Infections And Infestations Flashcards
(71 cards)
1
Q
What features do head lice have ? (3 points)
A
- claw on each of the 6 legs to cling firmly onto host skin and hair
- can survive without a host up to 3 days (55 hours)
- can survive underwater
2
Q
What is the life cycle of head lice?
A
2-3 weeks
3
Q
What are the limitations of head lice? (2 points)
A
- do not survive on household pets
- do not jump or fly from host to host
- prefer clean hair
4
Q
What are nits? (3 points)
A
- Greyish white oval Lice eggs.
- These are laid by the adult female
- hatch around 7-10 days
5
Q
Where are the nits attached? (2 points)
A
- on the hair shaft Around 0.5cm from the scalp
- cementing substance not easily dislodged keeps the nit in place
6
Q
What do nits >1cm from the scalp indicate?
A
Nits have most likely hatched
7
Q
What are the symptoms of head lice? (5 points)
A
Intense itchiness on the scalp and hair shaft
- behind the ears
- on the crown
- at the nape of neck
- facial hair elf, eyebrows, eyelashes
- scratching may lead to secondary bacterial infection
8
Q
How are headline detected? (2 points)
A
- lower the head over pale surface and comb the hair from root to tip. Conditioner may help
- life portions of hair around ears, crown or nape of neck to check for nits
9
Q
What are the differential diagnoses of head lice? (2 points)
A
- dandruff (white spears easily dislodged)
- dermatitis (itchy, but no nits present
10
Q
What are the general rules for head lice treatment? (7 points)
A
- use pediculicide to treat actual infestations (not for prophylaxis)
- check all family members
- follow directions carefully. Do not shorten the waiting time
- do not share articles that have come into contact with infected persons head, neck or shoulders
- wash brushes and combs in some pediculicide or very hot water.
- brush hair nightly (breaks female louses legs and prevents egg laying)
- wash clothes on hot wash
11
Q
What can be done with clothing or linen that cannot be washed? (In the treatment of head lice)
A
-dry clean, hot iron, or bag in plastic for a few days
12
Q
What are the different pediculicide treatments? (5 points)
A
- paraplus aerosol
- full marks mousse
- a lices shampoo
- parasidose lice repellant spray
- lice blaster
13
Q
What is paraplus aerosol? (3 points)
A
- 0.25% malathion, 0.5% permethrin, 2% piperonyl butoxide
- not heat resistant (do not blow dry), but chlorine resistant
- spray in short bursts over DRY hair until fully covered and leave for 10mins
14
Q
What is full marks mousse? (4 points)
A
- 0.5% phenothrin
- spray foam on hair and spread from root to tip. Dry. Leave for 30 min. Wash off with regular shampoo
- repeat in 7 days. Up to 3 applications
- not for children under 6 months
15
Q
What is A lices shampoo? (4 points)
A
- 1% malathion shampoo
- lather into wet hair and leave for at least 10 min
- repeat in 1 week
- also used to treat pubic lice
16
Q
What is parasidose lice repellant spray? (2 points)
A
- essential oils of eucalyptus, clove, palmarosa, lavender, mint, rose, citronella, ylangylang, geranium, pettigrain
- prevents lice infestation but based on weak evidence
17
Q
What is lice blaster? (4 points)
A
- contains herbs and essential oils
- natural preparation but weak evidence
- apply to dry hair and leave on for 20min. Rinse off with warm water
- repeat in 1 week
18
Q
What are the general advice for head lice shampoos? (6 points)
A
- avoid mucous membranes and eyes
- use at least 20ml depending on hair length
- shampoo into dry or damp scalp (only use a little water)
- Leave on for 10min and rinse off
- use fine toothed nit comb to remove nits
- soaking in 50/50 water/vinegar mix may help loosen glue holding the nits onto hair shaft
19
Q
When should head lice be referred?
A
-when Secondary infection is present (weeping, swollen glands)
20
Q
What are head lice?
A
Small wingless insects that feed on human blood
Ectoparasites
21
Q
What is threadworms also known as? (2 points)
A
- pin worm
- enterobios vernicularis
22
Q
What is the prevalence of threadworms in NZ?
A
-accounts for 95% of human worm infestations
23
Q
What is a threadworm?
A
-intestinal parasite passed on to humans when eggs are swallowed unknowingly
24
Q
What is the life cycle of a threadworm? (5 points)
A
- egg hatches out of duodenum
- larvae pass into large intestine and grow into threadworms
- adult female moves down the gut to anus to lay eggs
- the glue sticking the eggs to the anus irritates the host causing scratching
- eggs will stick onto fingernails and be transferred to mouth, other people, food, furniture, etc.
25
What are the signs and symptoms of threadworms? (4 points)
- sometimes asymptomatic
- usually itching around anus at night
- white cotton pieces (5-10mm) wriggling around anus or outside of bowel motion
- restless sleep, irritability, bedwetting, loss of appetite
26
What information must be gathered from the patient regarding threadworm treatment? (6 points)
- confirmation of threadworm
- treatments tried and efficacy
- number in family
- age and weight
- other diseases (esp. Liver problems)
- pregnancy/breastfeeding
27
How are threadworms treated? (7 points)
- medicines and hygiene measures to prevent re-infection
- treat whole family, tell child's school teacher
- thorough washing of hands and fingernails with soap and water esp. Before eating and after the toilet
- children to wear close fitting underpants at night to stop scratching
- shower before bed and again in morning to remove eggs laid at night
- wash bed linen, bed clothes, underwear in hot water, vacuum bedroom and toilet floor to get rid of dry eggs
- disinfect toilet seat, bath and shower
28
What are the anthelmintic agents to treat threadworm? (2 points)
- Pyrantel ebonate
| - Mebendazole
29
What is pyrantel ebonate? (6 points)
- combantrin chocolate squares
- paralyses worms which are then excreted
- dosed by body weight (10mg/kg)
- treats threadworm, roundworm and hookworm
- okay for children from 1 year old
- avoid in acute liver disease
30
What is mebendazole? (7 points)
- deworm, Vermont, combantrin-1.
- interferes with worm glucose absorption causing starvation
- one dose for all treatment (100mg)
- treats threadworm, roundworm, hookworm, whipworm and tapeworm
- avoid in pregnancy, acute liver disease, children
31
What is scabies? (2 points)
- Parasitic infestation of skin
| - caused by 8 legged itch mite sarcoptes scabei var. hominins
32
What is the nature of the scabies parasite? (2 points)
- female burrows into skin to lay her eggs
| - scabies is highly contagious but only transmitted by direct skin contact
33
What are the signs and symptoms of scabies treatment? (6 points)
- intense itching, especially at night 1-8 weeks after contact
- mites or eggs present at end of red threadlike burrows (wrists me between fingers and toes
- linear ink stains remaining under skin - burrows made by scabies
- secondary bilateral itchy rash due to sensitisation of mite exudate and coat (wrists my hands, axillae, nipples, genitals, head and neck in infants
- secondary bacterial infection
- close personal or family contacts may be asymptomatic
34
How long can the scabies sensitisation rash last for?
2-4 weeks after treatment,
| This does not indicate treatment failure.
35
What are the general treatment principles for scabies? (10 points)
- treat individual and any close personal or family contacts (if they are asymptomatic they may reinfect the person as well as themselves)
- do not over treat, 1-2 treatments is adequate, otherwise refer
- wait until after initial scabei ice treatment to use topical CS
- soap and water alone will not work. Need a scabicide
- can be spread by sharing clothes or bedding
- scabies do not live in furniture or carpets
- follow directions for applying scabicide a exactly
- clothes worn against the skin in the last week must be washed, not laundered or dry cleaned. Wash sheets but not blanket/duvet
- children
36
What are the different scabicides used? (4 points)
- gamma benzene hexachloride 1%
- malathion 0.5%
- permethrin 5%
- crotamiton
37
What is gamma benzene hexachloride 1%? (6 points)
- lindane, benhex cream
- warm-cool bath first, dry thoroughly, cool down
- massage into body neck down (infants include face, neck, ears and scalp)
- Leave for 8-12 hours, then wash off
- usually once application sufficient
- avoid in pregnancy and young children
38
What is malathion 0.5%? (6 points)
- A lices, malathion lotion
- warm cool bath first, dry thoroughly then cool down
- massage from the neck down, ensure coverage under fingernails
- leave for 24 hours then wash off
- reapply 7-10 days later
- caution in children
39
What is permethrin 0.5%? (8 points)
- lyderm cream, A-scabies lotion
- warm cool bath, dry thoroughly, cool down
- massage a thin layer onto whole body from neck down
- leave for 8-14 hours (but best left until 24 hours)
- usually one application is enough
- do not use more than 2 tubes
- transient stinging burning sensation but non staining and odourless
- caution in children 70 years, and people sensitive to permethrin, pregnancy and breastfeeding
40
What is crotamiton? (5 points)
- eurax, itch-soothe
- good antipruritic but weak scabicide
- useful for post treatment itch
- apply 2-3 times daily
- not recommended in pregnancy or lactation
41
What products can be used to treat the scabies itch? (5 points)
- crotamiton
- calamine lotion (may be drying) calamine cream
- pinetarsol bath, or diluted as dab on lotion
- topical CS (but only after scabicide is used, do not use on infested areas)
- oral antihistamine (sedating helps with sleeping)
42
When should scabies be referred? (4 points)
- presence of secondary bacterial infection
- rash does not respond at all to treatment (no decrease in itch 5 or more days after treatment)
- resistance (live mites present even after appropriate treatment used)
- uncertainty about diagnosis
43
What are the two main types of fungal/yeast infections?
- Candida albicans (topical yeast infections)
| - tinea infections
44
What are the main characteristics of topical yeast infections? (5 points)
- red and scaly
- poorly defined border
- may have scattered satellite pustules outside main rash area
- often assoc. with immunodeficiency and diabetes
- usually located in warm moist areas such as skin creases
45
What are the common sites of topical yeast infections? (5 points)
- groin
- nail fold
- under breasts
- between buttocks
- between toes
"Warm moist areas"
46
What are three main classes of dermatophytes that cause tinea infections ?
- trichophyton
- microsporon
- epidermophyton
47
What are the main areas involved with tinea infections? (3 points)
Hair, skin and nails
48
What are the main types of tinea infections? (5 points)
- corporis (body)
- capitus (head)
- cruris (groin)
- pedis (feet)
- ungium (nails)
49
What are the main char actuaries of tinea corporis? (6 points)
- affects the body e.g. Ringworm
- spreading circular red lesions
- rings can join together
- scaling at leading edge of lesion
- mild itch
- hair loss within lesion area
50
What are the main characteristics of tinea capitus? (4 points)
- affects the head
- spreading circular red lesions
- scaling scalp
- hair loss e.g. Broken off, or stubble
51
What are the main characteristics of Texan cruris? (5 points)
- affects groin e.g. Joggers itchy, jock itch, crotch rot.
- very itchy, red spreading lesions
- pimple like eruptions
- marked red border at leading edge of lesion
- may spread to buttocks
52
What are the main characteristics of tinea pedis? (5 points)
- affects the feet e,g, atheletes foot
- mild redness with some scaling and peeling
- may be macerated my weeping, bad smell (due to yeast, bacteria)
- itch or burning sensation
- often between the toes or soles/sides of feet
53
What are the main characteristics of tinea ungium? (3 points)
- affects the nails
- often associated with tinea of the skin
- associated with crumbling, yellow nails.
54
What are the main principles of fungal infection treatment ? (5 points)
- dry area thoroughly (saline soaks 3-4x/day to dry weeping areas)
- most antifungals are applied once or twice daily and continued 1-2 weeks after infection has cleared
- dry up wet areas with powder, gel or lotion
- moisturise dry areas with creams and ointments (strengthen skin barrier)
- do not use hydrocortisone unless combined with effective anti-fungal
55
Why should hydrocortisone not be used alone in fungal skin infections? (2 points)
- hydrocortisone does not treat the infection
- it may reduce the immune response and encourage infection spread which causes strange and paler patterns known as tinea incognito
56
How can fungal infections of the feet be prevented? (5 points)
- keep areas dry, esp. Between ties
- wear cotton socks (not nylon or acrylic)
- avoid plastic or rubber shoes
- don't walk barefoot in public showers
- use antifungal powder or spray to dust shows and feet
57
How can fungal infections of the groin be prevented? (3 points)
- wear cotton underwear
- avoid wearing nylon next to the skin e.g. Pantyhose, underwear)
- keep skin dry e.g. Neat feet range, products containing antiperspirants prevent swearing and chafing in these areas.
58
What are the different dosage forms available to treat fungal/yeast infections? (7 points)
- solutions
- creams
- lotions
- ointments
- gels
- powders
- sprays
59
What are antifungal solutions suitable for? (3 points)
- inflamed and moist areas
- they have a cooling effect, especially between toes or hair areas
- be careful with alcoholic vehicles as they may sting
60
What are antifungal creams suitable for? (2 points)
- general body surfaces
| - caution as they tend to run when applied to weeping areas
61
What are antifungal lotions suitable for? (3 points)
- hairy and weeping areas
- also suitable for inflamed and moist areas due to cooling effect
- caution with alcoholic vehicles as they may sting
62
What are antifungal ointment suitable for?
-dry, Scaly lesions
63
What are antifungal gels suitable for?
-hairy areas
64
What are antifungal powders suitable for? (2 points)
- flexural areas and in between the toes to absorb moisture
| - can be used once infection has cleared to dust skin and shows as a preventative
65
What are antifungal sprays suitable for? (5 points)
- all kinds of surfaces EXCEPT sensitive genital areas
- can be used once infection has cleared to dust skin and shoes as a preventative
- powder has good staying power on skin
- as it is a non-contact delivery devices it can be used on many people due to no cross contamination
- good for hard to reach areas and skin folds
66
Which medications are used to treat fungal infections? (5 points)
- imidazoles
- terbinafine
- ciclopiroxolamine
- undecylenic acids, benzoic acids, salicylic acids
- gentian violet, castellani's paint
67
What are the imidazoles? (5 points)
- fungalstatic drugs such as clotrimazole, Miconazole, econazole, ketonconazole, tioconazole
- active against candida and G+ bacteria
- almost no systemic absorption
- 70-100% cure rate
- apply bd and 14 days after clearing
68
What is terbinafine? (6 points)
- fungalcidic drug e,g, allymine antifungal
- active against some yeasts
- apply bd for 1-2 weeks and another week after clearing
- good skin penetration within 3 days, acts more rapidly than imidazoles to eradicate dermatophytes.
- dermatophytes may be killed before skin has healed completely
- also available as lamisil once but data on clearance rate not clear.
69
What is ciclopiroxolamine ? (3 points)
- broad spectrum antifungal and antibacterial
- use bd and 14 days after clearing
- available as nail lacquer to treat nail fungal infections
70
What are the undecylenic acids, benzoic acids, salicylic acids? (2 points)
- not active against candida or bacteria
| - requires continual treatment 4 weeks after lesions have cleared
71
What is gentian violet and castellani's paint? (3 points)
- old remedies for fungal skiing infections
- gentian violet is rx only
- stains clothing, messy to use and not recommended due to mutagenic activity
