Helminths – Microbiology – Flashcards

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Nematodes
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Round worms
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Cestodes
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tape worms (segmented)
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trematodes and Tx
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flukes (non-segmented); tx: praziquantel (all)
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Mode of infection for Cestodes
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Ingestion
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Tx for Cestodes
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albendazole, praziquantel, niclosamide
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Taenia Saginata
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Beef Tape Worm
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Taenea Solium
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Pork Tapeworm
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Cysticercosis and tx
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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
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Worms seen in vitreous humor
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Taenia Solium
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Tx of T. Solium GI infx
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Praziquantel, niclosamide
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Diphyllobothrium Latum and Tx
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Fish tapeworm and Praziquantel
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Helminth that competes for B12
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Diphyllobothrium Latum
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Echinococcus Granulosus and tx
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Dog Tapeworm and Albendazole followed by cyst aspiration; tx: albendazole followed by cyst aspiration
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Hydatid cyst dz
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Manifestation of Echinococcus Granulosus; can involve the liver, lungs and brain causing dysf(x)
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Snails are intermediate hosts
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Flukes
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Clonorchis Sinensis and tx
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Chinese Liver Flukes; tx: praziquantel
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Helminth infx from undercooked fish
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clonorchis sinensis and diphyllobothrium latum
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Helminths that mature in biliary tree
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clonorchis sinensis
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Helminth infx assoc. w/ cholangiosarcoma
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Clonorchis sinensis
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paragonimus westermani and tx
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Lung fluke; tx: praziquantel
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Helminth infx assoc. w/ hemoptysis
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paragonimus westermani
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Helminth infx from ingesting under-cooked shellfish
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Paragonimus westermani
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Schistosomes; transmission; tx
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Blood flukes; larvae released in to water, penetrate exposed skin and migrate to target tissues via bloodstream; Tx: praziquantel
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Katayama fever
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constitutional sx after infx by schistosomes: HA, fever, hives, weight loss and cough.
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swimmer's itch
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dermatitis after schistosome infx
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Helminth assoc. w/ portal HTN
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Schistosoma Japonicum and Schistosoma mansoni
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Helminth assoc. w/ intestinal polyps
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schistosoma japonicum and schistosoma mansoni
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Helminth assoc w/ UTI sx and squam cell ca of the bladder
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Schistosoma hematobium
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MC Helminth infx in the world
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Ascaris lumbricoides
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Tx for ascaris lumbricoides
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pyrantel pamoate, mebendazole, albendazole
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Helminth assoc. w/ migration to lungs -> trachea-> GIT
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Ascaris lumbricoides, strongyloides stercoralis, hookworms (necator americanus and ancylostoma duodenale)
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Helminth that causes malnutrition
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Ascaris lumbricoides
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Enterobius Vermicularis and tx
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Pin worms; pyrantel pamoate, mebendazole, albendazole
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scotch tape test
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dx of Enterobius Vermicularis
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intense peri-anal itching
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enterobius vermicularis
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Trichuris Trichuria and tx
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Whip Worm; Tx: mebendazole and abendazole
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Helminth assoc. w/ bloody diarrhea
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trichuris trichuria
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Trichinella spiralis and tx
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Pork roundworm; tx: mebendazole, abendazole and corticosteroids (for muscle cysts)
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Helminth assoc. w/ myocarditis and encephalitis
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Trichinella spiralis
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Helminth not dx w/ visualizing eggs
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Trichinella spiralis
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Dracunculus Medinensis and tx
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Guinea Worm; Tx: surgical removal of nodules or slowly pulling out with matchsticks
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Helminth tx by pulling out with stick
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Drancunculus Medinensis
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Helminth that live in crustaceans
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Dracuncularis medinensis
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Toxocaris Canis and tx
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Dog ascaris; tx: infx is self-limited, but steroids may help
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Helminth assoc. w/ dog shit
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Toxocaris canis
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Visceral Larva Migrans
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Toxocaris Canis
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Stronyiloides stercoralis and tx
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Threadworm; tx: ivermectin and thiabendazole
Use Ivermectin to overcome strongyloides
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Helminth assoc. w/ autoinfection
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Stongyloides stercoralis
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Helminth assoc. w/ larvae in stool
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Strongyloides stercoralis
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Helminth that penetrates skin
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Strongyloides stercoralis, schistosomes, hookworms (ancylostoma duodenale, necator americanus, cat or dog hookworm)
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Necator Americanus
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New World Hook Worm
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Ancylostoma Duodenale
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Old Work Hook worm
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Tx for hookworm
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mebendazole, pyrantel pamoate, Fe and folic acid for anemia
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Helminth assoc. w/ microcytic anemia
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Hookworm
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Helminth that penetrates the skin, but cannot penetrate basemenet membrane
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Cat or dog hookworm
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Cutaneous larva migrans and tx
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Cat or dog hookworm; tx: self-limited
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Onchocerca Volvulus and tx
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River Blindness; tx: ivermectin for microfilarae only, surgery for nodules
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Arthropod borne Helminth
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Onchocera Volvulus, loa loa, wucheria bancrofti
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Black Fly
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Onchocera Volvulus
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Adult Helminths cannot migrate, die in skin and cause fibrotic nodules
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Onchocera Volvulus
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Loa Loa and tx
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Eye Worm; tx: diethylcarbamazapine
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Chrysops Fly
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Loa Loa
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Calabar Swellings
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Episodic swellings assoc. w/ loa loa infx
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Can be seen migrating through subconjunctiva
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Loa loa
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Wucheria Bancrofti and tx
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Elephantiasis; tx: diethylcarbamazapine and doxy
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Helminth transmitted by mosquito bite
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Wucheria Bancrofti
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Adults migrate to and fibros in lymphatics causing edema
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wucheria bancrofti
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Swelling of the genitals and lower limbs
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Wucheria bancrofti
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dx made by seeing in blood at night
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wucheria bancrofti
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Management of extraperitoneal rectal injury
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Primary repair or diverting colostomy to allow injury to heal
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Management of intraperitoneal rectal injuries
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Primary repair; only need to divert if the pt has severe associated injuries with significant blood loss
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Management of blunt kidney injury
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# 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.
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Management of distal ureter injury
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# 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
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Clinically significant hemodynamic alterations in late term pregnant women to be aware of in trauma
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Blood volume is increased but volume is increased proportionately more which would increase the amount of blood loss required to produce hypotension and tachycardia
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Clinically significant phsysiologic alterations in late term pregnant women to increase O2 delivery to fetus and to be aware of in trauma
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# 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
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Anatomic changes of later pregnancy to keep in mind during trauma
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# 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
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Management of suspected bladder injury
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# 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
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Management of suspected blunt cardiac injury
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# 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
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Order of preference for peripher IV access in a child younger than 6
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1. AC fossa
2. cutdown on superficial saphenous vein
3. intrerosseous cannulation of proximal tibia
4. interosseous cannulation of distal femur
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Cattell maneuver and what vascular structures it's good for exposing
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# medial visceral rotation of the cecum and ascending colon;
# good for exposing retropertineal structures, like the IVC and R ureter
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Kocher maneuver and what vascular structures it's good for exposing
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# mobilization and medial rotation of the duodenum
# exposes the suprarenal IVC below the liver
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Mattox maneuver and what vascular structures its' good for exposing
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# 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
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Way to expose injuries to the distal IVC and iliac vein bifurcations
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# division of the R CIA and primary repair
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Way to expose injuries to the SMA and the confluence of the portal vein
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# division of the neck of the pancreas
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Indications for operative management of penetrating or blunt injuries to thoracic structures
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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
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Management of a through-and-through injuring to a single lung lobe with an active air leak and bleeding
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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
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Grading system of duodenal injuries
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I-V; Grade I is a simple hematoma and grad V is a massive disruption of a pancreatico duodenal complex
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Management of a simple duodenal hematoma
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# 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
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Management of a full-thickness duodenal laceration
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Primary repair, closing transversely, with an omental patch
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management of a large ( > 50% of the luminal circumference) duodenal injury
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# 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
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Trauma indication for a Whipple
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Massive dissruption of the pancreatic head and duodenum
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Management of a pancreatic injury without ductal disruption
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Drainage
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Management of a distal pancreatic injury with dictal disruption
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distal pancreatectomy
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Physical exam suggestive of neurogenic shock
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Hypotension, relative bradycardia, WWP extremities (reflecting loss of sympathetic tone), evidence of high spinal cord injury and priapism (unopposed parasympathetic stimulation)
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Management of hypotension in patient with neurogenic shock
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Fluids; once adequately resuscitated, pure alpha agonist- phenylephrine (Neo)
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A positive DPL
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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
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Grades of a kidney injury
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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
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Management of kidney injury
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any injury can be managed non-operatively as long as pt is HD stable
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management of renal trauma with urinary extravasation
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Observation with possible percutaneous drainage or urinary stent placement if it does not resolve on it's own.
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Methods of lowering ICP
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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
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Management of colonic injuries
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# 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
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Cushing reflex
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Hypertension and bradycardia in setting of traumatic inctracranial bleeding
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Of the possible sources of significant bleeding, the one that takes precedence over the others
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Peritoneal
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3 radiographic findings suspicious for aortic transection
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1. depressed left mainstem bronchus
2. widened mediastinum
3. deviated trachea
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Factors that make primary amputation of the leg a better option
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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
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Way to diagnose duodenal perforation in the setting of an equivocal CT
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Upper GI series with water solube contrast that shows "coiled spring" appearance of the duodenal wall
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Stages of damage control surgery
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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
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Type of injury which is a contra-indication to damage control surgery
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Arterial injuries
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Type of liver injury amenable to suturing and best method for liver suturing
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# Superficial lacerations
# Chromic suture with blunt needle
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Indications for immediate OR explioration of neck wounds
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# 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
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Management of penetrating neck trauma
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# 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
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Management of Carotid artery injury
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repair if neurological deficit
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Definition of flail chest
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3 or more ribs fractured in at least 2 locations
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Indications for internal fixation of the chest wall
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# 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
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Pulsatile exophthalmos in a pt with racoon eyes and/or hemotympanum
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Carotid-cavernous fistula
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Signs of carotid-cavernous fistula
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# pulsatile exophthalmous
# eyelid edema
# auscultation of a bruit over the eye
# edema of the conjunctiva
# double vision
# swelling of the eye
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Management of caroitid-cavernous fistula
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open neurosurgical approach or endovascular embolization
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Signs of compartment syndrome
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# pain out of proportion to the injury
# pain on passive motion of the limb
# tense edema with tenderness on palpation fo the compartment
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# First compartment to be involved in compartment syndrome of the leg
# Sx of involvement of that compartment
# pathogenesis of said sx
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# Anterior compoartment of the leg
# numbness in the first web space
# entrapment of the deep peroneal nerve which runs in the anterior compartment
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In compartment syndrome:
# compartment most difficult to decompress
# structure contained in that compartment
# best way to decompress that compartment
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# deep posterior compartment
# tibial nerve
# detachment of the soleus muscle from the tibia
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Grades of traumatic peripheral nerve injuries and definition
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# 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;
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Type of peripheral nerve injury a/w distal wallerian degeneration
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Axonotmesis
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Types of peripheral nerve injuries which are amenable to regeneration and which require surgical repair
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# regeneration: neuropraxia and axonotmesis
# requires surgery: neurotmesis
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MC traumatic peripheral nerve injury
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# 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
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Rate at which peripheral nerves regenerate
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1 mm/day
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Grading of pancreatic injuries
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# I- minor contusion or laceration
# II-
# III
# IV
# V: major disruption of pancreatic head
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Management of pancreatic injuries
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# 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
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Indications for Whipple in trauma
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# injury to main pancreatic duct to R of mesenteric vessels and massive disruption of pancreatic head
# devascularization of duodenum
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Beck's Triad
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Distended neck veins, muffle heart sounds, hypotension==>> pericardial tamponade
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Management of tamponade
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# 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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