RVT - Registered Vascular Technologist Abdominal Vascular Duplex Exams Questions and Answers

Question 1

A patient with refractory hypertension is referred for a renal artery duplex exam. The peak systolic velocity (PSV) in the suprarenal aorta is 80 cm/s. The highest PSV obtained in the proximal right renal artery is 300 cm/s. What is the calculated Renal-Aortic Ratio (RAR), and what is the most likely interpretation?

Accepted Answer

RAR is 3.75, suggestive of a hemodynamically significant stenosis (>60%).

Answer

The Renal-Aortic Ratio (RAR) is calculated by dividing the highest peak systolic velocity (PSV) in the renal artery by the PSV of the aorta at the level of the renal arteries. In this case, 300 cm/s ÷ 80 cm/s = 3.75. A widely accepted criterion for a hemodynamically significant stenosis of 60% or greater is an RAR of 3.5 or higher.

Question 2

When measuring the maximum diameter of an abdominal aortic aneurysm (AAA) via duplex ultrasound for surveillance, which of the following is the standard, most reproducible technique?

Accepted Answer

Anterior-posterior diameter measured from outer wall to outer wall in a transverse plane.

Answer

The standard protocol for measuring an abdominal aortic aneurysm is to obtain the maximum anterior-posterior (AP) diameter from the outer wall to the outer wall. This measurement should be taken in a transverse plane, ensuring the calipers are perpendicular to the long axis of the aorta. This technique is the most accurate and reproducible for serial surveillance and clinical decision-making.

Question 3

A 40-year-old patient presents with post-prandial epigastric pain. During a mesenteric duplex exam, the celiac artery PSV is 140 cm/s during quiet inspiration. When the patient performs a deep expiration, the PSV increases sharply to 360 cm/s with associated post-stenotic turbulence. These findings are most characteristic of:

Accepted Answer

Median Arcuate Ligament Syndrome (MALS).

Answer

Median Arcuate Ligament Syndrome (MALS) is caused by extrinsic compression of the celiac artery by the median arcuate ligament of the diaphragm. This compression is most pronounced during expiration, leading to a significant, transient increase in velocity. The velocity normalizes or improves during inspiration as the diaphragm moves and relieves the compression. Atherosclerotic disease would not vary with respiration.

Question 4

A patient with a history of chronic liver disease undergoes an abdominal duplex exam. Which of the following findings is the most specific indicator of severe portal hypertension?

Accepted Answer

Hepatofugal (reversed) flow in the main portal vein.

Answer

While an enlarged portal vein diameter (>13 mm) and splenomegaly are common findings in portal hypertension, the most specific and definitive sign of severe disease is hepatofugal flow in the main portal vein. This indicates that the resistance within the liver is so high that blood flow has reversed its normal direction and is flowing away from the liver through collateral pathways.

Question 5

A patient with ascites, hepatomegaly, and abdominal pain is referred for an abdominal vascular duplex exam. Which of the following findings would be most consistent with a diagnosis of Budd-Chiari syndrome?

Accepted Answer

Absence of detectable flow or visualization of thrombus within the major hepatic veins.

Answer

Budd-Chiari syndrome is a condition defined by the obstruction of hepatic venous outflow. The primary diagnostic finding on duplex ultrasound is the direct evidence of this obstruction, such as thrombosis, stenosis, or complete absence of flow in one or more of the major hepatic veins. The other findings are related to different pathologies.

(RVT) Registered Vascular Technologist Practice Test

(RVT) Registered Vascular Technologist Practice Test

RVT - Registered Vascular Technologist Abdominal Vascular Duplex Exams Questions and Answers