question

Nematodes

answer

Round worms

question

Cestodes

answer

tape worms (segmented)

question

trematodes and Tx

answer

flukes (non-segmented); tx: praziquantel (all)

question

Mode of infection for Cestodes

answer

Ingestion

question

Tx for Cestodes

answer

albendazole, praziquantel, niclosamide

question

Taenia Saginata

answer

Beef Tape Worm

question

Taenea Solium

answer

Pork Tapeworm

question

Cysticercosis and tx

answer

When humans eat taenia solium eggs, which hatch in the intestine, migrate throughout the body and encyst in the brain (causing seizures or blindness)or skeletal muscle
Tx: albendazole and corticosteroids

question

Worms seen in vitreous humor

answer

Taenia Solium

question

Tx of T. Solium GI infx

answer

Praziquantel, niclosamide

question

Diphyllobothrium Latum and Tx

answer

Fish tapeworm and Praziquantel

question

Helminth that competes for B12

answer

Diphyllobothrium Latum

question

Echinococcus Granulosus and tx

answer

Dog Tapeworm and Albendazole followed by cyst aspiration; tx: albendazole followed by cyst aspiration

question

Hydatid cyst dz

answer

Manifestation of Echinococcus Granulosus; can involve the liver, lungs and brain causing dysf(x)

question

Snails are intermediate hosts

answer

Flukes

question

Clonorchis Sinensis and tx

answer

Chinese Liver Flukes; tx: praziquantel

question

Helminth infx from undercooked fish

answer

clonorchis sinensis and diphyllobothrium latum

question

Helminths that mature in biliary tree

answer

clonorchis sinensis

question

Helminth infx assoc. w/ cholangiosarcoma

answer

Clonorchis sinensis

question

paragonimus westermani and tx

answer

Lung fluke; tx: praziquantel

question

Helminth infx assoc. w/ hemoptysis

answer

paragonimus westermani

question

Helminth infx from ingesting under-cooked shellfish

answer

Paragonimus westermani

question

Schistosomes; transmission; tx

answer

Blood flukes; larvae released in to water, penetrate exposed skin and migrate to target tissues via bloodstream; Tx: praziquantel

question

Katayama fever

answer

constitutional sx after infx by schistosomes: HA, fever, hives, weight loss and cough.

question

swimmer's itch

answer

dermatitis after schistosome infx

question

Helminth assoc. w/ portal HTN

answer

Schistosoma Japonicum and Schistosoma mansoni

question

Helminth assoc. w/ intestinal polyps

answer

schistosoma japonicum and schistosoma mansoni

question

Helminth assoc w/ UTI sx and squam cell ca of the bladder

answer

Schistosoma hematobium

question

MC Helminth infx in the world

answer

Ascaris lumbricoides

question

Tx for ascaris lumbricoides

answer

pyrantel pamoate, mebendazole, albendazole

question

Helminth assoc. w/ migration to lungs -> trachea-> GIT

answer

Ascaris lumbricoides, strongyloides stercoralis, hookworms (necator americanus and ancylostoma duodenale)

question

Helminth that causes malnutrition

answer

Ascaris lumbricoides

question

Enterobius Vermicularis and tx

answer

Pin worms; pyrantel pamoate, mebendazole, albendazole

question

scotch tape test

answer

dx of Enterobius Vermicularis

question

intense peri-anal itching

answer

enterobius vermicularis

question

Trichuris Trichuria and tx

answer

Whip Worm; Tx: mebendazole and abendazole

question

Helminth assoc. w/ bloody diarrhea

answer

trichuris trichuria

question

Trichinella spiralis and tx

answer

Pork roundworm; tx: mebendazole, abendazole and corticosteroids (for muscle cysts)

question

Helminth assoc. w/ myocarditis and encephalitis

answer

Trichinella spiralis

question

Helminth not dx w/ visualizing eggs

answer

Trichinella spiralis

question

Dracunculus Medinensis and tx

answer

Guinea Worm; Tx: surgical removal of nodules or slowly pulling out with matchsticks

question

Helminth tx by pulling out with stick

answer

Drancunculus Medinensis

question

Helminth that live in crustaceans

answer

Dracuncularis medinensis

question

Toxocaris Canis and tx

answer

Dog ascaris; tx: infx is self-limited, but steroids may help

question

Helminth assoc. w/ dog shit

answer

Toxocaris canis

question

Visceral Larva Migrans

answer

Toxocaris Canis

question

Stronyiloides stercoralis and tx

answer

Threadworm; tx: ivermectin and thiabendazole
Use Ivermectin to overcome strongyloides

question

Helminth assoc. w/ autoinfection

answer

Stongyloides stercoralis

question

Helminth assoc. w/ larvae in stool

answer

Strongyloides stercoralis

question

Helminth that penetrates skin

answer

Strongyloides stercoralis, schistosomes, hookworms (ancylostoma duodenale, necator americanus, cat or dog hookworm)

question

Necator Americanus

answer

New World Hook Worm

question

Ancylostoma Duodenale

answer

Old Work Hook worm

question

Tx for hookworm

answer

mebendazole, pyrantel pamoate, Fe and folic acid for anemia

question

Helminth assoc. w/ microcytic anemia

answer

Hookworm

question

Helminth that penetrates the skin, but cannot penetrate basemenet membrane

answer

Cat or dog hookworm

question

Cutaneous larva migrans and tx

answer

Cat or dog hookworm; tx: self-limited

question

Onchocerca Volvulus and tx

answer

River Blindness; tx: ivermectin for microfilarae only, surgery for nodules

question

Arthropod borne Helminth

answer

Onchocera Volvulus, loa loa, wucheria bancrofti

question

Black Fly

answer

Onchocera Volvulus

question

Adult Helminths cannot migrate, die in skin and cause fibrotic nodules

answer

Onchocera Volvulus

question

Loa Loa and tx

answer

Eye Worm; tx: diethylcarbamazapine

question

Chrysops Fly

answer

Loa Loa

question

Calabar Swellings

answer

Episodic swellings assoc. w/ loa loa infx

question

Can be seen migrating through subconjunctiva

answer

Loa loa

question

Wucheria Bancrofti and tx

answer

Elephantiasis; tx: diethylcarbamazapine and doxy

question

Helminth transmitted by mosquito bite

answer

Wucheria Bancrofti

question

Adults migrate to and fibros in lymphatics causing edema

answer

wucheria bancrofti

question

Swelling of the genitals and lower limbs

answer

Wucheria bancrofti

question

dx made by seeing in blood at night

answer

wucheria bancrofti

question

Management of extraperitoneal rectal injury

answer

Primary repair or diverting colostomy to allow injury to heal

question

Management of intraperitoneal rectal injuries

answer

Primary repair; only need to divert if the pt has severe associated injuries with significant blood loss

question

Management of blunt kidney injury

answer

# do nothing unless injury is bilateral or if pt only has one kidney
# if leaving it in situ leads to persistant hypertension, delayed nephrectomy indicated.

question

Management of distal ureter injury

answer

# ideal: spatulate both ends and do end-to-end anastamosis over a double J stent.
# if not enough length: psoas hitch to mobilze the bladder; uretero-ureterostomy; mobilize the kidney and bring into pelvis;
# damage control: ligate both ends of ureter, perform nephrostomy later, and delayed repair of ureter; temporary cutaneous ureterostomy over J stent

question

Clinically significant hemodynamic alterations in late term pregnant women to be aware of in trauma

answer

Blood volume is increased but volume is increased proportionately more which would increase the amount of blood loss required to produce hypotension and tachycardia

question

Clinically significant phsysiologic alterations in late term pregnant women to increase O2 delivery to fetus and to be aware of in trauma

answer

# increased minute ventilation which causes mild respiratory alkalosis, but decreases mother's FRC and respiratory reserve
# increased 2,3-DPG to aid in O2 offloading from hemoglobin

question

Anatomic changes of later pregnancy to keep in mind during trauma

answer

# fetus may compress IVC, so lay mother on LLD position
# more prone to aspiration from cranially displaced stomach so early NGT placement
# constant stretching of peritoneum leads to desensitization making it possible that the mother will not show peritoneal signs

question

Management of suspected bladder injury

answer

# CT cystogram if hematuria in presence of pelvic fxs
# Intraperitoneal: open 3-layer repair with chromic suture and suprapubic cystostomy
# Extraperitoneal: foley catheter drainage for 7-10 days

question

Management of suspected blunt cardiac injury

answer

# Order troponin and EKG; If neg, repeat both in 8 hrs; 2 consecutive negatives rules it out.
# if either EKG or trop are positive, admit for obs in a monitored bed
# If unstable, stat echo to look for anatomic abnormality; if neg, invasive monitoring +/- pressor; if positive, problem is addressed

question

Order of preference for peripher IV access in a child younger than 6

answer

1. AC fossa
2. cutdown on superficial saphenous vein
3. intrerosseous cannulation of proximal tibia
4. interosseous cannulation of distal femur

question

Cattell maneuver and what vascular structures it's good for exposing

answer

# medial visceral rotation of the cecum and ascending colon;
# good for exposing retropertineal structures, like the IVC and R ureter

question

Kocher maneuver and what vascular structures it's good for exposing

answer

# mobilization and medial rotation of the duodenum
# exposes the suprarenal IVC below the liver

question

Mattox maneuver and what vascular structures its' good for exposing

answer

# medial rotation of the left colon, kidney and spleen toward the midline
# combined with division of the left crus of the diaphragm and dividing the celiac plexus, can expose the celiac axis

question

Way to expose injuries to the distal IVC and iliac vein bifurcations

answer

# division of the R CIA and primary repair

question

Way to expose injuries to the SMA and the confluence of the portal vein

answer

# division of the neck of the pancreas

question

Indications for operative management of penetrating or blunt injuries to thoracic structures

answer

1. Initial hemothorax drainage of > 1500 ml or hemothorax drainage of > 200 ml/hr x 3hrs
2. Caked hemothorax (persistance of a large hemothorax even after a 2nd chest tube
3. Large air leak with inadequate ventilation or persistant collapse of the lung
4. esophageal perforation
5. Cardiac tamponade

question

Management of a through-and-through injuring to a single lung lobe with an active air leak and bleeding

answer

Pulmonary tractotomy: insertion of linear staple into the bullet hole to create two staple lines and ligating the lung in between to allow access to the bleeding vessels and leaking bronchi

question

Grading system of duodenal injuries

answer

I-V; Grade I is a simple hematoma and grad V is a massive disruption of a pancreatico duodenal complex

question

Management of a simple duodenal hematoma

answer

# If recognized pre-operatively, NGT and TPN;
# If found intraoperatively and small, leave it alone
# If large (involving > 50% of lumen), incise the serosa, drain the hematoma, and reclose the serosa

question

Management of a full-thickness duodenal laceration

answer

Primary repair, closing transversely, with an omental patch

question

management of a large ( > 50% of the luminal circumference) duodenal injury

answer

# 1st or 4th portion: resection with a duodenoduodenostomy
# 2nd or 3rd and the ampula is not injuried: RNY duodenojejunostomy
# distal to the ampula, distal portion of the duodenum is oversewn and EEA anastamosis of jejunum to prox duodenum and drainage of distal duodenum into jejunum

question

Trauma indication for a Whipple

answer

Massive dissruption of the pancreatic head and duodenum

question

Management of a pancreatic injury without ductal disruption

answer

Drainage

question

Management of a distal pancreatic injury with dictal disruption

answer

distal pancreatectomy

question

Physical exam suggestive of neurogenic shock

answer

Hypotension, relative bradycardia, WWP extremities (reflecting loss of sympathetic tone), evidence of high spinal cord injury and priapism (unopposed parasympathetic stimulation)

question

Management of hypotension in patient with neurogenic shock

answer

Fluids; once adequately resuscitated, pure alpha agonist- phenylephrine (Neo)

question

A positive DPL

answer

1. > 10 mL of free blood aspirated
2. > 100,000/m3 RBC for blunt trauma and > 5000/m3 RBC for penetrating trauma
3. the detection of bile, amylase or vegetable or fecal matter
4. WBC > 500/m3

question

Grades of a kidney injury

answer

I: Contusion or subcapsular and non-expanding hematoma
II:
III: deep lacerations that do not involve the collecting system
IV: lacerations involving the collecting system or injury to the man renal artery
V: completely shattered kidney or avulsion of the renal hilum

question

Management of kidney injury

answer

any injury can be managed non-operatively as long as pt is HD stable

question

management of renal trauma with urinary extravasation

answer

Observation with possible percutaneous drainage or urinary stent placement if it does not resolve on it's own.

question

Methods of lowering ICP

answer

1. hypertonic saline with Na goal 155-160
2. mild hyperventilation with pCO2 > 30 (goal is to decrease swelling by causing vasoconstriction, too much vasoconstriction is bad)
3. Mannitol
4. EVD
5. Barbiturate coma to decrease metabolic demands of brain

question

Management of colonic injuries

answer

# primary repair if less than 50% of the circumference is involved
# resection for > 50% circumferential involvement with primary anastamosis if pt stable (and not required too much blood) or possibly if morbidly obese
# resection and colostomy if large wound and unstable

question

Cushing reflex

answer

Hypertension and bradycardia in setting of traumatic inctracranial bleeding

question

Of the possible sources of significant bleeding, the one that takes precedence over the others

answer

Peritoneal

question

3 radiographic findings suspicious for aortic transection

answer

1. depressed left mainstem bronchus
2. widened mediastinum
3. deviated trachea

question

Factors that make primary amputation of the leg a better option

answer

1. hemodynamic instability
2. ischemia > 6 hrs
3. complete traumatic amputation
4. tib/fib fx with large soft tissue defect and arterial injury
5. transection of the tibial nerve

question

Way to diagnose duodenal perforation in the setting of an equivocal CT

answer

Upper GI series with water solube contrast that shows "coiled spring" appearance of the duodenal wall

question

Stages of damage control surgery

answer

1. abreviate resuscitative surgery in which hemorrhage and bowel contamination are controled with packing and a temporary abd closure (delay repair of non-life threatening injuries)
2. rewarm, resuscitate and fix coagulopathy in ICU and look for other injuries
3. re-exploration after restoration of normal physiology to remove packs and complete any additional repairs

question

Type of injury which is a contra-indication to damage control surgery

answer

Arterial injuries

question

Type of liver injury amenable to suturing and best method for liver suturing

answer

# Superficial lacerations
# Chromic suture with blunt needle

question

Indications for immediate OR explioration of neck wounds

answer

# hard signs fo vascular injury: rapidly expanding hematoma or visible exanguination
# shock, even without hard signs b/c the presumption is that the pt exsanguinated in the field

question

Management of penetrating neck trauma

answer

# To OR if hemodynamically unstable or hard signs of vascular injury
# If hemodynamically stable, 4-vessel arteriography or CTA of neck
# When feasible, assessment for injuries to the aerodigestive tract (triple endoscopy and/or esophagoscopy) and C-spine
# Xray of head neck and chest to look for the bullet

question

Management of Carotid artery injury

answer

repair if neurological deficit

question

Definition of flail chest

answer

3 or more ribs fractured in at least 2 locations

question

Indications for internal fixation of the chest wall

answer

# flail chest in pts already undergoing thoracotomy for an intrathoracid injury
# Flail chest without pulmonary contusion
# noticeable paradoxical movement while pt is being weaned
# severe deformity of chest wall

question

Pulsatile exophthalmos in a pt with racoon eyes and/or hemotympanum

answer

Carotid-cavernous fistula

question

Signs of carotid-cavernous fistula

answer

# pulsatile exophthalmous
# eyelid edema
# auscultation of a bruit over the eye
# edema of the conjunctiva
# double vision
# swelling of the eye

question

Management of caroitid-cavernous fistula

answer

open neurosurgical approach or endovascular embolization

question

Signs of compartment syndrome

answer

# pain out of proportion to the injury
# pain on passive motion of the limb
# tense edema with tenderness on palpation fo the compartment

question

# First compartment to be involved in compartment syndrome of the leg
# Sx of involvement of that compartment
# pathogenesis of said sx

answer

# Anterior compoartment of the leg
# numbness in the first web space
# entrapment of the deep peroneal nerve which runs in the anterior compartment

question

In compartment syndrome:
# compartment most difficult to decompress
# structure contained in that compartment
# best way to decompress that compartment

answer

# deep posterior compartment
# tibial nerve
# detachment of the soleus muscle from the tibia

question

Grades of traumatic peripheral nerve injuries and definition

answer

# Neuropraxia- focal demyelination from stretch or compression; axon is intact so conduction proximal and distal to the lesion is in tact
# Axonotmesis- axon is damagamed but surrounding structures preserved which allows regeneration to occur
# Neurotmesis- complete transection or disruption;

question

Type of peripheral nerve injury a/w distal wallerian degeneration

answer

Axonotmesis

question

Types of peripheral nerve injuries which are amenable to regeneration and which require surgical repair

answer

# regeneration: neuropraxia and axonotmesis
# requires surgery: neurotmesis

question

MC traumatic peripheral nerve injury

answer

# Upper extremity more common than lower
# MC periph nerve injury: radial nerve a/w humerus fx
# MC lower extremity periph nerve injury is peroneal nerve a/w posterior knee dislocation

question

Rate at which peripheral nerves regenerate

answer

1 mm/day

question

Grading of pancreatic injuries

answer

# I- minor contusion or laceration
# II-
# III
# IV
# V: major disruption of pancreatic head

question

Management of pancreatic injuries

answer

# 1st step is to determine of the main pancreatic duct is injured and whether it is injured to the R or L of the superior mesenteric vessels--> pancreatography via contrast injected into the GB
# if duct disrupted to the left of mesenteric vessels: distal pancreatectomy
# if disrupted to R but no major head disruption: drainage and delayed pancreaticoenteric anastomosis if fistula fails to heal
# if disrupted to R with major head disruption: pancreaticoduodenectomy
# any such operation can be delayed if damage control laparotomy needed

question

Indications for Whipple in trauma

answer

# injury to main pancreatic duct to R of mesenteric vessels and massive disruption of pancreatic head
# devascularization of duodenum

question

Beck's Triad

answer

Distended neck veins, muffle heart sounds, hypotension==>> pericardial tamponade

question

Management of tamponade

answer

# IVF first, especially if early, because volume can overcome the tamponade
# if stable, fast exam looking for tamponade or abd free fluid; if tamponade confirmed --> OR for median sternotomy and repair
# if unstable, left anterolateral thoracotomy in ED, longitudinal incision in pericardium avoiding phrenic nerve, evacuate clot and finger in the injury

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