great toe

A. distal pad of the great toe

Which of the following is not a characteristic of a normal PVR tracing of the lower extremity? A. diastolic flow reversal B. dicrotic notch C. anacrotic limb D. peaked amplitude

A. diastolic flow reversal

The following pressure readings from a segmental pressure evaluation were obtained in a patient suffering from low back and thigh pain. What is the ABI for each leg? Lt Ankle 106 Rt Ankle 98 Lt Arm 124 Rt Arm 134 A. Lt = 0.85, Rt = 0.73 B. Lt = 0.85, Rt = 0.79 C. Lt = 0.79, Rt = 0.73 D. Lt = 1.17, Rt = 1.36

C. Lt = 0.79, Rt = 0.73

A diabetic patient presents with an injury to his big toe that won't seem to heal and has been open for over 3 weeks. Which of the following exam techniques should be used to evaluate this patient? A. digital pressures and PPG evaluation B. segmental pressure exam C. cold sensitivity testing D. treadmill testing

A. digital pressures and PPG evaluation

What is the most accurate method of thigh pressure assessment? A. Doppler velocity used in the Bernoulli equation to calculate thigh pressure B. 4 cuff segmental pressure exam C. 3 cuff segmental pressure exam D. Intravenous catheter measures pressure in the superficial femoral vein

C. 3 cuff segmental pressure exam

An abnormal Penile/Brachial Index will be: A. < 1.0 B. > 1.0 C. < 0.65 D. > 0.65

C. < 0.65

A normal lower extremity arterial response to reactive hyperemia is: A. <35% decrease in ankle pressures that return to baseline within one minute B. no change in ankle pressures C. <50% increase in ankle pressures with return to baseline in under 5 minutes D. <50% decrease in ankle pressures that return to baseline within one minute

A. <35% decrease in ankle pressures that return to baseline within one minute

A patient presents with left lower extremity pain that awakens him at night. The pain is relieved by sitting at the side of the bed for a few minutes. What would the predicted ABI value be for the left leg? A. 0.8 B. 0.6 C. 0.4 D. above 1.0; these symptoms are most likely unrelated to arterial disease

C. 0.4

The following pressure readings from a segmental pressure evaluation were obtained in a patient suffering from low back and thigh pain when walking. Which of the following describes a possible reason for the patient's symptoms? Lt Ankle 136 Rt Ankle 128 Lt Arm 124 Rt Arm 120 A. May Thurner B. stenosis of the common femoral artery C. stenosis of the external iliac artery D. neurogenic claudication

D. neurogenic claudication

The ankle brachial index is commonly performed as a part of which of the following exams? A. photoplethysmography B. exercise testing C. strain gauge plethysmography D. transcutaneous oximetry

B. exercise testing

A diabetic patient presents for a segmental pressure exam. The patient complains of an injury to his big toe that won't seem to heal and has been open for over 3 weeks. The digital pressure in the affected toe will most likely be _____. A. <30mmhg B. >200mmHg C. 60-90mmHg D. 30-0mmg

A. <30mmhg

Which of the following is a contraindication for exercise testing? A. More than one of the above B. Non-compressible calf arteries C. Systemic HTN with systolic pressure >200mmHg D. History of cardiac procedure or myocardial infarction

A. More than one of the above

A patient presents with left leg claudication. The right ABl is 1.32 and the left ABl is 1.37. What should you do next for this patient? A. switch to 16cm thigh cuffs and continue the segmental exam to include the proximal calf and thigh pressures B. stop the segmental pressure exam and obtain toe pressures along with PVR waveforms C. use the rapid cuff inflator to repeat the ankle pressure measurements D. end the exam and record the findings

B. stop the segmental pressure exam and obtain toe pressures along with PVR waveforms

Which blood vessel is most commonly evaluated with Doppler to obtain the thigh pressure when performing a segmental pressure exam? A. distal calf artery with lowest ankle pressure B. popliteal artery just above the calf cuff C. femoral artery just proximal to the thigh cuff D. distal calf artery with highest ankle pressure

D. distal calf artery with highest ankle pressure

Rest pain is associated with ankle pressures less than ______ and toe pressures less than _______ will be associated with a non-healing wound. A. 50mmHg, 30mmHg B. 100mmHg, 30mmHg C. 70mmHg, 50mmHg D. 50mmHg, 50mmHg

A. 50mmHg, 30mmHg

Which extremity arterial evaluation technique can be described as the placement of multiple cuffs around the extremity that measure the volume changes beneath them? A. Impedance plethysmography B. Pulse volume recording C. Segmental Pressures D. Photoplethysmography

B. Pulse volume recording

When evaluating suspected thoracic outlet syndrome, a PG exam can be performed with the sensor placed on the ______ or a Doppler exam can be performed with the transducer placed _______. A. 2nd digit, on the radial artery B. 1st digit, on the carotid artery C. lateral wrist, on the brachial artery D. medial wrist, on the radial artery

A. 2nd digit, on the radial artery

A patient presents with HTN, DM and left lower extremity pain that worsens as he walks. He usually begins to have pain after he walks to his mailbox with increasing pain as he returns to the house. The pain is relieved by resting his leg for a few minutes. A bilateral resting ABI is performed with the right leg, 1.12 and the left leg 1.34. Which of the following statements is true regarding the findings? A. Blood pressure and PG evaluation of the digital arteries should be performed. B. These symptoms are most likely unrelated to arterial disease. C. The patient should be evaluated for popliteal entrapment in the left leg. D. Hypertensive disease usually leads to overestimation of the ABI values.

A. Blood pressure and PG evaluation of the digital arteries should be performed.

Which of the following indicates single level arterial obstruction in the leg? A. post exercise ankle recovery time 6-12 minutes B. ABI >0.5 C. ABI <0.5 D. velocity of 200cm/s or less

B. ABI >0.5

Which of the following is a normal response from the capillary beds of the feet and ankles after 5 minutes of vigorous exercise? A. increased osmotic pressures B. vasodilation C. no change in the flow in normal vessels D. vasoconstriction

B. vasodilation

What setting on the photoplethysmography system should remain constant during an extremity arterial evaluation and if it is adjusted it must be documented on the tracing? A. Signal output B. Size control C. Sweep speed D. Baseline level

B. Size control

A 25yr old presents with recent onset of left calf pain when riding his bike. He has been training for a race for the last six months without problem until 2 weeks ago. Exercise testing demonstrates a 50mmHg drop in pressure compared to the right leg with no drop in pressure. These findings are most suggestive of: A. Popliteal entrapment B. Popliteal cyst C. Incorrect cuff placement D. Buerger disease

A. Popliteal entrapment

The lower extremity segmental pressure exam is most commonly performed with a/an _____ to obtain the Doppler signal for the pressure measurements at the ankle. A. 2-3MHz CW Doppler probe B. 8-10MHz CW Doppler probe C. 8-10Mhz vector array D. 5-7MHz linear array

B. 8-10MHz CW Doppler probe

The Adson maneuver is helpful in the diagnosis of what vascular disorder? A. Thoracic outlet syndrome B. Raynaud syndrome C. Venous insufficiency D. Collateral formation with carotid occlusion

A. Thoracic outlet syndrome

In photoplethysmography, the sensor uses __________ to detect _______ changes. A. light, blood volume B. light, blood pressure C. pressure cuff, blood pressure D. thin mercury tubing, volume

A. light, blood volume

Which of the following is a contraindication for a lower extremity segmental pressure exam? A. ulceration on the 3rd and 4th toes B. diabetes mellitus C. recent saphenous vein arterial bypass grafting D. current anticoagulant treatment

C. recent saphenous vein arterial bypass grafting

Venous PPG tracings are obtained. The right side demonstrates a venous refill time of 14 seconds. The left side demonstrates a refill time of 23 seconds. Which of the following describes the next step in evaluation? A. A tourniquet will be applied to both legs at the thigh level and the VRT assessment will be repeated. B. The results are normal. No further evaluation is necessary. C. A tourniquet will be applied to the left leg at the thigh level and the VRT assessment will be repeated. D. A tourniquet will be applied to the right leg at the thigh level and the VRT assessment will be repeated.

D. A tourniquet will be applied to the right leg at the thigh level and the VRT assessment will be repeated.

A segmental pressure exam demonstrates the following pressures; right arm: 136mmHg right leg: thigh 110mmHg, calf 100mmHg, ankle 92mmHg. Which of the following could explain these results? A. aortic disease or popliteal disease B. common iliac disease or distal femoral artery C. medial calcification D. aortic disease or common iliac disease

D. aortic disease or common iliac disease

A diabetic patient presents for a segmental pressure exam. The calf and ankle vessels are non-compressible with up to 220mmHg. What alternative exam can be performed to evaluate lower extremity pressures? A. A pulse volume recording exam B. photoplethysmography with ankle cuffs C. photoplethysmography and toe cuffs D. Doppler ultrasound

C. photoplethysmography and toe cuffs

A patient is short of breath after walking to the facility for the arterial duplex evaluation. What is the first thing you should do when starting his exam? A. Have him rest for 20-30 minutes to allow flow in the legs to normalize B. Have him lie down and start with the Duplex exam and perform the pressures later. C. Take his ankle pressures using the PTA and DPA. D. Take his brachial pressures.

A. Have him rest for 20-30 minutes to allow flow in the legs to normalize

Which of the following exams does not use PW or CW Doppler? A. pulse volume recording B. extracranial exam C. periorbital exam D. transcranial exam

A. pulse volume recording

Which of the following is a reason to perform exercise with a segmental pressure exam? A. to differentiate true claudication from pseudoclaudication B. to evaluate volume changes in the limb C. to evaluate the effects of vasoconstriction D. to differentiate an SFA stenosis from an occlusion

A. to differentiate true claudication from pseudoclaudication

A segmental pressure exam demonstrates the following pressures; distal thigh 144, calf 166, ankle 132. Which of the following could explain these results? A. incorrect cuff size would be the only possible cause B. improper cuff placement and incorrect cuff size, but not medial calcification C. medial calcification or venous insufficiency D . incorrect cuff size, medial calcification and improper cuff placement

D . incorrect cuff size, medial calcification and improper cuff placement

An asymptomatic patient demonstrates a normal left ABI, but the left tibial arteries demonstrate a monophasic waveform with sharp upstroke and rapid deceleration. What is the most likely cause for this tinding? A. Scale settings set too high to detect low velocity flow reversal. B. Filter settings set too low to detect diastolic flow reversal. C. The patient should be evaluated for popliteal entrapment. D. Raynaud syndrome

A. Scale settings set too high to detect low velocity flow reversal.

When performing a photoplethysmography exam for venous insufficiency, where should you place the sensor? A. distal pad of the great toe B. medial distal calf C. dorsal aspect of the great toe D. groin

B. medial distal calf

The difference in systolic pressure between two adjacent levels in the same leg should be no more than _____ mmHg. A. 15 B. 20 C. 25 D. 30

D. 30

An ABl of 0.77 indicates ______ disease. A. severe B. minimal C. mild - moderate D. unable to determine without exercise portion

C. mild - moderate

When performing post-occlusive reactive hyperemia, pressure measurements in the lower extremities are obtained: A. immediately after cuff release and every 30 seconds until pressures return to baseline levels B. immediately after cuff release and every 2 minutes until pressures return to baseline levels C. 1 minute after cuff release and every 30 seconds until pressures return to baseline levels D. 1 minute after cuff release and every 2 minutes until pressures return to baseline levels

A. immediately after cuff release and every 30 seconds until pressures return to baseline levels

Which of the following correctly describes cuff placement for a segmental pressure exam? A. The width of the cuff should be at least 20% narrower than the girth of the limb segment B. Cuffs should be placed straight around the limb, rather than angled to the curve of the limb C. Once the patient is supine, ask him/her to raise their foot about 6 inches above the table to you can properly wrap the cuff around the leg D. The proximal edge of the cuff should always cover a bony structure like the malleolus or tibial tubercle

B. Cuffs should be placed straight around the limb, rather than angled to the curve of the limb

Lower extremity arterial segmental pressure exam results in a post exercise basal pressure recovery time of > 6 minutes which suggests: A. Multi-level stenosis B. Iliac disease C. Popliteal entrapment syndrome D. Single level stenosis

A. Multi-level stenosis

When performing a segmental pressure exam on a patient with claudication, which of the following describes the response to exercise in a patient with pseudoclaudication? A. ABI will most likely be 0.5-0.9 B. Leg pain will be associated with a drop in ankle pressure C. Leg pain will not be associated with a drop in ankle pressure D. ABI will most likely be <0.5

C. Leg pain will not be associated with a drop in ankle pressure

Which of the following is NOT an appropriate reason to terminate the treadmill exercise for a lower extremity arterial exam? A. patient complains that the treadmill is too noisy B. patient complains of chest pain C. patient complains of shortness of breath D. patient complains of leg pain

A. patient complains that the treadmill is too noisy

Which of the following describes the expected change in the PVR tracing on an immediate post procedure evaluation of a patient after successful revascularization of the common femoral artery? A. increased amplitude by >100% B. loss of the dicrotic notch C. increased amplitude by >50% D. decreased amplitude by >50%

C. increased amplitude by >50%

Which of the following is performed with the patient sitting upright? A. A penile Doppler exam B. PVR evaluation of the toes C. pressure evaluation of the fingers D. pressure evaluation of the toes

C. pressure evaluation of the fingers

A patient presents for a bilateral segmental pressure exam and complains of mild leg pain since their heart attack last year. A duplex exam showed medium velocity, triphasic flow with minimal atherosclerosis in the bilateral arteries. The recorded pressures are as follows: Right Arm 110mmHg, Right PTA 88mmHg, Right DPA 92mmHg Left Arm 105mmHg, Left PTA 90mmHg, Left DPA 94mmHg Which of the following could explain the findings? A. The patient most likely has reduced cardiac output causing the right ABI 0.84 and left ABI 0.85. B. The normal arterial duplex exam correlates with the normal lower extremity segmental exam with right ABl 1.20 and left ABI 1.17. C. The patient is most likely suffering from Burger disease. D. The patient most likely has reduced cardiac output causing the right ABI 0.8 and left ABI 0.82.

A. The patient most likely has reduced cardiac output causing the right ABI 0.84 and left ABI 0.85.

You are performing an upper extremity segmental pressure evaluation and obtain the following information: Brachial 140mmHg Upper forearm 132mmHg Wrist - Radial 108mmHg Wrist - Ulnar 130mmHg Which of the following correctly describes the findings? A. obstruction of the mid ulnar artery B. subclavian steal C. obstruction of the mid radial artery D. obstruction of the distal brachial artery

C. obstruction of the mid radial artery

A patient presents for an exercise arterial exam after an abnormal resting exam. The report from the resting exam describes: elevated velocities that indicate a stenosis of >50% in the distal femoral artery on the left leg, biphasic waveforms in the PTA and DPA and an ABI of 0.96. There is no change in the waveforms or decrease in ankle pressures in the left leg with exercise. What could explain these findings? A. extensive collateral formation B. obstructed venous outflow C. Raynaud syndrome D. congestive heart failure

A. extensive collateral formation

Which of the following statements is true regarding a PPG exam for venous insufficiency? A. The best readings with severe insufficiency will be obtained at an ulceration site. B. Prolonged venous refill time (>20s) indicates competent venous valves. C. Tourniquets are used in conjunction with PPG exam to depict the extent of DVT. D. Waveforms obtained for a venous PG exam are similar to those obtained in a venous duplex exam.

B. Prolonged venous refill time (>20s) indicates competent venous valves.

Abnormal results for a penile Doppler evaluation that suggest impotence include ______ peak systolic flow velocity and a peak pressure _______. A. >60cm/s, >30mmHg B. <60cm/s, >60mmHg C. <30cm/s, <60mmHg D. >30cm/s, >60mmHg

C. <30cm/s, <60mmHg

What is the normal change in flow velocity in response to releasing the cuff during reactive hyperemia? A. increase by more than 35% above the resting flow velocity B. decrease to less than half of the resting flow velocity C. increase to more than double the resting flow velocity D. decrease by more than 35% below the resting flow velocity

C. increase to more than double the resting flow velocity

Which of the following patients would require reactive hyperemia testing instead of exercise testing for a lower extremity exam to evaluate new onset of left leg claudication? A. Prior history of DVT 3yrs ago B. Prior history of synthetic graft in the right leg C. Prior history of untreated multilevel disease in the right leg D. Prior history of coronary bypass surgery

C. Prior history of untreated multilevel disease in the right leg

An upper extremity segmental pressure exam produces the following pressures: Brachial RT 140mmHg AND LT 132mmHg Radial RT 144mmHg AND LT 136mmHg Ulnar RT 138mmHg AND LT 138mmHg 2nd Digit RT 130mmHg AND LT 104mmHg Which of the following correctly describes how to report the findings? A. Suspected disease of the left palmar arch or digital artery of the second digit B. Suspected disease of the proximal left ulnar artery C. Suspected disease of the proximal left radial artery D. Suspected disease of the right palmar arch or digital artery of the second digit

A. Suspected disease of the left palmar arch or digital artery of the second digit

An arterial duplex exam demonstrates monophasic flow in the popliteal and calf arteries. The bilateral ABI calculations are over 1.0. What type of testing can be used to better evaluate the pressures in the lower extremities in this patient? A. Repeat the ABl using larger width of cuff to reduce the peak pressure obtained B. Impedance plethysmography C. Repeat the ABl using smaller width of cuff to reduce the peak pressure obtained D. Digit plethysmography

D. Digit plethysmography

When using the 4 cuff method to obtain segmental pressures in the legs, the blood pressure in the proximal thigh normally exceeds the brachial systolic pressure by _____ mmHg. A. 10-20 B. 20-30 C. 30-40 D. 40-50

C. 30-40

When evaluating arterial pressures in the toes, the patient should be: A. supine B. walking C. sitting D. standing

A. supine

What are the average treadmill settings utilized in exercise testing? A. 2mph at 12% grade B. 5mph at 10% grade C. 5mph at 12% grade D. 3mph at 8% grade

A. 2mph at 12% grade

Which of the following is a characteristic of a normal lower extremity arterial PVR waveform? A. slow downslope B. low amplitude C. slow upslope D. prominent dicrotic notch

D. prominent dicrotic notch

Which of the following is NOT normally performed after the injection of papaverine into the tissues proximal to the shaft of the penis: A. Repeat the ABI measurements B. Apply the 2.5cm blood pressure cuff around the shaft of the penis C. Doppler waveforms are obtained in the cavernous arteries and veins 1-2 minutes post-injection D. Measure the diameter of the cavernous arteries

A. Repeat the ABI measurements

Which of the following is not proper procedure for a venous PPG evaluation of the legs? A.The optimal speed for the strip chart recorder is 5mm/sec B. Always place the sensor over the largest varicose vein in the calf C. A tourniquet is applied to the leg after initial testing shows a VRT < 20 sec D. Patient is seated with legs dangling over edge of bed for the exam

B. Always place the sensor over the largest varicose vein in the calf

You are preparing for a lower extremity segmental pressure exam on a patient with leg pain. She was admitted to the hospital 2 days ago due to extensive lower extremity DVT. How will you proceed? A. obtain Doppler waveforms and toe-brachial indices B. cancel the exam C. use cuffs only over areas of the leg where DVT was not identified D. check the chart for anticoagulant medication and if it is listed, proceed normally with the exam

A. obtain Doppler waveforms and toe-brachial indices

Photoplethysmography (PPG) is useful to assess all of the following, except: A. Thoracic Outlet Syndrome (TOS) B. Digit perfusion C. Raynaud disease D. Carotid stenosis

D. Carotid stenosis

When performing an upper extremity segmental pressure exam, you obtain the following readings on the right arm. Right upper arm 140mmHg Right radial artery 110mmHg Right ulnar artery 130mmHg. Which of the following correctly explains the findings? A. radial and ulnar artery disease B. distal brachial artery obstruction C. radial artery disease D. subclavian artery obstruction

C. radial artery disease

How many cuffs are recommended when performing a bilateral lower extremity segmental pressure evaluation? A. 3 B. 8 C. 5 D. 4

B. 8

The following pressures were obtained in a patient with left claudication. What are the ABl values for both legs? Right: PTA 128mmHg, DPA, 124mmHg, Calf 130mmHg, Thigh 140mmHg, Brachial 130mmHg Left: PTA 98mmHg, DPA 122mmHg, Calf 126mmHg, Thigh 138mmHg, Brachial 126mmHg A. RT 0.98, LT 0.94 B. RT 0.95, LT 0.75 C. RT 0.98, LT 0.77 D. RT 1.01, LT 0.96

A. RT 0.98, LT 0.94

Most commonly the posterior tibial and dorsalis pedis arteries are used to obtain the pressure at the ankle. Which of the following describes the correct calculation of the ankle brachial index? A. highest ankle pressure on each leg divided by the highest brachial pressure B. highest right ankle pressure divided by the right brachial pressure and highest left ankle pressure divided by the left brachial pressure C. lowest ankle pressure on each leg divided by the highest brachial pressure D. highest brachial pressure divided by the highest ankle pressure on each ankle

A. highest ankle pressure on each leg divided by the highest brachial pressure

A segmental pressure exam is performed with the following results. Lt arm 140mmHg Lt ankle 155mmHg Rt arm 110mmHg Rt ankle 145mmHg Which of the following correctly describes the findings? A. There is no vascular disease present in the right leg, but the left leg demonstrates mild disease. B. There is mild vascular disease present in the lower extremities. C. There is mild vascular disease present in the lower extremities and there is most likely a subclavian steal present. D. There is no vascular disease present in the legs, but there is most likely a subclavian steal present.

D. There is no vascular disease present in the legs, but there is most likely a subclavian steal present.

URR: Physiologic Flashcards

(125 cards)