Skin Infestations

Question 1

What is the medical term for lice?

Answer 1

Pediculosis

Question 2

How is lice spread?

Answer 2

Head to head contact (they can’t fly or jump); often at class/daycare

Question 3

Where is lice usually found on the body?

Answer 3

Head - behind the ears, nape of the neck, and hairline (but it can technically be found in any hair)

Question 4

What is the treatment for lice? When can a child return to school?

Answer 4

-Permethrin 1% cream (apply to scalp, leave on for 10 min; may need to repeat in 1 week) -Leave location where lice are for 24 hours if possible (lice can’t survive >24 hrs off host head) -Can also use Elimite, Nix -Can return to school after treatment

Question 5

What is the causative agent of scabies? What are the two types of scabies?

Answer 5

Sarcoptes scabieie, a burrowing mite that gets under the skin and lays egg, which hatch in 2-4 days Two types: Noncrusted (common) and Crusted/Norweigen

Question 6

How is scabies transmitted?

Answer 6

Skin-to-skin contact; typically by people living in close quarters with many other people, indigent populations, institutionalization; can also be immunosuppressed/poor hygiene

Question 7

Describe physical findings of scabies

Answer 7

-burrows seen in interdigital web space -papules/nodules -itching gets worse at night -Crusted will have thick, crusted lesions with thousand sod mites

Question 8

How would you treat scabies?

Answer 8

-wash clothes/bedding in hot water the day after treatment -bag everything that can’t be washed for 1 week -Permethrin 5% cream; apply from neck down, wash after 8-14 hrs (may need to repeat after 2 weeks) -Crusted: add Ivermectin

Question 9

What is this condition?

Answer 9

Lice (pediculosis)

Eggs are white, mites are black

Question 10

What is this condition?

Answer 10

Scabies

Question 11

What is this?

How is the difinitive diagnosis made?

Answer 11

Black Widow bite

Definitive diagnosis is made IF: the spider is seen biting the patient AND the spider is caught

Question 12

What complications may occur from a Black Widow Spider bite?

What follow up may be needed

Answer 12

Tx:

Consider need for antivenom

Complication: possibility for secondary infection

Follow up: consider referal for alergy testing in anaphalaxis

Question 13

True or false:

Black Widow Bites cause tissue necrosis

Answer 13

False

Tissue Necrosis may occur with brown recluse bites

Question 14

True or False:

This bite leads to HTN, n/v, SOB, and tachycardia

Answer 14

False

HTN, SOB, n/v and tachycardia may occur with Black widow spider bites, this is a bite from a brown recluse

Question 15

What is this mark called, what does it indicate?

Answer 15

This is an Erythema Migrans

and is indicitive of Lyme disease

Reminder: this may not always appear perfectly targetoid

Question 16

A patient presents with a wood tick imbeded in his skin that he wants removed. The patient had been hiking/camping and the tick has been imbeded in his skin for a few days…he thinks….

Should you test for Lyme Disease?

Why or why not?

And what is the actuall infectious agent transmited by the tic that causes Lyme disease?

Answer 16

No testing for lyme needed based on given information

Lyme disease is transmitted by Ixodes scapularis ( a.k.a deer, bear, or black leged tick) not wood ticks

Infection is caused by Borrelia burgdorferi

Question 17

You have screened a patient for Lyme disease, he suspected his exposure was 5-7 days ago. The test came back negative.

This patient is good to go! True or False

and why

Answer 17

False.

Lyme screen is not 100% sensitive and will produce a false negative if tested too early; recheck 2 weeks

Question 18

1: Tx for a patient exposed to Lyme disease (tick had been

   imbeded 36 hours...probably) presenting within 3 days of exposure. 

2: Tx for sympotmatic patient?

Answer 18

1: Doxycycline 200mg PO q day x 1 day
2: Doxycycline 100mg bid 14 days

Question 19

follow up/possible complications of Lyme disease?

Answer 19

Arthritic, cardiac, neurological

Question 20

Your patient has Lyme disease, is symptomatc and has an allergy to tetracycline abx so Doxy is off the table…now what do you do?

Answer 20

Amoxicillin 500mg tid x 14 d

or

Cefuroxime 500 mg bid x 14 d