Miscalenous Flashcards
Swan CO
4-8 L/min
Swan CI
2.5-4L/min/m2
Swan PA pressure
20-30/5-15 mmHg
Swan wedge (PAWP)
8-12mmHg
Swan SVR
900-1300
TPN formula
1g/kg/day protein
25 kcal /kg/day (out of that 25% glucose, 3-4% aminoacids, 10% free fatty acids)
50% non protein calories as glucose and 50% fatty acids
sensitivity
true positive / true positive + false negative
ability to SENCE the disease
specificity
true negative / true negative + false positive
positive predictive value
true positive / true positive + false positive
negative predictive value
true negative / true negative + false negative
Horner’s syndrome
miosis (constricted pupil)
ptosis
anhydrosis (if pre-ganglionic)
enophtalmus
due to injury of sympathetic chain
post - sympathetcomy neuralgia
50% of patients
anteromedial thigh pain
Marfan’s mutation
FBN1 mutation
TGF-beta - 1 role
causes fibrotic reaction in skin in chronick venous insufficiency (inverted bottle neck)
Hollenhorst plaque
cholesterol cristal embolization to retinal circulation, incidental, not associated with increased risk of stroke
Hard signs of vascular injury
1) absent distal pulses
2. signs of distal ischemia
3. bruit / thrill
4. active, pulsatile bleeding
5. large, expanding hematoma
6. pulsatile hematoma
soft signs of vascular injury
- non expending hematoma
- peripheral nerve deficit
- h/o bleeding at the time of injury
- hypotension
- bony injury / penetrating wound
nephrogenic systemic fibrosis
after giving gadolinium in patients with renal insufficiency for MRA
diagnosed by skin bx
no treatment
what factors are expressed in macrophages of aortic aneurysms
MMP 2 and MMP 9
where is MMP 2 mostly expressed
in small aneurysms
where is MMP 9 mostly expressed
in large and ruptured aneurysms
what inhibits MMP
doxycycline
what excretes renin
juxtoglomerular aparatus
what’s renin function
conversion of angiotensinogen to angiotensin I
where is angiotensinogen produced
liver
where is angiotensin converting enzyme produced
lung
metabolic syndrome
3 or more of the following:
- HTN >130 / >85
- triglicerides >150mg/dl
- HDL <50 mg/dl for women and <40mg/dl for male
- fasting blood glucose >110 mg/dl
- abdominal obesity
whats the difference between hemangioma and AV malformation
hemangioma is proliferative and they will involute in puberty. Malformation is on bases of dysmorphogenesis
What happens to arteries with age
Larger arteries stiffen with reduced compliance
Systolic pressure increases
Loss of recoil and ability to maintain the diastolic pressure within compartment
Diastolic pressure decreases
Plus pressure increases
What is the anti inflammatory action of nitric oxide
Inhibits is xpression of pro inflammatory mediators (monocytes chemoattractant protein 1, interleukins, macrophage colony stimulating facto r)
Inhibits activity of NF-kB v
What is a primary vasoconstrictor
Endothelial. Also potent motive not
What is tunica intima
Endothelium
Innermost layer
Monolayer of endothelium cells
Matrix of elastic fibers and collagen
Tunic media
Thick middle layer
Varying amounts of collagen, elastic fibers and smooth muscles
Amount of elastic decreases progressively from large to small vessels
Provides structure
Maintaining vessel tone
Responding to signals from intimate endothelial cells
Tunica adventitia
Outermost layer
Appears fragile and thin but strong collagen and elastic structure
One of the key components in overall strength of artery
Collagen, autonomic nerves, vasa vasorum
Trunks arterial malformations
Persistent sciatic artery Kommerells diverticulum Persistent right subclavian artery Aortic ring Mid aortic syndrome
What is sciatic artery
Embryonic continuation of internal iliac artery
75% complete - hypoplastic or absent sfa
25% incomplete stops in the thigh
Extratunkal arterial malformation definition
Embryologically developed inborn errors of vascular morphogenesis leading to true structural anomalies
Types of vascular anomalies and division
- Tumors - hemangiomas and others
2. Malformations - high flow and low flow. Low flow - venous, lymphatic and combined
Definition of hemangioma
True neoplasticism disorder and pathohistologically demonstrating increase endothelial cell turn over rate
Definition of AVM
Arise by dysmorphogenesis without increased endothelial proliferation
Infantile hemangioma
Most common vascular anomalies
Proliphwrarive phase in first year of life
Spontaneous involution
Usually doesn’t need treatment
Therapy is usually medical with corticosteroids and propranolol
AVM on duplex
Demonstrates aretrialized venous waveform and spectral broadening
Imaging modality of choice for hemodynamic diagnosis and treatment planning of AVM
DceMRI
Bernoulli’s principle
When fluid flows it’s total energy remains constant provided there are no frictional losses
When area increases velocity decrease
Fluid energy possess
Viscous losses result from friction between adjacent layers of blood or between blood and the vessel wall
Inertial losses relate to changes in the velocity or direction of blood flow
Poiseuilles law
Pressure equals volume flow times resistance (8xlengthx viscosity over pi x radius to fourth)
What does Poiseuille’s law describe
Describes the energy losses in an idealized fluid system
Estimates minimum pressure gradient expected for arterial flow
Describe resistance in collaterals
It’s always higher than in normal vessels.
It’s fixed - does not change with exercise —> claudication
Which way do you retract text is during spine exposure minimally invasive
Laterally
When does retrograde ejaculation occur
Injury to sympathetic nerve plexus
