Pinworms

Question 1

pinworms is an intestinal infection with ___________

Answer 1

enterobius vermicularis

Question 2

enterobius vermicularis is a

Answer 2

parasitic helminth

Question 3

what is the msot comon helminth infection in Canada

Answer 3

pinworms

Question 4

on average, how many pinworms does an infected person have

Answer 4

severe to several hundreds

Question 5

pinworms are most common in children ______ and uncommon ______

Answer 5

5-14yrs
uncommon <2yrs

Question 6

which of the following is false
1. there is a higher incidence of pinworms in crowded living conditions
2. 1/3 canadian children will develop pinworms in childhood
3. pinworms are most commonly found in children <2yrs
4. an adult female worm is 2-5mm long
5. 3 and 4

Answer 6

5

Question 7

describe the 5 steps of pinworm transmission

Answer 7

Eggs deposited in perianal folds
Infected individual scratches around the anus and touches another person or object
Uninfected person puts contaminated hand/ object into mouth and swallows eggs
Larvae hatch in small intestine and adults reside in colon
At night, female worm migrates to perianal region to lay eggs

Question 8

what is the most common sx of pinworms + other sx?

Answer 8

pruritus ani - esp at night
disrupted sleep, restlessness and irritability
loss of appetite

Question 9

what are some complications of pinworms

Answer 9

Generally just a nuisance but may spread to other organs = infection, appendicitis, other related complications
Migration to vaginal area = irritation, discharge, urinary incontinence
Severe perianal scratching may lead to bacterial infections

Question 10

2 diagnostics for pinworms

Answer 10

flashlight test
scotch tape test

Question 11

how would you do the flashlight test

Answer 11

may see thread like worm at night with flashlight
Can place worms in alcohol or vinegar and bring to clinic for confirmation

Question 12

how would you perform the scotch tape test

Answer 12

Perform at home in the morning before defecation or showering
Piece of transparent adhesive tape pressed on perianal skin- then stuck to a slide to be examined under microscope
May have to repeat several times
1 examination will confirm diagnosis in 50% of cases, 3 exams = 90%, 5 exams = 99%

Question 13

what education should you provide parents about pinworms

Answer 13

not caused by uncleanliness
best to avoid prophylactic tx
treat everyone in the household >2yrs

Question 14

list 3 nonpharm ways to treat pinworms

Answer 14

Meticulous hand washing after defecation and before eating
Keep fingernails cut short + discourage scratching
Change underwear, pajamas, and bed linens daily
Wash underwear, pajamas, and hand towels daily in hot water for 2 weeks
Shower in the morning so eggs laid the previous night will be washed away
Frequent washing of toilet seat
Clean the floors and vacuum all areas of bedroom

Question 15

pts may use a _______ to relieve itching from pinworms

Answer 15

zinc oxide preparation

Question 16

what are 2 pharm tx for pinworms

Answer 16

pyrantel pamoate
mebendazole

Question 17

combatrin
- cure rate: __________
- single dose of _________ and repeat in _______

Answer 17

90-100%
11mg/kg (max 1g) and repeat in 2 wks

Question 18

pyrantel pamoate MOA

Answer 18

Paralyzes adult worm = prevents from attaching to GI wall

Question 19

when using combatrin, exercise caution with
1. liver dysfunction
2 .blood disorders
3. SJS
4. none of the above

Answer 19

1

Question 20

combatrin has _________ systemic absorption

Answer 20

little

Question 21

mebendazole cure rate

Answer 21

100%

Question 22

mebendazole is a single dose of _________ in ________ and repeat in ____________

Answer 22

100mg in adults and children =>2yrs
repeat in 2 wks

Question 23

MOA of mebendazole

Answer 23

inhibits worm glucose absorption

Question 24

mebendazole SEs

Answer 24

GI (N/V/D)
rare: derm (SJS), blood dyscrasias

Question 25

pinworm medication only kills ________, leaving ________ unaffected

Answer 25

adult worms
eggs and larvae

Question 26

pinworm ova floating in air can cause reinfection for ___

Answer 26

2wks

Question 27

why is it important to retreat for pinworms after 2 wks

Answer 27

cause the meds only kill adult worms- not eggs and larvae

Question 28

for pinworm tx in pregnancy
1. should be avoided in first trimester
2. should be avoided if pt asymptomatic as it will not cause harm to mother or child
3. should treat if symptomatic and natural cure unlikely
4. should treat if symptomatic with combatrin or mebendazole in 2nd trimester or later
5. all of the following is true

Answer 28

5

Question 29

itching from pinworms should resolve in _______ of starting treatment. if not, _________

Answer 29

7-14 days
repeat tx

Question 30

if itching from pinworms doesn’t resolve within ______ of 2nd course = refer

Answer 30

7 days

Question 31

why is there a very high likelihood of being reinfected with pinworms

Answer 31

Scratching
Not properly washing of hands after scratching or using washroom
Exposure to infected soils, dust, clothing, etc
Meds only kill adult worms