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213 Midterm
Midterm
71
Medical
Professional
03/24/2014

Additional Medical Flashcards

 


 

Cards

Term
What is the significant time-threshold of reflux on spectral Doppler?
Definition
>5 ms
Term
Group of three perforators from medial malleolus up almost to midcalf?
Definition
Posterior Tibial Perforators (formerly Cockett's) I: 7 cm above medial malleolus II: 12 cm above medial malleolus III: 18 cm above medial malleolus
Term
Perforator near the knee?
Definition
Paratibial Perforator (formally Boyd's)
Term
Perforators around mid and distal thigh connection GSV to FV?
Definition
Perforators of the Femoral Canal (formally Dodd in distal thigh and Hunterian in proximal/mid thigh)
Term
How big are normal perforators?
Definition
<1-2 mm
Term
What causes venous pulsatility?
Definition
Venous hypertention
Term
Typically, how big is a perforator that is likely to be to cause significant symptoms?
Definition
>3 mm
Term
What contains the high pressure of the muscle pump?
Definition
Fascial envelopes
Term
What single condition cause CVI symptoms?
Definition
Venous hypertention
Term
What are the symptoms of CVI?
Definition
edema
aching, heaviness, fatigue, "venous claudication"
stasis pigmentation (brawny edema)
induration (lipodermatosclerosis)
stasis ulcer
Term
How does the normally-functioning muscle pump work?
Definition

Relaxation of the calf muscles allows blood to fill the deep venous system via arterial inflow through the superficial and distal deep venous system.  With prolonged standing, the veins slowly fill up and become distended, allowing the valves to open and eventually increase pressure that is directly related to the height of the column of blood.  Contraction of the muscle pump with again empty the veins.

 

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Term

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A

Definition
Lateral Circumflex
Term

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B

Definition
Sapheno-femoral junction
Term

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C

Definition
Common Femoral Vein
Term

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D

Definition
Profunda Vein
Term

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E

Definition
Lateral Accessory Saphenous Vein
Term

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F

Definition
Femoral Vein
Term

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G

Definition
Prudendal Vein
Term

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H

Definition
Medial Accessory Saphenous Vein
Term

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I

Definition
Great Saphenous Vein
Term
According to the CVI article, varicose veins have an estimated prevalence between __% to __% in the adult population, with a _____ to _____ predomimance of __ to __.
Definition
5% to 30%, female to male, 3 to 1
Term
According to the CVI article, what are the risk factors found to be associated with CVI?
Definition
age, sex, family history of varixose veins, obesity, pregnancy, phlebitis, and previous leg injury
Term
According tothe CVI article, the more serious consequences of CVI such as venous ulcers have an estimated prevalence of ~0.3%, although active or healed ulcers are seen in about ~__% of the adult population.
Definition
1
Term
According to the CVI article, the overall prognosis of venous ulcers is _____, with delayed healing and recurrent ulceration being _____.  More than __% of venous ulcers require _____ therapy lasting _____.
Definition
poor, common, 50%, >1 year
Term
According to the CVI article, what is the normal ambulating venous pressure in the lower extremities and why?
Definition
Immediately after ambulation, the pressure within the veins of the lower extremity is normally low (15 to  30mm/Hg) because the venous system has been emptied by the muscle pump.
Term
According to the CVI article, unabated venous hypertension may result in?
Definition
Dermal changes with hypergigmentation, subcutaneous tissue fibrosis ("lipodermatosclerosis"), and eventual ulceration.
Term
What is the primary cause of venous reflux?
Definition
Incompedent venous valves
Term
According to the CVI article, what problem causes increased venous pressure with muscle contraction a secondary muscle pump disfunction?
Definition
Venous outflow obstruction, DVT
Term
According to the CVI article, what are the major clinical features of CVI?
Definition
Dilated veins, edema, leg pain, and cutaneous chages
Term
According to the CVI article, what presumably produces the pain by increasing intracompartmental and subcutaneous volume and pressure?
Definition
Edema
Term
According to the CVI article, what may lead to venous claudication?
Definition
Obstruction of the deep venous system
Term
According to the CVI article, what is primary and secondary CVI?
Definition
Primary CVI is that that is present at birth, although they may be recognized later in life.  Secondary is the result of an acquired condition.
Term
For the PPG evaluation of venous refill time, what is considered normal?
Definition
> 20 seconds
Term
For APG evalution of venous outflow, the tracing should fall to the baseline in what amount of time after high thigh cuff deflation to be considered normal?
Definition
Within 3 seconds
Term
According to the CVI article, what is sclerotherapy and what is it used for?
Definition
A treatment modality of detergent injection for obliterating telangiectases (spider veins), varicose veins, and venous segments with reflux .  May be used as a primary treatment or in conjunction with surgical procedures in the correction of CVI.
Term
What are the GSV diameters compatible with incompetence at the levels of the SFJ, mid thigh, and mid calf?
Definition

SFJ >9 mm

mid thigh >7 mm

mid calf >5 mm

Term
What is CVI?
Definition
Chronic venous insufficiency: a condition characterized by changes that take place in the tissues of the leg secondary to long-standing venous hypertension caused by structural or functional abnormalities in the veins and/or venous valves.
Term
What is the most common sequelae to symptomatic DVT?
Definition
CVI
Term
What is the clinical hallmark of CVI?
Definition
Edema
Term
What is normal standing venous pressure?
Definition
`80-90 mmHg.
Term
Define junctional valve failure:
Definition
Incompetence of the primary valve at the junction of the CFV and the GSV at the site called the SFJ.
Term
Define perforator valve failure:
Definition
Without normal check-valves, higher pressure from the deep system transmits into the superficial system via incompetent perforators.
Term
What are the symptoms of Raynaud's Disease?
Definition
During a typical Raynauds' attack the affected area may first become white (pallor) as the blood suppy is reduced, then blue (cyanosis) as the oxygen supply to the area is depleted, followed by bright red (rubor) as the blood returns to the area (reactive hyperemia).  By definition, Raynaud's involves three color changes.  However, they do not always occur in the same order for all people all of the time nor do all three changes always occur in a given attack.
Term
What is TOS?  What are the 3 types?
Definition

Thoracic outlet syndrome

 

1. neural (80%)

2. arterial (15%)

3. venous (5%)

Term
What are the 3 manuvers used for TOS evaluation and how are they performed?
Definition
  1. Adson maneuver: head to the left and right (with deep breath, leaning the head back as someone standing behind you calling your name.)
  2. Costoclavicular maneuver: shrug shoulders back into exaggerated military posture.
  3. 90° and 180º hyperabduction
Term
What is an arteriovenous fistula?
Definition
Abnormal communication between artery and vein.
Term
What are the Doppler findings in an AV fistula?
Definition

Flow in fistula: very high velocity, turbulence

Flow and pressure in distal artery: reduced

Flow in proximal artery: very high diastolic component

Flow in proximal vein: very high velocity

 

Term

[image]

A

Definition
Superficial dorsal vein
Term

[image]

B

Definition
Deep dorsal artery
Term

[image]

C

Definition
Corpus cavernosum
Term

[image]

D

Definition
Internal pudendal artery (branch off the internal iliac artery feeding dorsal penile, deep cavernosal, and urethral arteries)
Term

[image]

E

Definition
Corpus spongiosum
Term

[image]

F

Definition
Urethra
Term

[image]

G

Definition
Deep fascia
Term

[image]

H

Definition
Superficial fascia
Term

[image]

I

Definition
Deep dorsal vein
Term
What are some possible causes of penile dysfunction
Definition

1. Inadequate inflow due to atherosclerotic disease, thrombosis, trauma, etc.

2. Venous leakage due to defective veno-occlusive mechanism

3. Ateriovenous shunt

4. Psychogenic, neurologic, endocrine, or structural causes

5. Pharmacological causes: side effects of medications such as hypertensive meds

Term
What is IMT and what is it used for?
Definition
Intima-media thickness.  It is used as an indicator of cardiovascular disease risk.
Term
What are some risk factors for elevated IMT?
Definition

1. Age

2. Smoking

3. Dyslipidemia

4. Hypertension

5. Genetic predisposition

6. Gender (Male > Females)

7. Race

8. Obesity

9. Diabetes

10. Radiation therapy

Term
What is the purpose of a graft?
Definition
To go around arterial obstruction or repair aneurysm.  Many lower-extremity grafts are an effor to save a diabetic foot.
Term
Name some sites for grafts
Definition
aortoiliac, femorofemeoral, femorotibial, iliofemoral, axillofemoral, femoroperoneal, aortofemoral, femoropopliteal, popliteal-tibial, subclavian-carotid, superficial temporal to middle cerebral, ect.
Term
What are some materials used for grafts?
Definition
Gortex, Polytetrafluoroethylene (PTFE)
Term
What are some vein grafts?
Definition
In situ greater saph, reversed greater saph, lesser saph, cephalic, basilic
Term
What is the tool used to strip valves in an in situ vein graph?
Definition
valvulotome
Term
What are some types of anastomoses?
Definition
end to side, end to end, side to side
Term
What is a problematical flow rate at an anastomotic site?
Definition
45 cm/sec threshold
Term
Where is the usual site of first trouble in a graft?
Definition

Distal anastomosis, possibly due to turbulence and slower flow

 

Other problem sites: venous vlaves, inflow disease, outflow disease, graft aneurysm, neointimal proliferation, kinks and tortuosities

Term
What is the radial-cephalic avf called?
Definition
Brescia-Cimino Fistula
Term
What is an autogenous access graft and what are some common area?
Definition

A synthetic (usually PTFE) graft that bridges the gap between the artery and vein.

 

Forearm loop from brachial artery to basilic or median cubital vein.

Upper arm loop from brachial artery to axilllary vein.

Straight graft from radial artery in forearm to basilic vein near antecubital fossa.

Straight graft from brachial artery to antecubital fossa to basilic vein near axilla.

Term
Over time, what could be some problems with an AVF?
Definition
  • > 80% of graft stenoses occur at the venous anastomotic site
  • Venous anastomic stenosis results in graft HTN and ultimately graft thrombosis
  • Intrinsic narrowing or stenosis can occur anywhere along the graft or venous oultlow tract
  • Upper extremity cntral venous obstuction or occlusion has an incidence between 10-40%
Term
What is the blood flow velocity threshold that signifies AVF failure?
Definition
100 cm/sec
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