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Senior - Derm 3 > 13 - Bites, Stings, Infestations > Flashcards

13 - Bites, Stings, Infestations Flashcards

1
Q

What is human scabies?

A

Highly contagious dz caused by sarcoptes scabiei mite

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2
Q

S/s of human scabies?

A

Bruising/excoriations from itching/scratching

Kids - vesicles

Secondary staph impetigo

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3
Q

Human scabies may be mistaken for?

A

May be mistaken for atopic dermatitis

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4
Q

Etiology of human scabies?

A

Mite
Skin to skin contact
Crowded living conditions
Can live for several days outside skin

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5
Q

Who doesnt get scabies?

A

DPP rarely acquire it

We dont know why

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6
Q

Common locations of scabies infection?

A

Slide 5

Arm pits
Belt line
Groin
Wrist 
Finger webbing
Anus 
Knees
Heels of Feet
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7
Q

Morphology of scabies?

A 
Create a burrow (tunnel)
- best seen where they cant scratch 
Itching (at night)
1st lesion is usually destroyed by scratching
Secondary lesions 
- pinpoint erosions (from scratching)
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8
Q

Describe human scabies lesions?

A

Burrows 2-15mm long
Pink/white
Slightly elevated
Mite - black dot

MC location

  • finger webws
  • writs
  • sides of hands/feet
  • penis
  • buttocks
  • scrotum
  • palms/soles (infants)
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9
Q

Diagnosis of scabies?

A

Clinical

Touch the burrow w a felt tipped pen and it will suck up ink

Deroof burrow #15 blade and transfer to slide w immersion oil
- mites, eggs, feces

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10
Q

Tx for scabies?

A

Permethrin 5%
Lindane (1% kwell)
Ivermectin

Treat family members

HC in Eucerin for inflammation

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11
Q

How long does itching last w scabies?

A

Continues until mite, eggs, and stool are expholiated

Tx w antihistamine prn

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12
Q

Lindane 1% (kwell) rundown

A 
Chemical pesticide
Toxic
NOT FOR KIDS <2
NOT FOR PREGGO
Pretreat w steroids
Apply to dry skin
Sleep nude (occlusion)
Only for confirmed infestation
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13
Q

Ivermectin (stromectrol) basics?

A

Vet medicine

Human dose 12mg PO on day 1 and 8

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14
Q

What types of scabies get ivermectin?

A 
Norwegian scabies
HIV
Institutionalized
Nursing home
Tx failure
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15
Q

Whats the deal with crusted Norwegian scabies?

A

HIV pts

Its a variant of scabies but

  • w 1000’s of mites
  • not much itch
  • highly contageous
  • scaly
  • significant crusts
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16
Q

Where does crusted norwegian scabies like to go?

A

Primarily hands and face

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17
Q

Pediculosis is aka?

A

Lice

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18
Q

Clinical manifestations of pediculosis?

A 
Pediculosis capitis - hairPediculosis corpis - body
Pediculosis pubis (crabs)
19
Q

How to ID lice?

A

See them in seams of clothes

Woods lights - yellow-green to blue-green

20
Q

Pediculosis etiology

A

Skin to skin contact
Formite to skin
Sex
Head like rare in DPP

21
Q

Pediculosis management?

A

Clean/burn clothes

Clotes/formites bugs may survive 10 days - 3 weeks off a host

22
Q

Body lice concerns?

A

Can carry typhus and trench fever

23
Q

Pediculosis txt?

A

Body lice

  • permethrin (elimite)
  • (head to toe, leave on 10 min)

Head lice

  • permetherin shampoo
  • (10 min)
  • coat eyelashes w vaseline
  • wash w body shampoo TID x 5 days

Crabs (P. Pubis)

  • permethrin shampoo (for body)
  • comb/shave pubic hair
  • check for STI
24
Q

All types of pediculosis need?

A

Tx close contacts
Retreat q 7-10 days
Wash/burn everything
- may be able to use dyer on high

25
Q

MC skin disease among travelers to tropical countries?

A

Cutaneous larva migrans

Aka creeping eruption

26
Q

Cutaneous larva migrans are commonly seen?

A

Back buttocks, foot/hand

In the SE Us

27
Q

Etiology of cutaneous larva migrans?

A

Accidental invasion of hookworms

  • burrows 1-2mm qd
  • long serpiginous lesions
  • larva eventually dies
28
Q

Cutaneous larva migrans management?

A

Topical
- steroid to decrease inflammation

Oral (sever cases)

  • ivermectin repeat in 1-2 wks
  • albendazole x 3-7 days

Its self limiting though so dont go crazy

29
Q

Management of fleas?

A 
Symptomatic tx
- antihistamine
- topical abx
- topical steroids
Get rid of fleas
- treat pets
- bedding
30
Q

Presentation of bed bugs

A

On exposed skin
Rows of 3-5 bites
Adenopathy and fever (numerous bites)
Look for bugs at night

31
Q

Etiology of bed bugs?

A

Cimex lectularius

32
Q

Management of bed bugs?

A

Get rid of bugs

Symptomatic tx

  • antihistamines
  • topical preps PRN
33
Q

What are chiggers?

A

Mite that attaches to human from tall grass

34
Q

Presentation of chiggers?

A

Legs and belt line (or other ares of constriction)
Intense itch
FB reaction
Persisten

35
Q

Management of chiggers?

A

OTC chigger meds
Nail polish
Chig-a-way

Treat symptoms

36
Q

Unlike the previous stuff., fire ants?

A

Sting (not a bite)
W immediate pain

Also prone to anaphylaxis
- wasps and bees are their cousins

37
Q

Presentation of fire ant sting?

A

Wheal -> vesicle -> pustule

38
Q

Tx for fire ant sting?

A

Symptomatic

  • cool compress
  • sarna lotion (OTC anti-itch)
  • antihistamine
  • steroids (if severe)
39
Q

Presentation of cat scratch fever?

A 
Exposure to cats
- scratch or bite
- fleas (may spread it)
Malaise
Low grade fever
Ocular manifestations

More common in kids/teens

40
Q

Morphology of cat scratch fever?

A 
Single red papule (non-pruritic)
Evolve to vesicle filled w sterile fluid 
Spread to node-enlarged
Tender and firm
May suppurate
41
Q

Distribution of cat scratch disease?

A

Usually extremities but anywhere you got scratched/bit

42
Q

Cat scratch fever diagnosis

A

Primary lesion
- papule/pustule site in the presence of LAD and H/O cats

Causative agent
- bartonella henselas

Lymph node biopsy

  • small plepmorphic bacilli
  • via warthin-starry silver strain
43
Q

Tx for cat scratch disease?

A

Mild
- spontaneous resolution in 4-6 wks

Severe

  • Antibiotic therapy
  • azithromycin (z pack)
  • erythromycin
  • doxy

Suppurative node can be drained
- needle aspiration

44
Q

What sound do porcupines make when they kiss?

A

ouch!

Senior - Derm 3 (7 decks)

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