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 |