Lange Review Ultrasonography Examination, 4th Edition


GENERAL INSTRUCTIONS: For each question, select the best answer. Select only one answer for each question, unless otherwise indicated.

1. All deep veins of the lower leg have at least how many valves

(A) 10

(B) 7

(C) 5

(D) 2

2. What is the longest vein in the body?

(A) cephalic vein

(B) femoral vein

(C) great saphenous vein

(D) inferior vena cava (IVC)

3. The popliteal vein passes through what structure to become the femoral vein?

(A) profunda hiatus

(B) adductor canal

(C) Scarpa’s triangle

(D) flexor hallucis longus

4. Which of the following veins is not part of the superficial venous system?

(A) great saphenous vein

(B) femoral vein

(C) short saphenous vein

(D) basilic vein

5. Which of the following is not typically exhibited by normal veins of the lower extremity above the knee?

(A) spontaneous flow

(B) phasic flow

(C) pulsatile flow

(D) compressibility

6. What percentage of blood in the body can be found within the venous system?

(A) 60–65%

(B) 50–65%

(C) 70–75%

(D) 75–80%

7. All of the following are true of veins except?

(A) Veins have thicker walls than arteries.

(B) Veins are distensible.

(C) Veins are collapsible.

(D) Veins can be divided into deep and superficial systems.

8. Which of the following complications is the primary clinical concern in deep vein thrombosis (DVT)?

(A) claudication

(B) pulmonary embolism (PE)

(C) valve competency

(D) loss of extremity

9. Duplex scanning of the deep venous system of the lower extremities is usually performed with the patient in which of the following positions?

(A) supine position with the leg straight

(B) supine position with the leg externally rotated

(C) supine position with the leg internally rotated

(D) prone position with the leg internally rotated

10. The outermost layer of the vein wall is called the tunica

(A) media

(B) intima

(C) adventitia

(D) endothelium

11. A spontaneous venous signal may not be heard in which one of the following vessels?

(A) external iliac vein

(B) posterior tibial vein

(C) deep femoral vein

(D) common femoral vein

12. Which of the following terms best describes a normal venous signal in the lower extremity?

(A) continuous

(B) phasic

(C) pulsatile

(D) oscillating

13. Extensive iliofemoral thrombosis producing a tight leg edema, severe pain, and cyanotic mottled skin is commonly referred to as?

(A) Raynaud’s phenomenon

(B) claudication

(C) Byrum trace syndrome

(D) phlegmasia cerulea dolens

14. Deep vein thrombosis often destroys the venous valves sometimes resulting in post-phlebitic syndrome, which can lead to all of the following except

(A) thin vessel walls

(B) chronic induration

(C) stasis dermatitis

(D) ulcers

15. During inspiration, as the intra-abdominal pressure increases

(A) blood flows smoothly throughout the body, at the moment of exhalation the valves close, and then quickly reopen again

(B) blood flow from the lower extremities decreases while increasing the flow from the upper part of the body

(C) blood flow from the lower extremities increases while decreasing the flow from the upper part of the body

(D) but there is no significant effect on the venous flow patterns

16. Which of the following cannot be used to evaluate chronic venous insufficiency?

(A) photoplethysmography

(B) air plethysmography

(C) duplex ultrasound

(D) CT scan

17. Which of the following is not a component of “Virchow’s triad”?

(A) injury to the vessel wall

(B) hypercoagulability

(C) immobility of extremity

(D) stasis

18. Which vessels’ distal landmark is the area between the medial malleolus and the Achilles tendon near the skin surface?

(A) anterior tibial veins

(B) posterior tibial veins

(C) short saphenous vein

(D) great saphenous vein

19. Which layer of the vein wall are the venous valves attached to?

(A) tunica adventitia

(B) tunica intima

(C) tunica media

(D) tunica lateral

20. A Greenfield filter, is normally placed in the

(A) right internal jugular

(B) inferior vena cava

(C) superior vena cava

(D) external iliac of thrombosed leg

21. The subclavian vein gives off what branch just before becoming the axillary vein?

(A) costocoracoid vein

(B) basilic vein

(C) cubital vein

(D) cephalic vein

22. The gastrocnemius plexus drains the blood from the gastrocnemius muscle and empties into which of the following vessels?

(A) posterior tibial vein

(B) anterior tibial veins

(C) popliteal vein

(D) peroneal vein

23. The dynamic venous pressure normally measures about 15–20 mm Hg in the venules. What does it normally measure in the right atrium?

(A) 15–20 mm Hg

(B) 100 mm Hg

(C) 0 mm Hg

(D) 50 mm Hg

24. Which of the following is least likely to compromise blood flow on the basis of compression?

(A) Baker’s cyst

(B) lymph nodes

(C) varicose veins

(D) hematomas

25. Which of the following is not a normal characteristic of veins?

(A) phasicity

(B) spontaneity

(C) compressibility

(D) augmentation

(E) continuous signal without respiratory movements

26. There are no valves present in which of the following veins?

(A) innominate veins

(B) axillary vein

(C) external jugular vein

(D) internal jugular vein

27. The superficial veins of the lower extremities can be demonstrated sonographically within 1–2 cm of the skin surface; where do they lie?

(A) within the subcutaneous fat

(B) within the connective tissue sheath

(C) just below the subcutaneous fat

(D) just above the deep fascia

28. The Brescia–Cimino fistula is created surgically between which of the following vessels?

(A) distal ulnar artery and basilic vein

(B) cephalic vein and the radial artery

(C) proximal radial artery and transpose basilic vein

(D) brachial artery and cephalic vein

29. Deep vein thrombosis of the upper extremity is becoming more frequent because of which of the following?

(A) Increased number of patients having radiation therapy and complications

(B) Increased incidence of trauma patients with complications

(C) Increased incidence of thoracic outlet syndrome

(D) Increased use of central venous catheters

30. Which of the following describes the normal route of venous flow in the lower extremity?

(A) superficial veins to perforator veins to the deep veins

(B) deep veins to the perforator veins to the superficial veins

(C) deep veins to superficial veins to perforator veins

(D) superficial veins to the deep veins to perforator veins

31. Which of the following veins is a continuation of the dorsalis pedis and lies between the tibia and fibula on top of the interosseous membrane?

(A) popliteal vein

(B) anterior tibial vein

(C) short saphenous vein

(D) peroneal vein

32. Which one of the following is most likely to lead to hemodialysis access failure?

(A) a large outflow vein

(B) perigraft collection

(C) outflow vein stenosis

(D) the “steal syndrome”

33. What is sclerotherapy?

(A) surgical removal of the superficial veins

(B) use of support stockings and appropriate exercise

(C) injection of superficial veins with agent to induce thrombosis

(D) injection of deep and superficial veins with agent to induce thrombosis

34. Which of the following is not a cause of chronic venous insufficiency?

(A) varicose veins

(B) surgery

(C) post-thrombotic syndrome

(D) chronic recurrent thrombosis

35. Which one of the following is not used to augment veins?

(A) distal compression of the vein

(B) coughing

(C) Valsalva maneuver

(D) compression of the vein with the transducer probe

36. Venography shows a clot in the venous system as

(A) an echogenic mass within the vein

(B) a filling defect within the vein

(C) a heterogeneous mass within the vein

(D) a dilated vein with a spongy appearing mass in the lumen

37. Acute thrombus is soft and may be compressed to a certain extent. Chronic thrombus

(A) is not compressible to any extent

(B) may be easily compressed to a certain extent

(C) will easily compress completely

(D) with some difficulty (pressure) will compress completely

38. Chronic venous insufficiency may be characterized by all of the following except

(A) absence of leg pain

(B) varicose veins

(C) chronic swelling of the leg

(D) cutaneous hyperpigmentation

39. Which of the following is not believed to be a contributing factor to primary varicose veins?

(A) abnormal wall weakness

(B) increased distending force

(C) large arteriovenous fistulas

(D) multiple arteriovenous fistulas

40. Ascending venography cannot be used for which of the following?

(A) to assess the function of the proximal valves in the lower extremity

(B) to determine the location of incompetent perforator

(C) to localize recanalized channels indicating previous thrombophlebitis

(D) to determine the absence or presence of varicosities

41. Which of the following terms describes varicose veins with competent deep vein valves and incompetent superficial veins?

(A) secondary varicose veins

(B) primary varicose veins

(C) first varicose veins

(D) thigh varicose veins

42. Which vein(s) arise(s) from and drain the plantar venous arch and superficial venous net of the foot?

(A) anterior tibial veins

(B) posterior tibial veins

(C) great saphenous vein

(D) short saphenous vein

43. Which vein receives both the superficial and deep venous systems of the upper extremity?

(A) innominate vein

(B) cephalic vein

(C) brachial vein

(D) subclavian vein

44. The axillary veins consist of 5% smooth muscle, whereas veins in the feet consist of

(A) 60–80% smooth muscle

(B) 35–50% smooth muscle

(C) 25–45% smooth muscle

(D) 75–85% smooth muscle

45. Each toe has two dorsal digital and two plantar veins that unite to form the dorsal metatarsal veins that join to form which of the following?

(A) dorsal metatarsal venous arch

(B) superficial dorsal venous arch

(C) deep dorsal venous arch

(D) plantar–dorsal venous arch

46. The communicating veins or “perforators” are located throughout the leg; in most legs, there are

(A) more than 50 of these veins

(B) more than 1000 of these veins

(C) more than 100 of these veins

(D) more than 500 of these veins

47. The only point in the body (in any position except upright) where the arteriovenous pressure gradient remains the constant (83 mm Hg) is the hydrostatic indifferent point (HIP), which is located

(A) at the external jugular

(B) at the hip

(C) at the aorta bifurcation

(D) just below the diaphragm

48. After thrombus fills the vein and adheres to the wall of the vessel, it will then contract, and recanalization will begin. How long does this generally take?

(A) about 10 days after formation

(B) about 3 days after formation

(C) about 5 days after formation

(D) about 12 days after formation

49. Which of the following is not among the most significant risk factor for deep vein thrombosis?

(A) obesity

(B) the use of oral contraception

(C) diabetes

(D) smoking

(E) pregnancy

50. Deep vein thrombus can originate anywhere in the venous system, but studies have shown the single most common site to be which of the following?

(A) soleal sinusoids

(B) posterior tibial vein

(C) iliofemoral veins

(D) saphenous–femoral junction

51. The veins in the sole of the foot form the planter cutaneous arch, which drains into the medial and lateral marginal veins, which in turn empty into

(A) great and short saphenous veins

(B) anterior and posterior tibial veins

(C) anterior tibial vein and short saphenous vein

(D) great saphenous vein

52. What type of venography offers the ability of assessing valvular functions?

(A) posterior venography

(B) descending venograph

(C) ascending venograph

(D) visceral venograph

53. Which one of the organs listed below does not empty blood through the portal vein?

(A) spleen

(B) gallbladder

(C) renal

(D) pancreas

54. In what anatomic region is/are the venous valves found?

(A) tunica intima

(B) tunica media

(C) tunica adventitia

(D) both A and C

55. The right ovarian vein drains directly into the inferior vena cava. The left ovarian vein drains into which of the following veins?

(A) the right ovarian vein

(B) the left internal iliac vein

(C) the inferior vena cava

(D) the left renal vein

56. A functioning valve is competent if

(A) it simultaneously opens and closes

(B) it allows both forward and reverse venous flow

(C) it will not allow reversal of venous blood flow

(D) it stays open continuously allowing continuous venous flow

Questions 57 through 64: Match the structures in Fig. 13–31 with the terms in Column B.


FIGURE 13–31.


57. ______

58. ______

59. ______

60. ______

61. ______

62. ______

63. ______

64. ______


(A) popliteal vein

(B) great saphenous vein

(C) femoral vein

(D) distal inferior vena cava

(E) internal iliac vein

(F) deep femoral vein (profunda)

(G) external iliac vein

(H) common femoral vein

Questions 65 through 72: Match the structures in Fig. 13–32 with the terms in Column B.


FIGURE 13–32.


65. ______

66. ______

67. ______

68. ______

69. ______

70. ______

71. ______

72. ______


(A) anterior tibial veins

(B) plantar digital veins

(C) soleal veins

(D) posterior tibial veins

(E) plantar metatarsal veins

(F) peroneal veins

(G) popliteal vein

(H) great saphenous vein

Questions 73 through 76: Match the letters on the sonogram with the structures in column A


FIGURE 13–33.


73. posterior enhancement ______

74. common femoral vein ______

75. great saphenous vein ______

76. femoral vein ______

77. Which of the following is shown in the compression image in Fig. 13–34?


FIGURE 13–34.

(A) normal response to compression maneuver

(B) thrombosed common femoral vein

(C) vascularized lymph node

(D) groin pseudoaneurysm

78Fig. 13–35 represents which of the following?


FIGURE 13–35.

(A) normal phasic flow

(B) refluxing saphenous vein

(C) normal response to distal compression

(D) pulsatile venous flow

79Fig. 13–36 represents which of the following?


FIGURE 13–36.

(A) normal phasic flow

(B) incompetent valves

(C) normal response to distal compression

(D) pulsatile venous flow

80. Posterior to the neck of the pancreas, what two veins join to form the portal vein?

(A) splenic vein and hepatic vein

(B) hepatic vein and superior mesenteric vein

(C) hepatic vein and celiac vein

(D) splenic vein and superior mesenteric vein

Questions 81 through 94: Match the letter in Column B with the appropriate veins as seen in Fig. 13–37.


FIGURE 13–37.


81. Ulna ______

82. Left subclavian ______

83. Vertebral ______

84. Cephalic ______

85. External jugular ______

86. Axillary ______

87. Basilic ______

88. Radial ______

89. Internal jugular ______

90. Brachiocephalic ______

91. Brachial ______

92. Inferior thyroid ______

93. Right subclavian ______

94. Internal thoracic ______
















95. What percentage of patients with deep vein thrombosis will be likely to develop venous insufficiency in 5–10 years?

(A) 50%

(B) 60%

(C) 70%

(D) 80%

96. Which of the following is a pathological condition that can mimic a deep vein thrombosis?

(A) aortic aneurysm

(B) Baker’s cyst

(C) phlegmasia cerulea dolens

(D) decreased skin temperature

97Fig. 13–38 demonstrates a normal thin-walled vein with which of the following?


FIGURE 13–38.

(A) a closed valve

(B) a opened valve

(C) the early stages of a thrombosis

(D) an artifact

98. This compression image in Fig. 13–39 at the midthigh represents which of the following?


FIGURE 13–39.

(A) An artifact within the lumen

(B) incompressibility of a vein segment

(C) compressibility of a vein segment

(D) Rupture of vein segment due to transducer compression

99. This spectral analysis image Fig. 13–40 shows venous flow with


FIGURE 13–40.

(A) normal respiratory movements

(B) augmentation

(C) collateral flow pattern

(D) vein pulsatility

100Fig. 13–41 is a gray-scale image of the common femoral vein (C) at the saphenous–femoral junctions. What is the arrow pointing to?


FIGURE 13–41.

(A) plaque at the saphenous–femoral junction

(B) an artifact

(C) open valves at the saphenous–femoral junction

(D) early stages of thrombosis at the saphenous–femoral junction

101. The spectral analysis of the portal vein in Fig. 13–42 shows normal respiratory movements and


FIGURE 13–42.

(A) blood flow away from the liver

(B) flow that is bidirectional

(C) pulsatility

(D) blood flow toward the liver

102. The image in Fig. 13–43 is of the common femoral vein with a Doppler waveform demonstrating


FIGURE 13–43.

(A) normal distal augmentation

(B) augmentation demonstrating venous insufficiency

(C) normal phasic waveform

(D) augmentation demonstrating proximal thrombus

103. The spectral analysis of the middle hepatic vein in Fig. 13–44 shows the characteristics of


FIGURE 13–44.

(A) augmentation demonstrating reflux

(B) pulsatile Doppler waveform

(C) normal phasic waveform

(D) continuous Doppler waveform

104. What is shown in the image in Fig. 13–45?


FIGURE 13–45.

(A) popliteal trifurcation

(B) confluence of the deep femoral and femoral veins

(C) sapheno-popliteal junction

(D) sapheno-femoral junction

105. What is shown in the image in Fig. 13–46?


FIGURE 13–46.

(A) normal sapheno-femoral junction

(B) occlusion of the great saphenous vein

(C) chronic occlusion of the saphenous vein

(D) static valve at the sapheno-femoral junction

106. After an episode of deep vein thrombosis, the venous valves are destroyed and become incompetent. This is termed

(A) thrombophlebitis

(B) Raynaud’s phenomenon

(C) post-phlebitic syndrome

(D) phlegmasia cerulea dolens

107Fig. 13–47 represents


FIGURE 13–47.

(A) reflux in the femoral vein

(B) thrombus in the common femoral vein

(C) thrombus in the proximal great saphenous vein

(D) normal great saphenous vein

108Fig. 13–48 represents


FIGURE 13–48.

(A) a large Baker’s cyst

(B) a ruptured gastrocnemius muscle

(C) multiple veins in the calf (posterior tibial and peroneal veins)

(D) soleal vein thrombosis

109. Identify the findings in Fig. 13–49.


FIGURE 13–49.

(A) normal flow dynamics of the neck vessels

(B) partially occluded external jugular vein

(C) partially occluded internal jugular vein

(D) retrograde internal jugular vein flow

110. Identify the findings in Fig. 13–50.


FIGURE 13–50.

(A) normal appearance of the short saphenous vein in the foot

(B) occluded, varicose superficial vein

(C) partially occluded deep vein in the leg

(D) an occluded popliteal vein behind the knee