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