Lice, Scabies, Spider Bites

Question 1

Medical Term for Lice

Answer 1

Pediculosis

Question 2

Define Pediculosis

Answer 2

Ectoparasites that live on the body & feed on human blood after piercing the skin

Question 3

Clinical Presentation

Answer 3

Pururitis
Secondary cellulitis
Pubic lice: eval for other STIs
Pink eye
Swollen lymph nodes

Question 4

Diagnosis of Pediculosis

Answer 4

Eggs (nits)
Nymphs
Mature lice
Found behind ears & back of neck
Wood lamp of area

Question 5

Focus of Treatment of Pediculosis

Answer 5

Neurotoxicity
Suffocation via “coating”
Hyper-excitation & death by paralysis

Question 6

Treatment of Pediculosis

Answer 6

Permethrin 1% lotion (Nix)
Benzyl alcohol 5% lotion (Ulesfia)
Spinosad 0.9% (Natroba)
Environmental control

Question 7

Medical Term for Scabies

Answer 7

Sarcoptes Scabiei

Question 8

What is scabies?

Answer 8

Parasite that burrows under the host’s skin causing intense itching

Question 9

Transmission of Scabies

Answer 9

Objects
Direct skin to skin contact
Crowded conditions

Question 10

How long until patient’s become symptomatic?

Answer 10

2-6 weeks

Question 11

What causes the itching?

Answer 11

Allergic reaction to the mites
Worse with warmth
Usually worse at night
Watch for excoriation

Question 12

Diagnosis of Scabies

Answer 12

Scraping of skin

View under microscope

Question 13

Treatment for Scabies

Answer 13

Permethrin Cream 5%
Lindane Lotion 1%
Oral Ivermectin

Question 14

SE of Permethrin Cream 5%

Answer 14

Mild to moderate burning & stinging
Itching
Rash
Redness

Question 15

Education for Permethrin Cream 5%

Answer 15

Apply head to toe
Leave on 8-14 hours then wash with soap & water
Repeat in 7 days
Treat family members & sexual partners

Question 16

Other Treatment for Scabies

Answer 16

Wash clothing, bedding, towels in hot water & dry with hot temp
Pruritis: atarax (hydroxyzine), benadryl
Steroid cream

Question 17

Lindane Lotion 1% for Scabies

Answer 17

More neurotoxic

Head to toe

Question 18

Oral Ivermectin

Answer 18

More effective than Lindane
Less effective permethrin
Oral medication

Question 19

2 Spiders That are a Threat to Humans

Answer 19

Black widow

Brown recluse

Question 20

Insect Bites that Mimic Spider Bites

Answer 20

Ant bites
Bedbug bites
Flea bites
Fly bites
Reduviid bug bites
Mite bites
Tick bites

Question 21

Skin Disorders that Mimic Spider Bites

Answer 21

Erythema chronic migrans
Erythema nudism
Leukocytosclastic vasculitis
Sporotrichosis
Toxic epidermal necrolysis

Question 22

Infections that Mimic Spider Bites

Answer 22

Chronic herpes simplex
Cutaneous anthrax
Disseminated gonococcal infection
MRSA
Septic emboli in endocarditis or IVDU

Question 23

Trauma that Mimics Spider Bites

Answer 23

Self-inflicted injuries

Subcutaneous drug injection

Question 24

Location of Black Widow Spiders

Answer 24

Worldwide

Question 25

Location of Recluse Spiders

Answer 25

North & South America

Question 26

Acute Presentation of Spider Bites

Answer 26

Appears within minutes Papule Pustule Wheal

Question 27

Recent History with Black Widow Spider Bites

Answer 27

Recent

Question 28

Symptoms of Black Widow Spider Bites

Answer 28

``` Muscle pain Mild pain at site Tremor Weakness Shaking of the extremity Distressed & inconsolable (infants & children) Refusing food & drink (infants & children) Generalized erythema ```

Question 29

Physical Findings of Black Widow Spiders

Answer 29

``` VS normal (70%) Intermittent muscle rigidity & tenderness adjacent to the bit Weakness Tremor Myoclonus Diaphoresis Blanched circular patch Surrounding red perimeter Central puncture Appears "target" lesions ```

Question 30

Diagnosis of Black Widow Spider Bite

Answer 30

``` S/S with Hx Leukocytosis Elevated creatinine, liver enzymes EKGs (cardiac risk) Cardiac enzymes (cardiac risk) ```

Question 31

PE Findings of Mild Envenomation from Black Widow Bites

Answer 31

Localized pain at bit | Normal VS

Question 32

PE Findings of Moderate Envenomation from Black Widow Bites

Answer 32

Muscular pain in area Extension of muscular pain to chest or abdomen Local diaphoresis at bite Normal VS

Question 33

PE Findings of Severe Envenomation from Black Widow Bites

Answer 33

``` Generalized muscular pain in back, abdomen, & chest Diffuse diaphoresis ABnormal VS: tachycardia, tachypnea N/V Headache ```

Question 34

Treatment of Mild Envenomation of Black Widow Bites

Answer 34

Local: clean bite Analgesia: acetaminophen, ibuprofen, oxycodone or hydrocodone Muscle relaxers: Valium, methocarbamol (Robaxin) Tetanus prophylaxis

Question 35

Treatment of Moderate to Severe Envenomation of Black Widow Spiders

Answer 35

``` Local wound care Tetanus prophylaxis Parenteral opioids, benzodiazepines Antiemetic therapy Antivenom administration ```

Question 36

Risk of Antivenom Administration

Answer 36

Anaphylactic reactions

Question 37

Pregnancy Category of Antivenom Administration

Answer 37

Category C

Question 38

Where are brown recluse bites normally?

Answer 38

Upper extremities Thorax Inner thigh

Question 39

Areas Where Brown Recluse Spiders are Located

Answer 39

South West Midwest

Question 40

Local Symptoms of a Brown Recluse Bite

Answer 40

Develop 2-8 hours after a bite Painless initially Minor burning Severe pain at site after 4 hours

Question 41

Systemic Symptoms of a Brown Recluse Bite

Answer 41

Malaise N/V Fever Myalgia

Question 42

Physical Findings of a Brown Recluse Bite

Answer 42

``` Initially: bite site mildly red May reveal fang marks Blistering Necrosis of skin & subcutaneous fat Severe destructive necrotic lesions with deep wide borders ```

Question 43

Diagnosis of a Brown Recluse Bite

Answer 43

History Clinical Presentation Definitive: spider seen, recovered, collected & identified

Question 44

Conditions Mistaken for a Brown Recluse Spider Bite

Answer 44

``` Bacterial Deep fungal Pseudomonas aeruginosa Parasitic Viral Topical & exogenous causes Venous Neoplastic disease Necrotizing vasculitis Diabetic ulcers ```

Question 45

Treatment of Brown Recluse Bite

Answer 45

Local wound care Pain management: NSAIDs or opioids Tetanus prophylaxis Dapsone to prevent progression to necrosis & reduce pain

Question 46

Local Wound Care of Brown Recluse Bites

Answer 46

Clean with mild soap & water Apply cold packs Maintain affected part in elevated or neutral position