Bites And Stings

Question 1

most common response to a Hymenoptera sting is a ___________________ that can last up to several days and generally spontaneously resolves

Answer 1

transient local reaction

Question 2

Wasps, bees, and ants belong to what order

Answer 2

Hymenoptera

Question 3

Subgroup which includes the honeybee and bumblebee

Answer 3

Apidae

Question 4

Subgroup which includes yellow jackets, hornets, and wasps

Answer 4

Vespidae

Question 5

Subgroup of ants

Answer 5

Formicidae

Question 6

True or false

Honeybees and bumblebees are usually docile, stinging only when provoked.

A female honeybee is capable of stinging only once (male bees have no stinger) because its stinger has multiple barbs that cause the sting apparatus to detach from the bee’s body, leading to evisceration and eventual death.

Answer 6

True

Question 7

a known membrane-active polypeptide that can cause degranulation of basophils and mast cells, constitutes >50% of the dry weight of bee venom

Answer 7

Melittin

Question 8

In Anaphylaxis, Fatalities that occur within the first hour after the sting usually result from _______________ or _____________

Answer 8

airway obstruction

hypotension

Question 9

General treatment for bee stings

Answer 9

1. If the bee stinger is present in the wound, remove it. Immediate removal is the important principle, and the method of removal is irrelevant.
2. Wash the sting site thoroughly with soap and water to minimize the potential for infection.
3. For local reactions, intermittent application of cold compresses at the site may diminish pain and swelling.
4. Oral analgesics, including NSAIDs and antihistamines may limit discomfort and pruritus, respectively.
5. If edema is significant, elevation and rest of the affected limb may be beneficial.

corticosteroids: no clear benefit

Question 10

The venom of the brown recluse contains multiple enzymes, including hyaluronidase and _______________, which is the major enzyme responsible for necrosis

Answer 10

sphingomyelinase D

Question 11

Identify

Answer 11

brown recluse spider (Loxosceles reclusa)

Close-up look at the characteristic fiddle-shaped back marking. Note the eyes, which are distributed as a single anterior pair and two lateral pairs; the paired eyes are very close together.

Question 12

Identify

Answer 12

Early brown recluse spider bite (approximately 8 hours old) with a violaceous center surrounded by a faint spreading erythema.

Question 13

Identify

Answer 13

Black widow spider (Latrodectus mactans) with offspring. Note characteristic hourglass marking on abdomen.

Question 14

In Latrodectus envenomation, in all cases, the most prominent feature of envenomation is local, regional, or generalized ________ which may be associated with systemic symptoms and autonomic effects.

Answer 14

pain

Question 15

Describe the clinical syndrome of envenomation is referred to as latrodectism

Answer 15

1. pinprick sensation at the bite site,
2. increasing local pain that may spread quickly to include the entire bitten extremity.
3. Erythema appears approximately 20 to 60 minutes after the bite.
4. In some bites, a small, <5-mm erythematous macule develops that may evolve into a larger target lesion with a blanched center and surrounding erythema
5. Victims frequently complain of cramp- like spasms in large muscle groups, although physical examination of the “cramping” extremity rarely reveals rigidity.
6. The pain often increases progressively, becomes generalized, and can involve the trunk, back, and abdomen.
7. Localized diaphoresis near the site of envenomation can be seen.

Question 16

Identify

Answer 16

Black widow spider bite on the knee

Question 17

the deadliest spiders in the world

Answer 17

Funnel-web spiders

Question 18

Treatment for the deadliest spiders

Answer 18

1. To reduce venom absorption and systemic toxicity from a bite on an extremity, apply a compressive elastic BANDAGE to the entire length of the limb, and SPLINT extremity to prevent movement.
2. IMMOBILIZE the victim and transport promptly to the hospital.
3. The specific treatment for systemic toxicity is Funnel-Web Spider Antivenom® (CSL Ltd., Melbourne, Australia). If the patient has signs of systemic toxicity upon arrival or develops them after the compressive elastic bandage is carefully removed, antivenom should be administered until symptoms improve. Antivenom appears effective in reversing many of the manifestations of envenomation and appears to improve mortality. It does not appear effective in reversing cardiac damage.
4. Supportive therapy for hypotension (IV fluid), bronchorrhea (atropine), tremors and agitation (benzodiazepines), and hypertension and tachycardia (β-blockers) may be necessary.

Question 19

ATRAX Symptoms and signs of systemic toxicity

Answer 19

perioral paresthesias

cholinergic excess (nausea, vomiting, diaphoresis, saliva- tion, lacrimation, bronchorrhea)

neuromuscular stimulation (muscle fasciculation, tremors, spasms, weakness)

CNS toxicity (altered level of consciousness)

Myocardial damage with pulmonary edema may occur early after envenomation and is thought to be from massive catecholamine release.

Question 20

a granulomatous, nodular reaction that can occur in cases of ocular exposure to tarantula hairs.

Answer 20

Ophthalmia nodosa

Question 21

Scorpion venom contains many toxins, but the toxins with the most serious medical effects can do what?

Answer 21

open neuronal sodium channels and cause prolonged and excessive depolarization

Question 22

The most dangerous clinical manifestation of scorpion envenomation worldwide is

Answer 22

acute heart failure and pulmonary edema

Question 23

For this reason, a blister beetle should be removed from the skin by

Answer 23

blowing or flicking