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Dermatology Board Prep > DERM (11) Infections, Infestations, and Bites > Bites and Stings > Flashcards

Bites and Stings Flashcards

1
Q

What is a clinical distinguisher of bullous arthropod from another inflammatory bullous disease?

A

The bullae are in a distribution of bug bites and they often form several cm tense bullae without significant edematous/erythematous bases

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2
Q

What causes immediate reactions to to bites or stings?

A

Release of histamine, serotonin, formic acid, or kinin

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3
Q

What do the bites of the fire ant look like?

A

5-10mm sterile pustules on lower extremities, can occur in a cluster as the ant can bite and then “swing” stinger around

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4
Q

What toxin does the fire ant have?

A

Solenopsin D

  • Increases membrane permeability and increases histamine release
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5
Q

What is the toxin that bees/wasps/hornets have (Hymenoptera)?

A

Phospholipase A; can lead to anaphylaxis

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6
Q

What class of insects most often causes anaphylaxis?

A

Hymenoptera (bees/wasps/hornets)

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7
Q

What is the formal name for bed bugs?

A

Cimex lectularius

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8
Q

What is the clinical presentation of bed bugs and what causes it?

A

Grouped “breakfast, lunch and dinner” urticarial papules at bite sites

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9
Q

What toxin does lytta vesicatoria/Spanish fly have?

A

cantharidin (these are otherwise known as blister beetles)

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10
Q

What diseases can be passed by the rat flea?

A

Xenopsylla cheopis vector for R. Typhi (endemic typhus) and also Y pestis (bubonic plague)

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11
Q

What diseases can be spread by the cat flea?

A

Ctenocephalides felis and canis: vector for Bartonella henselae (cat scratch disease, bacillary angiomatosis) and Bartonella Quintana (bacillary angiomatosis)

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12
Q

What causes the lesions of lepidopterism (caterpillar dermatitis)?

A

Direct contact with hairs and toxin-mediated reactions (not an allergy)

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13
Q

What is the appearance of the dermatitis from caterpillars (lepidopterism)

A

Can have a train-track appearance of urticaria or hemorrhage.

  • Can cause ophthalmia nodosa which are ocular reactions as hairs tend to migrate inward (looks like redness and small little papules on the surface of the eye or conjunctiva
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14
Q

What does the puss caterpillar look like and what lesions does it cause?

A

Megalopyge opercularis: lightly brown and wooly appearance. and it causes painful linear petechiae

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15
Q

What does the Io caterpillar look like?

A

Automeris io: green with longitudinal white strip

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16
Q

What does the gypsy caterpillar look like and what is unique about it?

A

Lymantria dispar: it looks like blue/purple body with red to blue papilla with numerous spines emanating from them

  • The spines/hair have histamine which can become airborne
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17
Q

What does the saddleback caterpillar look like?

A

Sibine stimulae: green saddle-like area on the back

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18
Q

What are the 4 main ticks discussed in dermatology?

A

Ornithodorus, dermancentor, Ixodes, Amblyomma (lone star tick)

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19
Q

What does the ornithodorus tick look like?

A

Warty/rough, gray, and soft appearance

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20
Q

What does the ornithodorus tick transmit?

A

B. duttonii (tick-born relapsing fever)

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21
Q

What does the dermacentor tick look like?

A

One of the larger types of ticks, has a patterned brown and light brown back for males, and a distinctive lighter area in the mid-body for the males.

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22
Q

What diseases does the Dermacentor tick transmit?

A

RMSF (#1), tularemia, tick paralysis (if on for more than 4 days), and human granulocytic anaplasmosis/ehrlichiosis

23
Q

What is the clinical presentation of tick paralysis?

A

Sudden ascending flaccid paralysis

24
Q

What are the types of Ixodes ticks and what geographic areas do they correspond to?

A

Pacificus: Northwestern/western coast of the US

Ricinus: European species

Scapularis: Northern midwest of the US and southeastern cananda, east coast

dammini: similar/synonym to scapularis

25
Q

What diseases do Ixodes ticks pass?

A

Lyme disease (#1 B. Burgdorferi), acrodermatitis chronic atrophicans (B. garinii and B. afzelli), babesiosis (#1 causes(, and human granulocytic anaplasmosis

26
Q

What is a distinctive feature of the lone star tick?

A

It has a distinctive white dot on the back of the females

27
Q

What disease do the lone star ticks transmit?

A

Transmits human monocytic ehrlichiosis; tularemia; African tick bite fever; Brazil spotted fever; STARI

28
Q

What are chigger/harvest mites and what can they spread?

A

These are free-living mites called Trombicula alfreddugesi

  • Vector for R. tsutsugamushi (scrub typhus)
29
Q

What is the appearance of bites from chiggers?

A

Causes grouped pruritic papules on lower extremities/ankles and waistband. Also causes summer penile syndrome in boys

30
Q

What disease can the house mouse mite spread?

A

R. Akari (rickettsialpox)

31
Q

What disease can the fowl mite spread?

A

Western equine encephalitis

32
Q

What is walking dandruff?

A

Caused by contact with dogs/cats and it is a type of mite. The organisms when stuck on look like dandruff, is pruritic in humans but asymptomatic in animals

33
Q

What agents cause the Baker’s itch and Grocer’s itch?

A

Baker’s itch: grain mite

Grocer’s itch: cheese mite

34
Q

What are the symptoms of a black widow bite?

A

acute pain and edema at the site, systemic sx’s can include chills, abdominal pain/ rigidity, rhabdomyolysis, chest pain, sweating, hypertension, and shock

35
Q

What is the scientific name for a black widow?

A

Latrodectus mactans

36
Q

What toxin does the black widow employ and what does it do?

A

Alpha-lactotoxin and it depolarizes neurons (sodium channel modulator)

37
Q

What is the treatment for black widow envenomation?

A

IV calcium gluconate; antivenom; benzodiazepine can be used for supportive care

38
Q

What is the scientific name for the brown recluse and what is the appearance of it?

A

Loxosceles reclusa, has a characteristic dark brown-black violin/fiddle-shaped marking on the front of it near the jaws

39
Q

What is the clinical appearance and progression of brown recluse bites?

A

Necrosis with eschar formation at the site of bite (painless; erythema then ischemia then thrombosis)

40
Q

What is the toxin associated with brown recluse bites?

A

Sphingomyelinase D and hyaluronidase (allows eschars to spread)

  • can have hemolytic anemia, shock, and death
41
Q

What is the treatment for the brown recluse bite?

A

Do not debride, supportive (dapsone if early), antivenom

42
Q

What is the distinctive appearance of jumping spiders (phidippus formosus)

A

Dark and hairy with 4 years (two larger centrally and two smaller ones laterally)

43
Q

What is the toxin for jumping spiders?

A

Hyaluronidase

44
Q

What is the toxin that wolf spiders have?

A

Histamine

45
Q

What is the toxin of the sac spider?

A

lipase

(yellow-colored spider)

46
Q

What is the apperence of the hobo spider and what does its bite cause?

A

It has a herringbone pattern on the back and it causes an eschar/local necrosis (similar to the brown recluse but not as bad)

47
Q

What is the appearance of the Peucetia viridans?

A

Green lynx spider, unique neon green color with red spots

  • Its bite is painful, but it doesn’t cause systemic sxs
48
Q

What lesions can be caused by the Theraphosidae (tarantula)?

A

Urticating hairs can be ejected when threatened. Can lead to ophthalmia nodosa like the caterpillar hairs

49
Q

What are the cutaneous signs of scorpion stings?

A

Pain and paresthesia out of proportion to skin lesions

  • systemic sx’s convulsions, hemiplegia, temperature, instability , tremor, arrhythmia, pulmonary edema, and HTN
50
Q

What skin lesions can centipedes and millipedes cause?

A
  • Centipedes: one pair of legs per segment, bites produce pain and paraesthesia, look for two puncture wounds
  • Millipedes: two pairs of legs per segment, chemical irritant contact dermatitis from secretions which lead to burn and blistering
51
Q

What does the bite of the rattlesnake or the copperhead cause?

A

Multiple toxins including thrombin-like glycoproteins –> thrombocytopenia and DIC

52
Q

What toxins does the coral snake have and what does it cause?

A

Alpha neurotoxin: causes neurologic sx’s, nausea, headache, abdominal pain and paresthesia

  • Phospholipase A2 causes wound
53
Q

What is the clinical appearance of the cnidarians jellyfish (jellyfish, Portuguese man of war, coral, and anemones) lesions and what is the treatment?

A

Flagellate eruption in affected areas. The physical touch or osmotic trigger releases a coiled filament that discharges toxins

-Can use vinegar to denature the nematocysts in some but not all species

54
Q

What is important about the toxin in the Portuguese man of war?

A

Contain a heat-labile toxin that produces cardiac disturbances and paralysis: skin lesions are hemorrhagic and vesicular

DERM (11) Infections, Infestations, and Bites (13 decks)

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