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RPhS practice questions

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Question 1Phlebology Sonography

During a venous duplex examination, which transducer maneuver best demonstrates the great saphenous vein in transverse cross-section at the saphenofemoral junction?

  1. Increasing color gain until tissue noise fills the image
  2. Applying sustained heavy compression to collapse all superficial veins
  3. Slowly sliding the probe caudally from the groin while keeping the vessel centered Correct answer.
  4. Angling the transducer 90 degrees to the skin in sagittal orientation

Explanation

Transverse imaging with caudal sliding tracks the great saphenous vein from the saphenofemoral junction down the medial thigh, keeping the vessel centered for measurement. This technique is the standard survey approach for mapping superficial venous anatomy.

Question 2Phlebology Sonography

Which finding on continuous-wave Doppler most directly supports a diagnosis of venous insufficiency in the lower extremity?

  1. Augmentation of flow with distal manual compression
  2. Reflux lasting longer than 0.5 seconds after release of distal compression Correct answer.
  3. Cessation of flow with distal limb elevation
  4. Pulsatile flow synchronous with the cardiac cycle

Explanation

Reflux exceeding roughly 0.5 seconds in superficial veins after release of distal compression indicates valvular incompetence. The threshold is a widely used criterion for defining pathologic venous reflux.

Question 3Phlebology Sonography

When performing a venous duplex study, the patient is positioned in reverse Trendelenburg. What is the primary purpose of this positioning?

  1. To compress the popliteal vein against the femur
  2. To eliminate respiratory variation in the femoral vein
  3. To reduce the effect of gravity on venous filling so reflux is not masked Correct answer.
  4. To increase arterial inflow to the calf muscles

Explanation

Reverse Trendelenburg distends lower extremity veins and removes gravity-dependent hydrostatic effects, improving detection of reflux and venous distensibility. Adequate venous filling is essential for reliable reflux assessment.

Question 4Phlebology Sonography

Which vein is most commonly evaluated as the deep venous continuation of the popliteal vein in the calf?

  1. Anterior tibial vein
  2. Peroneal vein Correct answer.
  3. Lesser saphenous vein
  4. Soleal sinusoids

Explanation

The popliteal vein typically bifurcates into the anterior tibial vein and the tibioperoneal trunk, which then divides into posterior tibial and peroneal veins. The peroneal vein is a major paired deep calf vein frequently assessed for thrombosis.

Question 5Phlebology Sonography

A color Doppler image shows flow that is blue in the femoral vein on one side and red on the contralateral femoral vein using identical settings. What is the most likely explanation?

  1. Unilateral venous thrombosis
  2. Incorrect color map assignment
  3. Opposite transducer orientation relative to flow direction Correct answer.
  4. Severe arterial insufficiency

Explanation

Color Doppler encodes direction relative to the transducer; reversing probe orientation relative to flow direction inverts the displayed color. Symmetric settings and anatomy make orientation the most likely cause.

Question 6Phlebology Sonography

Which structure serves as a landmark for locating the saphenofemoral junction during duplex mapping?

  1. Popliteal fossa crease
  2. Adductor canal hiatus
  3. Femoral artery and common femoral vein Correct answer.
  4. Lesser saphenous vein at the lateral malleolus

Explanation

The saphenofemoral junction lies where the great saphenous vein joins the common femoral vein, adjacent to the femoral artery in the groin. Recognizing these arterial and venous landmarks confirms the junction level.

Question 7Phlebology Sonography

What does the term 'augmentation' refer to during a lower extremity venous examination?

  1. Increase in venous flow caused by distal manual compression Correct answer.
  2. Increase in probe frequency during imaging
  3. Increase in color box size
  4. Increase in venous diameter during Valsalva

Explanation

Augmentation is the transient increase in venous flow produced by compressing the distal limb, demonstrating that the segment between compression and probe is patent. It is a key patency test in venous duplex.

Question 8Phlebology Sonography

Which finding on B-mode imaging is most consistent with acute deep vein thrombosis?

  1. Echogenic, noncompressible lumen with venous distension Correct answer.
  2. Biphasic arterial waveform within the vein
  3. Thin-walled compressible vein with phasic flow
  4. Calcified intimal plaque within the vein wall

Explanation

Acute thrombus typically appears hypoechoic to echogenic, distends the vein, and prevents complete compression. Noncompressibility is the most reliable B-mode sign of acute deep vein thrombosis.

Question 9Phlebology Sonography

During a venous reflux study, a technologist performs distal compression and release while recording spectral Doppler. Which parameter is measured to quantify reflux?

  1. Resistive index
  2. Pulsatility index
  3. Peak systolic velocity
  4. Reflux time Correct answer.

Explanation

Reflux time, the duration of retrograde flow after release of distal compression, is the standard measurement for quantifying venous valvular incompetence. It is compared against established thresholds for superficial and deep veins.

Question 10Phlebology Sonography

Which of the following best describes the normal phasic pattern of flow in the common femoral vein?

  1. Absent flow at rest with flow only on compression
  2. High-resistance triphasic flow
  3. Phasic variation with respiration and cardiac pulsatility Correct answer.
  4. Continuous flow with no variation

Explanation

Normal common femoral venous flow varies with respiration and may show slight cardiac pulsatility, reflecting transmission of right heart and intrathoracic pressure changes. Loss of phasicity can indicate proximal obstruction.

Question 11Phlebology Sonography

A patient presents with a swollen, painful calf after prolonged immobilization. Duplex shows a hypoechoic, noncompressible popliteal vein with absent phasicity. What is the most appropriate interpretation?

  1. Chronic venous insufficiency
  2. Superficial thrombophlebitis
  3. Acute popliteal deep vein thrombosis Correct answer.
  4. Normal variant venous anatomy

Explanation

Noncompressibility, hypoechoic material in the lumen, and loss of phasicity together indicate acute deep vein thrombosis in the popliteal vein. Clinical presentation and duplex findings are concordant with this diagnosis.

Question 12Phlebology Sonography

Which parameter should be adjusted to optimize detection of slow venous flow in a dilated calf vein?

  1. Increase the velocity scale (PRF)
  2. Decrease color gain to zero
  3. Lower the velocity scale and adjust wall filter appropriately Correct answer.
  4. Increase the Doppler angle to 90 degrees

Explanation

Lowering the velocity scale improves sensitivity to slow venous flow, while an appropriate low wall filter reduces clutter without eliminating true flow. These adjustments are essential for detecting low-velocity venous signals.

Question 13Phlebology Sonography

What is the primary role of the Valsalva maneuver during a saphenofemoral junction assessment?

  1. To eliminate respiratory phasicity
  2. To provoke reflux across the terminal valve Correct answer.
  3. To measure arterial inflow
  4. To collapse the femoral vein

Explanation

The Valsalva maneuver raises intra-abdominal pressure and provokes retrograde flow across an incompetent terminal valve at the saphenofemoral junction. Reflux duration during the maneuver helps confirm junctional incompetence.

Question 14Phlebology Sonography

Which vein connects the superficial and deep venous systems in the calf and is frequently evaluated for incompetence?

  1. Cockett perforating veins Correct answer.
  2. Femoral vein
  3. Great saphenous vein
  4. Lesser saphenous vein

Explanation

Perforating veins, including those in the Cockett group in the medial calf, connect the superficial and deep systems and are assessed for outward flow and incompetence. Their incompetence contributes to chronic venous disease.

Question 15Phlebology Sonography

In a venous duplex report, what does 'reflux at the saphenopopliteal junction' most specifically indicate?

  1. Thrombosis of the popliteal vein
  2. Incompetence where the lesser saphenous vein joins the popliteal vein Correct answer.
  3. Incompetence of the common femoral vein
  4. Obstruction of the posterior tibial vein

Explanation

The saphenopopliteal junction is the termination of the lesser saphenous vein into the popliteal vein, and reflux there indicates incompetence at that junction. This finding guides decisions about intervention in posterior calf venous disease.

Question 16Phlebology Sonography

A technologist notes that a venous spectral waveform loses respiratory phasicity and becomes continuous during a study of the common femoral vein. Which condition should be suspected?

  1. Normal variant
  2. Proximal venous obstruction Correct answer.
  3. Superficial vein reflux
  4. Distal arterial stenosis

Explanation

Loss of respiratory phasicity and continuous flow in the common femoral vein suggest an obstruction proximal to the sampling site, such as iliac vein thrombosis or compression. The finding reflects impaired transmission of intrathoracic pressure changes.

Question 17Phlebology Sonography

Which factor most influences the accuracy of venous diameter measurements obtained during duplex mapping?

  1. Use of maximum color gain
  2. Use of pulsed-wave rather than continuous-wave Doppler
  3. Patient's fasting status
  4. Consistent limb position and avoidance of probe pressure Correct answer.

Explanation

Venous diameter varies with limb position and applied probe pressure, so consistent positioning and minimal compression are necessary for reproducible measurements. Standardized technique improves the reliability of mapping data.

Question 18Phlebology Sonography

Which statement best describes the appearance of chronic post-thrombotic changes in a deep vein on duplex imaging?

  1. Absent vein with no identifiable structure
  2. Distended vein with hypoechoic acute thrombus
  3. Thickened, echogenic vein wall with partial compressibility and possible reflux Correct answer.
  4. Uniformly anechoic lumen with full compressibility

Explanation

Chronic post-thrombotic veins often show wall thickening, echogenic residual material, partial compressibility, and valvular reflux. These findings differ from the distended, noncompressible appearance of acute thrombosis.

Question 19Phlebology Sonography

A patient with a history of iliofemoral thrombosis has a common femoral vein that is echogenic and partially compressible with continuous flow. Which interpretation is most appropriate?

  1. Acute thrombosis requiring immediate anticoagulation
  2. Superficial venous incompetence
  3. Normal venous examination
  4. Chronic post-thrombotic change with possible proximal obstruction Correct answer.

Explanation

Echogenic, partially compressible vein walls with continuous flow indicate chronic post-thrombotic change and suggest residual proximal obstruction. The history and loss of phasicity support this interpretation rather than acute thrombosis.

Question 20Phlebology Sonography

When assessing the lesser saphenous vein, where should the transducer be placed to evaluate its proximal segment?

  1. Medial thigh near the groin
  2. Dorsal foot
  3. Posterior calf and popliteal fossa Correct answer.
  4. Anterior shin

Explanation

The lesser saphenous vein courses in the posterior calf and terminates at the saphenopopliteal junction, so proximal evaluation requires imaging the posterior calf and popliteal fossa. Correct anatomic placement is essential for complete venous mapping.

Question 21Phlebology Sonography

Which Doppler angle is generally recommended for accurate venous velocity measurement during spectral Doppler sampling?

  1. 30 degrees
  2. 0 degrees
  3. 60 degrees or less, ideally near 60 Correct answer.
  4. 90 degrees

Explanation

Doppler shift depends on the cosine of the angle between the beam and flow; angles near 60 degrees or less provide acceptable accuracy. Angles approaching 90 degrees yield negligible shift and unreliable velocities.

Question 22Phlebology Sonography

A technologist observes bidirectional color flow in a perforating vein during calf compression and release. What does this finding most likely represent?

  1. Normal inward flow during compression with outward flow on release Correct answer.
  2. Complete venous occlusion
  3. Artifact from excessive wall filter
  4. Arterial flow within the perforator

Explanation

Perforating veins normally direct flow from superficial to deep during compression and may show brief outward flow on release; sustained outward flow indicates incompetence. Bidirectional flow must be interpreted with the compression cycle.

Question 23Phlebology Sonography

During a reflux study, a technologist measures a reflux time of 0.4 seconds in the great saphenous vein and 0.7 seconds in the common femoral vein. How should these findings be interpreted?

  1. Only the common femoral vein meets the deep venous reflux threshold Correct answer.
  2. Neither segment shows reflux
  3. Only the great saphenous vein is incompetent
  4. Both segments are incompetent

Explanation

Reflux thresholds differ by venous system: superficial veins are typically considered incompetent above about 0.5 seconds, while deep veins generally require a longer threshold, often around 1.0 second. The 0.7-second deep reflux therefore does not meet the deep threshold.

Question 24Phlebology Sonography

Which technical factor most likely produces a false-positive color Doppler signal in a vein adjacent to a pulsatile artery?

  1. Velocity scale set too high
  2. Color write priority set too low with high color gain Correct answer.
  3. Wall filter set too high
  4. Doppler angle set to 60 degrees

Explanation

High color gain with low write priority allows arterial pulsatility or tissue motion to appear within the venous lumen, mimicking flow. Reducing gain and adjusting priority or filter settings helps distinguish true venous flow from artifact.

Question 25Phlebology Sonography

A patient's duplex study shows a dilated, noncompressible superficial vein with surrounding echogenic fat and no flow on color Doppler. What is the most likely diagnosis?

  1. Arteriovenous fistula
  2. Deep vein thrombosis
  3. Normal superficial vein
  4. Superficial thrombophlebitis Correct answer.

Explanation

A dilated, noncompressible superficial vein with inflammatory changes in surrounding tissue and absent flow is characteristic of superficial thrombophlebitis. The findings are confined to the superficial system.

Question 26Phlebology Sonography

Which transducer orientation convention is standard when imaging the lower extremity veins in transverse plane?

  1. The screen orientation is irrelevant for venous imaging
  2. The top of the screen always represents superficial tissue regardless of probe marker
  3. The right side of the screen corresponds to the patient's right side
  4. The left side of the screen corresponds to the patient's right side Correct answer.

Explanation

By convention the probe marker is directed toward the patient's right, so the left side of the display shows the patient's right side in transverse imaging. Consistent marker orientation lets the sonographer map medial versus lateral structures reliably, which matters when distinguishing the great saphenous vein from adjacent deep veins.

Question 27Phlebology Sonography

Which venous segment is imaged just distal to the inguinal ligament before it becomes the femoral vein?

  1. Peroneal vein
  2. Gastrocnemius vein
  3. Popliteal vein
  4. Common femoral vein Correct answer.

Explanation

The external iliac vein becomes the common femoral vein as it passes under the inguinal ligament. It lies medial to the common femoral artery and receives the great saphenous vein at the saphenofemoral junction just below this level.

Question 28Phlebology Sonography

What does a venous duplex finding of 'continuous flow' in the common femoral vein most directly suggest?

  1. A proximal obstruction such as iliac vein thrombosis or compression Correct answer.
  2. Normal valve competence at the saphenofemoral junction
  3. Isolated calf muscle pump failure
  4. Normal respiratory variation

Explanation

Continuous, nonphasic flow in the common femoral vein indicates loss of the normal respiratory modulation, which usually reflects an obstruction proximal to the sample site such as iliac vein thrombosis or compression. The phasic pattern depends on transmitted right heart pressure changes through an open proximal pathway.

Question 29Phlebology Sonography

Which structure is the most reliable landmark for identifying the popliteal vein behind the knee?

  1. The small saphenous vein, which lies deep to the fascia
  2. The popliteal artery, which lies anterior to the vein in the popliteal fossa Correct answer.
  3. The tibial nerve, which lies lateral to the vessels
  4. The popliteal artery, which lies superficial to the vein

Explanation

In the popliteal fossa the popliteal vein lies superficial (posterior) to the popliteal artery, so the artery serves as a dependable landmark when tracing the vein. Confirming the paired artery helps avoid mistaking a dilated superficial or muscular vein for the popliteal vein.

Question 30Phlebology Sonography

A technologist images the calf and sees paired veins accompanying a single artery within the deep posterior compartment. Which veins are most likely being examined?

  1. Small saphenous vein
  2. Great saphenous vein
  3. Peroneal veins Correct answer.
  4. Soleal veins

Explanation

The peroneal (fibular) veins are paired deep veins that run with the peroneal artery in the deep posterior compartment. Paired veins accompanying a single named artery are a hallmark of the deep calf venous system, whereas the saphenous veins are single superficial channels.

Question 31Phlebology Sonography

Which maneuver best demonstrates competence of the deep venous valves in the femoral vein during a reflux study?

  1. Manual augmentation of the calf with abrupt release
  2. Valsalva maneuver Correct answer.
  3. Elevation of the limb above heart level
  4. Application of continuous probe pressure

Explanation

The Valsalva maneuver raises intra-abdominal pressure and challenges the proximal venous valves, so a competent femoral valve prevents retrograde flow during straining. Distal augmentation tests more distal segments but does not stress the proximal valve as directly.

Question 32Phlebology Sonography

Which color Doppler artifact is most likely when the color gain is set too high in a venous study?

  1. Loss of all color signal in the lumen
  2. Color bleeding into surrounding tissue and apparent flow in anechoic structures Correct answer.
  3. Underestimation of peak velocity
  4. Reversal of the color map

Explanation

Excessive color gain causes color to spill beyond the vessel wall into adjacent tissue and can create spurious color in anechoic areas such as cysts. Reducing gain until color just fills the lumen without extending outside the wall is the standard adjustment.

Question 33Phlebology Sonography

What is the primary purpose of performing distal compression during a venous duplex examination?

  1. To assess valve competence and provoke flow toward the heart Correct answer.
  2. To increase arterial pulsatility
  3. To reduce patient discomfort
  4. To measure venous wall thickness

Explanation

Distal compression augments venous flow and, on release, allows assessment of valve competence by revealing retrograde flow. It also confirms continuity of the venous segment being examined.

Question 34Phlebology Sonography

During a study of the small saphenous vein, which landmark helps identify its junction with the deep system?

  1. The saphenofemoral junction at the groin
  2. The medial malleolus
  3. The popliteal fossa where it joins the popliteal vein Correct answer.
  4. The anterior tibial vein at the ankle

Explanation

The small saphenous vein ascends in the posterior calf and typically joins the popliteal vein in the popliteal fossa, forming the saphenopopliteal junction. Its level of termination varies, so the junction should be confirmed rather than assumed.

Question 35Phlebology Sonography

A patient has a swollen leg and duplex shows a dilated superficial vein with spontaneous echogenic swirling flow and marked compressibility. What is the most likely interpretation?

  1. Arteriovenous fistula
  2. Venous valve incompetence with stagnant flow Correct answer.
  3. Normal venous flow with possible sluggish circulation
  4. Acute superficial thrombophlebitis with occlusion

Explanation

Spontaneous echogenic swirling (rouleaux formation) in a dilated but fully compressible vein suggests sluggish flow from valve incompetence or stasis rather than thrombosis. Compressibility argues against an occlusive thrombus.

Question 36Phlebology Sonography

Which finding best distinguishes a recanalized chronic deep vein thrombosis from an acute thrombus on gray-scale imaging?

  1. Uniform hypoechoic material filling a dilated vein
  2. Anechoic lumen with full compressibility
  3. Absent flow with a smooth, thin wall
  4. Echogenic, irregular lumen with partial compressibility and collateral channels Correct answer.

Explanation

Chronic post-thrombotic veins often show echogenic, irregular walls, partial recanalization with residual filling defects, and prominent collateral channels. Acute thrombus tends to appear as hypoechoic material distending a vein with loss of compressibility.

Question 37Phlebology Sonography

What is the principal reason to use a stand-off pad when imaging superficial veins?

  1. To eliminate respiratory phasicity
  2. To reduce color gain requirements
  3. To increase the Doppler angle
  4. To place the vein within the optimal focal zone and improve near-field resolution Correct answer.

Explanation

A stand-off pad increases the distance between the transducer and the skin surface so that superficial structures fall into the focal zone, improving resolution of small superficial veins. It also reduces near-field artifact from the skin surface.

Question 38Phlebology Sonography

Which parameter most directly affects the accuracy of reflux time measurements in a superficial vein?

  1. The color box width
  2. The sample volume length and its position relative to the valve Correct answer.
  3. The depth of the vessel
  4. The patient's body mass index

Explanation

Reflux time depends on placing the spectral sample volume at the correct location relative to the valve and keeping it short enough to avoid sampling across multiple segments. Sample volume length and position therefore directly influence the measured duration.

Question 39Phlebology Sonography

Which venous segment is most commonly evaluated for reflux in a patient with medial ankle skin changes?

  1. The anterior tibial vein
  2. The small saphenous vein
  3. The popliteal vein
  4. The great saphenous vein and its tributaries Correct answer.

Explanation

Medial ankle skin changes such as pigmentation and ulceration are typically associated with incompetence of the great saphenous system and its tributaries, particularly the calf perforators. The small saphenous vein drains the lateral aspect and is less commonly implicated in medial changes.

Question 40Phlebology Sonography

Which feature on spectral Doppler most reliably confirms that flow is venous rather than arterial?

  1. High pulsatility with a sharp systolic peak
  2. Flow reversal during diastole
  3. Continuous flow that varies with respiration and augments with distal compression Correct answer.
  4. A triphasic waveform

Explanation

Venous flow is typically continuous, varies with respiration, and increases with distal compression, which distinguishes it from the pulsatile, multiphasic arterial pattern. These features reflect the low-pressure, capacitance nature of the venous system.

Question 41Phlebology Sonography

During a venous study, the technologist notes a color signal within a vein that persists even after the vessel is fully compressed by probe pressure. What is the most likely explanation?

  1. Thrombus with recanalization
  2. Spontaneous contrast from slow flow
  3. True venous flow within the lumen
  4. Color artifact from adjacent arterial pulsation or motion Correct answer.

Explanation

Color that persists after the vein is compressed cannot represent flow within that lumen, so it most likely reflects transmitted pulsation from a nearby artery, motion artifact, or flash artifact. Adjusting the color box and gain and confirming with spectral Doppler clarifies the finding.

Question 42Phlebology Sonography

Which of the following is the most appropriate patient position for a standard lower extremity venous duplex examination?

  1. Standing with the leg fully weight-bearing
  2. Seated with the leg dependent
  3. Prone with the knee fully extended
  4. Supine with the leg slightly externally rotated and knee slightly flexed Correct answer.

Explanation

The supine position with slight external rotation and knee flexion relaxes the musculature and improves access to the femoral and popliteal veins. Reverse Trendelenburg positioning may be added for venous distention.

Question 43Phlebology Sonography

What does the term 'venous hypertension' most directly refer to in the context of chronic venous disease?

  1. Increased pulmonary venous pressure
  2. Sustained elevated ambulatory venous pressure due to valvular incompetence or obstruction Correct answer.
  3. Elevated arterial pressure in the lower limb
  4. Transient pressure rise during exercise

Explanation

Chronic venous disease produces sustained elevation of ambulatory venous pressure from reflux, obstruction, or calf pump failure, which drives skin changes and ulceration. Duplex findings of reflux or obstruction help identify the mechanism.

Question 44Phlebology Sonography

A technologist cannot compress the popliteal vein because of patient discomfort and a large calf. Which approach is most appropriate to complete the examination?

  1. Increase color gain to compensate for the depth
  2. Assume the vein is normal if color flow is present
  3. Use a lower-frequency transducer, adjust depth, and apply graded compression with the knee flexed Correct answer.
  4. Skip the popliteal vein and document the limitation

Explanation

A lower-frequency transducer improves penetration in a large limb, and flexing the knee relaxes the popliteal structures to permit graded compression. Color flow alone does not exclude nonocclusive thrombus, so compressibility remains essential.

Question 45Phlebology Sonography

Which of the following best explains why the great saphenous vein is often measured at the mid-thigh during venous mapping?

  1. It is the narrowest point of the vein
  2. It is a consistent location for diameter measurement and reflux assessment Correct answer.
  3. It is the only site where valves are present
  4. It is the site of the saphenofemoral junction

Explanation

The mid-thigh is a reproducible landmark where the great saphenous vein diameter and reflux can be measured consistently across patients and serial examinations. Standardized measurement sites improve comparison and treatment planning.

Question 46Phlebology Sonography

What does the presence of a hypoechoic filling defect within the lumen of the common femoral vein on color Doppler most likely represent?

  1. Normal flow separation at a bifurcation
  2. Artifact from overlying bowel gas
  3. Normal valve leaflet
  4. Partial venous thrombosis Correct answer.

Explanation

A hypoechoic filling defect within the lumen that persists across cardiac cycles and is associated with reduced compressibility suggests partial thrombosis. Normal valve leaflets are thin and mobile, and flow separation occurs at specific bifurcations without a discrete defect.

Question 47Phlebology Sonography

Which statement best describes the normal appearance of the venous wall on high-resolution B-mode imaging?

  1. Irregular with intimal thickening
  2. Markedly thickened with surrounding edema
  3. Thin, smooth, and barely visible Correct answer.
  4. Thick, calcified, and brightly echogenic

Explanation

Normal vein walls are thin, smooth, and often difficult to distinguish from the anechoic lumen. Thickening, irregularity, or calcification suggests chronic change or prior thrombosis.

Question 48Phlebology Sonography

A patient with a history of recurrent superficial thrombophlebitis has a dilated, tortuous great saphenous vein with reflux at the saphenofemoral junction. Which factor most likely contributes to recurrence?

  1. Normal calf muscle pump function
  2. Adequate valve competence along the deep system
  3. Low ambulatory venous pressure
  4. Sustained venous hypertension from junctional incompetence Correct answer.

Explanation

Junctional incompetence transmits high hydrostatic pressure into the superficial system, producing dilation, stasis, and a predisposition to recurrent superficial thrombosis. Addressing the incompetent junction is central to preventing recurrence.

Question 49Phlebology Sonography

Which Doppler setting adjustment is most helpful when evaluating slow flow in a small perforating vein?

  1. Increase the Doppler angle to 90 degrees
  2. Decrease the wall filter and lower the velocity scale Correct answer.
  3. Increase the color gain to maximum
  4. Increase the pulse repetition frequency

Explanation

Lowering the wall filter and velocity scale improves sensitivity to low-velocity flow in small perforators. The Doppler angle should be kept below 60 degrees, and excessive color gain creates artifact rather than improving detection.

Question 50Phlebology Sonography

What is the most appropriate action when a venous duplex study shows reflux in the great saphenous vein but the patient reports no symptoms?

  1. Repeat the study in 24 hours
  2. Ignore the finding because it is asymptomatic
  3. Recommend immediate surgery without further evaluation
  4. Report the finding and correlate with clinical symptoms and signs Correct answer.

Explanation

Reflux may be present without symptoms, so the duplex finding should be reported and interpreted alongside the clinical picture. Correlation helps determine whether the reflux is clinically significant and guides management.