Bites, Infestations, and Uncommon Infectious Diseases

Question 1

Bee and Wasp stings general reaction?

Answer 1

immediate burning, pain, and local erythema and swelling subsiding in several hours

Question 2

Bee and Wasp stings intermediate-severe reaction?

Answer 2

more intense reactions such as intense, localized swelling up to a week
some have a generalized, systemic, anaphylactic reactions generalized through uticaria and angioedema

Question 3

Treatment of Bee and Wasp stings?

Answer 3

remove stinger
mild reaction: wash, ice, elevate, antihist., ibuprofen
Anaphylazis is treated with subcut. epi and supportive measures

Question 4

Scorpion stings

Answer 4

limited pain and numbness but can become more serious with cardiac and neurologic sym
young children most at risk
most cases no treatment is available

Question 5

Fleas

Answer 5

bites result in pruritic papules
topical corticosteroids and oral antihistamines
eradication is necessary

Question 6

Pediculosis (lice)

Answer 6

Transmission is through direct contact or indirect contact through sharing of bedding, clothing, hairbrushes

Question 7

Pediculosis Capitis

Answer 7

infestation of the scalp
active infection, nits close to the scalp
treatment is permethrins for 10 min and wash off repeat in 9-14 days

Question 8

Pediculosis Corporis

Answer 8

infestation of body
treatment on infested clothing, should be discared or washed with hot water
Elimite from head to toe, leave for 8-10 hours then wash off (1 treatment)

Question 9

Pediculosis Pubis

Answer 9

pubic lice (crabs), sexually transmitted but can also be through shared towels etc.
can spread to thighs, beard, axilla, and eyelashes
treatment similar to head lice (permethrins)

Question 10

Mites

Answer 10

Chigger=harvest mites
multiple itchy bites around clothing restrictions that spent time outdoors
treatment= antihistamines

straw itch mites
harvesting straw or hay have itching with patchy dermatitis spreading over trunk/arms
Fever and HA may occur
Systemic corticosteroids may help

Question 11

How are scabies transmitted?

Answer 11

skin to skin but also through linens
can live for several days off human skin
close contact for 20 min is required

Question 12

Signs and symptoms of scabies?

Answer 12

Severe pruritus

red, scaly, excoriations, favoring webs in palms, wrists, axillae, scrotum (usually not on face or neck)

Question 13

Pathognomonic lesion is?

Answer 13

a burrow (tunnel) caused by mite as it moves through the stratum corneum - in scabies

Question 14

Havey infestations of scabies can result in _______ with a thick crust

Answer 14

plaque

Question 15

What is considered the gold standard for diagnosis of scabies?

Answer 15

Place a drop of mineral oil over a burrow, scrape with a blade and examine under microscope

Question 16

Treatment of scabies?

Answer 16

Permethrin 5 % cream (Elimite) is most common
apply to whole body below neck and set for 8-14 hours then wash off
repeated after one week
Oral ivermectin is also an option

Question 17

Educate your patients that rash and pruritus can continue after successful treat of scabies for ___ to ___ weeks so they they don’t think the treatment has ____

Answer 17

2-4; failed

Question 18

What bacteria is transmitted by ticks in Lyme disease?

Answer 18

Borrelia burgdorferi

Question 19

What is the most common vector borne disease in the U.S.

Answer 19

Lyme Disease (mandatory reporting to CDC)

Question 20

Highest incident of Lyme disease occurs where?

Answer 20

North-eastern U.S. and forested areas of Europe

in association with hiking, camping, hunting

Question 21

Stage 1 of Lyme Disease

Answer 21

Localized; Erythema Mirgrans** (bullseye) that develops 3-32 after bite
Lymphocytoma, malar rash, diffuse urticaria

Question 22

Stage 2 of Lyme Disease

Answer 22

Secondary EM lesions; multiple lesions may develop that are smaller, less migratory, and less annular
days-weeks after initial EM
can have cardiac, neurologic, fever, and musculoskeletal symptoms

Question 23

Stage 3 of Lyme Disease

Answer 23

Systemic findings: neurologic symptoms are rare but may occur months to years later
musculoskeletal symptoms are most common
fever and lymphadenopathy may persist

Question 24

“Stage 4” of Lyme disease

Answer 24

“Post-lyme disease syndrome” when symptoms persist >6 months despite antibiotic therapy

Question 25

Diagnosis of Lyme disease

Answer 25

early clinical findings (stage 1 & 2) plus a hx of tick infested area is sufficent, no labs necessary
Late findings (stage 3) require 2 step blood test (ELISA first) and if thats positive continue on to western blot or ELISA if its negative you can stop there

Question 26

Treatment of Lyme disease

Answer 26

Doxycycline 100mg bid x 14 days = early detection
If < 9 uses amoxicillin or cefuroxime axetil

if later diagnosis will need longer course and maybe IV antibiotics

Question 27

A tick much be attached _____ hours in order to transmit infection.

Answer 27

24-48 hours, injection occurs at end of feeding

Question 28

What is Rocky Mountain Spotted Fever?

Answer 28

infection caused by R. rickettsii, transmitted through dog tick and wood tick
everywhere but rocky mountains
high mortality rate

Question 29

Signs and Symptoms of RMSF?

Answer 29

triad of fever, severe HA and rash (not all symptoms will present)
characteristic rash begins on wrist and ankles after other symptoms have begun, it spreads toward the trunk, blanchable red macules become papular and develop into petechiae

Question 30

If RMSF is suspected what do you do?

Answer 30

do not wait on confirmed diagnosis, start treatment immediately

Question 31

What is the gold standard for diagnosis of RMSF?

Answer 31

Immunofluorescent Assay

Question 32

Treatment of RMSF?

Answer 32

Doxycycline 100 mig bid, treat for 72 hrs after afebrile
even if child is less than 9 still give
if pt. is pregnant consider chloramphenicol instead

Question 33

Spider bites cause

Answer 33

local pain, redness and swelling

Question 34

Black Widow Spider looks like?

Answer 34

smooth black body with red hour glass mark on underside abdomen

Question 35

What does a Black Widow spider bite feel and look?

Answer 35

immediate sharp pain or gradual pain followed by burning, area may become red and swollen and muscles adjacent may be painful

Question 36

Severe symptoms of Black Widow bites include?

Answer 36

muscle spasms of entire extremity, abdominal, back and chest pain
dizziness, HA, sweating, N/V, tachycardia

Question 37

Treatment of Black Widow bites?

Answer 37

localized, without muscle spasms= oral pain medication, clean wound, ice pack. and tetanus if necessary

severe symptoms= narcotics for pain, muscle relaxants, antimetic medication can be given for n/v

*antivenim is pt doesn’t respond to above treatment

Question 38

Brown Recluse spider looks like?

Answer 38

brown body with fiddle shaped marking on back, mainly in midwest

Question 39

Brown Recluse spider bite feels and looks like?

Answer 39

stinging and a reaction of swelling, erythema with hallmark “red, white and blue” sign
< 10% of pts develop a severed localized reaction

Question 40

Severe Brown Recluse spider bites symptoms

Answer 40

2-3 days after bit, tissue becomes necrotic and slough off, leaving ulcer, systemic reaction may develop(rare) with nausea to severe renal failure

Question 41

Treatment for Brown Recluse spider bite?

Answer 41

Ice, elevation, and rest
Steroids to control symptoms
Dapsone (antibiotics) is sometimes used
Topical nitroglycerin (vasodilation) can decrease the necrotic ulcer
Hyperbaric oxygen therapy in severe cases

Question 42

Poisonous snakes include?

Answer 42

rattlesnake, water moccasin, copperhead, and coral snake(in different family, different antivenom from the other 3)

Question 43

Degree of toxicity of a snake bites depends on the _____ of the venom, the amount _____, the size and condition of the snake, and the size of the ____ bitten

Answer 43

potency, injected, person

Question 44

Venom causes what?

Answer 44

cell and tissue destruction, which is very painful

Question 45

Symptoms of snake bites

Answer 45

startin within 5 minutes of bite, if not developed in 8 hrs you are in the clear
local pain, edema, numbness, n/v, sweating, fever, slurred speech, bleeding gums, hematemesis

Question 46

Treatment of snake bites

Answer 46

must establish bite is from poisonous snake, stabilize and transport, keep bite below hear or in sling

antivenim (FabAV given within 4 hours) 4-6 vials is loading dose and then more doses may be required
painkiller and ivs may be given