Skin: 7. Johnson : Anaphylaxis Snake Bite

Front 1

full blown anaphylaxis include what 4 things

Back 1

urticaria (hives), and/or angioedema,with HoTN and bronchospasm.

Front 2

is anaphylaxis rare?

Back 2

naawwwwwww

Front 3

what type of HS rxn is anaphylaxis?

Back 3

Type I

Front 4

with anaphylaxis do you have to be pre-exposed, or do you get it on first contact?

Back 4

pre-exposed

Front 5

what mediates anaphylaxis?

Back 5

IgE

Front 6

is an anaphylactoid reaction IgE mediated?

Back 6

no

substances cause a direct breakdown of the mast cell and basophil membrane

Front 7

with anaphylactoid reaction do you have to be pre-exposed, or do you get it on first contact?

Back 7

it can occur on first exposure (this is the major difference from anaphylaxis)

Front 8

radiopaque contrast media, fluorescein, NSAID’s, thiamine, opiates cause what kind of reaction?

Back 8

Anaphylactoid reaction

Front 9

1/3 of anaphylactic episodes are triggered by ...

Back 9

FOOD

Front 10

if a patient has a large localized reaction, is this predictive of a generalized rx to occur later? Would you treat this with Epi?

Back 10

NO!! not predictive, so don't give epi

Front 11

is the cause of anaphylaxis always obvious?

Back 11

no

Idiopathic anaphylaxis is common
Triggers may be hidden
food, latex
Patient may not recall the details of exposure, clinical course

Front 12

what are the 4 major organ systems affected in anaphylaxis?

Back 12

skin, respiratory tract, GI tract, CV system.

Front 13

what is the difference in upper and lower respiratory response to anaphylaxis?

Back 13

Upper Respiratory: Congestion, rhinorrhea, sneezing, itchy eyes, tearing of eyes, conjunctival injection


Lower Respiratory: Bronchospasm, throat/chest tightness, hoarseness, wheezing, SOB, cough, hypoxia

Front 14

in patients experiencing food induced anapyhlaxis, what is often the first symptom?

Back 14

Oral pruritis (itching)

Front 15

what is a hive

Back 15

raised red or white welts (wheals) of various sizes.
Can burn/sting/itch.
May seem to “move around” as one area resolves a new one “pops up”

Front 16

timeframe for chronic vs acute hives?

Back 16

acute=1d to 6 wk, chronic>6 wk (mo-yr in some cases

Front 17

T/F

anaphylaxis always presents with cutaneous manifestations

Back 17

F

About 10-20% of anaphylaxis cases will NOT present with hives or other cutaneous manifestations
About 80% of food-induced fatal anaphylaxis cases were NOT associated with cutaneous signs and symptoms

Front 18

why would you want to observe a patient for 6 hours after an anaphylactic episode?

Back 18

it could be biphasic, in which recurrance can occur up to 8 hrs later

Front 19

should you wait for labs to treat anaphylaxis?

Back 19

NEVER!! don't you do it!

Front 20

what is RAST

Back 20

Measures specific allergic antibodies in blood
Has limited number of allergens it can test for
More useful in food allergies

Front 21

for an adult, where is the best place to give epi?

Back 21

IM or SC in the THIGH

Front 22

for first line treatment, in addition to epi, what do you want to do?

Back 22

Put in supine or Trendelenburg’s position to slow progression of hemodynamic compromise
Establish/maintain airway
Provide O2 if prolonged anaphylactic reaction
Use normal saline iv line to replace fluids and provide iv access

Front 23

what is the 2nd line therapy to epinephrine?

Back 23

Use diphenhydramine (Benadryl) im/iv

Front 24

ranitidine (Zantac) in combo w/diphenhydramine would be considered what type of treatment?

Back 24

second line

Front 25

what dosage of diphenhydramine (benadryl) do you give to an adult as 2nd line treatment

Back 25

50-100mg

Front 26

a patient comes to your office and says he has been bitten by a snake described as red, yellow, and black bands. what kind of snake was it

Back 26

coral snake

Front 27

how do coral snakes release their venom?

Back 27

from chewing on you

Front 28

describe the symptoms of a bite from a coral snake

Back 28

described as anticlimactic. There is little or no pain or swelling at the site of the bite, there may be no obvious bite marks, and other symptoms can be delayed for 12 hr. However, if untreated by antivenin, the neurotoxin begins to disrupt the connection between the brain and muscles,--the earliest symptoms may begin as nausea, vomiting and sweating, then as the neurotoxin continues to disrupt things it may cause lethargy, slurred speech, dble vision, drooping eyelids, difficulty swallowing and muscular paralysis—eventually leading to respiratory or cardiac failure

Front 29

a patient gets bitten by a pit viper, what happens at the site of bite?

Back 29

Hemorrhagins cause vascular leaking leading to local and systemic bleeding

Front 30

what are the acute risks of a rattler snake bite

Back 30

Acute risks on initial presentation may include rapidly developing edema of the bitten limb, with fluid shifts and secondary shock, coagulopathy with major secondary bleeding, and allergic response to the venom, such as angioedema and anaphylaxis. Physicians should watch for later fluid reabsorption from the bitten limb, which can lead to fluid overload and secondary cardiac failure]

Front 31

for outpatient treatment of snake bites, what do you want to do?

Back 31

Keep patient as inactive as possible
Apply pressure dressing/splint, keep at or below heart level
GO DIRECTLY TO THE ER

Front 32

for a snake bite patient do you want to apply suction, ice, incision, or tourniquets?

Back 32

NO!

Front 33

when a person is in the hospital for a snake bite what do you want to do

Back 33

monitor ABCs, take labs, find appropriate antivenom

Front 34

a patient says he was bitten by something but doesnt know what. the bite shows blanched circular patch w/surrounding red perimeter and central punctum. what bit this person?

Back 34

black widow

Front 35

what does the neurotoxin do from black-widow spiders?

Back 35

The toxin is of the latrotoxin type and it can trigger a massive exocytosis from presynaptic nerve terminals in a variety of neurosecretory cells. Acetylcholine, norepi, dopamine, glutamine and enkephalin systems are all susceptible to the toxin.

Front 36

bites from a brown recluse spider can become what?

Back 36

necrotic

Front 37

a patient says he was bit by a spider that was in his dresser. he didn't think much of it at the time, but now it formed a blister, then develop a dark depressed center over the ensuing 24-48 hr, culminating in a dry eschar that subsequently ulcerates

what bit him

Back 37

brown recluse

Front 38

patient comes in with a pustule and says doc I got bit by a spider. You ask if they have seen the spider to get a better idea. they say they didn't actually see any spiders. what do you think they might have (ON TEST)

Back 38

community acquired MRSA


Methicillin-resistant Staphylococcus aureus

Front 39

what are corns

Back 39

Corns are thickenings of skin composed of keratin, typically found on or between toes, may be found on botton/sides of foot—caused by repeated friction/pressure to the area

Front 40

patient comes in thickenings of skin inbetween the toes. you ask the patient what her occupation is (being a good osteopathic doc) and she tells you she is a stripper. Further questioning reveals that she is required to wear high-heels that push her toes together. what does she have?

Back 40

Corns due to repeated friction of her stripper shoes

Front 41

a man slams his finger in a door and the nail now looks brownish underneath. what does he have?

Back 41

subungual hematoma

Front 42

how do you treat a subungual hematomoa?

Back 42

trephination (you burn a hole through the nail, drain the blood)

Front 43

what is Onychomycosis?

Back 43

toenail fungus

due to T. rubrum

Front 44

what treatment do you use for Onychomycosis

Back 44

oral itraconazole or terbinafine (topicals don't work b/c : it’s usually d/t fungal infection (dermatophyte) of the toenails or fingernails. )

Front 45

what is a callus?

Back 45

A callus is a thickening of the skin that occurs in response to excessive, repeated shear or friction forces, commonly d/t repeated rubbing of the skin.

Front 46

if in the field, what is the best way to treat a snake bite? 4 things

Back 46

1. apply pressure/immobilization bandage (help to prevent/slow the spread of the toxin

2. apply elastic wrap like you would a sprained ankle. They recommend wrapping away from the heart first then toward the heart. Get as low as you can and go as hi as you can . Then place a splint over this.

3. Keep the patient quiet and inactive—do not let them get up and walk around

4. Keep the limb a little below heart level

Front 47

What are plantars warts? ON TEST

Back 47

skin—caused by HPV. Plantar warts grow on the plantar, or bottom, surface of the feet.
They tend to be found in areas of pressure, eg heel and ball of foot. Plantar warts often grow into the deeper layers of skin because of the pressure they receive d/t their location

Front 48

a patient comes to you with a wart on the bottom of their foot. you see small black dots on the wart. what does this patient have? what caused it? what are the black dots?

TEST

Back 48

Plantar Warts

HPV

dots=thrombosed capillaries

Front 49

must know how to recognize anaphylaxis

Back 49

this should be easy...right?

Front 50

what are the 2 treatments for plantar warts

Back 50

Cryotherapy, duct tape occlusion are equally efficacious for wart removal

Front 51

test questions:

treat snake in wild

anaphylaxis vs anaphylactoid

plantar warts

MRSA

maybe a spider bite

Back 51

i would bet on it