Infectious Flashcards
1
Q
HPV virus has early proteins and late proteins. What are their roles?
A
Early proteins (E1-E7) are improtant for DNA replication. Late proteins (L1-L2) encode structural proteins
2
Q
What genes in HPV allow for amplification?
A
E5,E6, E7
3
Q
HPV gene E6 and E7 are in high risk types. E6 destroys what?
A
Destroys p53, decreasing apoptosis, increasing replication
4
Q
HPV gene E6 and E7 are in high risk types. E7 destroys what?
A
Destroys RB, loss of inhibition of E2F transcription factor, increasing expression of genes important for DNA replicatoin
5
Q
mucosal/cutaneous HPV vs EDV. Which is genus alpha and which is genus beta?
A
mucosal/cutaneous are genus alpha
6
Q
Common warts
A
1, 2, 4
7
Q
Flat warts
A
3, 10
8
Q
Butcher’s warts
A
7, 2
9
Q
Ridged warts that retain normal dermatoglyphics?
A
HPV60
10
Q
EDV
A
Genus Beta, HPV 5, HPV8
11
Q
Acquired EDV seen in
A
HIV
12
Q
Can EDV warts progress to SCC?
A
Yes HPV 5 and HPV 8 can progress to SCC and Aks
13
Q
High risk cervical types
A
HPV 16, 18, 31, 33, 45. Not HPV 6 and 11.
14
Q
Associated with high risk HPV types? Bowenoid papulosis
A
Yes
15
Q
Associated with high risk HPV types? Erythroplasia of queyrat
A
Yes
16
Q
Verucous carcinomas include which types?
A
HPV 6,11. buschke lowenstin, oral florid papillomatosis, epithelioma cuniculatum.
17
Q
Hecks disease is presents as what? What HPV type?
A
multiple flat wart like papules on gingival/ buccal and labial mucosa (children in south america) (HPV 13, 32)
18
Q
Recurrent respiratory papillomatosis d/t which HPV type
A
HPV 6, 11
19
Q
Use of what medication can increase your risk of eczema herpeticum?
A
topical calcineurin inhibitors
20
Q
Herpetic whitlow d/t which HPV type?
A
HSV1 in children and HSV 2 in adults
21
Q
What part of the brain is most commonly affected by HSV encephalitis?
A
temporal lobe is number 1 site
22
Q
disseminated zoster can cause complications like? Name 3
A
SIADD, life-threatening pneumonitis, encephalitis, vasculopathy
23
Q
Ramsay-Hunt syndrome is d/t disease of what nerve?
A
Disease of geniculate gangilion of CN7
24
Q
Symptoms of Ramsay Hunt include
A
Ear pain, deafness, tinnitus, ipsilateral facial nerve paralysis, anterior 2/3 tongue taste loss
25
If zoster affect CN5, what happens?
Aseptic meningitis or vasculopahty
26
If zoster affect CN8, what happens?
deafness
27
If zoster affect CN2, 3, 5, what happens?
herpes zoster opthalmicus
28
what is the most common type of HSV eye invovlement
uveitis
29
If zoster affect CN7, what happens?
bells palsy
30
If zoster affect cervial dermatome, what happens?
motor neuropathy of arm and diaphragm weakness
31
How much of an increase in IgG confirms infection?
four-fold
32
Within how many days do you have to treat varicella?
3 dyas of lesion onset
33
If you're immunosuppressed, pregnant or a neonate, and you're exposed to varicella, what do you need?
Get Varicella zoster immunoglobulin OR IVIG. AND start oral acyclovir wihtin 10 days of expsure
34
Varicella vaccine should be given to what type of patients post-exposure?
immunocompetent patients who are nonimmune
35
What's a complication of chicken pox in older patients?
penumonia
36
Where does the EBV virus lay formant?
B cells
37
Infected B cells with EBV can continue to replicate and cause lymphoproliderative disorders in what type of immune-deficient pts?
Cell-mediated immunity
38
recalcitrant ulcers of perineum in HIV patients due to
CMV
39
reactivation of HHV6 can be seen which what 2 rashes?
Pityriasis Rosea and DRESS
40
HHV8 is also associated what other disease besides kaposi's
multicentric castleman disease, primary effusion lymphoma, paraneoplastic pemphigus
41
Eczema vaccinatum caused by
vaccinia (ortho pox, pox virus) used for live smallpox vaccine
42
What pox virus can you get from dogs? Cats? Sheep/goat/reindeer? Cows?
monkeypox, cowpox, orf/parapox, paravaccinia virus
43
Do you have to treat orf?
no, it self resolves
44
Chikungunyna virus transmitted by? Presents as?
Aedes mosquito. Presents as high fever, headache, joint symptoms
45
Zika virus transmitted by? Presnet cutaneous as?
Aedes mosquito. Presents as morbiliform rash on face, that spreads down
46
Dengue virus most commonly presnts as:
Asymptomatic.
47
Classic dengue fever presetns like Zika in the sens that it has
Fever, mobiliform rash, severe headache/myalgia/arthralgia, and petechial mucosal lesions.
48
Describe classic dengue rash?
widespread erythema with white islands of sparing
49
Dengue hemorrhagic fever occurs?
Occus if you develop when a patient previously infected with 1 serotype is subsequently infected with a different viral serotype
50
Dengue hemorrhagiv fever more commonly occurs in?
children younger than 15yo
51
Necrolytic acral erythema looks like? Associated with? Tx
Looks like well defined plaques of eczema. Associated with Hepc and zinc deficiency. Tx with Zinc
52
EED in HIV is often assciated with
B hemolytic strep
53
herpes vegetans (anogenital exophytic verrucous plaques) is often resistant to what? Tx?
acyclovir. Treat with intralesion cidofovir
54
what HIV associated dermatosis present at CD4 counths greater than 500?
Seb derm, oral hairy leukoplakia, vaginal candidiasis
55
What HIV medications cause antiretroviral-associatedlipodystrohy?
protease inhibitor (navir)
56
HIV drug most likely to cause dress?
abacavir, Bactrim, dapsone
57
HIV drug with the most retinoid like effects including periungal pyogenic granulomas?
indinavir
58
Nonbullous impetigo caused by Strep pyogenes can lead to?
post-streptococcal glomerulonephritis in 5%. Risk is not changed with antibiotics
59
Can you get rheumatic fever from strep impetigo?
no
60
If you get bullous impetigo in a renally insufficient person, what can happen?
Exfoliatoxin may disseminate causing staph scalded skin syndrome
61
what makes MRSA resistant to methicillin?
mecA gene (encodes penicillin-binding protein, PBP2a)
62
MRSA virulence factor?
Panton-Valentine leukocidin (PVL) leasd sot more severe necrosi sof skin
63
Blood cultures of ppl with Staph scalded skin are pos or neg?
Positive in adults and negative in children
64
Tx for staph scaleded skin, ecthyma?
dicloxacillin or keflex
65
how does staph toxic shock present?
High fever (greater than 102), rash, hypotension in 100 percent of patients
66
how do children get staph scalded skin?
primary infeciton sidtes are nasopharyns and conjucntiva
67
Tx for staph toxic shock and strep toxic shock?
Clindamycin (suppresses toxin production ), IVIG, fluids. For strep you may need surgical debridement
68
Staph vs Strep toxic shock. Which has lower mortality?
staph-TSS has lower mortality, more frequent rash and less frequent blook culture positivity
69
Pyomyositis is
staph aureus infecoitn of skeletal muscle
70
Imaging for pyomyositis?
MRI
71
Botryomycosis most commonly cuased by? Best imaging?
Staph aureus, MRI
72
What percent of botryo is skin limited? If it affects visceral organs, which one?
70% is skin limited. Affect lungs
73
Botyro granules would stain for
PAS, Gram, Giemsa stain positive
74
Ecthyma most commonly caused by
strep pyogenes. Also risk of post-streptococcal glomeriulonephritis
75
Erysipelas aka st anthony fire caused by
group a beta hemolytic strep (strep pyogenes)
76
Erysipelas is very red because of
Because it has prominent lymphatic involvement
77
Erysipelas number 1 site?
lower extremitiy , then face
78
Erysipelas is basically a superfical cellulitis. Treatment of choice?
Penicillin for 14 days. If allergic, then erythromycin
79
Erysipelas is basically a superfical cellulitis. Treatment of choice if allergic to penicillin?
Erythromycin
80
Perianal strep tx?
oral cefuroxime
81
Blistering distal dactylitis most commonly caused by
strep pyogenes more than staph aureus
82
Blistering distal dactylitis most commonly affects who? Presents as?
children. Presents as dark patch of skin that progresses to bulla
83
Scarlet fever presents as
sore throat, purulent pharyngitis, high fevers, then sandpaper rahs
84
Pastia lines
Linear petechiae in flexures of scarlet strep fever
85
what percentage of strep throat patients develop scarlet fever?
10%
86
Strep toxic shock due to steph M type 1 and 3 that produce
SPE A, B, and C
87
cellulitis common cause
strep pyogenes
88
Necrotizing fasciitis in children most commonly caused by
strep M type 1 and 3 (same type that causes streph toxic shock)
89
Necrotizing fasciitis in adults most commonly caused by
polymicrobial (steph, staph, ecoli, clostridium, bacteroides)
90
Corynebacteria is what type of bacteria?
Gram positive filamentous rod
91
Erythrasma fluoresces red because of
coproporphyrin 3 production
92
Erythrasma tx?
Topical clindamycin/erythromycin, 2% aluminum chloride
93
Erythrasma caused by
cornebacteria minutissimum
94
Pitted keratolysis caused by. Affects what part of the feet?
Kytococcus sedentarius. Affects weiht bearing areas of plantar skin
95
Trichomycosis axillaris caused by
corynebacterium tenuis
96
Clostridium is what type of bacteria?
Spore forming Gram positive rod
97
Skin with crepitus and foul-smelling brown exudate. Thick of
clostridium skin infection
98
Clostridium has what 2 toxins?
alpha toxin (cleaves lipids) and perfringolysin (induced vascular clots)
99
Actinomyces israelii is what type of bacteria? Found where?
Non acid fast filamentous bacteria. Found in mouth
100
Nocardia brasiliensis is what type of bacteria? Found where?
Weekly acid fast filatemntou sbacteria. Found in soil.
101
Numbe one cause of mycetomas in USA? In south america?
In us, it's tru fungi. In south america, it's nocardia brasiliensis
102
Cutaneous anthrax treatment?
quinolone or doxycyline x 2 weeks
103
Anthrax lethal toxin incrased levels of what?
Increases level of TNF alpha
104
Anthrax edema toxin incrased levels of what?
cAMP
105
Erysipeloid typically affects what part of the hand?
Affect finger webspaces w/ sparing of terminal phalanges
106
Erysipeloid cause? tx?
Ersipelothix rhusiopathiae (gram pos rod) penicllin, ciprofloxacin
107
Listeria tx in a penicillin allergic patient?
bactrim. If not allergic, then ampicillin
108
Treatment for ecthyma gangrenosum?
IV aminoglycoside and antipseudomonal PCN. PO cipro or levo
109
Bacillary angiomatosis caused by
bartonella henselae or quintana
110
Bacillary angiomatosis: histology?
pyogenic granuloma plus neutrophilic infiltrate and bacteria in endothelial cells seen with Warthin Starry stain
111
Bartonella is what type of bacteria?
Intracellular gram negative bacteria
112
what does bartonella look like on warthin-starry stain?
bartonell organisms are black and the background is gold
113
Rickettsia are what type of bacteria? What type of cells do they live in?
Obligate intracellular gram negative organisms. Live in endothelial cells
114
Ricketsial disease that have bad prognosis, and good prognosis?
Bad: RMSF, epidemic typhus Good: endemic typhus, tickettsial pox
115
Ricketsial disease usally have an eschar at inoculation site except for
RMSF and typhus group(r thyphi and r prowazekii)
116
Tx for meningococcemia?
Ivpenicillin, quinolones (if pencillin allergic)
117
meningococcemia prophylaxis for close contacts?
ciprofloxacin 500mg single dose (250mg if child less than 11) OR rifampin 600mg
118
Bartonellosis is caused by? Tx in acute phase (oroya fever)? In chronic phase (verruga peruana)
Bartonella bacilliformis. Tx is chloramphenicol and beta lactam. Chronic: Rifampin and streptomycin
119
Bartonella henselae transmitted by what vector?
Ctenocephalides felis (cat flea)
120
Cat scratch tx?
Supportive care if mild, if severe, then doxy plus rifampin
121
Bacillary angiomatosis Tx?
Erythromycin
122
Who gets trench fever? What bacteria? What vector?
Bartonella quintana, Human body louse, homeless and poor
123
Vector for RMSF (2)
Dermacentor variabilis (eastern US) and Dermacentor andersoni (western)
124
RMSF treatment for adults, kids, pregnant women?
Doxy for adults and children. Chlorampheniol is the treatment of choise of pregnant women
125
Rickettsial pox caused by what bacteria? What vector? Tx?
Rickettsia akari, house mite (liponyssoides sanguineus), non required, self-resolves
126
Scrub Typus caused by what bacteria? What vector? Tx?
Oreintia tsusugamushi. Larval mites (chiggers), doxycyline. Seen in asia
127
Human monocytic whrlichoiosis transmitted by what vector?
Amblyomma americanum (lone start tick)
128
Epidemic typhus aused by what bacteria? What vector? Tx?
Rickettsia prowazekii. Human body louse. Doxycyline
129
Glanders caused by what bacteria. What tx?
burkholderia mallei in horses or donkeys. Augmentin for 60 days
130
Malakoplakia is what?
chronic grannulomatous infectoin as a result of inability of macrophages to kill phagocytosed Ecoli
131
what patients get malakoplakia?
Immunosuppressed (BMT, HIV, AIDs)
132
Where on the body do you see malakoplakia?
perianal genital (ulcerated abscesses). Most common affects GU tract
133
Michaelis Gutmann body seen in ?
Malakoplakia. The are incompletely killed bacteria wihtin calcified phagolysosomes
134
Malakoplakia tx?
surgical excision
135
tularemia tx?
streptomycin (sherry owns bunnies)
136
Hinfluenze cellulitis blood cultures pos or neg?
positive
137
Rhinoscleroma d/t
inhalation of klebsilla rhinoscleromatis from torpical location
138
Mikuliz cells are seen in ?
Rhinoscleroma. Large vacuolated histiocytes containing bacteria
139
Tx of rhinoscleroma?
tetracycline for 6 months along with surgical correction of airway
140
Vibrio tends to affect what type of patients?
people with liver disease and diabetes
141
Vibrio exposure risk?
Exposure to contaminated seawater/shellfish
142
Vibrio treatment?
doxycyline and third generation cephalosporin
143
Dog bite tx?
augmentin (amoxicillin clauvulanate)
144
borrelia burgdorferi transmitted by what vector?
Ixodes scapularis har dbody tick
145
borrelia lymphocytoma is a sign of early local or early disseminated disease?
result of hematogenous spread of spirochetes if the initial phase is untreated
146
borrelia lymphocytoma typiccally presents as? In children? In adults?
plum-colored tender nodule/plaques on the earlobbes in children and nipple/adults
147
Early disseminated symptoms of lyme disease include?
arthritis of the knees, bells palsy, av block
148
lyme disease co-infection?
babesiosis, hga (human granulocyic anaplasmosis)
149
borrelia lymphocytoma and acrodermatitis chronica atrophicans classically caused by?
Borrelia afzelli
150
Vitiligo like lesion over bony prominences?
treponemal pallidum carateum, which affects all ages
151
Syphilis stages?
primary is 1 month, secondary is month 2-4, latency, tertiary 2 years
152
Syphilis tx?
IM benzathine penacillin (2.4IU for up to latent disease, 7.2 for tertiary syphilic. Neurosyphilis is IV penicillin G
153
most common form of cutaneous TB is? Occurs in patient who have immunity to TB?
tuberculosis verruc cutis. Occus in patients w previous infectoin w high immunity
154
high immunity or low immunity: lupus vulgaris
high immunity contiguous spread or hematogenous/lymphatic
155
high immunity or low immunity: scrofuloderma
low immunity, contiguous spread of infection to skinf rom underlying lymph nodes an dbones
156
high immunity or low immunity: orificial tuberculosis
autoinoculation of mucosa/skin
157
high immunity or low immunity: acute miliary tuberculosis
immunosupressed
158
tx for TB?
RIPE. Rifampin, isoniazid, pyrazinamide, ethambutol. RIPE for 2 months, then RI for 4 months
159
Chancroid organism. Giemsa stain
Hemophilius ducreyi. School of fish sign on giemsa stain of exudate smear
160
Chancroid presentation:
Ragged painful ulcer with undermined borders. Kissing lesion. Painful lymphadenitis
161
Chancroid tx:
Axithromycin 1g po x 1 dose
162
Gonorrhea organism. Culture medium
Neisseria gonorrhoeae. Thayer Martin media
163
Gonorrhea presentation:
Hemorrhagiv aral pustuels w arthritis of larger joints
164
Gonorrhea tx:
Axithromycin 1g po AND ceftriazine 250mg IM
165
Lymphogranuloma venereum organism. Giemsa Stain?
Chlamydia trachomatis L1-L3. Gamma Favre bodies
166
Lymphogranuloma venereum presentation
about 1 -6 months after infection, get buboes above and below inguinal ligament with groove sign
167
Lymphogranuloma venereum tx
Doxycyline 100mg PO BID for 3 weeks
168
What is a complication of lymphogrnauloma venereum if untreated?
proctocolitis w perirectal absceses fistula
169
Granuloma inguinale organism. Geimsa stain?
Klebsiella granulomatis. Safety in Donovan bodies
170
Granuloma inguinale Presentation
2 week after infection, painless ulcer with beefy red friable grnaulation tissue
171
Granuloma inguinale tx?
Azithromycin 1gm PO once weekly until lesions have resolved
172
Tuberculoid leprosy clinical presentation?
Dry scaly hypopigmented and anesthetic plaques with raised peripheral rim
173
Absent sensation in lesions is more lepromatous or tuberculoid leprosy?
tuberculoid
174
Cell-mediated immunity in leprosy? LL and TT
LL is Th2, TT is Th1
175
LL cytokin mileu?
IL4, IL5, Il10, IFN beta
176
TT cytokin mileu?
IL2, INF gamma
177
How does AFB stain differ in LL and TT?
stains positive in LL and negative in TT
178
mycobacteria leprae parasitize what cells?
marcophages and schwann cells
179
can leprosy be cultured in vitro?
no, must be cultivated in mouse foot pads or in armadillos
180
Do leprosy patients change between LL, BL, BB, BT and TT?
polar forms (LL or TT) are stable and do not change. Borderline forms are unstable
181
type 1 reversal reaction
Th1. downgrading or upgrading. Present with ulceration of existing lesions and preferntila targeitn go nerves resulting in dangerous neuritis
182
highest risk for type 1 reveral reaction?
broderline forms.
183
type 1 reversal reaction treatment
prednisone
184
Type 2 reversal reaction
Th2. immune complexes form EN like lesions, resulting in multisystem vasculitis and EN like lesoins in previously unaffected areas
185
Type 2 reversal reaction preferred areas of body?
extensor forearms and medial thighs
186
Type 2 reversal reaction highes risk?
LL and BL forms
187
Type 2 reversal reaction tx
thalidomide
188
Tx for leprosy?
rifampin 600mg montly, clofazimine 300mg once a day and dapsone 100mg daily
189
M marinum grows best at
31 degrees celsius
190
Mycobacteria rapid grow are which ones? Rapid growers grow within
3-5 days. Fortuitum, chelonae, abscessus
191
Tx for mycobacteria?
clarithromycin
192
black dot is endothrix or ectothris?
Endothrix
193
Endothrix mnemonic
Inside: Yaomings tonsil were red and gouged by a violent sudanese. (rubrum, tonsurans, yaounde, violaceum, gourvilli, soudanese)
194
Ectothrix mnemonic
outisde: Cats and dogs fight and growl sometimes. Canis, audouinii, distorum, ferrugineum, gypsum, schoenleinii
195
Favus
T schoenleinii. Like a flattened French toast
196
Kerion
Exuberant reactions to fungus. Boggy scalp. Zoophilic organisms. Mcanis dog, T verrucosum cattle, T mentag rodents
197
Tinea faceii common organisms?
M canis, T metag (dogs and rodents)
198
Proximal white subungal and distal subungal onychomycosis
T rubrum
199
White superficial onychomycosis
T mentagrophytes (adults) T rubrum in children
200
uncommon cause of white superifical onychomycosis
fusarium
201
Anthropophilic dermatophytes include which ones
All trichophyton (except mentagrophytes and verrucosum), E floccosum, M. audouinii
202
Zoophilic dermatophtes include?
M canis, T metag (dogs and rodents) M nanum (pigs), T verrucosum (cattle)
203
how do dermatophytes stain on histology? PAS, Giemsa
red in PAS and black on GMS
204
Tinea cruris vs candidiasis, which spares the scrotum?
Tinea cruris
205
Erosive interdigitalis blastomycetia affects which fingers? What sthe cultprit?
between middle and ring fingers. Candida vs 4th and 5th fingers for dermatophytes
206
black piedra and white piedra organism
black is piedra hortae, white is trichosporon ovoides (scalp) T inkin (pubic) T asahii (immunocompromised)
207
white/black piedra. Hard/soft. Mobile or not?
white is soft mobile. Black is hard non mobile.
208
how do ppl with white/back piedra present?
hair breakage in scalp, axilla and pubic region
209
Sporotrichosis is a ubiquitous saprophyte from what plants?
rose thorns, wod splinters, spagnum moss
210
Sporotrichosis tx?
itraconazole
211
Black grain mycetoma is
eumycetoma (fungus) madurella or pseudallescheria spp.
212
Red grain mycetoma is
actinomycetoma (actinomadura pelletieri)
213
Chromomycosis aka Chromoblastomycoses organism. Microscopy.
Fonseca pedrosoi. Copper pennies
214
Chromoblastomycoses exposure?
traumatic inoculation by thorns or splinters
215
Chromoblastomycoses sequele?
SCC
216
Tx for histo, blasto, coccidio, paracoccidio?
Itraconazole.
217
What candida is resistant to fluconazole?
C glabrata, C krusei
218
two most common candida?
C albican, C tropicalis
219
ccryptococcus tx
fluconasole for mild disease, amphotericin b for CNS meningoencephalitis
220
aspergillous primary cutanous vs secondary organisms?
a flavus primary via iv cath a fumigatus via inhallation in immunosuppressed
221
most common fungus cultures in burn patients?
fusarium
222
aspergillous and fusariusm septate or nonseptate?
septate
223
mucormycosis tx
amphotericin b
224
protothecosis is not a fungus but a ? Exposure? Clincial presenation
algae from contaminated water. Olecranon bursitis
225
Rhinosporidiosis is not a fungus but a ? Exposure?
protozoa from contaminated water.
226
Rhinosporidiosis clinical presentation?
looks a PG in the nose or eye. With Epistaxis
227
where to look for head lice?
occipital and post-auricular
228
body louse is vector for
trench fever (B quintana), louse-borne relapsing fever (b recurrentis), epidemic typhus (R prowazekii)
229
Leishmaniasis tx for cutaneous and mucocutaneous?
pentavalent antimony
230
Leishmaniasis tx for visceral lesihmaniasis?
amphotericin b
231
Leishmaniasis vector? Which is new world, old world?
sandfly (new world lutzomyia), old world is (lphebotomus)
232
Leishmaniasis culture medium
NNN. Novy McNeal Nicolle
233
Kinetoplasts in ?
Leishmaniasis
234
Trypanosomiasis vector?
TseTse fly
235
African trypanosomiasis Tx
Pentamidine (SNAP)
236
South american trypanosomiasis Tx
Nifurtimox (SNAP)
237
Ancylostoma brasiliense causes
cutaneous larva migrans
238
Stronglycoides stercoralis
Larva currens
239
Onchocerciasis River blindness vector?
balck fly aka simulium fly
240
Onchocerciasis tx?
ivermectin and excision of onchocercomas
241
Filariasis cause
Wuchereria bancrofti
242
Filariasis presentation?
lymphedema
243
swimmer's itch
schistosoma fresh water uncovered skin
244
seabather
salt water, edwardsiella, linuche, covered skin
245
bed bugs species name
cimex lectularius
246
bed bugs toxin?
nitrophorin
247
fire ants toxin?
solenopsin D
248
Bees toxin?
phospholipase A
249
cat flea is a vector for
bartonell henselae (cat scratch, BA), bartonella quintana (bacillary angiomatosis)
250
puss caterpillar rash
linear petechiae. Super hairy catepriller
251
summer penile syndrome in boys
chigger mites (trombicula alfreddugesi)
252
black widow spider
alpha lactotoxin
253
brown recluse spider
sphingomyelinase d. dangerous because pt can hav ehemolytic anemia, shock and death
254
jumping spider (4 eyes)
hyaluronidase
255
wolf spider (8 eyes)
histamine
256
sac spider (albino spider)
hilipase
257
centipede bite. What does it look like. How many legs per segment?
one pair of leg per segment, two punture wounds
258
milipede bite. What does it look like. How many legs per segment?
two pairs of legs per segment. Chemical irritant dermatitis. Burn and blistering
