Snake/Arthropods/marine

Question 1

40 year old male, sleeping on ground, wakes in night with chest pain, SOB and abdo pain, by morning paralysis. ∆?

Answer 1

Nocturnal paralytic krait bite (Bungarus)

Question 2

2 main snake families

Answer 2

Viperidae - vipers, adders, moccasins, rattlesnakes, pit vipers - short thick body, short tail, slow movement, sharp movement

Elapidae - cobras, kraits, mambas, corals, venomous sea snakes - relatively long thin body, long- tail, uniformly coloured (except corals), some spread hood, fast

Question 3

minor families of snakes?

Answer 3

Atractaspididae - burrowing asps
Colubridae - most common - non front fanged

Question 4

4 main families of protein/polypeptide in venom?

Answer 4

*Phospholipases A2
* Metalloproteases
* Serine proteases
* Three-finger toxins (neuro, cyto)

Question 5

Clinical effects of envenoming?

Answer 5

Cytotoxicity - local effects
Haemotoxicity
Neurotoxicity
CVS toxicity
Renal toxicity
Myotoxicity

Question 6

Common snakes causing cytotoxicity?

Answer 6

cobras, vipers, burrowing
asps

Question 7

Common snakes causing haemotoxicity?

Answer 7

vipers, Oceanian elapids,
a few colubrids

Question 8

Common causes of haematotoxicity?

Answer 8

Elapids, some vipers

Question 9

Hypovolaemic shock and myocardial toxicity - which snake?

Answer 9

Vipers

Question 10

Most likely to cause rhabdo?

Answer 10

Sea snakes

Question 11

First aid for snake bite?

Answer 11

Pressure pad immobilisation over site of venom depot

Question 12

Key priniciples in management snake bite?

Answer 12

observation for 24 hrs
Assess and resuscitate
Toxoid
Antivenom IV
Treat bitten limb

Question 13

Different types of antivenom?

Answer 13

*Polyspecific antivenoms: raised against venoms of the species of greatest medical importance in that region
*Monospecific antivenoms: raised against the venom of one species

Question 14

Indications for antivenom?

Answer 14

Organ failure
Local swelling

Question 15

What to give before antivenom?

Answer 15

Prophylactic small dose of adrenaline

Question 16

Biggest problem with antivenom?

Answer 16

Anapylaxis
Late serum-sickness-type reactions

Question 17

Another symptomatic Rx for snake bite?

Answer 17

Anticholinesterase (give with antimuscarininic)

Question 18

Prevention of snake bites?

Answer 18

wearing protective footwear, using a light after dark,
sleeping off the ground or under a mosquito net

Question 19

When do you repeat a dose of antivenom?

Answer 19

failure of restoration of blood coagulability after 6 h, or progression of other signs of envenoming

Question 20

What to consider for bitten limb?

Answer 20

surgical debridement. antibiotics
Signs of compartment syndrome may be
misleading; fasciotomy is rarely justified.

Question 21

Bite from a viperidae?

Answer 21

Viperidae (vipers, adders, and pit vipers—rattlesnakes, moccasins, lanceheads)
can cause severe local swelling, bruising, blistering, and necrosis together with
shock, coagulopathy, spontaneous systemic bleeding, acute kidney injury, and, in a few species, neuromyotoxicity

Question 22

Bite from an elapidae?

Answer 22

Elapidae (cobras, kraits, mambas, coral snakes, Australian snakes, and sea
snakes) can cause descending flaccid paralysis, starting with bilateral ptosis and
progressing to bulbar and respiratory paralysis. Some elapid venoms cause local
necrosis (cobras), rhabdomyolysis (sea-snakes) and haemostatic disturbances
(Austro-Oceanian elapids)

Question 23

Bite that causes intense local pain, likely bitten by what?

Answer 23

Scorpion

Question 24

What happens physiologically following sting from scorpion?

Answer 24

1. parasympathetic - salivating, lacrimating, vomiting
2. sympthathetic - sweating, myocarditis and HR BP up
3. Neurotoxic effects - spasms, fasciculation’s

Question 25

What is this?

Answer 25

Loxosceles bite

Question 26

Pattern of disease loxosceles bite

Answer 26

Initial local pain and swelling but develop slowly! Red/white/blue sign Systemic symptoms Local necrosis and black ulcer Rarely progress to fever, jaundice, haemolytic anaemia

Question 27

Neurotoxic araneism what is pathopneumonic?

Answer 27

Local swelling, erythema, sweating, paraesthesia, fasciculations - AT SITE OF BITE PROGRESSES TO Tachycardia, hypertension, agitation, vomiting, salivation

Question 28

Which spider causes truisms?

Answer 28

Black widow (Latrodectus indistinctus) bites

Question 29

Most toxic spiders in world?

Answer 29

Australian funnel web - Atrax, Hadronyche Cause autonomic storm

Question 30

Neurotoxic araneism caused by?

Answer 30

black and brown widow spiders (Latrodectus), Latin American banana spiders (Phoneutria), and Sydney/Australian funnel-web spiders (Atrax, Hadronyche)

Question 31

2 broad syndromes of spiders

Answer 31

Neurotoxic and necrotoxic

Question 32

Management of marine stings with fish, sea urchin or jelly fish?

Answer 32

Immerse stung part in hot, not scalding, water! (<45) water

Question 33

Jellyfish sting - how do you know it is a jelly fish?

Answer 33

Local: intense pain, wheals (diagnostic patterns), swelling, erythema, vesiculation, necrosis, scarring

Question 34

Fish stings and sea urchins cause?

Answer 34

Local effects only

Question 35

Difference in timing of seafood poisoning?

Answer 35

Onset in 1-120 mins: scombroid Onset 10-180 mins: puffer fish 30-180 mins: shellfish 60 min - 24 hrs: ciguatera

Question 36

Nausea, vomiting, abdo pain with change in temperature in limbs and on drinking, paraesthesia. ∆? What causes the pathology?

Answer 36

Ciguatera fish poisoning Sodium channel blockage

Question 37

Commonest cause of non bacterial fish poisoning? Toxin?

Answer 37

Ciguatera Ciguatoxins

Question 38

Which fish cause ciguatera?

Answer 38

Reef fish High risk: moray eel, parrot fish, trigger fish

Question 39

Which fish do scombroid come from?

Answer 39

Mackerel, yellow fin tuna

Question 40

Immediate symptom of scombroid?

Answer 40

Periorbital tingling

Question 41

Cause of scombroid?

Answer 41

Histamine release - cause metabolism of histidine to histamine due to bacteria in the fish.Cooking fish does not prevent it.

Question 42

Deadliest fish toxin? How does it present?

Answer 42

Puffer fish tetrodotoxin - FUGU poisoning Generalised rapidly progressing paralysis

Question 43

Symptoms of scombroid?

Answer 43

vomiting and diarrhoea, pruritus, urticaria, throbbing headache, bronchospasm, burning throat, angioedema, facial swelling,

Question 44

Spectrum of shellfish poisoning?

Answer 44

Paralytic, amnesic, neurotoxic, diarrhoeal Neurotoxic and paralytic forms come from dinoflagellates from 'red tide'

Question 45

Management of ciguatera poisoning?

Answer 45

IV mannitol

Question 46

Management of scombroid poisoning?

Answer 46

antihistamines and adrenaline

Question 47

Management of paralytic shellfish poisoning?

Answer 47

Supportive