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Session 2 CM derm12
CM- Derm -12- Insect BItes and infestations
| Question | Answer |
|---|---|
| What are two methods that bugs cause cutaneous response | they inject toxin or enzyme that direct inures tissue or produce a venom that contain inflammatory mediators |
| Who tneds to react more severely to toxins and superficial irritants and get secondary infection easier from scratching | children |
| What age group react more severely to toxic venom but are less likely to develop hypersensitvity reactions | the elderly |
| What is the problem with bug bites and the immunocompromised and or debilitated patients | they react more extensively and extremely to toxins and venoms |
| Common lesion caused by bug bite or stings | a discrete erythematous papule or wheal with central punctum could turn into hemorrhagic vesicobullous response |
| Where are you most likely to see flying insect bites | on exposed surfaces |
| Where can you see crawling insect bites | localized under clothing or areas of skin in contact with the ground |
| Classic sign of this insect is a burrow that tend to involve fingerwebs wrists axillary folds and genitalia | scabies |
| Apart from the burrow what else will you see with scabies | erythematous, excoriated papuples or papulovesicles with severe itching especially at night |
| Dx for scabies | skin shaving for mite, egg and feces |
| how contagious are mites(scabies) | extremely contagious |
| What is the Tx for scabies | elamite, eurax or oral invermectin |
| How long can patient continue to have itching even after treatment and what does that mean | they can continue to have itching for 3 weeks after treatment don't retreat unless they have reinfected them selves |
| What is the treatment for scabies that has been banned in california and is only approved by FDA for second line use | Kwell (lindane) |
| What type of scabies presents a big problem in immunocompromised individuals where you get widespread scaling with itching. Generally infected with millions of mites as opposed to 11 on normal patient | norwegian scabies |
| redbug or harvest mite bite show papulovesicle with central hemorrhagic punctum pruritic usually around the beltline, socks or on buttocks and thigh | chigger bites |
| do chiggers burrow | no make sure patient doesn't scratch or dig trying to get them out |
| What is tx for chiggers | treat the pruritis |
| What is the bite pattern for ticks | erythematous papule or wheal with a central punctum |
| Disease transmitted by ticks with 2 stages | lyme disease |
| what is the 1st stage of lymes disease | s/s include a rash with an evolving annular erythema, fatigue, flu like symptoms, and pain |
| What is the 2nd stage of lymes disease | numbness and pain in arms and legs, meningitis, unilateral facial paralysis |
| What is the tx for lymes disease | Abs |
| disease transmitted by ticks most cases in eastern US characterized by prodromal headache, malaise, anorexia, photophobia, chills, fever, arthralgia, and myalgia | Rocky Mountain Spotted fever |
| What are the S/sx of rocky mountain fever that appear after prodromal symptoms | fever, rash and hx of tick bite rash starts on cooler portions of body as macular and blanches then rash becomes petechial or purpuric |
| What is the Tx for rocky mountain spotted fever | Abs and supportive care |
| What are the three types of pediculosis | head, body and pubic lice |
| How do you dx pediculosis | you will see the lice, nits on hair shafts, Head lice will often have excoriated papuples on scalp |
| What is the Tx for pediculosis | Nix, Rid or any pyrethrins treatment Rx- ovide usually only for recalcitrant infestations |
| What is the second line treatment for pediculosis | kwell shampoo |
| Typically cuase papules or wheals with central punctum secondary infection and excoriation are common can be vector or bubonic/pneumonic plague | FLEAS |
| most notice blood on bedding or night clothing and grouped wheals with a central purpuric punctum on distal extremities face or upper chest | Bed Bugs |
| What do you note if you crush a bed bug | a distinctive unpleasant order |
| What is the Tx for bedbugs | antihistamines for itching |
| How does a fire ant bite present | generally devopls into a urticarial papule with a hemorrhagic punctum this may develop into a vesicopustule that may become necrotic. Very painful with burning and itching |
| what is the tx for fire ant bites | use potent steroid gel on individual lesions and stronger sytsemic medication if generalized s/s |
| What is the positive to fire ant bites | rarely get urticaria, erythema multifrome or anaphylaxis |
| What is the problem with bee stings how do they present | they can cause anaphylaxis and present with localized pain, edema and erythema |
| what is the tx for bee stings | use ice or for more severe pain use oral prednisone |
| Most common cause of pruritis ani dx by ova or worm specimen in stool very common in children | pinworms |
| what is the tx for pinworms | one dose of vermox or use antepar |
| A cutaneous disorder characterized by migratory linear or serpiginous lesions that cause bizarre patterns | Creeping eruption larva migrans |
| What causes serpiginous pattern in creeping eruptions | caused by migration of larvae of helminths or flies usually hookworm |
| What is the Tx for larva migrans | oral thiabendazole but only with extensive infestations |
| venom is a potent neurotoxin composed of proteins, lipids, and carbohydrates affects sympathetic and parasympathetic nerves | black widow |
| What are the s/sx of black widow bite | sharp pinprick sensation followed by localized cramping, edema, weakness, diaphoresis, generalized muscle cramping, fever, paralysis. May have erythema or erythema nodosum |
| What is the untreated mortality rate in children with black widow bites | 50% |
| Has dermatotoxic venom sphingomyelinase D | Brown Recluse |
| What are the clincal outcome from a brown recluse bite | range from inconsequential cutaneous rxns to full skin thickness necrosis but rarely death |
| what are the s/sx of brown recluse bite | swelling, erythema, purpura with stinging. Characteristic trizonal response with a central blue gray area due to thrombosis |
| what is the major problem with mosquitoes | there action as a vector for disease not necessarily any problem their bite may cause |
Created by:
smaxsmith
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