ARDMS Vascular Technology (VT) Exam — Questions and Answers

Question 1: During segmental pressure testing, a 30 mmHg pressure gradient is found between the proximal thigh and above-knee segments. Where is the disease most likely located?

Popliteal artery
Tibial vessels
Aortoiliac segment
Superficial femoral artery (Correct answer)

Correct answer: Superficial femoral artery

A gradient >20 mmHg between proximal thigh and above-knee cuffs localizes disease to the superficial femoral artery in the mid-thigh region.

Question 2: If an RVT credential lapses, which of the following steps is required to reinstate it?

Automatically renewing online without additional requirements
Retaking only the physics portion of the exam
Completing a new residency program
Completing a reinstatement application and paying applicable fees within the allowed reinstatement window (Correct answer)

Correct answer: Completing a reinstatement application and paying applicable fees within the allowed reinstatement window

Lapsed credentials can be reinstated by submitting a reinstatement application with fees within ARDMS's specified reinstatement window.

Question 3: According to the widely accepted SRU (Society of Radiologists in Ultrasound) consensus criteria for grading internal carotid artery stenosis, which of the following findings is most consistent with a stenosis of 70% or greater?

ICA/CCA PSV ratio of 1.5
Peak Systolic Velocity (PSV) of 125 cm/s
Peak Systolic Velocity (PSV) greater than 230 cm/s (Correct answer)
End-Diastolic Velocity (EDV) of 30 cm/s

Correct answer: Peak Systolic Velocity (PSV) greater than 230 cm/s

The SRU consensus criteria use a Peak Systolic Velocity (PSV) of greater than 230 cm/s as a primary parameter to diagnose an internal carotid artery stenosis of 70% or greater, up to near occlusion. Additional parameters like an End-Diastolic Velocity (EDV) >100 cm/s and an ICA/CCA PSV ratio >4.0 are also used to confirm high-grade stenosis.

Question 4: Which type of continuing medical education (CME) or continuing education (CE) activity is SPECIFICALLY required to maintain RVT credential through ARDMS?

Peer-reviewed publication of at least one article per 3-year cycle
30 CE credits in the registered specialty area every 3 years (Correct answer)
Annual hands-on simulation lab competency demonstration
At least 50% of CE credits must be in ethics

Correct answer: 30 CE credits in the registered specialty area every 3 years

ARDMS requires 30 continuing education credits in the registered specialty area every three years for credential maintenance, ensuring ongoing competency in the registered discipline.

Question 5: A vascular lab's Doppler velocity measurements drift 15% higher than baseline over six months. The MOST likely cause is:

Transducer crystal degradation changing frequency output (Correct answer)
Technologist technique variability
Software algorithm update
Patient body habitus changes

Correct answer: Transducer crystal degradation changing frequency output

Piezoelectric crystal aging or damage shifts the actual transmitted frequency, causing systematic velocity calculation errors because the Doppler equation uses the known center frequency.

Question 6: How does ARDMS verify that RVT candidates have the required clinical experience before taking the exam?

Through a physician-signed attestation form submitted with the application (Correct answer)
By reviewing hospital payroll records
Via a proctored skills demonstration at a testing center
By contacting the candidate's state licensing board

Correct answer: Through a physician-signed attestation form submitted with the application

Candidates must submit a physician-signed attestation form documenting their clinical experience as part of the ARDMS application process.

Question 7: What happens if an RVT fails to meet the renewal requirements?

The RVT must retake the initial exam
Certification becomes inactive (Correct answer)
The RVT must pay additional fees but remains certified
Certification becomes permanently revoked

Correct answer: Certification becomes inactive

If an RVT fails to meet the renewal requirements, such as completing the necessary CME credits within the five-year cycle, their certification becomes inactive. While not permanently revoked, an inactive certification means the individual cannot legally or professionally represent themselves as a certified RVT. Reinstatement typically requires fulfilling the missed requirements.

Question 8: During intraoperative TCD monitoring of a carotid endarterectomy, which finding should prompt the surgeon to insert an intraluminal shunt?

Pulsatility index increase of 0.2 units
MCA mean velocity increase of 15% after clamping
Appearance of spectral broadening in the MCA waveform
MCA mean velocity decrease of more than 50% from pre-clamp baseline (Correct answer)

Correct answer: MCA mean velocity decrease of more than 50% from pre-clamp baseline

A >50% drop in ipsilateral MCA mean velocity after carotid cross-clamping indicates inadequate collateral perfusion and cerebral ischemia risk. This threshold is widely used as the criterion for shunt placement to maintain cerebral blood flow during the endarterectomy.

Question 9: Which segment of the vertebral artery (V1-V4) is most accessible to duplex ultrasound and is the most common site for atherosclerosis?

V3 - from C2 to dura (atlantoaxial loop)
V1 - origin from subclavian to C6 transverse foramen (Correct answer)
V4 - intradural segment to basilar junction
V2 - within the transverse foramina C6 to C2

Correct answer: V1 - origin from subclavian to C6 transverse foramen

The V1 segment at the vertebral artery origin from the subclavian is the most common site of atherosclerosis and is accessible to duplex imaging.

Question 10: An RVT who earns the Registered Phlebology Sonographer (RPhS) credential gains specialized recognition in which career niche?

Venous disease management and superficial venous assessment (Correct answer)
Abdominal aortic aneurysm surveillance
Pediatric cardiac imaging
Transcranial Doppler monitoring

Correct answer: Venous disease management and superficial venous assessment

The RPhS credential specifically validates expertise in superficial venous assessment and venous disease management, opening opportunities in vein specialty practices and phlebology clinics.

Question 11: Which component is a part of the RVT certification exam?

Obstetric Ultrasound
Cardiac Imaging
Vascular Technology (Correct answer)
General Anatomy

Correct answer: Vascular Technology

The Registered Vascular Technologist (RVT) certification specifically assesses a candidate's expertise in vascular technology. The exam covers topics directly related to the anatomy, physiology, pathology, and sonographic evaluation of the vascular system, ensuring that certified individuals are competent in performing and interpreting vascular ultrasound studies.

Question 12: Which PSV ratio across a graft stenosis is most consistent with a hemodynamically significant (>50%) lesion?

PSV ratio >1.0
PSV ratio >2.0 (Correct answer)
PSV ratio >1.5
PSV ratio >3.5

Correct answer: PSV ratio >2.0

A peak systolic velocity ratio greater than 2.0 at the stenosis versus the adjacent graft segment indicates a hemodynamically significant stenosis of greater than 50%.

Question 13: Which collateral pathway opens when the ipsilateral ICA is occluded and the contralateral ICA is patent?

Anterior communicating artery (Correct answer)
Ophthalmic artery retrograde flow
Posterior communicating artery
Basilar artery-to-MCA anastomosis

Correct answer: Anterior communicating artery

The anterior communicating artery connects the two ACAs, allowing contralateral ICA flow to supply the ipsilateral hemisphere via the ACoA.

Question 14: A patient with a reversed saphenous vein graft undergoes duplex 2 years postoperatively. A valve cusp remnant is identified causing turbulent flow with a PSV ratio of 1.8. What is the recommended management?

Close interval surveillance (every 3 months) to monitor for progression, with referral if ratio exceeds 2.0 (Correct answer)
Immediate surgical revision
Anticoagulation alone
No further monitoring as valve remnants are benign

Correct answer: Close interval surveillance (every 3 months) to monitor for progression, with referral if ratio exceeds 2.0

A PSV ratio of 1.8 at a valve site does not yet meet the >2.0 threshold for intervention but warrants shortened surveillance intervals to detect progression.

Question 15: Which parameter, when increased, will reduce the maximum depth from which unambiguous pulsed Doppler signals can be obtained?

Sample volume size
Pulse duration
Pulse repetition frequency (PRF) (Correct answer)
Transmit frequency

Correct answer: Pulse repetition frequency (PRF)

Higher PRF reduces the time between pulses, meaning echoes from deep structures may return after the next pulse is fired, causing range ambiguity.

Question 16: During peripheral arterial physiologic testing, what is the significance of a 'pole test' (elevation test)?

It assesses venous valve competence in the lower extremity
It determines the critical closing pressure of limb arteries by elevating the limb until Doppler signal disappears (Correct answer)
It measures the increase in cardiac output with limb elevation
It identifies deep vein thrombosis by elevation-induced pain

Correct answer: It determines the critical closing pressure of limb arteries by elevating the limb until Doppler signal disappears

The pole test elevates the limb to determine the height at which Doppler signal disappears, estimating the effective perfusion pressure in critically ischemic limbs when cuff pressures are unreliable.

Question 17: Which duplex ultrasound finding in an arteriovenous fistula (AVF) differentiates it from a pseudoaneurysm?

To-and-fro waveform at the communication neck
Arterialized (pulsatile, low-resistance) flow in the adjacent vein (Correct answer)
Absence of color flow within the lesion
High-resistance waveform in the feeding artery

Correct answer: Arterialized (pulsatile, low-resistance) flow in the adjacent vein

The hallmark of an AVF is arterialized (pulsatile, high-velocity, low-resistance) flow detected in the draining vein due to direct arteriovenous communication.

Question 18: Which parameter is measured during exercise ABI testing that is NOT assessed in resting ABI?

Dorsalis pedis waveform morphology
Brachial systolic pressure
Tibial artery compressibility
Post-exercise pressure recovery time (Correct answer)

Correct answer: Post-exercise pressure recovery time

Post-exercise pressure recovery time assesses the hemodynamic reserve not apparent at rest, revealing functionally significant lesions that may normalize at rest.

Question 19: After endovenous laser ablation (EVLA) of the great saphenous vein, which duplex finding at 1 week indicates a successful procedure?

Closure of the GSV with absence of flow and echogenic occlusive thrombus within the treated segment (Correct answer)
Partial recanalization with turbulent flow
Unchanged GSV diameter with reduced flow velocity
Residual flow with reduced diameter

Correct answer: Closure of the GSV with absence of flow and echogenic occlusive thrombus within the treated segment

Successful EVLA results in GSV occlusion demonstrated by absence of color flow and an echogenic thrombus filling the treated lumen.

Question 20: Which of the following vascular pathologies is characterized by a non-atherosclerotic, non-inflammatory process that causes abnormal cell growth in the arterial wall, often leading to a 'string of beads' appearance on angiography?

Fibromuscular dysplasia (FMD) (Correct answer)
Marfan syndrome
Giant cell arteritis
Buerger's disease

Correct answer: Fibromuscular dysplasia (FMD)

Fibromuscular dysplasia (FMD) is a condition causing stenosis or aneurysms in medium-sized arteries, most commonly the renal and internal carotid arteries. The classic angiographic 'string of beads' appearance is caused by alternating areas of medial fibroplasia (causing stenosis) and aneurysmal dilatation. Giant cell arteritis is inflammatory, Buerger's disease is an inflammatory vasculopathy linked to tobacco, and Marfan syndrome is a connective tissue disorder.

Question 21: What is the maximum number of times a candidate may attempt the ARDMS RVT examination within a 12-month period?

Unlimited attempts
Three attempts (Correct answer)
Two attempts
One attempt only

Correct answer: Three attempts

ARDMS limits candidates to three examination attempts per 12-month period, with required waiting periods between attempts.

Question 22: Which Doppler waveform characteristic differentiates the external carotid artery from the internal carotid artery?

ECA has higher peak systolic velocity than ICA in all individuals
ECA shows bidirectional flow; ICA shows monodirectional flow
ECA has high-resistance pulsatile flow with little or no diastolic flow; ICA has continuous low-resistance flow (Correct answer)
ECA has low-resistance continuous diastolic flow; ICA has none

Correct answer: ECA has high-resistance pulsatile flow with little or no diastolic flow; ICA has continuous low-resistance flow

The ECA supplies high-resistance muscle and skin beds, producing a pulsatile waveform with minimal diastole, while the ICA supplies the low-resistance brain with continuous diastolic flow.

Question 23: Why is the RVT credential important in vascular technology?

It demonstrates a commitment to professional excellence. (Correct answer)
It is required for all medical jobs.
It allows exemption from state licensure.
It replaces the need for clinical experience.

Correct answer: It demonstrates a commitment to professional excellence.

The RVT credential is vital because it demonstrates a commitment to professional excellence in vascular technology. It signifies that an individual has met rigorous national standards of knowledge and skill, assuring employers and patients of their expertise. This certification enhances credibility and trust in the diagnostic services provided.

Question 24: Which hemodynamic principle states that flow rate equals the pressure gradient divided by resistance?

Bernoulli's principle
Poiseuille's law
Laplace's law
Ohm's law analogy for blood flow (Correct answer)

Correct answer: Ohm's law analogy for blood flow

The hydraulic analogy to Ohm's law describes blood flow (Q) as the pressure difference (ΔP) divided by vascular resistance (R).

Question 25: A patient undergoes carotid endarterectomy (CEA). Intraoperative TCD monitoring detects a sudden drop in MCA mean velocity to below 15 cm/s after cross-clamping. This indicates:

Hyperemic response to ischemia
Cerebral hypoperfusion requiring shunt placement (Correct answer)
Vasospasm from surgical manipulation
Successful shunting with normal perfusion restored

Correct answer: Cerebral hypoperfusion requiring shunt placement

An MCA mean velocity <15 cm/s or >50% drop from baseline after carotid cross-clamp indicates inadequate collateral flow and warrants intraoperative shunting.

Question 26: A 68-year-old male presents with episodes of dizziness, vertigo, and bilateral visual disturbances. A carotid duplex ultrasound reveals antegrade flow in both internal carotid arteries and the right vertebral artery. However, the left vertebral artery demonstrates sustained retrograde flow. What is the most likely diagnosis?

Bilateral carotid artery stenosis
Right subclavian steal syndrome
Left subclavian steal syndrome (Correct answer)
Vertebrobasilar insufficiency

Correct answer: Left subclavian steal syndrome

Subclavian steal syndrome is characterized by the reversal of blood flow in the vertebral artery on the same side as a significant stenosis or occlusion of the proximal subclavian artery. The retrograde flow in the left vertebral artery indicates that blood is being 'stolen' from the posterior circulation to supply the left arm, which is diagnostic of left subclavian steal syndrome.

Question 27: What is the standard format for questions on the ARDMS RVT examination?

True/false questions with brief justifications
Single-best-answer multiple choice with four options (Correct answer)
Matching questions pairing diagnoses with waveforms
Extended matching with up to eight answer options

Correct answer: Single-best-answer multiple choice with four options

The RVT examination uses single-best-answer multiple choice questions, each with four answer options, consistent with standardized credentialing exam formats.

Question 28: In a stenotic vessel, where is the highest flow velocity observed according to the continuity equation?

At the site of maximum narrowing (Correct answer)
Distal to the stenosis
Proximal to the stenosis
At the vessel wall

Correct answer: At the site of maximum narrowing

The continuity equation (A1V1 = A2V2) requires velocity to increase at the point of greatest cross-sectional area reduction.

Question 29: Which anatomical variant describes the absence of one segment of the Circle of Willis, making a patient more vulnerable to stroke if a feeding vessel is occluded?

Fenestrated basilar artery
Persistent trigeminal artery
Duplicated MCA
Aplastic or hypoplastic communicating artery (Correct answer)

Correct answer: Aplastic or hypoplastic communicating artery

Aplasia or hypoplasia of communicating arteries (ACoA or PCoA) limits collateral flow reserve, increasing stroke risk when a major feeding vessel is compromised.

Question 30: An RVT candidate completes an accredited 2-year vascular technology program but has not yet graduated. Can they apply to sit the ARDMS exam?

No, only physicians may apply before completing formal training
Yes, they may apply as a final-year student under ARDMS's graduate eligibility rule (Correct answer)
Yes, any enrollment in a health program qualifies immediately
No, official graduation and transcript submission are required before any application is accepted

Correct answer: Yes, they may apply as a final-year student under ARDMS's graduate eligibility rule

ARDMS allows final-year students in accredited programs to apply under a graduate eligibility window before official graduation.

Question 31: During ultrasound-guided central venous access, the primary advantage of real-time needle visualization over landmark technique is:

Elimination of the need for post-procedure chest X-ray
Confirmation of venous (vs. arterial) waveform before catheter insertion
Automatic calculation of catheter depth required
Direct visualization of needle tip position within the target vessel lumen in real time (Correct answer)

Correct answer: Direct visualization of needle tip position within the target vessel lumen in real time

Real-time ultrasound guidance allows the operator to see the needle tip entering the vessel lumen, confirming correct placement before guidewire advancement. This directly reduces complications such as inadvertent arterial puncture, pneumothorax, and posterior wall perforation compared to landmark-only technique.

Question 32: Why is it important for an RVT to update their contact information with ARDMS promptly?

Renewal reminders and audit notices are sent to the address on file (Correct answer)
State licensing boards require ARDMS contact data to be current
ARDMS charges extra fees for outdated addresses
Outdated information results in automatic credential suspension

Correct answer: Renewal reminders and audit notices are sent to the address on file

ARDMS sends critical renewal and audit communications to the registrant's address on file, so outdated information can cause missed deadlines.

Question 33: A vascular technologist is performing a Transcranial Doppler (TCD) examination through the transtemporal window. To identify the middle cerebral artery (MCA), what is the expected direction of blood flow relative to the transducer?

Antegrade (towards the transducer) (Correct answer)
Variable depending on patient position
Bidirectional
Away from the transducer

Correct answer: Antegrade (towards the transducer)

When insonating through the transtemporal window for a TCD exam, the ultrasound beam is typically aimed superiorly and slightly anteriorly. The middle cerebral artery (MCA) courses laterally from the circle of Willis, so its blood flow is directed towards the transducer, resulting in an antegrade or positive Doppler shift.

Question 34: A patient presents with a pulsatile abdominal mass and a bruit. Duplex ultrasound shows an aortic diameter of 4.2 cm. According to standard guidelines, what is the recommended surveillance interval?

Immediate surgical referral
Every 3 months
Every 6 months
Every 12 months (Correct answer)

Correct answer: Every 12 months

AAAs between 4.0–4.9 cm are typically surveilled annually per most US guidelines (e.g., SVS).

Question 35: What does the term 'post-thrombotic syndrome' describe in the context of peripheral venous disease?

Recurrent DVT in the same limb
Acute pulmonary embolism following DVT
Chronic venous hypertension and symptoms resulting from prior DVT damage to valves and vein walls (Correct answer)
Venous malformation detected after thrombophlebitis

Correct answer: Chronic venous hypertension and symptoms resulting from prior DVT damage to valves and vein walls

Post-thrombotic syndrome results from valve destruction and chronic venous hypertension following DVT, causing pain, edema, and skin changes.

Question 36: Which topic is covered in the physics section of the RVT exam?

Pharmacology
Surgical techniques
Human embryology
Doppler principles (Correct answer)

Correct answer: Doppler principles

The physics section of the RVT exam covers essential principles of ultrasound, including Doppler principles. Understanding Doppler is critical as it explains how blood flow velocity and direction are measured and displayed in vascular ultrasound. A strong grasp of these concepts is fundamental for accurate diagnostic interpretation and performing vascular studies.

Question 37: Which of the following correctly describes the anatomical relationship of the great saphenous vein to the fascia?

It runs alongside the femoral artery in the femoral canal
It runs in the saphenous compartment between the superficial and deep fascia (Correct answer)
It is located superficial to all fascial layers
It lies within the muscular compartment deep to the deep fascia

Correct answer: It runs in the saphenous compartment between the superficial and deep fascia

The great saphenous vein runs within the saphenous compartment, a fibrofatty layer bounded by the superficial and deep (muscular) fascia.

Question 38: When assessing the portal vein by duplex, which finding is most consistent with portal hypertension?

Phasic flow variation with respiration greater than 30%
Hepatofugal flow reversal in the main portal vein (Correct answer)
High-velocity turbulent flow exceeding 100 cm/s
Hepatopetal flow with velocity less than 16 cm/s and increased vessel diameter

Correct answer: Hepatofugal flow reversal in the main portal vein

Hepatofugal (away from the liver) flow reversal in the main portal vein is a hallmark finding of significant portal hypertension.

Question 39: A 70-year-old male presents with sudden, severe 'tearing' chest pain radiating to his back. An abdominal ultrasound visualizes a linear, echogenic structure fluttering within the aortic lumen, separating it into two distinct channels. What is this classic finding called?

Atherosclerotic plaque
Reverberation artifact
Mural thrombus
Intimal flap (Correct answer)

Correct answer: Intimal flap

The clinical presentation is highly suggestive of an aortic dissection. The sonographic finding of a mobile, linear structure within the lumen that separates a true lumen from a false lumen is the characteristic intimal flap, which represents the torn intimal layer of the vessel wall.

Question 40: In the CEAP classification for chronic venous disease, what does a classification of C3 indicate?

Active venous ulcer
Varicose veins without edema
Edema without skin changes (Correct answer)
Telangiectasias or reticular veins

Correct answer: Edema without skin changes

C3 in the CEAP classification denotes edema of venous origin without skin changes.

Question 41: Lateral resolution in ultrasound imaging is best at the:

Depth equal to half the wavelength
Focal zone of the transducer (Correct answer)
Near field (Fresnel zone) directly below the transducer face
Far field (Fraunhofer zone) at maximum depth

Correct answer: Focal zone of the transducer

Lateral resolution (ability to separate two side-by-side structures) is optimal at the focal zone where the beam is narrowest, and degrades in both the near and far fields as the beam diverges.

Question 42: Carotid artery stenting (CAS) post-procedure surveillance with duplex ultrasound uses different velocity thresholds than native vessel criteria because stents:

Reduce wall compliance and increase velocities, requiring higher threshold cutoffs (Correct answer)
Increase wall compliance and decrease velocities
Only affect diastolic velocities
Have no effect on Doppler velocities

Correct answer: Reduce wall compliance and increase velocities, requiring higher threshold cutoffs

Stents reduce arterial wall compliance and produce intrinsically higher peak velocities, necessitating higher PSV thresholds (e.g., >300-450 cm/s for ≥50% in-stent restenosis) compared to native vessel criteria.

Question 43: A vascular lab implements a protocol requiring dual verification of all lower extremity bypass graft surveillance reports. This is an example of which patient safety concept?

Failure mode and effects analysis (FMEA)
Lean Six Sigma waste reduction
Redundancy / independent double-check (Correct answer)
Root cause analysis

Correct answer: Redundancy / independent double-check

Independent double-check (redundancy) adds a second verification step to catch errors before they reach the patient, a core patient safety strategy in high-reliability organizations.

Question 44: When performing ultrasound-guided thrombin injection for a femoral pseudoaneurysm, what is the most critical step before injection?

Compress the femoral vein to redirect flow
Confirm absence of AV fistula and clearly visualize the neck of the pseudoaneurysm (Correct answer)
Measure the peak systolic velocity in the native artery
Administer systemic anticoagulation to prevent distal thrombosis

Correct answer: Confirm absence of AV fistula and clearly visualize the neck of the pseudoaneurysm

Identifying the neck and confirming no concurrent AV fistula is essential to prevent thrombin from entering the native circulation.

Question 45: During mesenteric duplex imaging, the inferior mesenteric artery (IMA) is best evaluated in which patient position and window?

Supine, anterior midline transabdominal approach at the level of L3-L4 (Correct answer)
Left lateral decubitus, left flank approach
Supine, subcostal approach angled toward the spine
Prone, posterior approach at the level of L1

Correct answer: Supine, anterior midline transabdominal approach at the level of L3-L4

The IMA originates from the anterior aortic wall at approximately L3-L4 and is best accessed from the anterior midline in a supine patient.

Question 46: When a vascular laboratory experiences a near-miss event (an error that was caught before reaching the patient), the BEST institutional response is to:

Document the event confidentially, analyze contributing factors, and implement process improvements (Correct answer)
Ignore the event since no patient was harmed
Report the event only if it recurs a second time
Discipline the staff member involved to deter future errors

Correct answer: Document the event confidentially, analyze contributing factors, and implement process improvements

Near-miss events are high-value learning opportunities; confidential reporting combined with systems-based root cause analysis and process improvement is the gold standard in patient safety science.

Question 47: Which duplex finding best distinguishes carotid plaque hemorrhage from calcified plaque?

Calcified plaque appears isoechoic to surrounding tissue
Hemorrhagic plaque appears highly echogenic with acoustic shadowing
Hemorrhagic plaque always shows posterior enhancement
Hemorrhagic plaque appears hypoechoic or heterogeneous without shadowing; calcified plaque shows dense shadowing (Correct answer)

Correct answer: Hemorrhagic plaque appears hypoechoic or heterogeneous without shadowing; calcified plaque shows dense shadowing

Intraplaque hemorrhage appears hypoechoic or heterogeneous on ultrasound, while calcification produces bright echoes with posterior acoustic shadowing.

Question 48: Which Doppler parameter is most sensitive for detecting a hemodynamically significant stenosis when peak systolic velocity is limited by low cardiac output?

Resistive index of the CCA
Peak systolic velocity alone
End-diastolic velocity alone
ICA-to-CCA peak systolic velocity ratio (Correct answer)

Correct answer: ICA-to-CCA peak systolic velocity ratio

The ICA/CCA PSV ratio normalizes for cardiac output, making it more reliable than absolute velocity in low-flow states; a ratio >4.0 indicates ≥70% stenosis.

Question 49: What is the primary purpose of performing a celiac axis duplex examination during both inspiration and expiration?

To evaluate postprandial hemodynamic response of the celiac axis
To maximize Doppler angle correction accuracy
To differentiate celiac artery from superior mesenteric artery origin
To distinguish extrinsic compression by the median arcuate ligament from intrinsic atherosclerotic stenosis (Correct answer)

Correct answer: To distinguish extrinsic compression by the median arcuate ligament from intrinsic atherosclerotic stenosis

Median arcuate ligament compression of the celiac artery typically worsens during expiration and improves with inspiration, distinguishing it from fixed atherosclerotic disease.

Question 50: During carotid endarterectomy surveillance, which finding at the endarterectomy site is MOST concerning for restenosis requiring intervention?

Mild intimal thickening with PSV <125 cm/s
ICA PSV of 160 cm/s with mild spectral broadening
ICA PSV of 200 cm/s with ICA/CCA ratio of 2.5
ICA PSV >300 cm/s with ICA/CCA ratio >4.0 (Correct answer)

Correct answer: ICA PSV >300 cm/s with ICA/CCA ratio >4.0

An ICA PSV >300 cm/s combined with an ICA/CCA ratio >4.0 indicates severe (>70%) post-CEA restenosis, which typically warrants intervention.

Question 51: A patient is referred for a cerebrovascular ultrasound due to symptoms of vertebrobasilar insufficiency (VBI). Which of the following symptoms is LEAST likely to be associated with this condition?

Drop attacks (sudden leg weakness)
Unilateral facial droop (Correct answer)
Bilateral vision loss (diplopia)
Vertigo and dizziness

Correct answer: Unilateral facial droop

Vertebrobasilar insufficiency results from reduced blood flow to the posterior circulation of the brain. Symptoms typically involve structures supplied by the vertebral and basilar arteries, such as the cerebellum and brainstem, leading to vertigo, vision changes, and coordination issues. A unilateral facial droop is a classic symptom of anterior circulation stroke, often involving the middle cerebral artery territory, not typically isolated in VBI.

Question 52: Which statement BEST describes the Windkessel effect and its importance in peripheral arterial testing?

It describes the collateral recruitment response to arterial occlusion
It is the pressure gradient measured across a stenosis during exercise
It refers to venous pooling that affects ABI accuracy
It is the elastic recoil of large arteries that dampens pulsatile flow and maintains diastolic pressure (Correct answer)

Correct answer: It is the elastic recoil of large arteries that dampens pulsatile flow and maintains diastolic pressure

The Windkessel effect is the storage and release of energy by elastic vessel walls, sustaining forward flow during diastole and contributing to normal triphasic waveform morphology.

Question 53: When using the NASCET criteria to measure ICA stenosis, the denominator (reference vessel) is the:

Common carotid artery diameter
Distal ICA beyond the stenosis and bulb (Correct answer)
External carotid artery diameter
Bulb diameter at its widest point

Correct answer: Distal ICA beyond the stenosis and bulb

NASCET measures stenosis as (1 - stenotic lumen / distal normal ICA lumen) × 100%, using the distal ICA as the reference.

Question 54: A vascular technologist is preparing for the RVT exam and wants to review lower extremity arterial content. Which evaluation should receive the most study time?

Penile blood flow assessment
Segmental pressure and duplex evaluation of the lower extremity arteries (Correct answer)
Toe photoplethysmography only
Iliac vein compression assessment

Correct answer: Segmental pressure and duplex evaluation of the lower extremity arteries

Lower extremity arterial evaluation including segmental pressures and duplex scanning is the highest-weighted component of the peripheral arterial section.

Question 55: Which Doppler waveform pattern is characteristic of a low-resistance vascular bed, such as the internal carotid artery or renal artery?

Continuous forward flow throughout diastole with broad systolic peak (Correct answer)
Sharp systolic upstroke with complete diastolic cessation
Triphasic pattern with diastolic reversal
High systolic peak with absent diastolic flow

Correct answer: Continuous forward flow throughout diastole with broad systolic peak

Organs with continuous metabolic demand (brain, kidneys) maintain low resistance, producing persistent forward diastolic flow on Doppler.

Question 56: A 55-year-old male runner presents with exertional leg pain. Resting ABI is 1.0 bilaterally. Post-exercise ABI drops to 0.6 bilaterally and recovers in 3 minutes. He has no risk factors for PAD. Which diagnosis should be considered FIRST?

Popliteal artery entrapment syndrome (Correct answer)
Bilateral superficial femoral artery disease
Exertional compartment syndrome
Medial tibial stress syndrome

Correct answer: Popliteal artery entrapment syndrome

Popliteal artery entrapment syndrome classically presents in young, athletic males with normal resting ABIs and significant post-exercise ABI drops due to muscular compression of the popliteal artery.

Question 57: Ultrasound-guided compression repair of a femoral pseudoaneurysm is MOST likely to fail or be contraindicated when the patient is:

Female with a body mass index under 25
Older than 70 years of age
Undergoing anticoagulation therapy (Correct answer)
Post-diagnostic (non-therapeutic) catheterization

Correct answer: Undergoing anticoagulation therapy

Anticoagulation significantly impairs the ability to thrombose the pseudoaneurysm sac during compression, making the procedure much less effective and requiring prolonged compression times. In anticoagulated patients, ultrasound-guided thrombin injection is the preferred alternative because it does not depend on the coagulation cascade.

Question 58: A 68-year-old woman has rest pain and an ABI of 0.38. Her toe pressure is 22 mmHg. According to TASC II criteria, this patient most likely has:

Non-occlusive mesenteric ischemia
Claudication (Fontaine stage II)
Critical limb ischemia (Fontaine stage III-IV) (Correct answer)
Mild peripheral arterial disease

Correct answer: Critical limb ischemia (Fontaine stage III-IV)

Critical limb ischemia is defined by rest pain or tissue loss with ankle pressure <50 mmHg or toe pressure <30 mmHg, consistent with this patient's findings.

Question 59: A patient with subclavian steal syndrome will demonstrate which finding on vertebral artery duplex?

Antegrade high-velocity flow throughout systole and diastole
Monophasic low-resistance antegrade flow
Absence of Doppler signal bilaterally
Complete reversal of flow direction throughout the cardiac cycle (Correct answer)

Correct answer: Complete reversal of flow direction throughout the cardiac cycle

Complete subclavian steal causes full reversal of vertebral artery flow as blood is 'stolen' retrograde to supply the ischemic subclavian artery territory.

Question 60: What is the preferred ultrasound-guided intervention for an iatrogenic femoral pseudoaneurysm that fails compression therapy?

Balloon angioplasty of the puncture site
Ultrasound-guided thrombin injection into the pseudoaneurysm sac (Correct answer)
Surgical ligation under general anesthesia
Elastic compression bandaging for 72 hours

Correct answer: Ultrasound-guided thrombin injection into the pseudoaneurysm sac

Ultrasound-guided thrombin injection is the first-line treatment for pseudoaneurysms that do not respond to compression. A small volume of thrombin (100–500 units) is injected directly into the sac under real-time imaging, inducing rapid thrombosis while the neck is monitored to prevent inadvertent arterial embolization.

Question 61: What is the expected spectral Doppler waveform morphology in a normally functioning, mature lower extremity reversed saphenous vein bypass graft that is supplying the ankle and foot?

A 'tardus parvus' waveform
A continuous, non-pulsatile venous-like signal
High-resistance, multiphasic (triphasic or biphasic) (Correct answer)
Low-resistance, monophasic with high diastolic flow

Correct answer: High-resistance, multiphasic (triphasic or biphasic)

A bypass graft assumes the hemodynamic characteristics of the vascular bed it supplies. Since the arteries of a resting lower extremity are a high-resistance bed, a normal graft waveform should be high-resistance, meaning it will be multiphasic (triphasic or strongly biphasic) with sharp systolic upstroke and minimal diastolic flow. [23]

Question 62: Performing research studies evaluating a new vascular imaging protocol most closely aligns with which RVT career track?

Clinical research coordinator or scientist role (Correct answer)
Medical billing compliance officer
Home health aide
Per-diem clinical staffing

Correct answer: Clinical research coordinator or scientist role

RVTs involved in evaluating new imaging protocols function as clinical research coordinators, applying their technical expertise to advance evidence-based vascular diagnostics.

Question 63: Which of the following is a primary purpose for performing an exercise stress test in a patient with suspected peripheral arterial disease (PAD) and a borderline resting ABI?

To determine the patient's pain tolerance.
To unmask a hemodynamically significant stenosis that is not apparent at rest. (Correct answer)
To measure the maximum heart rate achieved during exercise.
To evaluate for coronary artery disease.

Correct answer: To unmask a hemodynamically significant stenosis that is not apparent at rest.

Exercise increases blood flow demand in the lower extremities. In a patient with PAD, a stenosis that is not flow-limiting at rest may become significant during exercise, causing a drop in ankle pressures. This helps to confirm the diagnosis and assess the functional severity of the disease when resting studies are inconclusive.

Question 64: A sonographer measures a peak systolic velocity in the common carotid artery and notes that the Doppler angle of insonation is 75 degrees. What is the most likely consequence of using this angle for the velocity measurement?

The measurement will be accurate as long as the sample volume is small.
The velocity will be significantly overestimated.
The velocity will be significantly underestimated. (Correct answer)
Aliasing artifact will be minimized.

Correct answer: The velocity will be significantly underestimated.

The Doppler equation uses the cosine of the angle between the ultrasound beam and the direction of blood flow to calculate velocity. As this angle increases towards 90 degrees, its cosine value decreases sharply. Angles above 60 degrees introduce a large potential for error, leading to a significant underestimation of the true velocity.

Question 65: When performing thigh PVR measurements, which error would MOST likely cause falsely elevated thigh pressures?

Performing the test in a cold room
Using a cuff that is too narrow relative to thigh circumference (Correct answer)
Using a cuff that is too large for the thigh circumference
Measuring immediately after exercise

Correct answer: Using a cuff that is too narrow relative to thigh circumference

A narrow thigh cuff requires higher pressure to compress the underlying artery, producing falsely elevated pressures—a cuff width of at least 40% of limb circumference is needed for accuracy.

Question 66: An RVT who teaches an accredited sonography CME course may claim credits under which category?

Volunteer community service
Teaching/faculty credit (Correct answer)
Research publication credit
Patient care hours

Correct answer: Teaching/faculty credit

ARDMS allows CME credit for teaching accredited courses, categorized as teaching or faculty credit.

Question 67: During exercise, peripheral arterial waveforms typically change from triphasic to monophasic because:

Cardiac output decreases
Peripheral resistance decreases due to vasodilation (Correct answer)
Blood viscosity increases
Heart rate decreases

Correct answer: Peripheral resistance decreases due to vasodilation

Exercise-induced vasodilation in muscle beds reduces peripheral resistance, allowing continuous forward diastolic flow and a monophasic pattern.

Question 68: A patient presents with claudication. The right brachial pressure is 140 mmHg and the left brachial pressure is 130 mmHg. The right posterior tibial artery pressure is 70 mmHg and the right dorsalis pedis artery pressure is 65 mmHg. What is the correct Ankle-Brachial Index (ABI) for the right leg?

0.50 (Correct answer)
0.96
1.07
0.46

Correct answer: 0.50

To calculate the ABI, the highest ankle pressure on one side is divided by the highest of the two brachial pressures. In this case, the highest right ankle pressure is 70 mmHg (from the posterior tibial artery) and the highest brachial pressure is 140 mmHg. Therefore, 70 / 140 = 0.50. This value indicates moderate to severe peripheral arterial disease.

Question 69: The spectral broadening seen in disturbed flow distal to a stenosis is caused by:

A wide range of velocities across the vessel lumen (Correct answer)
Reduced wall filter settings
Elevated peak systolic velocity only
Increased laminar flow organization

Correct answer: A wide range of velocities across the vessel lumen

Turbulent and disturbed flow creates multiple velocity vectors simultaneously, filling in the normally clear spectral window below the waveform.

Question 70: In venous duplex imaging, 'augmentation' refers to which of the following?

Increase in vein diameter with inspiration
Enhancement of color Doppler signal with contrast agents
Rise in peak systolic velocity with proximal compression
Increase in venous flow velocity with distal manual compression (Correct answer)

Correct answer: Increase in venous flow velocity with distal manual compression

Augmentation is the transient increase in venous flow velocity produced by squeezing the limb distal to the transducer.

Question 71: In the context of vascular laboratory QA, what is the purpose of a 'correlation study'?

To calculate inter-rater agreement between two sonographers scanning the same patient consecutively
To compare the lab's duplex findings with those from another imaging modality to validate diagnostic accuracy (Correct answer)
To measure Doppler angle reproducibility across technologists
To assess whether equipment cleaning reduces infection rates

Correct answer: To compare the lab's duplex findings with those from another imaging modality to validate diagnostic accuracy

A correlation study compares duplex ultrasound findings to a reference standard such as CTA, MRA, or angiography to verify the lab's diagnostic thresholds are clinically valid.

Question 72: Which condition is most associated with spontaneous carotid artery dissection in young patients without atherosclerotic risk factors?

Hyperlipidemia
Fibromuscular dysplasia (Correct answer)
Diabetes mellitus type 2
Hypertensive emergency

Correct answer: Fibromuscular dysplasia

FMD weakens the arterial wall media, predisposing young patients to spontaneous dissection of the ICA or vertebral artery.

Question 73: Which OSHA standard is most directly applicable to vascular laboratory staff who handle patient specimens such as blood?

29 CFR 1910.147 Lockout/Tagout
29 CFR 1910.1200 Hazard Communication
29 CFR 1910.1030 Bloodborne Pathogens (Correct answer)
29 CFR 1910.95 Occupational Noise Exposure

Correct answer: 29 CFR 1910.1030 Bloodborne Pathogens

29 CFR 1910.1030 specifically governs exposure to bloodborne pathogens and mandates exposure control plans, PPE use, and hepatitis B vaccination offers.

Question 74: During surveillance of a prosthetic femoropopliteal bypass graft, a focal area of color aliasing is noted mid-graft. The peak systolic velocity (PSV) within this segment is 320 cm/s. The PSV in a normal-appearing graft segment just proximal to this area is 150 cm/s. What is the velocity ratio (Vr), and what is the most likely interpretation?

Vr = 0.47; Suggests proximal disease
Vr = 2.5; Suggests impending occlusion
Vr = 1.7; Mild (<50%) stenosis
Vr = 2.1; Significant (≥50%) stenosis (Correct answer)

Correct answer: Vr = 2.1; Significant (≥50%) stenosis

The velocity ratio (Vr) is calculated by dividing the highest PSV at the stenosis (320 cm/s) by the PSV in a normal proximal segment (150 cm/s), which equals 2.13. A Vr ≥ 2.0 is a widely accepted criterion indicating a hemodynamically significant stenosis of 50% or greater in a peripheral bypass graft. [14]

Question 75: Photoplethysmography (PPG) is used to assess digital perfusion. What does a flattened, obstructive waveform on digital PPG indicate?

Vasospasm that will resolve with warming
Normal variant in elderly patients
Venous hypertension in the digit
Significant arterial obstruction reducing pulsatile flow to the digit (Correct answer)

Correct answer: Significant arterial obstruction reducing pulsatile flow to the digit

A flat or nearly absent PPG waveform indicates severely reduced or absent pulsatile arterial inflow to the digit, consistent with significant obstruction or critical ischemia.

Question 76: Which condition can produce a falsely HIGH ABI, potentially masking severe peripheral arterial disease?

Cardiac tamponade
Acute deep vein thrombosis
Severe anemia
Medial arterial calcification (Mönckeberg sclerosis) (Correct answer)

Correct answer: Medial arterial calcification (Mönckeberg sclerosis)

Medial calcification renders vessels incompressible, requiring supra-systolic cuff pressures that never fully occlude the artery, resulting in ABI values >1.3 despite significant disease.

Question 77: An increased pulsatility index (PI) proximal to a segment of arterial occlusion suggests:

Increased downstream resistance due to the obstruction (Correct answer)
Improved collateral circulation
Hyperdynamic cardiac function
Arteriovenous fistula formation

Correct answer: Increased downstream resistance due to the obstruction

Proximal to an occlusion, high outflow resistance causes the waveform to become more pulsatile with reduced or absent diastolic flow.

Question 78: The vertebral arteries typically originate from which vessels?

Aortic arch directly
Brachiocephalic trunk bilaterally
Subclavian arteries (Correct answer)
Common carotid arteries

Correct answer: Subclavian arteries

The vertebral arteries arise from the subclavian arteries bilaterally and ascend through the transverse foramina of C6 to C1.

Question 79: Which of the following best describes the purpose of the ARDMS Continuous Quality Improvement (CQI) program for RVT holders?

To replace the CME requirement for experienced technologists
To certify new sonography graduates before sitting for the RVT exam
To encourage ongoing self-assessment and professional development beyond minimum CME (Correct answer)
To audit hospital vascular laboratory accreditation status

Correct answer: To encourage ongoing self-assessment and professional development beyond minimum CME

The CQI program promotes lifelong learning and professional growth beyond the baseline CME renewal requirements.

Question 80: Which intraoperative duplex finding after infrainguinal bypass graft creation most likely warrants immediate surgical revision?

Focal peak systolic velocity ratio greater than 3:1 across an anastomotic segment (Correct answer)
Mild color-flow turbulence immediately distal to the proximal anastomosis
Graft diameter slightly smaller than the native tibial artery
Phasic (triphasic) flow pattern throughout the graft body

Correct answer: Focal peak systolic velocity ratio greater than 3:1 across an anastomotic segment

A PSV ratio >3:1 across a focal segment indicates a hemodynamically significant stenosis (≥75% diameter reduction). When found intraoperatively before the wound is closed, it signals a technical defect — suture narrowing, intimal flap, or kinking — that should be corrected immediately to prevent early graft failure.

Question 81: When evaluating a composite sequential bypass graft (vein proximally, PTFE distally with distal vein cuff), where is the HIGHEST risk location for stenosis development?

The proximal vein-to-artery anastomosis
The proximal aortic inflow
The vein-to-PTFE anastomosis and the distal vein cuff-to-native artery anastomosis (Correct answer)
The mid-PTFE segment

Correct answer: The vein-to-PTFE anastomosis and the distal vein cuff-to-native artery anastomosis

Composite graft failure is most common at the synthetic-to-vein junction and the distal anastomosis where intimal hyperplasia preferentially develops at material transitions and anastomotic sites.

Question 82: What hemodynamic principle explains why a 50% diameter stenosis may not produce a resting pressure gradient but becomes hemodynamically significant during exercise?

Bernoulli's equation: pressure loss is proportional to flow velocity squared (Correct answer)
At rest, collateral resistance exceeds stenosis resistance
Poiseuille's law: resistance increases with the square of radius reduction
Flow velocity remains constant regardless of stenosis severity

Correct answer: Bernoulli's equation: pressure loss is proportional to flow velocity squared

Pressure loss across a stenosis is proportional to flow velocity squared (Bernoulli), so the increased flow demanded during exercise dramatically amplifies pressure gradient across a previously subcritical stenosis.

Question 83: Which of the following statements about CME credits for RVT renewal is accurate?

Credits earned abroad are never accepted
Only online webinars qualify for renewal credits
Credits can be earned through approved activities such as courses, publications, and professional meetings (Correct answer)
Credits must all be earned in the final year of the renewal cycle

Correct answer: Credits can be earned through approved activities such as courses, publications, and professional meetings

ARDMS accepts CME credits from a variety of approved activities including courses, journal articles, research publications, and professional meetings.

Question 84: A 65-year-old man has a popliteal aneurysm repaired with an interposition vein graft. Duplex at 6 months shows the vein graft is patent with a mid-graft PSV of 45 cm/s and triphasic waveforms. This finding suggests:

Anastomotic pseudoaneurysm
Graft arteriovenous fistula requiring repair
A low-risk, well-functioning graft that should continue surveillance (Correct answer)
Impending thrombosis requiring urgent intervention

Correct answer: A low-risk, well-functioning graft that should continue surveillance

A mid-graft PSV of 45 cm/s with triphasic waveforms indicates adequate graft flow without focal stenosis; surveillance should continue per protocol.

Question 85: The Nyquist limit in pulsed wave Doppler determines the maximum detectable Doppler shift without aliasing, which equals:

Twice the pulse repetition frequency (2×PRF)
The pulse repetition frequency (PRF)
The transducer frequency
Half the pulse repetition frequency (PRF/2) (Correct answer)

Correct answer: Half the pulse repetition frequency (PRF/2)

Aliasing occurs when the Doppler shift exceeds the Nyquist limit, which is one-half of the pulse repetition frequency.

Question 86: What is required to maintain RVT certification?

Participating in workshops every year
Obtaining additional certifications
Renewing state licenses annually
Completing CME credits (Correct answer)

Correct answer: Completing CME credits

To maintain RVT certification, registered vascular technologists must complete Continuing Medical Education (CME) credits. This requirement ensures that professionals stay current with the latest advancements, techniques, and best practices in vascular technology. It demonstrates a commitment to lifelong learning and helps maintain high standards of patient care.

Question 87: Which vessel is most commonly responsible for a watershed infarct between the MCA and ACA territories?

Basilar artery thrombosis
Vertebral artery occlusion
Posterior communicating artery aneurysm
Internal carotid artery stenosis (Correct answer)

Correct answer: Internal carotid artery stenosis

Severe ICA stenosis reduces perfusion pressure, making the border-zone watershed region between MCA and ACA territories vulnerable to ischemia.

Question 88: How many questions are typically included in the RVT certification exam?

200 questions
100 questions
170 questions (Correct answer)
250 questions

Correct answer: 170 questions

The RVT certification exam typically includes 170 multiple-choice questions. This number of questions is designed to thoroughly assess a candidate's knowledge across all required domains within the allotted time. It ensures a comprehensive evaluation of their understanding of both ultrasound physics and vascular technology.

Question 89: During splenic artery duplex evaluation, the normal waveform pattern reflects which hemodynamic state?

High-resistance triphasic flow with brief flow reversal
Pulsatile bidirectional flow synchronous with respiration
Low-resistance flow with continuous forward diastolic flow (Correct answer)
Monophasic flat waveform with no diastolic component

Correct answer: Low-resistance flow with continuous forward diastolic flow

The splenic parenchyma is a low-resistance vascular bed, so the splenic artery normally displays continuous forward diastolic flow similar to other visceral vessels.

Question 90: Which duplex ultrasound finding is MOST suggestive of a hemodynamically significant stenosis in an AV fistula requiring intervention?

PSV ratio >2:1 across a focal stenosis with access flow <400 mL/min (Correct answer)
Mild color-flow aliasing throughout the entire fistula body
PSV of 180 cm/s at the venous anastomosis with a normal Qa
Pulsatile waveform pattern in the outflow vein

Correct answer: PSV ratio >2:1 across a focal stenosis with access flow <400 mL/min

A PSV ratio >2:1 (stenotic segment vs. adjacent normal segment) combined with a reduced access flow (<400 mL/min) meets the threshold for intervention in most clinical guidelines. Isolated velocity elevation without flow reduction may not be hemodynamically significant; both criteria together confirm clinically meaningful stenosis.

Question 91: A patient with a history of 'food fear' and significant weight loss is evaluated for chronic mesenteric ischemia. In a fasting state, which of the following duplex findings would be most indicative of a hemodynamically significant (>70%) stenosis?

A low-resistance waveform in the superior mesenteric artery (SMA).
A peak systolic velocity (PSV) of 150 cm/s in the celiac artery.
Retrograde flow in the common hepatic artery.
A peak systolic velocity (PSV) greater than 280 cm/s in the superior mesenteric artery (SMA). (Correct answer)

Correct answer: A peak systolic velocity (PSV) greater than 280 cm/s in the superior mesenteric artery (SMA).

The most widely accepted duplex criterion for a hemodynamically significant stenosis (>70%) in the superior mesenteric artery (SMA) is a peak systolic velocity (PSV) of ≥275 cm/s in a fasting state. A low-resistance waveform in a fasting SMA is a normal post-prandial finding, not a sign of stenosis. A celiac PSV of 150 cm/s is normal. Retrograde common hepatic flow indicates celiac occlusion, but elevated PSV in the SMA is a direct measure of its own stenosis.

Question 92: What is the physiologic explanation for the brief paradoxical increase in ABI sometimes seen immediately after exercise in a patient with claudication?

Arterial vasodilation increases cardiac output and systemic pressure (Correct answer)
Collateral vessels temporarily dilate beyond their capacity
Cardiac output decreases, reducing peripheral resistance
Post-exercise brachial artery vasospasm falsely lowers the denominator

Correct answer: Arterial vasodilation increases cardiac output and systemic pressure

Immediately after exercise, cardiac output and brachial pressure may transiently rise due to sympathetic activation, which can briefly elevate the ABI before ischemic vasodilation reduces ankle pressures.

Question 93: A patient with diabetes and suspected digital ischemia undergoes photoplethysmography (PPG) of the great toe. The resulting waveform is severely dampened with a delayed upstroke and a rounded peak. What is the most likely interpretation of this finding?

Vasospastic disorder
Normal arterial inflow
Venous insufficiency
Significant proximal arterial occlusive disease (Correct answer)

Correct answer: Significant proximal arterial occlusive disease

Photoplethysmography (PPG) assesses changes in blood volume in the capillary beds. A normal PPG waveform has a sharp systolic upstroke and a dicrotic notch. A dampened, rounded waveform with a slow upstroke indicates poor arterial perfusion, which is characteristic of significant proximal (upstream) arterial stenosis or occlusion that reduces pulsatile flow to the digits.

Question 94: The normal intima-media thickness (IMT) of the common carotid artery in adults under 50 years is generally accepted as less than:

0.5 mm
1.5 mm
1.2 mm
0.9 mm (Correct answer)

Correct answer: 0.9 mm

An IMT of less than 0.9 mm is generally considered normal in adults, while values ≥1.0 mm suggest subclinical atherosclerosis.

Question 95: The posterior inferior cerebellar artery (PICA) most commonly originates from the:

Superior cerebellar artery
Basilar artery
Posterior cerebral artery
Vertebral artery (Correct answer)

Correct answer: Vertebral artery

PICA typically arises from the distal intracranial vertebral artery, and its occlusion causes the lateral medullary (Wallenberg) syndrome.

Question 96: What is the normal toe-brachial index (TBI) value in a healthy adult?

>1.00
>0.60 (Correct answer)
>0.80
>0.40

Correct answer: >0.60

A normal TBI is ≥0.70 in most references, with values below 0.60 generally considered abnormal and indicating significant digital arterial disease.

Question 97: In pulsed-wave Doppler, aliasing occurs when the Doppler shift frequency exceeds:

The transducer frequency
Half the pulse repetition frequency (Nyquist limit) (Correct answer)
The wall filter setting
The sample volume depth

Correct answer: Half the pulse repetition frequency (Nyquist limit)

Aliasing occurs when the Doppler shift exceeds the Nyquist limit (PRF/2), causing the waveform to wrap around and appear on the opposite side of the baseline.

Question 98: In continuous wave (CW) Doppler, the major advantage over pulsed wave Doppler is:

Color flow mapping capability
Range resolution
Better lateral resolution
Ability to measure very high velocities without aliasing (Correct answer)

Correct answer: Ability to measure very high velocities without aliasing

CW Doppler has no PRF limitation and can accurately measure very high velocities, making it ideal for severe stenoses or cardiac jets.

Question 99: Which parameter is used to calculate volume flow rate (mL/min) when performing duplex assessment of a dialysis access?

End-diastolic velocity and pulsatility index
Time-averaged mean velocity and vessel cross-sectional area (Correct answer)
Acceleration time and vessel diameter
Peak systolic velocity and resistivity index

Correct answer: Time-averaged mean velocity and vessel cross-sectional area

Volume flow = time-averaged mean velocity (TAMV) × cross-sectional area (πr²) × 60, providing flow in mL/min.

Question 100: An RVT credential holder retires from clinical practice. What happens to their credential?

It remains active indefinitely at no cost
It is immediately revoked upon retirement
It is automatically transferred to an honorary status
It will lapse at the next renewal deadline if CME and fees are not submitted (Correct answer)

Correct answer: It will lapse at the next renewal deadline if CME and fees are not submitted

Credentials are maintained only if renewal requirements (CME credits and fees) are met; retirement does not grant automatic active or honorary status.

Question 101: The acoustic impedance of a medium is determined by:

Density and propagation speed (Correct answer)
Frequency and wavelength
Pulse duration and duty factor
Attenuation coefficient and depth

Correct answer: Density and propagation speed

Acoustic impedance (Z) equals the product of the medium's density (ρ) and the speed of sound (c) in that medium: Z = ρc.

Question 102: A patient presents with transient monocular blindness (amaurosis fugax). Which artery is the most likely source of the embolic event?

Internal carotid artery ipsilateral to the affected eye (Correct answer)
Vertebral artery
Basilar artery
Posterior cerebral artery

Correct answer: Internal carotid artery ipsilateral to the affected eye

Amaurosis fugax is caused by emboli from the ipsilateral ICA traveling into the ophthalmic artery and its branch, the central retinal artery.

Question 103: What does the resistivity index (RI) formula [(PSV - EDV) / PSV] primarily reflect?

Cardiac output
Blood viscosity
Vessel wall compliance
Downstream vascular resistance (Correct answer)

Correct answer: Downstream vascular resistance

The resistivity index quantifies the pulsatility of flow and correlates with peripheral vascular resistance distal to the sample site.

Question 104: In aortic dissection, which ultrasound finding distinguishes the true lumen from the false lumen?

The true lumen always has higher peak systolic velocity than the false lumen
The true lumen is always posterior in the descending thoracic aorta
The false lumen demonstrates pulsatile expansion on M-mode
The false lumen is typically larger with slower flow and may contain spontaneous echo contrast or thrombus (Correct answer)

Correct answer: The false lumen is typically larger with slower flow and may contain spontaneous echo contrast or thrombus

The false lumen is often larger, has lower velocity swirling flow, may show spontaneous echo contrast (smoke), and may be partially thrombosed.

Question 105: An RVT who publishes a peer-reviewed article on carotid artery duplex ultrasound may apply for CME credit under which category?

Patient outcomes reporting
Quality assurance credit
Institutional committee service
Research and publication credit (Correct answer)

Correct answer: Research and publication credit

ARDMS recognizes peer-reviewed publication as an eligible CME activity, classified under research and publication credit.

Question 106: Carotid body tumors (paragangliomas) at the bifurcation characteristically displace which two vessels on duplex ultrasound?

CCA and vertebral artery are compressed together
CCA and ECA are splayed apart
ICA and ECA are splayed apart (lyre sign) (Correct answer)
ICA and vertebral artery are displaced medially

Correct answer: ICA and ECA are splayed apart (lyre sign)

The 'lyre sign' describes widening of the angle between the ICA and ECA caused by a hypervascular carotid body tumor seated at the bifurcation.

Question 107: Which organization specifically accredits vascular ultrasound testing laboratories in the United States for quality standards compliance?

The Joint Commission (TJC)
The American College of Radiology (ACR) exclusively
ARDMS (the RVT credentialing body)
The Intersocietal Accreditation Commission (IAC) (Correct answer)

Correct answer: The Intersocietal Accreditation Commission (IAC)

The IAC (Intersocietal Accreditation Commission) operates an accreditation program specifically for vascular testing laboratories, evaluating protocols, equipment, personnel credentials, report quality, and QA processes. Many payers and hospitals require IAC accreditation as a condition of reimbursement. ARDMS credentials individuals, not laboratories.

Question 108: A duplex exam shows a dilated, tortuous vessel in the popliteal fossa with arterial waveform and adjacent venous signal. What is the most likely diagnosis?

Popliteal vein aneurysm
Baker's cyst with hemorrhage
Pseudoaneurysm of the popliteal artery
Popliteal arteriovenous fistula (Correct answer)

Correct answer: Popliteal arteriovenous fistula

An arteriovenous fistula presents with arterialized flow in a dilated venous structure adjacent to the feeding artery.

Question 109: A peak systolic velocity of 220 cm/s with an end-diastolic velocity of 85 cm/s in the ICA corresponds to which NASCET stenosis category per the Society of Radiologists in Ultrasound (SRU) consensus criteria?

Less than 50% stenosis
70-99% stenosis (Correct answer)
Near occlusion
50-69% stenosis

Correct answer: 70-99% stenosis

Per SRU criteria, ICA PSV ≥125 cm/s with EDV ≥40 cm/s and ICA/CCA ratio >2.0 indicates 70-99% stenosis requiring closer evaluation.

Question 110: In transcranial Doppler, the middle cerebral artery (MCA) is typically insonated through which window at a depth of 45-65 mm?

Suboccipital (transforaminal) window
Submandibular window
Transorbital window
Transtemporal window (Correct answer)

Correct answer: Transtemporal window

The transtemporal window, located above the zygomatic arch near the temporal bone, allows insonation of the MCA at depths of 45-65 mm.

Question 111: A patient has an ABI of 0.55 at rest. After a standard treadmill test, the patient stops at 2 minutes due to bilateral calf pain and the ankle pressure is unobtainable. The MOST likely diagnosis is:

Psychogenic pain with normal arterial physiology
Mild peripheral arterial disease with anxiety-related stopping
Venous claudication due to deep vein obstruction
Severe bilateral lower extremity PAD with exercise-limiting claudication (Correct answer)

Correct answer: Severe bilateral lower extremity PAD with exercise-limiting claudication

An already low resting ABI (0.55) with inability to complete treadmill testing and unobtainable post-exercise pressures indicates severe hemodynamically significant bilateral PAD.

Question 112: A patient with a forearm AV fistula reports pain, coldness, and numbness in the hand that worsens during dialysis. Duplex reveals reversal of flow in the radial artery distal to the fistula anastomosis. This presentation is MOST consistent with:

Arterial inflow stenosis proximal to the anastomosis
Dialysis-associated steal syndrome (Correct answer)
Central venous stenosis causing venous hypertension
Venous outflow obstruction causing elevated access pressures

Correct answer: Dialysis-associated steal syndrome

Steal syndrome occurs when the low-resistance AV fistula 'steals' blood from the distal limb. The reversed (retrograde) flow in the radial artery distal to the anastomosis is the pathognomonic duplex finding — blood that should perfuse the hand is instead diverted into the fistula, causing ischemic symptoms that worsen during high-flow dialysis sessions.

Question 113: A vascular technologist performing a surveillance duplex identifies a new, complete thrombotic occlusion of a previously patent femoral-popliteal bypass graft. What is the MOST appropriate immediate action?

Schedule a 3-month follow-up duplex and note findings in the report
Repeat the exam in 24 hours to confirm the finding
Notify the patient's family and recommend emergency department evaluation
Communicate the finding urgently to the ordering physician or on-call clinical team before the patient leaves (Correct answer)

Correct answer: Communicate the finding urgently to the ordering physician or on-call clinical team before the patient leaves

Acute graft occlusion is a limb-threatening emergency requiring immediate clinical decision-making (thrombectomy, thrombolysis, or revision). The technologist must notify the responsible physician or clinical team while the patient is still present so that timely intervention can be arranged. Documenting without communication causes dangerous treatment delays.

Question 114: Which of the following is the most common complication associated with a popliteal artery aneurysm?

Dissection
Embolization (Correct answer)
Venous compression
Rupture

Correct answer: Embolization

While rupture can occur, it is much less common than with aortic aneurysms. The most frequent and clinically significant complication of a popliteal artery aneurysm is the formation of thrombus within the aneurysm sac, which can then embolize distally, leading to acute limb ischemia.

Question 115: Which of the following sonographic findings is a key component of the 'Rule of 6s' for assessing the maturation of a newly created arteriovenous fistula (AVF) for hemodialysis access?

Volume flow should be greater than 600 mL/min (Correct answer)
Fistula depth from the skin surface must be greater than 6 mm
Minimum fistula diameter must be at least 6 cm
The fistula should be at least 6 cm from the antecubital fossa

Correct answer: Volume flow should be greater than 600 mL/min

The 'Rule of 6s' is a clinical guideline to assess AVF maturation. The sonographic criteria include: a minimum vein diameter of 6 mm, a vein depth from the skin of no more than 6 mm, and a measured volume flow of at least 600 mL/min. [5, 7, 9]

Question 116: What is the primary purpose of the Circle of Willis in the cerebrovascular system?

To supply blood to the cerebellum
To provide a collateral pathway for cerebral perfusion (Correct answer)
To act as the main venous drainage system
To regulate intracranial pressure

Correct answer: To provide a collateral pathway for cerebral perfusion

The Circle of Willis is an arterial anastomosis at the base of the brain that connects the anterior (internal carotid arteries) and posterior (vertebrobasilar system) circulations. Its primary function is to provide redundancy and collateral blood flow, which can help maintain cerebral perfusion if a major contributing artery becomes stenosed or occluded.

Question 117: The range resolution (axial resolution) of a pulsed ultrasound system is primarily determined by:

Transducer aperture size
Focal zone depth
Spatial pulse length (Correct answer)
Pulse repetition period

Correct answer: Spatial pulse length

Axial resolution ≈ spatial pulse length / 2; shorter pulses (higher frequency, fewer cycles) improve the ability to distinguish two closely spaced reflectors along the beam axis.

Question 118: During ergonomic assessment of a vascular sonographer's workstation, which finding poses the GREATEST cumulative trauma disorder risk?

Scanning hand held with wrist in ulnar deviation for extended periods (Correct answer)
Elbow supported on armrest during scanning
Monitor placed at eye level 18 inches away
Chair height adjusted so feet rest flat on floor

Correct answer: Scanning hand held with wrist in ulnar deviation for extended periods

Sustained ulnar deviation increases tension on extensor tendons and compresses the ulnar nerve, significantly raising the risk of work-related musculoskeletal disorders in sonographers.

Question 119: Which best describes the role of the Society for Vascular Ultrasound (SVU) in the RVT continuing education ecosystem?

SVU sets federal standards for vascular laboratory staffing ratios
SVU administers the RVT exam on behalf of ARDMS
SVU issues its own competing credential that replaces the RVT
SVU provides educational resources, accredited CME, and advocacy for vascular sonographers (Correct answer)

Correct answer: SVU provides educational resources, accredited CME, and advocacy for vascular sonographers

SVU supports RVT credential holders through educational programming, accredited CME opportunities, and professional advocacy rather than credentialing.

Question 120: Which condition causes bilateral vertebral artery flow reversal and is associated with syncope or posterior circulation TIA symptoms triggered by arm exercise?

Basilar artery occlusion
Bilateral vertebral artery stenosis
Bilateral subclavian steal syndrome (Correct answer)
Bilateral vertebral artery dissection

Correct answer: Bilateral subclavian steal syndrome

Bilateral subclavian steal causes bilateral retrograde vertebral flow as both upper extremities steal from the posterior circulation during exercise, precipitating symptoms.

Question 121: A false-negative rate of 12% is found during a QA audit of carotid duplex studies compared to angiography. Which action is MOST appropriate?

Conduct a root cause analysis to identify systematic scanning or interpretation errors (Correct answer)
Remove the outlying technologist from carotid scanning duties immediately
Increase the stenosis threshold to reduce false negatives
Accept the rate as within normal lab variation

Correct answer: Conduct a root cause analysis to identify systematic scanning or interpretation errors

A root cause analysis identifies whether the false negatives stem from protocol deviations, equipment issues, or interpretation criteria, enabling targeted corrective actions.

Question 122: A synthetic aortobifemoral bypass graft is being evaluated. Flow in the right limb is triphasic and normal. The left limb shows monophasic, low-velocity waveforms. The most likely cause is:

Stenosis or occlusion of the left graft limb or its outflow (Correct answer)
Aortic anastomotic pseudoaneurysm
Contralateral steal from the right limb
Bilateral iliac disease

Correct answer: Stenosis or occlusion of the left graft limb or its outflow

Asymmetric waveforms between graft limbs indicate a unilateral problem; monophasic low-velocity waveforms in the left limb suggest stenosis or occlusion within that limb or distal to it.

Question 123: A sonographer reports frequent right shoulder and neck pain. Which of the following is the most effective ergonomic practice to mitigate the risk of a work-related musculoskeletal disorder (WRMSD)?

Gripping the transducer with increased force to maintain better control.
Adjusting the exam table and chair so the scanning arm's angle of abduction is less than 30 degrees. (Correct answer)
Performing the majority of exams while standing to improve posture and core strength.
Scheduling similar exam types back-to-back to improve efficiency.

Correct answer: Adjusting the exam table and chair so the scanning arm's angle of abduction is less than 30 degrees.

Proper ergonomics are crucial for preventing WRMSDs in sonographers. Adjusting the exam table and personal chair height to keep the scanning arm close to the body (abduction < 30 degrees) and the elbow at approximately 90 degrees significantly reduces strain on the shoulder and neck muscles. Gripping the transducer too tightly and prolonged standing increase strain, while performing varied exam types is recommended over repetitive scheduling.

Question 124: In abdominal duplex scanning, the 'median arcuate ligament syndrome' most commonly affects which vessel?

Inferior mesenteric artery
Right renal artery
Superior mesenteric artery
Celiac artery (Correct answer)

Correct answer: Celiac artery

The median arcuate ligament of the diaphragm crosses anteriorly and may compress the celiac artery origin, causing extrinsic stenosis.

Question 125: Fibromuscular dysplasia (FMD) of the internal carotid artery most commonly affects which segment?

Mid-cervical ICA (C1-C2 level) (Correct answer)
Cavernous ICA siphon
Proximal ICA just above the bifurcation
Petrous ICA

Correct answer: Mid-cervical ICA (C1-C2 level)

FMD most commonly affects the mid-cervical segment of the ICA at the C1-C2 vertebral level, producing the classic 'string of beads' appearance.

Question 126: During an ARDMS audit of CME records, an RVT cannot produce certificates for 10 of the required 30 credits. What is the most likely outcome?

The RVT receives a warning with a 5-year correction window
Undocumented credits are automatically accepted
The credential is suspended until documentation is provided (Correct answer)
Credits are estimated based on employer attestation

Correct answer: The credential is suspended until documentation is provided

ARDMS requires verifiable documentation; inability to produce certificates for audited credits results in credential suspension.

Question 127: Which transducer design uses multiple elements fired in sequence to create a rectangular field of view?

Phased array
Linear array (Correct answer)
Annular array
Curvilinear array

Correct answer: Linear array

Linear array transducers fire elements sequentially across the footprint to produce a rectangular image with consistent width at all depths.

Question 128: As part of a vascular lab's quality assurance program, carotid duplex ultrasound findings are periodically correlated with a 'gold standard' imaging modality. Which modality has historically been considered the gold standard for quantifying the degree of arterial stenosis?

Digital Subtraction Angiography (DSA) (Correct answer)
Ankle-Brachial Index (ABI)
Computed Tomography Angiography (CTA)
Magnetic Resonance Angiography (MRA)

Correct answer: Digital Subtraction Angiography (DSA)

While less invasive methods like CTA and MRA are now widely used and highly accurate, Digital Subtraction Angiography (DSA) has long been considered the 'gold standard' for evaluating arterial stenosis. It is an invasive procedure that involves a catheter and contrast injection to directly visualize the vessel lumen, providing a precise map for stenosis measurement that noninvasive tests are validated against.

Question 129: Which imaging modality is considered the primary tool for evaluating peripheral arterial disease in an RVT examination?

MR angiography
Catheter angiography
CT angiography
Duplex ultrasound (Correct answer)

Correct answer: Duplex ultrasound

Duplex ultrasound is the primary non-invasive imaging modality used by vascular technologists to evaluate peripheral arterial disease.

Question 130: A patient presents 2 years after renal artery stent placement. Duplex shows an intrarenal acceleration time of 0.09 seconds with a tardus-parvus waveform. What does this suggest?

Significant in-stent restenosis proximal to the sampling site (Correct answer)
Normal post-stent hemodynamics
Acute tubular necrosis
Renal vein thrombosis

Correct answer: Significant in-stent restenosis proximal to the sampling site

An acceleration time >0.08 seconds with a tardus-parvus pattern indicates a significant proximal stenosis damping flow to the renal parenchyma, suggesting in-stent restenosis.

Question 131: A patient's right ABI is 0.85 and left ABI is 0.72. The right arm pressure is 130 mmHg and the left arm pressure is 118 mmHg. Which arm pressure should be used to calculate both ABIs?

Right arm pressure (130 mmHg) (Correct answer)
Average of both arm pressures (124 mmHg)
Either arm pressure is acceptable
Left arm pressure (118 mmHg)

Correct answer: Right arm pressure (130 mmHg)

The higher brachial pressure is always used as the denominator in ABI calculations to avoid overestimating the index and missing disease.

Question 132: A patient with Raynaud's phenomenon undergoes cold stimulation testing. Which finding would confirm vasospastic disease rather than fixed obstruction?

Persistent absence of digital Doppler signal after rewarming
No change in digital PPG waveform with cold exposure
Complete recovery of digital waveform amplitude after rewarming to 37°C (Correct answer)
Bilateral ABI reduction during cold exposure

Correct answer: Complete recovery of digital waveform amplitude after rewarming to 37°C

Vasospastic Raynaud's phenomenon is characterized by reversible digital vessel spasm that resolves completely with rewarming, distinguishing it from fixed structural obstruction.

Question 133: Which waveform characteristic on PVR (pulse volume recording) is MOST consistent with proximal aortoiliac occlusive disease?

Peaked systolic upstroke with sharp dicrotic notch
Flat, broad waveform with absent dicrotic notch throughout the limb (Correct answer)
Normal waveform at thigh with abnormal calf waveform
Biphasic waveform at the ankle with triphasic at the thigh

Correct answer: Flat, broad waveform with absent dicrotic notch throughout the limb

Aortoiliac disease produces diffusely flattened, broadened PVR waveforms throughout the entire lower extremity due to inflow obstruction affecting all segments.

Question 134: Which of the following represents a key difference between initial RVT certification and credential renewal?

Renewal requires a clinical competency evaluation by a supervising physician
Renewal requires passing a new written examination every cycle
Renewal is based on CME documentation rather than re-examination (Correct answer)
Initial certification requires CME but renewal requires only an application fee

Correct answer: Renewal is based on CME documentation rather than re-examination

After initial certification via examination, RVT renewal is maintained through CME documentation rather than retaking the exam.

Question 135: What probe frequency range is most appropriate for imaging superficial veins such as the great saphenous vein?

15-20 MHz
2-5 MHz
5-10 MHz
7-15 MHz (Correct answer)

Correct answer: 7-15 MHz

High-frequency transducers (7-15 MHz) provide optimal spatial resolution for superficial structures like the great saphenous vein.

Question 136: Which factor does NOT affect the Doppler frequency shift?

Depth of the vessel (Correct answer)
Angle between beam and flow
Transmitted frequency
Velocity of the moving reflector

Correct answer: Depth of the vessel

Depth affects PRF and time-gain compensation but is not a variable in the Doppler equation (fd = 2ft·v·cosθ / c).

Question 137: What does a resistive index (RI) greater than 0.80 in the renal parenchymal vessels suggest when evaluating for renovascular hypertension?

Acute renal vein thrombosis
High-grade renal artery stenosis requiring urgent intervention
Normal renal vascular resistance in an elderly patient
Intrinsic renal parenchymal disease that may limit benefit from revascularization (Correct answer)

Correct answer: Intrinsic renal parenchymal disease that may limit benefit from revascularization

An RI >0.80 suggests elevated intrinsic renal vascular resistance, indicating parenchymal disease that often predicts poor response to renal artery stenting.

Question 138: Which of the following is the first major branch of the internal carotid artery (ICA) after it enters the cranial cavity?

Anterior cerebral artery
Ophthalmic artery (Correct answer)
Posterior communicating artery
Middle cerebral artery

Correct answer: Ophthalmic artery

The ophthalmic artery is typically the first major branch arising from the supraclinoid segment of the internal carotid artery after it passes through the cavernous sinus and enters the cranial cavity. It supplies blood to the structures of the orbit.

Question 139: On duplex ultrasound, a post-stenotic flow pattern distal to a high-grade ICA stenosis is characterized by:

Normal triphasic waveform
High-resistance monophasic waveform
Tardus-parvus waveform with delayed systolic upstroke (Correct answer)
Reversed diastolic flow

Correct answer: Tardus-parvus waveform with delayed systolic upstroke

Tardus-parvus (slow-rising, rounded systolic peak with reduced amplitude) waveform is the classic post-stenotic pattern seen distal to significant stenosis.

Question 140: A 'string sign' seen on duplex ultrasound of the ICA most likely represents:

Normal low-flow state in a fasting patient
Arteriovenous fistula
Near-total occlusion with a thin residual lumen (Correct answer)
Carotid body tumor compressing the vessel

Correct answer: Near-total occlusion with a thin residual lumen

The string sign describes a thin trickle of flow through a near-totally occluded ICA, distinguishing it from complete occlusion.

Question 141: Which of the following best describes a 'primary-source verification' in the context of RVT credentialing?

Confirmation of credential status directly from ARDMS, rather than from the credential holder (Correct answer)
A copy of the candidate's academic transcript
A letter of recommendation from a supervisor
A background check performed by a local police department

Correct answer: Confirmation of credential status directly from ARDMS, rather than from the credential holder

Primary-source verification means an employer or institution confirms an RVT's credential status directly with ARDMS, the issuing body.

Question 142: A vascular laboratory manager notices that an RVT staff member's credential expired 4 months ago. The most appropriate action is to:

Remove the technologist from credentialed scanning duties until renewal is confirmed (Correct answer)
Allow the technologist to continue scanning under supervisor oversight
Issue an internal facility credential as a temporary replacement
Report the technologist to the state medical board immediately

Correct answer: Remove the technologist from credentialed scanning duties until renewal is confirmed

An expired ARDMS credential means the technologist no longer holds active certification; reassigning them from credentialed duties protects patients and the facility.

Question 143: Under the principle of universal precautions, how should vascular laboratory staff treat ALL patient blood and body fluids?

As requiring only standard gloves, with no additional PPE
As non-infectious unless the patient tests positive for HIV or hepatitis
As infectious only during invasive procedures
As potentially infectious regardless of the patient's known diagnosis (Correct answer)

Correct answer: As potentially infectious regardless of the patient's known diagnosis

Universal precautions mandate treating every patient's blood and body fluids as potentially infectious to protect staff from undiagnosed or unreported bloodborne pathogens.

Question 144: During evaluation of the mesenteric vessels, the superior mesenteric artery (SMA) waveform changes significantly with eating. Postprandially, the SMA waveform should demonstrate:

No change in waveform morphology from fasting state
Decreased diastolic flow and increased pulsatility indicating heightened resistance
Increased diastolic flow and decreased pulsatility index reflecting reduced resistance (Correct answer)
Reversal of diastolic flow due to increased intestinal demand

Correct answer: Increased diastolic flow and decreased pulsatility index reflecting reduced resistance

After eating, intestinal blood demand rises, causing mesenteric vasodilation and a drop in resistance, which increases diastolic flow and lowers the pulsatility index.

Question 145: Which patient preparation instruction is MOST important before performing a mesenteric arterial duplex examination?

No special preparation is required
NPO (nothing by mouth) for at least 6–8 hours prior to the exam (Correct answer)
Consume a high-fat meal 30 minutes before the scan
Drink 32 oz of water to achieve a full bladder

Correct answer: NPO (nothing by mouth) for at least 6–8 hours prior to the exam

Bowel gas from food or liquid intake significantly degrades visualization of the celiac axis and superior mesenteric artery. Fasting for 6–8 hours minimizes intraluminal gas and promotes mesenteric vasodilation, improving both image quality and the physiologic significance of post-prandial velocity changes.

Question 146: In the context of Doppler ultrasound, the angle of insonation should ideally be kept at or below:

30 degrees
45 degrees
60 degrees (Correct answer)
75 degrees

Correct answer: 60 degrees

Doppler angle correction is most accurate when the angle is ≤60°; beyond 60° the cosine function changes rapidly, introducing large velocity measurement errors.

Question 147: Which connective tissue disorder is most strongly associated with annuloaortic ectasia and ascending aortic aneurysm?

Marfan syndrome (Correct answer)
Pseudoxanthoma elasticum
Ehlers-Danlos syndrome type IV
Loeys-Dietz syndrome

Correct answer: Marfan syndrome

Marfan syndrome causes fibrillin-1 deficiency, leading to cystic medial necrosis and characteristic annuloaortic ectasia of the ascending aorta.

Question 148: Which finding on continuous-wave Doppler examination is MOST indicative of a hemodynamically significant proximal stenosis?

Triphasic waveform with normal peak systolic velocity
Biphasic signal with mild spectral broadening
High-pitched, multiphasic signal with clear window
Monophasic, low-velocity signal with loss of reverse flow component (Correct answer)

Correct answer: Monophasic, low-velocity signal with loss of reverse flow component

A monophasic, damped signal distal to a significant stenosis results from loss of pulsatility as pressure energy is dissipated across the lesion.

Question 149: When establishing normal reference ranges for a vascular lab's ankle-brachial index (ABI) measurements, the data should be stratified by:

Sonographer seniority level
Equipment manufacturer
Time of day the test was performed
Patient age, sex, and clinical indication (Correct answer)

Correct answer: Patient age, sex, and clinical indication

ABI reference ranges and interpretation thresholds can vary with patient demographics and clinical context, so stratification ensures the lab's internal norms reflect its specific patient population.

Question 150: When documenting a carotid duplex examination, which finding most accurately represents a 70–99% internal carotid artery stenosis by the Society of Radiologists in Ultrasound (SRU) criteria?

ICA PSV 100–124 cm/s with no plaque
ICA end-diastolic velocity < 40 cm/s with visible plaque
ICA PSV ≥ 230 cm/s with ICA/CCA PSV ratio ≥ 4.0 (Correct answer)
ICA PSV 125–229 cm/s with ICA/CCA ratio < 2.0

Correct answer: ICA PSV ≥ 230 cm/s with ICA/CCA PSV ratio ≥ 4.0

The SRU consensus criteria define ≥70% ICA stenosis as ICA PSV ≥230 cm/s AND an ICA/CCA PSV ratio ≥4.0, often accompanied by ICA EDV ≥100 cm/s. Using both absolute velocity and the ratio improves accuracy and accounts for hemodynamic variability between patients.

Question 151: Which of the following transducer types produces a sector-shaped image that is useful for accessing small acoustic windows?

Linear array
Annular array
Curvilinear array
Phased array (Correct answer)

Correct answer: Phased array

Phased array transducers electronically steer a narrow footprint beam to create a wide sector image, making them ideal for small acoustic windows such as between ribs.

Question 152: Which of the following best describes the role of the Society for Vascular Ultrasound (SVU) relative to the RVT credential?

SVU issues a competing credential identical to the RVT
SVU is a professional membership society that supports vascular sonographers but does not credential them (Correct answer)
SVU sets mandatory CME content that ARDMS must use
SVU administers the RVT examination

Correct answer: SVU is a professional membership society that supports vascular sonographers but does not credential them

The SVU is a professional organization providing education, advocacy, and resources, but credentialing is performed by ARDMS, not SVU.

Question 153: In patients with bilateral high-grade ICA stenosis, the CCA waveform may demonstrate which compensatory change?

Increased resistance with absent diastolic flow
Reduced resistance pattern with elevated diastolic flow bilaterally (Correct answer)
Reversal of systolic flow in the CCA
No change from normal

Correct answer: Reduced resistance pattern with elevated diastolic flow bilaterally

Bilateral severe ICA disease causes the brain to maximally vasodilate distal resistance vessels, creating a low-resistance high-diastolic pattern in both CCAs.

Question 154: Which of the following is considered a REQUIRED component of a complete vascular duplex examination report?

Insurance authorization code and billing CPT number
Clinical indication, technical description of findings, and diagnostic impression (Correct answer)
Comparison to the patient's prior imaging from outside institutions
The technologist's personal clinical impression and treatment recommendation

Correct answer: Clinical indication, technical description of findings, and diagnostic impression

A complete vascular report must include the reason the study was ordered (indication), a description of the vascular findings with supporting measurements, and a diagnostic conclusion or impression. These elements ensure the referring clinician has the information needed for clinical management.

Question 155: A patient is being evaluated one year after undergoing carotid artery stenting (CAS). Duplex ultrasound of the stented segment reveals a peak systolic velocity (PSV) of 350 cm/s and an end-diastolic velocity (EDV) of 145 cm/s. These findings are most consistent with:

Mild (<50%) in-stent restenosis.
Severe (≥70-80%) in-stent restenosis. (Correct answer)
Stent occlusion with collateral flow.
Normal, expected velocities within a carotid stent.

Correct answer: Severe (≥70-80%) in-stent restenosis.

Velocity criteria for stenosis are higher within a stent compared to a native artery. While criteria can vary slightly by institution, a PSV greater than 300-340 cm/s and an EDV greater than 140 cm/s are commonly used to identify a severe (≥70% or ≥80%) in-stent restenosis. [1, 2, 8]

Question 156: What is the minimum number of continuing medical education (CME) credits required for RVT renewal per 3-year cycle?

30 CME credits (Correct answer)
20 CME credits
15 CME credits
45 CME credits

Correct answer: 30 CME credits

RVT credential holders must earn 30 CME credits every 3 years to satisfy the ARDMS continuing education renewal requirement.

Question 157: During transcranial Doppler (TCD) monitoring, a high-intensity transient signal (HITS) most likely represents:

Normal turbulent flow at the MCA bifurcation
Artifact from patient movement
Circulating microemboli (gaseous or particulate) (Correct answer)
Venous air embolism from deep breathing

Correct answer: Circulating microemboli (gaseous or particulate)

HITS detected during TCD monitoring represent microemboli (air or solid particles) passing through the insonated vessel and are a marker of embolic risk.

Question 158: What is the primary duplex role during endovenous thermal ablation (EVTA) of the great saphenous vein?

Guiding catheter tip placement and detecting endothermal heat-induced thrombosis (EHIT) post-procedure (Correct answer)
Measuring total venous reflux time along the thigh
Assessing arterial inflow to the limb
Confirming deep venous valve competence before ablation

Correct answer: Guiding catheter tip placement and detecting endothermal heat-induced thrombosis (EHIT) post-procedure

Ultrasound guides correct catheter positioning (typically 2 cm distal to the saphenofemoral junction) and monitors tumescent anesthesia placement. Post-ablation, the technologist scans for EHIT — thrombus propagation into the deep system — which can occur in the first few days and requires classification and follow-up.

Question 159: Which criterion is most commonly used to recommend surgical or endovascular repair of an infrarenal AAA in a male patient?

Diameter ≥ 6.0 cm in any patient
Diameter ≥ 3.0 cm with thrombus present
Diameter ≥ 4.0 cm or growth > 3 mm/year
Diameter ≥ 5.5 cm or growth > 10 mm/year (Correct answer)

Correct answer: Diameter ≥ 5.5 cm or growth > 10 mm/year

Standard US guidelines recommend repair for AAAs ≥ 5.5 cm diameter in men or rapid growth > 10 mm per year due to rupture risk.

Question 160: An RVT interested in advancing to a supervisory role should prioritize which additional credential?

Certified Phlebotomy Technician (CPT)
American Registry for Diagnostic Medical Sonography (ARDMS) certificate in management (Correct answer)
Registered Diagnostic Medical Sonographer (RDMS)
Basic Life Support (BLS) recertification

Correct answer: American Registry for Diagnostic Medical Sonography (ARDMS) certificate in management

Earning an ARDMS management certificate or similar leadership credential demonstrates readiness for supervisory responsibilities in a vascular lab setting.

Question 161: An aortic aneurysm that extends above the renal arteries is classified as:

Suprarenal (Correct answer)
Infrarenal
Juxtarenal
Pararenal

Correct answer: Suprarenal

A suprarenal aneurysm involves aortic dilation above the level of the renal artery origins.

Question 162: When calibrating a segmental pressure cuff system, the technologist should verify that cuffs maintain pressure within what acceptable tolerance?

±1 mmHg
±15 mmHg
±10 mmHg
±5 mmHg (Correct answer)

Correct answer: ±5 mmHg

A ±5 mmHg tolerance is the accepted standard for pneumatic cuff calibration in vascular laboratories, ensuring accurate segmental pressure gradients are reported.

Question 163: Which of the following is a primary objective of the Intersocietal Accreditation Commission (IAC) for vascular testing laboratories?

To provide continuing medical education (CME) credits directly to technologists.
To mandate the specific brand of ultrasound equipment a lab must purchase.
To establish and recognize the provision of quality patient care through a peer-review process. (Correct answer)
To ensure the laboratory is financially profitable.

Correct answer: To establish and recognize the provision of quality patient care through a peer-review process.

The core mission of the IAC is to ensure high-quality patient care by providing a mechanism for facilities to undergo a thorough peer-review of their processes and demonstrate a commitment to established standards. This includes reviewing personnel qualifications, protocols, equipment, and quality assurance measures, but it does not dictate specific equipment brands or focus on profitability.

Question 164: In portal vein duplex evaluation, normal portal vein flow is described as hepatopetal with a velocity of approximately:

5–10 cm/s with marked phasicity
16–40 cm/s with mild respiratory phasicity (Correct answer)
60–90 cm/s with continuous non-phasic flow
Greater than 100 cm/s with turbulent waveform

Correct answer: 16–40 cm/s with mild respiratory phasicity

Normal portal vein flow is directed toward the liver (hepatopetal) at 16–40 cm/s, with slight variation related to respiration and cardiac pulsatility.

Question 165: What is required for RVT reaccreditation?

Obtaining additional certifications
Submitting proof of employment
Completing CME credits (Correct answer)
Passing a renewal exam

Correct answer: Completing CME credits

For RVT reaccreditation, the primary requirement is the completion of Continuing Medical Education (CME) credits. This ensures that RVTs remain knowledgeable about the latest advancements, techniques, and best practices in vascular technology. It is a fundamental component of maintaining professional competence and active certification.

Question 166: Ultrasound attenuation in soft tissue is approximately:

5 dB/cm/MHz
0.5 dB/cm/MHz (Correct answer)
0.05 dB/cm/MHz
2 dB/cm/MHz

Correct answer: 0.5 dB/cm/MHz

Soft tissue attenuates ultrasound at roughly 0.5 dB/cm/MHz, meaning a 5 MHz beam loses about 2.5 dB of intensity per centimeter traveled.

Question 167: The carotid siphon refers to the S-shaped segment of the internal carotid artery located in the:

Parapharyngeal space
Neck at the carotid bifurcation
Petrous temporal bone
Cavernous sinus within the skull base (Correct answer)

Correct answer: Cavernous sinus within the skull base

The carotid siphon is the S-shaped intracranial portion of the ICA that courses through the cavernous sinus.

Question 168: Which duplex finding best differentiates a true aortic aneurysm from a pseudoaneurysm of the aorta?

A pseudoaneurysm is always smaller than 3 cm in diameter
A true aneurysm involves all three vessel wall layers with fusiform or saccular dilation, while a pseudoaneurysm has no true wall (Correct answer)
A true aneurysm has yin-yang flow pattern on color Doppler
A pseudoaneurysm always contains organized thrombus, while a true aneurysm does not

Correct answer: A true aneurysm involves all three vessel wall layers with fusiform or saccular dilation, while a pseudoaneurysm has no true wall

A true aneurysm is defined by full-thickness wall involvement, while a pseudoaneurysm is a contained rupture with a fibrous capsule rather than a true vascular wall.

Question 169: A technologist notices the real-time B-mode image has a 'dropout' artifact in the far field during routine phantom testing. The MOST likely cause is:

Air bubble trapped between the transducer and the phantom surface (Correct answer)
Time-gain compensation (TGC) set too low in the far field
Excessive gain setting
Incorrect Doppler angle selected

Correct answer: Air bubble trapped between the transducer and the phantom surface

Air has very high acoustic impedance mismatch with tissue/gel, causing near-total reflection and creating acoustic shadowing that eliminates signal in deeper structures.

Question 170: What are the main components of the RVT certification exam?

Physics and Vascular Technology (Correct answer)
General Anatomy and Cardiac Imaging
Obstetrics and Gynecology
Physics and Musculoskeletal Sonography

Correct answer: Physics and Vascular Technology

The RVT certification exam primarily consists of two main components: Physics and Vascular Technology. The physics section covers the fundamental principles of ultrasound, while the vascular technology section focuses on the specific anatomy, physiology, and pathology relevant to vascular imaging. This dual focus ensures a comprehensive assessment of a candidate's knowledge required for the profession.

Question 171: The peak systolic velocity ratio (PSVR) used to grade arterial stenosis severity is calculated as:

Mean velocity at the stenosis divided by resistive index
PSV at the stenosis divided by PSV measured distal to the stenosis
End-diastolic velocity divided by peak systolic velocity at the stenosis
PSV at the stenosis divided by PSV in the adjacent proximal normal arterial segment (Correct answer)

Correct answer: PSV at the stenosis divided by PSV in the adjacent proximal normal arterial segment

The PSVR compares the elevated velocity at the stenosis to the velocity in the proximal normal (pre-stenotic) segment. This ratio corrects for patient-to-patient variation in cardiac output and overall flow state, making it a more reliable indicator of stenosis severity than an absolute PSV value alone.

ARDMS Vascular Technology (VT) Exam

The ARDMS Vascular Technology (VT) exam awards the Registered Vascular Technologist (RVT) credential, assessing competency in vascular sonography including cerebrovascular, peripheral arterial, peripheral venous, and abdominal vascular testing.

170

Questions

180 min

Time Limit

79%

To Pass

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