Free ARDMS RVT Practice Test

Answer: B. Lower resistance, with increased forward diastolic flow

Exercise dilates muscle arterioles and drops peripheral resistance, so diastolic flow increases and the early-diastolic reversal disappears. A ignores that resistance changes with demand. C signals upstream obstruction, not normal physiology. D is not the expected normal response to exercise.

Review topic: Exercise and arterial resistance
Domain: Normal Anatomy, Perfusion, and Function
Question ID: RVT-PT-01

Sources:

• SVM/SVU consensus — Interpretation of Peripheral Arterial and Venous Doppler Waveforms (2020) — Part 2 → Peripheral Arterial Circulation; Table 6, exercise/increased-temperature row.

Answer: B. Low resistance, with continuous forward flow throughout diastole

The ICA supplies the brain, a low-resistance bed, so forward flow continues through diastole. A is the normal resting pattern of an extremity artery. C is a tardus-parvus waveform downstream of significant obstruction. D is high resistance; in an ICA it would raise concern for a distal obstruction.

Review topic: Normal ICA waveform
Domain: Normal Anatomy, Perfusion, and Function
Question ID: RVT-PT-02

Sources:

• SVM/SVU consensus — Interpretation of Peripheral Arterial and Venous Doppler Waveforms (2020) — Part 2 → Normal cerebrovascular waveforms, Table 10 (ICA); Table 11, distal obstructive lesions.

Answer: C. Middle cerebral artery (M1)

The M1 segment of the MCA is insonated through the temporal window with flow toward the probe. The ACA's A1 segment flows away from the probe. The basilar artery is examined through the suboccipital (foramen magnum) window, and the ophthalmic artery through the transorbital window.

Review topic: TCD vessel identification
Domain: Normal Anatomy, Perfusion, and Function
Question ID: RVT-PT-03

Sources:

• AIUM Practice Parameter — Transcranial Doppler Ultrasound (2022 revision; published 2023) — Specification of the Examination → Adults and Children after Fontanelle Closure; transtemporal MCA/ACA, foramen-magnum and transorbital paragraphs.

Answer: A. Radial and ulnar arteries

The brachial artery normally divides near the elbow into the radial and ulnar arteries. A high bifurcation is a common variant worth noting when you map arm arteries. The axillary and subclavian arteries lie upstream of the brachial, the interosseous arteries branch from the ulnar system, and the palmar arches are in the hand.

Review topic: Upper-extremity arterial anatomy
Domain: Normal Anatomy, Perfusion, and Function
Question ID: RVT-PT-04

Sources:

• AIUM Practice Parameter — Ultrasound Vessel Mapping Prior to Dialysis Access Creation — Specifications of the Examination → Arterial Examination, brachial artery/high bifurcation paragraphs.

• OpenStax Anatomy and Physiology 2e — 20.5 Circulatory Pathways — 20.5 → Arteries Serving the Upper Limbs; Table 20.9.

Answer: D. Pulsatile, phasic flow reflecting right atrial pressure changes and respiration

Near the heart, venous flow mirrors right atrial pressure changes, so it's pulsatile, and it also varies with breathing. Continuous, nonphasic flow in a central vein can suggest obstruction or compression further toward the heart. Arterial-type flow doesn't belong in the IVC.

Review topic: Central venous waveforms
Domain: Normal Anatomy, Perfusion, and Function
Question ID: RVT-PT-05

Sources:

• SVM/SVU consensus — Interpretation of Peripheral Arterial and Venous Doppler Waveforms (2020) — Part 2 → Peripheral Venous Circulation, normal waveforms and Tables 8–9; respiratory/cardio-pulsatility discussion.

Answer: A. Antegrade (toward the head), low resistance

The vertebral artery normally flows toward the head in the same direction as the common carotid, and because it supplies the brain it has a low-resistance waveform with forward diastolic flow. Retrograde or bidirectional flow suggests subclavian steal physiology. Absent diastolic flow is abnormal.

Review topic: Normal vertebral flow
Domain: Normal Anatomy, Perfusion, and Function
Question ID: RVT-PT-06

Sources:

• SVM/SVU consensus — Interpretation of Peripheral Arterial and Venous Doppler Waveforms (2020) — Part 2 → Cerebrovascular Circulation; Tables 10–12, normal vertebral and vertebral steal patterns.

Answer: C. a wave

Right atrial contraction produces the a wave, a brief reversal toward the liver. The S and D waves are forward flow toward the heart during ventricular systole and diastole. Hepatic vein flow is normally pulsatile, not continuous, because it tracks right atrial pressure.

Review topic: Hepatic vein waveform
Domain: Normal Anatomy, Perfusion, and Function
Question ID: RVT-PT-07

Sources:

• SVM/SVU consensus — Interpretation of Peripheral Arterial and Venous Doppler Waveforms (2020) — Table 16 → Hepatic Vein: Pulsatile flow; A, S and D waves.

Answer: B. Rapid systolic upstroke with continuous forward diastolic flow

The kidney is a low-resistance bed, so intrarenal arteries normally show a brisk upstroke and continuous forward diastolic flow. A is a high-resistance peripheral pattern. C (tardus-parvus) suggests upstream renal artery stenosis. D indicates abnormally high resistance, which is not the expected normal intrarenal pattern.

Review topic: Normal renal waveform
Domain: Normal Anatomy, Perfusion, and Function
Question ID: RVT-PT-08

Sources:

• SVM/SVU consensus — Interpretation of Peripheral Arterial and Venous Doppler Waveforms (2020) — Part 2 → Normal renal arterial waveforms and Table 15.

Answer: D. Deep vein thrombosis

"Superficial femoral vein" is a misleading older name for the femoral vein, which is a deep vein. Thrombus there is DVT. Professional guidance recommends saying "femoral vein" precisely because the old term has led clinicians to treat DVT as a superficial clot.

Review topic: Femoral vein naming
Domain: Normal Anatomy, Perfusion, and Function
Question ID: RVT-PT-09

Sources:

• ASUM Statement on Use of “Superficial Femoral Vein” Term — PDF p2, §§1.1 Statement and 2 International Nomenclature.

Answer: A. Popliteal vein

The small saphenous vein most often joins the popliteal vein at the saphenopopliteal junction, though its termination varies and can be higher. The great saphenous vein, not the small saphenous, joins the common femoral vein at the saphenofemoral junction. The posterior tibial veins are paired deep calf veins.

Review topic: Saphenous anatomy
Domain: Normal Anatomy, Perfusion, and Function
Question ID: RVT-PT-10

Sources:

• ESVS 2022 Clinical Practice Guidelines — Chronic Venous Disease of the Lower Limbs — Printed pp194–195 (PDF pp11–12), §§1.2.1–1.2.2; Figure 3 caption.

Answer: C. Cephalic vein

The cephalic and basilic veins are superficial. The radial, ulnar, and brachial veins are paired deep veins that travel with their arteries, and the axillary vein is a deep vein that continues from the brachial vein after the basilic vein joins.

Review topic: Upper-extremity venous anatomy
Domain: Normal Anatomy, Perfusion, and Function
Question ID: RVT-PT-11

Sources:

• OpenStax Anatomy and Physiology 2e — 20.5 Circulatory Pathways — 20.5 → Veins Draining the Upper Limbs; Table 20.14, especially cephalic/basilic/brachial/axillary rows.

Answer: C. L4

The aorta usually divides at about L4. It passes through the diaphragm at about T12, and the renal arteries arise near L1–L2. S1 is too low.

Review topic: Aortic landmarks
Domain: Normal Anatomy, Perfusion, and Function
Question ID: RVT-PT-12

Sources:

• OpenStax Anatomy and Physiology 2e — 20.5 Circulatory Pathways — 20.5 → Thoracic Aorta and Major Branches; Abdominal Aorta and Major Branches.

• Lee et al. — Using MRI to evaluate anatomic significance of aortic bifurcation, right renal artery, and conus medullaris (2004) — Abstract → Results: aortic bifurcation and right renal artery vertebral levels.

Answer: D. To distend the superficial veins so their diameter and continuity can be assessed

A proximal tourniquet distends the superficial veins so you can measure their diameter and trace their continuity — features that help determine whether a vein can be used for a fistula. The arteries are evaluated during mapping too, not skipped. Reflux testing belongs to venous insufficiency exams.

Review topic: Dialysis vein mapping
Domain: Normal Anatomy, Perfusion, and Function
Question ID: RVT-PT-13

Sources:

• AIUM Practice Parameter — Ultrasound Vessel Mapping Prior to Dialysis Access Creation — Specifications of the Examination → Venous Examination, tourniquet and vein assessment paragraphs.

• AIUM Practice Parameter — Peripheral Venous Ultrasound Examination, 2024 Revision — Specifications of the Examination → Vein Mapping.

Answer: B. ICA/CCA peak systolic velocity ratio

The ICA/CCA ratio compares the ICA with the same patient's CCA and can help when systemic hemodynamics elevate absolute velocities. It must be interpreted with plaque, lumen appearance, and the other Doppler findings; contralateral or tandem disease can still complicate grading. ICA PSV alone can overestimate stenosis here. ECA velocity and vertebral direction don't grade ICA stenosis.

Review topic: ICA/CCA ratio
Domain: Pathology, Perfusion, and Function
Question ID: RVT-PT-14

Sources:

• AIUM Practice Parameter — Extracranial Cerebrovascular System, 2026 Revision — Interpretation → criteria and factors affecting velocities, including systemic and contralateral/tandem disease.

• IAC — Updated Recommendations for Carotid Stenosis Interpretation Criteria (November 2023) — Criteria table, ICA/CCA PSV ratio as an additional parameter.

Answer: D. Near occlusion

In near occlusion, velocities can be high, low, or undetectable, so a low PSV doesn't mean mild disease. The markedly narrowed lumen and residual flow support near occlusion. Total occlusion requires confirmation of absent flow with optimized Doppler settings and supportive lumen findings; an insensitive Doppler setting alone can miss slow flow. That's why the current IAC carotid criteria list near occlusion as its own category instead of grading it by velocity.

Review topic: Near occlusion
Domain: Pathology, Perfusion, and Function
Question ID: RVT-PT-15

Sources:

• IAC — Updated Recommendations for Carotid Stenosis Interpretation Criteria (November 2023) — Criteria table: Near Occlusion and Total Occlusion rows, including grayscale/color lumen findings.

• AIUM Practice Parameter — Extracranial Cerebrovascular System, 2026 Revision — Specifications of the Examination and Interpretation; grayscale, color/power and spectral Doppler assessment.

Answer: A. Higher resistance, with diminished diastolic flow

With the low-resistance ICA outflow gone, CCA flow goes mainly to the high-resistance ECA, so the CCA waveform becomes higher resistance with reduced (sometimes absent or reversed) diastolic flow. B is the opposite. A delayed CCA upstroke instead suggests a proximal inflow lesion. Reversal throughout the cycle is not the characteristic response described here.

Review topic: ICA occlusion effects
Domain: Pathology, Perfusion, and Function
Question ID: RVT-PT-16

Sources:

• SVM/SVU consensus — Interpretation of Peripheral Arterial and Venous Doppler Waveforms (2020) — Table 11 → Common Carotid Artery with Ipsilateral Internal Carotid Artery Occlusion; proximal CCA/innominate stenosis examples.

Answer: C. 3.75; vasospasm

Lindegaard ratio = MCA mean ÷ ipsilateral extracranial ICA mean = 150 ÷ 40 = 3.75. A ratio above 3 together with this elevated MCA mean velocity supports vasospasm. An elevated MCA velocity with a ratio below 3 suggests hyperemia — more flow overall, not narrowing. A inverts the ratio; D subtracts instead of dividing.

Review topic: Lindegaard ratio
Domain: Pathology, Perfusion, and Function
Question ID: RVT-PT-17

Sources:

• SIAARTI consensus on aneurysmal subarachnoid hemorrhage, Part 2 (2022) — Recommendation 5; Discussion → DCI-related vasospasm monitoring, Lindegaard definition and >3 criterion.

• AIUM Practice Parameter — Transcranial Doppler Ultrasound (2022 revision; published 2023) — Specification of the Examination → Adults and Children after Fontanelle Closure, subarachnoid hemorrhage/Lindegaard paragraph.

Answer: C. Incomplete compressibility of the vein under transducer pressure in the transverse plane

Noncompressibility in transverse is the primary criterion. Very fresh thrombus can be almost anechoic, so the absence of visible echoes doesn't exclude DVT. Absent color can come from slow flow or settings. Loss of phasicity suggests obstruction elsewhere, usually more central, rather than proving local thrombus. Noncompressibility alone does not establish the age of thrombus.

Review topic: DVT primary criterion
Domain: Pathology, Perfusion, and Function
Question ID: RVT-PT-18

Sources:

• SRU consensus — Ultrasound for Lower Extremity Deep Venous Thrombosis (2018) — Printed p1510 → Diagnostic Criteria: Gray-Scale Findings; p1507 Figure 1 and protocol discussion.

• AIUM Practice Parameter — Peripheral Venous Ultrasound Examination, 2024 Revision — Specifications of the Examination → Venous Thromboembolic Disease: Lower Extremity, Technique/Recordings/Interpretation.

Answer: A. A distended, incompletely compressible vein with soft, deformable intraluminal material

Acute thrombus typically distends the vein and may deform under transducer pressure. B, C, and D favor chronic postthrombotic change: a contracted vein, wall-adherent material, wall thickening, collaterals, and recanalized channels. These appearances favor a category; echogenicity alone cannot reliably date thrombus. Clinical history and prior imaging matter, and conflicting findings may need an indeterminate classification.

Review topic: Acute vs chronic thrombus
Domain: Pathology, Perfusion, and Function
Question ID: RVT-PT-19

Sources:

• SRU consensus — Ultrasound for Lower Extremity Deep Venous Thrombosis (2018) — Printed p1510 → Terminology for Ultrasound Reports: Scarring; Diagnostic Criteria: Gray-Scale Findings.

• AIUM Practice Parameter — Peripheral Venous Ultrasound Examination, 2024 Revision — Specifications of the Examination → Venous Thromboembolic Disease: Lower Extremity, Interpretation.

Answer: B. Right iliac vein

Continuous, nonphasic CFV flow can suggest obstruction central to that vein. With a normal left-sided waveform under comparable respiratory and positioning conditions, the right iliac veins are the best fit among these choices. An IVC obstruction would usually affect both sides. A popliteal thrombus is distal to the sampled CFV and does not best explain this unilateral loss of phasicity. This is why both CFVs should be compared.

Review topic: Unilateral central venous obstruction
Domain: Pathology, Perfusion, and Function
Question ID: RVT-PT-20

Sources:

• SVM/SVU consensus — Interpretation of Peripheral Arterial and Venous Doppler Waveforms (2020) — Part 2 → Peripheral Venous Circulation, abnormal venous waveforms; Table 9.

• AIUM Practice Parameter — Peripheral Venous Ultrasound Examination, 2024 Revision — Lower-extremity venous recordings: compare right and left common femoral/external iliac waveforms for asymmetry and loss of phasicity.

Answer: D. Right common iliac artery

In May-Thurner (iliac vein compression) syndrome, the right common iliac artery crosses over and compresses the left common iliac vein against the lumbar spine. The left renal vein is the compressed structure in nutcracker syndrome, not a compressor here.

Review topic: May-Thurner
Domain: Pathology, Perfusion, and Function
Question ID: RVT-PT-21

Sources:

• ESVS 2021 Clinical Practice Guidelines — Management of Venous Thrombosis — §2.1.4 Clinical manifestations of DVT, printed early-online p8: left common iliac vein/right common iliac artery compression.

• ESVS 2022 Clinical Practice Guidelines — Chronic Venous Disease of the Lower Limbs — §1.3 Pathophysiology, nonthrombotic iliac obstruction.

Answer: B. Outward flow lasting more than 500 ms and a diameter more than 3.5 mm

For CEAP C2, the definition includes outward (deep-to-superficial) flow of more than 500 ms and a diameter of more than 3.5 mm. An ulcer is not required for this C2 definition. Inward flow is the normal direction for leg perforators. The guideline defines reflux as more than 500 ms in superficial truncal veins and more than 1 second in the common femoral, femoral, and popliteal veins; the perforator diameter criterion should not be applied to every refluxing vein.

Review topic: Pathologic perforator
Domain: Pathology, Perfusion, and Function
Question ID: RVT-PT-22

Sources:

• SVS/AVF/AVLS 2023 Varicose Vein Guidelines, Part II — Implementation remarks §§1.3.1 and 1.3.3; full PDF pp2 and 10.

• ESVS 2022 Clinical Practice Guidelines — Chronic Venous Disease of the Lower Limbs — §1.2.1, normal perforator direction from superficial to deep (except foot).

Answer: A. Paget-Schroetter syndrome (effort thrombosis)

Effort thrombosis is subclavian-axillary vein thrombosis linked to repetitive overhead activity and compression at the thoracic outlet. Those veins are deep, so this isn't superficial thrombophlebitis. Arterial TOS involves the subclavian artery, and there's no catheter in this history.

Review topic: Effort thrombosis
Domain: Pathology, Perfusion, and Function
Question ID: RVT-PT-23

Sources:

• ESVS 2021 Clinical Practice Guidelines — Management of Venous Thrombosis — §3.1.1 Diagnosis of upper-extremity DVT, primary effort versus secondary catheter-related thrombosis; §3.1.1.1.

Answer: C. Ratio 2.9; at least 50% diameter stenosis

Velocity ratio = 260 ÷ 90 ≈ 2.9. In the native peripheral-artery criteria summarized by the SVM/SVU consensus, a ratio above 2 supports at least 50% diameter stenosis. Apply the laboratory's criteria for the artery and clinical setting rather than treating this as a universal graft or stent threshold. An occlusion would have no flow to measure.

Review topic: Peripheral velocity ratio
Domain: Pathology, Perfusion, and Function
Question ID: RVT-PT-24

Sources:

• SVM/SVU consensus — Interpretation of Peripheral Arterial and Venous Doppler Waveforms (2020) — Table 7 → Peripheral artery 50%–74% diameter stenosis, velocity ratio >2 compared with normal adjacent proximal segment.

• AIUM Practice Parameter — Peripheral Arterial Ultrasound Using Color and Spectral Doppler, 2025 Revision — Specification of the Examination → Appropriate Techniques and Diagnostic Criteria; Peripheral Arterial Disease.

Answer: D. Femoropopliteal segment (between the CFA and popliteal artery)

A delayed upstroke suggests flow-limiting disease upstream of the recording site. A preserved CFA waveform makes disease between the groin and the knee the best fit among these choices, but does not by itself rule out all inflow disease. The superficial femoral artery remains a current arterial name. Tibial-only disease does not best explain the delayed popliteal upstroke.

Review topic: Locating arterial disease by waveform
Domain: Pathology, Perfusion, and Function
Question ID: RVT-PT-25

Sources:

• SVM/SVU consensus — Interpretation of Peripheral Arterial and Venous Doppler Waveforms (2020) — Table 7 and following localization paragraph: distal-to-stenosis prolonged upstroke.

• AIUM Practice Parameter — Peripheral Arterial Ultrasound Using Color and Spectral Doppler, 2025 Revision — Peripheral Arterial Disease: delayed distal waveform significance and lower-extremity vessel list including superficial femoral artery.

Answer: C. Aortoiliac (inflow) segment

Damped, tardus-parvus waveforms at the groin suggest obstruction upstream of the CFA; when both sides look this way, think distal aorta or both iliac systems. Disease confined below the groin is a poorer fit for the delayed CFA upstrokes. The delayed upstroke is the important clue; phasicity alone is not a diagnosis.

Review topic: Aortoiliac inflow disease
Domain: Pathology, Perfusion, and Function
Question ID: RVT-PT-26

Sources:

• SVM/SVU consensus — Interpretation of Peripheral Arterial and Venous Doppler Waveforms (2020) — Table 7 and following localization paragraph; Table 1, descriptors are not diagnoses.

• AIUM Practice Parameter — Peripheral Arterial Ultrasound Using Color and Spectral Doppler, 2025 Revision — Specification of the Examination → Peripheral Arterial Disease, distal abnormalities and poststenotic tardus-parvus pattern.

Answer: B. Fibromuscular dysplasia

Fibromuscular dysplasia predominantly affects women. Its multifocal form usually involves the middle and distal renal artery and can have a "string of beads" appearance on angiography; it typically spares the ostium. Atherosclerotic stenosis typically sits at the ostium and proximal segment in older patients. Nutcracker syndrome and renal vein thrombosis are venous problems.

Review topic: Fibromuscular dysplasia
Domain: Pathology, Perfusion, and Function
Question ID: RVT-PT-27

Sources:

• First international consensus on diagnosis and management of fibromuscular dysplasia (ESH/SVM, 2019) — Introduction and angiographic classification (printed pp230–231); registry demographics Table 4 (p235); Clinical presentation/renal FMD.

Answer: A. Median arcuate ligament compression

The median arcuate ligament compresses the celiac axis during expiration, so velocity rises in expiration and falls toward normal on deep inspiration. A fixed atherosclerotic stenosis is less likely to improve markedly with inspiration. The pattern says nothing about the SMA, and this change follows respiration rather than a meal. Imaging evidence of compression alone does not establish symptomatic median arcuate ligament syndrome.

Review topic: Median arcuate ligament
Domain: Pathology, Perfusion, and Function
Question ID: RVT-PT-28

Sources:

• ESVS 2025 Guidelines — Diseases of the Mesenteric and Renal Arteries and Veins — §4.1 Diagnosis, printed pp173–174 (PDF pp21–22); Recommendations 26–28.

Answer: D. Tumor thrombus

Arterial (pulsatile) flow inside portal vein thrombus reflects tumor neovascularity and is characteristic of tumor thrombus; expansion of the vein supports it. Bland thrombus generally lacks this internal arterial signal. Its absence does not exclude tumor thrombus. Normal slow flow does not explain vascularized intraluminal material, and hepatofugal flow describes direction rather than the nature of that material.

Review topic: Portal vein tumor thrombus
Domain: Pathology, Perfusion, and Function
Question ID: RVT-PT-29

Sources:

• Furuse et al. — Diagnosis of portal vein tumor thrombus by pulsed Doppler ultrasonography (1992) — Abstract → Results: pulsatile intrathrombus signals in tumor versus bland portal clot.

Answer: B. Positional compression of the subclavian artery at the thoracic outlet

Loss of distal arterial signal only in provocative arm positions points to dynamic arterial compression at the thoracic outlet. Similar signal changes can occur in healthy people, so provocative Doppler findings alone do not diagnose clinical arterial thoracic outlet syndrome. Raynaud is triggered by cold or emotion, not position. A fixed occlusion would be abnormal at rest. Subclavian vein thrombosis does not best explain arterial signals that normalize when the arm returns to rest.

Review topic: Arterial thoracic outlet
Domain: Pathology, Perfusion, and Function
Question ID: RVT-PT-30

Sources:

• Bishop & Bartlett — Doppler waveform analysis during provocative maneuvers in arterial thoracic outlet assessment (2021) — Introduction, participant positioning, Results and Conclusion; compression in healthy participants.

• AIUM Practice Parameter — Peripheral Arterial Ultrasound Using Color and Spectral Doppler, 2025 Revision — Peripheral Arterial Disease → Upper extremity, provocative testing in suspected thoracic outlet syndrome.

Answer: C. Budd-Chiari syndrome

Budd-Chiari syndrome is obstruction of hepatic venous outflow: thrombosed or absent hepatic vein flow and intrahepatic ("spiderweb") collaterals, often with pain, ascites, and hepatomegaly. Right heart failure distends the hepatic veins and increases pulsatility rather than abolishing flow. The portal vein isn't the vessel described.

Review topic: Budd-Chiari
Domain: Pathology, Perfusion, and Function
Question ID: RVT-PT-31

Sources:

• EASL Clinical Practice Guidelines on vascular diseases of the liver (2025/2026) — Budd-Chiari syndrome → diagnostic definition and 'In patients with features of acute or chronic liver disease, what imaging modality should be used to establish the diagnosis of Budd-Chiari syndrome?'.

• Chawla et al. — Duplex Doppler sonography in patients with Budd-Chiari syndrome (1999) — Abstract → Methods and Results.

• SVM/SVU consensus — Interpretation of Peripheral Arterial and Venous Doppler Waveforms (2020) — Table 17 → Pathological hepatic vein, right-heart/tricuspid-related pulsatility.

Answer: A. Arteriovenous fistula

An iatrogenic AV fistula shunts arterial blood straight into a vein: a high-velocity jet, arterialized venous flow, and tissue vibration shown as a color bruit. A pseudoaneurysm has a sac with swirling "yin-yang" flow and to-and-fro flow in its neck. A hematoma has no internal flow. DVT is a venous clot, not a direct artery-to-vein channel.

Review topic: Post-catheter AV fistula
Domain: Pathology, Perfusion, and Function
Question ID: RVT-PT-32

Sources:

• AIUM Practice Parameter — Peripheral Arterial Ultrasound Using Color and Spectral Doppler, 2025 Revision — Other → Pseudoaneurysms; Abnormal communication between artery and vein (arterio-venous fistula).

• SVM/SVU consensus — Interpretation of Peripheral Arterial and Venous Doppler Waveforms (2020) — Table 7 → Arteriovenous fistula and Pseudoaneurysm.

Answer: D. Region D

The inflow (feeding) artery is the artery upstream of the anastomosis. In this radiocephalic fistula, that's the radial segment on the elbow side of the connection — D, where the arrow shows flow heading into the junction. A is the arteriovenous anastomosis itself, B is the outflow (draining) cephalic vein, and C is the radial artery continuing toward the hand past the anastomosis. A complete access duplex looks at all three parts: inflow artery, anastomosis, and outflow vein.

Review topic: AV access anatomy
Domain: Surgically Altered Anatomy and Pathology
Question ID: RVT-PT-33

Sources:

• ACR–AIUM–SRU Practice Parameter for the Performance of Vascular Ultrasound Examinations for Postoperative Assessment of Hemodialysis Access — Specification of the Examination: forearm AVFs; examination of inflow artery, anastomosis, and venous outflow; Doppler angle alignment.

Answer: B. High-risk stenosis that warrants consideration of intervention

A PSV above 300 cm/s with a velocity ratio above 3.5 identifies a high-risk graft stenosis linked to graft failure. Measurable flow excludes complete occlusion at the sampled site, and nothing here describes arterialized venous flow.

Review topic: Vein graft surveillance
Domain: Surgically Altered Anatomy and Pathology
Question ID: RVT-PT-34

Sources:

• SVS Guidelines Bundle: Follow-Up After Vascular Surgery Arterial Procedures — Page 6, Table 2: DUS Velocity and ABI Threshold Criteria for Stratification of Risk for Thrombosis of Infrainguinal Vein Grafts.

• Tinder CN, Bandyk DF. Detection of imminent vein graft occlusion: what is the optimal surveillance program? — Abstract, critical-stenosis criteria and consideration of intervention.

Answer: A. Stented segments tend to show higher velocities than native arteries with the same narrowing, so native criteria overestimate stenosis

A stent makes the artery stiffer and less compliant, so velocities run higher than in a native artery with the same degree of narrowing. Native criteria therefore overestimate in-stent stenosis, and modified, stent-specific thresholds are used. Stents are well seen on ultrasound; stenting does not inherently reverse flow or keep velocities below 50 cm/s.

Review topic: Carotid stent velocities
Domain: Surgically Altered Anatomy and Pathology
Question ID: RVT-PT-35

Sources:

• SVS Practice Guidelines: Follow-Up After Vascular Surgery Arterial Procedures, overview slides — PDF page 11, carotid artery stenting recommendation 3.

• Szegedi I et al. Role of carotid duplex in the assessment of carotid artery restenosis after endarterectomy or stenting — Discussion: Duplex ultrasound criteria for restenosis after CAS compared to stenosis in native ICA.

Answer: C. Hepatic artery stenosis upstream of the sampled site

A tardus-parvus waveform — RI below 0.5 with an acceleration time above 0.08 s — downstream of the anastomosis suggests upstream hepatic artery stenosis. It is a reason for further evaluation, not a diagnosis by itself; this waveform can give false-positive results. A normal hepatic artery has a brisk upstroke. The hepatic and portal veins aren't the vessel sampled.

Review topic: Liver transplant hepatic artery
Domain: Surgically Altered Anatomy and Pathology
Question ID: RVT-PT-36

Sources:

• Tardus parvus waveforms in Doppler ultrasonography for hepatic artery stenosis after liver transplantation: can a new cut-off value guide the next step? — Introduction; Materials and methods—Study population and Doppler ultrasonography; Results—traditional TPW; Discussion.

Answer: C. 0.72; abnormal

ABI = the higher ankle pressure in that leg ÷ the higher of the two brachial pressures = 108 ÷ 150 = 0.72. An ABI of 0.90 or less is abnormal and consistent with PAD. A used the lower ankle pressure (96 ÷ 150); B used the lower arm pressure (108 ÷ 136); D inverted the fraction.

Review topic: ABI calculation
Domain: Physiologic Exams
Question ID: RVT-PT-37

Sources:

• American Heart Association: A Clinical Assessment of Peripheral Artery Disease for Those on the Primary Care Spectrum — PDF page 31 / slide 31: STEP #3—The Resting ABI.

• 2024 ACC/AHA multisociety guideline for lower extremity PAD: official slide set — PDF page 38, Resting ABI recommendation 2; PDF page 40, Exercise ABI recommendation 6; PDF page 41, segmental pressures recommendation 8; PDF pages 16 and 28, claudication definition.

Answer: D. Borderline

The categories are: 0.90 or less abnormal, 0.91–0.99 borderline, 1.00–1.40 normal, and above 1.40 noncompressible. In a patient with exertional leg symptoms, a borderline result is a reason for further testing such as an exercise ABI.

Review topic: ABI categories
Domain: Physiologic Exams
Question ID: RVT-PT-38

Sources:

• 2024 ACC/AHA multisociety guideline for lower extremity PAD: official slide set — PDF page 38, Resting ABI recommendation 2; PDF page 40, Exercise ABI recommendation 6; PDF page 41, segmental pressures recommendation 8; PDF pages 16 and 28, claudication definition.

Answer: A. Exercise treadmill ABI, looking for a drop in ankle pressure after exercise

When symptoms suggest claudication but the resting ABI is normal or borderline, guidelines recommend an exercise treadmill ABI to unmask PAD. Venous and carotid duplex examine different vascular problems, and simply waiting to repeat the resting ABI does not evaluate the current exertional symptoms.

Review topic: Exercise ABI
Domain: Physiologic Exams
Question ID: RVT-PT-39

Sources:

• 2024 ACC/AHA multisociety guideline for lower extremity PAD: official slide set — PDF page 38, Resting ABI recommendation 2; PDF page 40, Exercise ABI recommendation 6; PDF page 41, segmental pressures recommendation 8; PDF pages 16 and 28, claudication definition.

Answer: B. 20 mmHg or more

A drop of 20 mmHg or more between adjacent cuff levels in the same leg generally suggests significant disease between those levels. Interpret segmental pressures with the waveforms and the rest of the examination; a smaller difference alone does not exclude disease.

Review topic: Segmental pressures
Domain: Physiologic Exams
Question ID: RVT-PT-40

Sources:

• Gerhard-Herman M et al. Guidelines for Noninvasive Vascular Laboratory Testing — PDF page 7 / journal page 961, Segmental Limb Pressure Interpretation.

• 2024 ACC/AHA multisociety guideline for lower extremity PAD: official slide set — PDF page 38, Resting ABI recommendation 2; PDF page 40, Exercise ABI recommendation 6; PDF page 41, segmental pressures recommendation 8; PDF pages 16 and 28, claudication definition.

Answer: D. Falsely high pressure

A cuff that's too small needs more pressure to compress the artery, so it artificially elevates the reading; a cuff that's too large gives an artificially low reading. That's why cuff size must match limb size at every level you measure.

Review topic: Cuff size error
Domain: Physiologic Exams
Question ID: RVT-PT-41

Sources:

• Muntner P et al. Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association — Cuff Size subsection, text preceding Table 2.

Answer: A. The time for skin blood volume to return to baseline after calf-muscle exercise empties the veins

After repeated calf contractions empty the leg veins, the PPG sensor tracks how long skin blood volume takes to return to baseline. Normally the veins refill slowly from arterial inflow (roughly 20 seconds or more); reflux refills them backward and shortens the time. B is pulse transit time, C is duplex reflux timing, and D isn't a measurement.

Review topic: Venous PPG refill
Domain: Physiologic Exams
Question ID: RVT-PT-42

Sources:

• Saliba Júnior OA et al. Pre- and Postoperative Evaluation by Photoplethysmography in Patients Receiving Surgery for Lower-Limb Varicose Veins — §2 Materials and Methods: PPG protocol and baseline curve; Figure 1; §4 Discussion: normal VRT convention and differing study cutoffs.

• Franceschi C. Who knows the rationale of the refilling time measured by plethysmography? — PDF page 1 / journal page 8, Pathophysiology significance of the refilling time; PDF page 2, Figure 1 caption.

Answer: C. A photoplethysmography (PPG) sensor on the toe tip

Toe pressures use a small digit cuff with a PPG sensor on the toe tip, which detects pulsatile changes in skin blood volume as the cuff deflates. The other options don't measure pressure at the digit.

Review topic: Toe pressure sensor
Domain: Physiologic Exams
Question ID: RVT-PT-43

Sources:

• Scanlon C et al. Interrater and intrarater reliability of photoplethysmography for measuring toe blood pressure and toe-brachial index in people with diabetes mellitus — Methods: toe pressure and TBI measurement procedure using PPG probe and small toe cuff.

Answer: B. Point B

B is inside the sac and away from the neck. Keeping the tip away from the neck reduces the risk of thrombin entering the native artery through the neck (A) and causing distal thrombosis; it does not eliminate that risk. The artery (C) and the vein (D) are not injection targets for this procedure.

Review topic: Thrombin injection target
Domain: Ultrasound-guided Procedures/Intraoperative Assessment
Question ID: RVT-PT-44

Sources:

• Altuwaijri T et al. Ultrasound-guided thrombin injection versus ultrasound-guided compression repair in post-catheterization femoral artery pseudoaneurysm — Methods—Surgical technique: first paragraph for UGCR, third/fourth paragraphs for UGTI; Discussion: thromboembolic complications and native-artery occlusion.

Answer: D. Stop flow into the pseudoaneurysm at the neck while keeping flow in the native artery

Pressure over the neck stops flow into the sac so it can thrombose, while flow in the femoral artery is maintained. Occluding the native artery would risk limb ischemia.

Review topic: Compression repair
Domain: Ultrasound-guided Procedures/Intraoperative Assessment
Question ID: RVT-PT-45

Sources:

• Altuwaijri T et al. Ultrasound-guided thrombin injection versus ultrasound-guided compression repair in post-catheterization femoral artery pseudoaneurysm — Methods—Surgical technique: first paragraph for UGCR, third/fourth paragraphs for UGTI; Discussion: thromboembolic complications and native-artery occlusion.

Answer: C. Position C

C marks the connection between the great saphenous vein and the common femoral vein: the saphenofemoral junction. Identifying this superficial-to-deep connection is part of mapping the anatomy before treatment. B is within the common femoral vein; A and D are along the great saphenous vein.

Review topic: Pre-ablation junction anatomy
Domain: Ultrasound-guided Procedures/Intraoperative Assessment
Question ID: RVT-PT-46

Sources:

• AIUM Practice Parameter for the Performance of Peripheral Venous Ultrasound Examinations, 2024 Revision — Specification of the Examination §§1.1.2 and 1.2.1.2 (GSV/SFJ and CFV-GSV confluence); §1.3.3 (reverse Trendelenburg for venous distention).

• SVS/AVF/AVLS clinical practice guidelines for varicose veins of the lower extremities, Part II — §1.4.3: complete venous reflux DUS including SFJ; §§11.1.1–11.1.4: early DUS after ablation; §11 introduction: ARTE terminology.

Answer: C. To assess for ablation-related thrombus extension (ARTE) or deep vein thrombosis

New symptoms after thermal ablation warrant early duplex to assess for ablation-related thrombus extension (ARTE) or deep vein thrombosis. ARTE includes the complication previously called endovenous heat-induced thrombosis (EHIT). The 2023 multisociety guideline recommends early duplex in symptomatic patients and advises it for high-risk patients; it recommends against routine early duplex solely to look for ARTE or DVT in average-risk, asymptomatic patients after thermal ablation. Vein graft measurement, confirming reopening, and an ABI do not address the suspected venous complication.

Review topic: Symptomatic post-ablation assessment
Domain: Ultrasound-guided Procedures/Intraoperative Assessment
Question ID: RVT-PT-47

Sources:

• SVS/AVF/AVLS clinical practice guidelines for varicose veins of the lower extremities, Part II — §1.4.3: complete venous reflux DUS including SFJ; §§11.1.1–11.1.4: early DUS after ablation; §11 introduction: ARTE terminology.

Answer: D. Wall filter set too high

A high wall filter strips out low-velocity signals near the baseline and can erase genuine diastolic flow, making a low-resistance vessel look high resistance. A too-low scale causes aliasing, not lost diastole. Center placement and a 50-degree angle are correct technique.

Review topic: Wall filter artifact
Domain: Quality Assurance, Safety, and Physical Principles
Question ID: RVT-PT-48

Sources:

• Bhide A et al. ISUOG Practice Guidelines (updated): use of Doppler velocimetry in obstetrics — Spectral pulsed-wave Doppler ultrasonography, wall-filter paragraph and Figure 4 caption: high filtering can obscure end-diastolic flow.

Answer: A. Panel A

The angle-correction cursor belongs parallel to the direction of flow — here, parallel to the vessel walls — so the system uses the true angle between the beam and the flow (60° in every panel). B lines the cursor up with the beam, C sets it perpendicular to the flow, and D tilts it 30° off the flow. Each makes the machine calculate velocity with the wrong angle. Keep the beam-to-flow angle at 60° or less, because velocity errors grow quickly at larger angles.

Review topic: Angle-correction cursor
Domain: Quality Assurance, Safety, and Physical Principles
Question ID: RVT-PT-49

Sources:

• ACR–AIUM–SRU Practice Parameter for the Performance of Vascular Ultrasound Examinations for Postoperative Assessment of Hemodialysis Access — Specification of the Examination: forearm AVFs; examination of inflow artery, anastomosis, and venous outflow; Doppler angle alignment.

Answer: B. 1.88

PI = (PSV − EDV) ÷ TAMX = (90 − 15) ÷ 40 = 1.875 ≈ 1.88. TAMX is the maximum-velocity envelope averaged over the cardiac cycle, not the intensity-weighted mean velocity. A is the resistive index, (90 − 15) ÷ 90. C divides PSV by TAMX; D divides PSV by EDV.

Review topic: Pulsatility index
Domain: Quality Assurance, Safety, and Physical Principles
Question ID: RVT-PT-50

Sources:

• Bhide A et al. ISUOG Practice Guidelines (updated): use of Doppler velocimetry in obstetrics — Which indices should be used?: PI = (S − D)/TAMX; distinction from intensity-weighted mean velocity; RI and S/D definitions.

Answer: C. From the onset of systole to the first (early) systolic peak

Acceleration time runs from the start of the systolic upstroke to the early systolic peak. A prolonged acceleration time — a slow upstroke — suggests obstruction upstream of where you're sampling.

Review topic: Acceleration time
Domain: Quality Assurance, Safety, and Physical Principles
Question ID: RVT-PT-51

Sources:

• Trihan JE et al. Arterial Blood-Flow Acceleration Time on Doppler Ultrasound Waveforms: What Are We Talking About? — §2 Measurement Methods; §3 Proposal and Perspectives; Figure 1.

Answer: B. Mirror image

The pleura–lung interface is a strong reflector that can produce a mirror-image duplicate of the subclavian artery, including its Doppler signal. Reverberation creates evenly spaced repeated lines; refraction creates edge shadows; aliasing is a Doppler wraparound.

Review topic: Mirror-image artifact
Domain: Quality Assurance, Safety, and Physical Principles
Question ID: RVT-PT-52

Sources:

• Rubin JM et al. Duplication images in vascular sonography — Abstract—five vascular duplication cases including subclavian arteries/vein, mirror-image multipath mechanism.

Answer: A. 90%

Sensitivity = true positives ÷ everyone with disease = 45 ÷ 50 = 90%. B is specificity (46 ÷ 50), C is positive predictive value (45 ÷ 49), and D is overall accuracy (91 ÷ 100). Correlation studies like this are how a lab checks its own criteria.

Review topic: Sensitivity and specificity
Domain: Quality Assurance, Safety, and Physical Principles
Question ID: RVT-PT-53

Sources:

• FDA. Statistical Guidance on Reporting Results from Studies Evaluating Diagnostic Tests — §7.1: estimates of sensitivity and specificity for a diagnostic test.

Answer: D. Stop the exam and get immediate help using the facility's emergency protocol

Possible acute cardiac or respiratory distress takes priority over the images. The sonographer monitors the patient's condition and activates the emergency protocol when needed.

Review topic: Patient monitoring
Domain: Quality Assurance, Safety, and Physical Principles
Question ID: RVT-PT-54

Sources:

• SDMS Scope of Practice and Clinical Standards for the Diagnostic Medical Sonographer — Clinical Standards §§1.4.5–1.4.6 and §1.5.4: monitor the patient and respond to emergencies.

Answer: B. Contact the ordering provider or supervising physician to confirm the appropriate exam

Exertional calf pain relieved by rest suggests arterial claudication. When the order doesn't fit the history, the sonographer clarifies it through facility policy with the supervising physician or referring provider — not by silently changing or cancelling it.

Review topic: Order appropriateness
Domain: Quality Assurance, Safety, and Physical Principles
Question ID: RVT-PT-55

Sources:

• SDMS Scope of Practice and Clinical Standards for the Diagnostic Medical Sonographer — Clinical Standards §§1.1.1–1.1.2: verify the order and relevant history; clarify the examination.

• 2024 ACC/AHA multisociety guideline for lower extremity PAD: official slide set — PDF page 38, Resting ABI recommendation 2; PDF page 40, Exercise ABI recommendation 6; PDF page 41, segmental pressures recommendation 8; PDF pages 16 and 28, claudication definition.

Answer: A. Mesenteric artery duplex

Mesenteric duplex is done after fasting (commonly 6 hours or more) to reduce bowel gas and to remove the effect of digestion, which increases mesenteric flow. Carotid, upper-extremity venous, and ABI exams need no fasting.

Review topic: Patient preparation
Domain: Preparation, Documentation, and Communication
Question ID: RVT-PT-56

Sources:

• Society for Vascular Technology. Mesenteric Artery Duplex Ultrasound Examination guideline — PDF page 2: Patient preparation.

Answer: D. Use at least two patient identifiers, such as full name and date of birth

At least two person-specific identifiers, such as full name and date of birth, are the patient-safety standard, and a room number never counts as one. A yes/no question invites a wrong "yes," and someone else's confirmation doesn't replace your own check.

Review topic: Patient identification
Domain: Preparation, Documentation, and Communication
Question ID: RVT-PT-57

Sources:

• The Joint Commission. Two Patient Identifiers—Understanding the Requirements — FAQ response: two person-specific identifiers; room number is not an acceptable identifier.

Answer: C. Raise the head of the bed or use reverse Trendelenburg, and document the position used

Raising the head of the bed or using reverse Trendelenburg can improve tolerance in this stable patient. Reverse Trendelenburg also improves leg-vein distention for compression. Document the adaptation so the study can be interpreted and repeated. The exam should not be abandoned or narrowed solely because the patient cannot lie flat.

Review topic: Adapting the exam
Domain: Preparation, Documentation, and Communication
Question ID: RVT-PT-58

Sources:

• AIUM Practice Parameter for the Performance of Peripheral Venous Ultrasound Examinations, 2024 Revision — Specification of the Examination §§1.1.2 and 1.2.1.2 (GSV/SFJ and CFV-GSV confluence); §1.3.3 (reverse Trendelenburg for venous distention).

• SDMS Scope of Practice and Clinical Standards for the Diagnostic Medical Sonographer — Clinical Standards §1.3.1 and §1.4.2: adapt the examination to the patient; §§1.5.2 and 1.6.1–1.6.3: limitations and documentation.

Answer: B. Explain that the interpreting physician will review the images and the results will come through the ordering provider, following facility policy

The sonographer refers specific diagnostic questions to the appropriate physician or healthcare provider and communicates results to the patient only as authorized by facility policy. A respectful explanation of the process avoids giving an unauthorized diagnosis, ignoring the patient, or falsely reassuring them.

Review topic: Patient questions and scope
Domain: Preparation, Documentation, and Communication
Question ID: RVT-PT-59

Sources:

• SDMS Scope of Practice and Clinical Standards for the Diagnostic Medical Sonographer — Clinical Standards §§1.2.3–1.2.4: patient questions and communication of results under facility authorization.

Answer: D. Confirm the images are archived and document the preliminary findings and any technical limitations

Finishing the exam means making sure the images reached the archive and documenting preliminary findings and limitations for the interpreting physician. Deleting images loses the record, and the diagnosis comes from the interpreting physician.

Review topic: Completing documentation
Domain: Preparation, Documentation, and Communication
Question ID: RVT-PT-60

Sources:

• SDMS Scope of Practice and Clinical Standards for the Diagnostic Medical Sonographer — Clinical Standards §§1.5.2 and 1.6.1–1.6.3: documentation, technical limitations, preliminary findings, and archiving.