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85 Cards in this Set

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scabies mite?
sarcoptes scabiei var. hominis
obligate parasite humans
scabies blacks?
rare
sarcoptes scabiei var. hominis
1/3 mm
8 legs
30 day life cycle
burrow within 1 hr
eggs 2 or 3/day
scybala
larvae hatch maturity 14 to 17 days
scabies type of rxn?
hypersensitivity
elevated IgE
eosinophilia
scabies layer of epi?
stratum corneum
norwegian scabies
scaly thick skin develops in immunosuprpressed or elderly patients thoughsand of mites
urrows enter underlying epi
scabies survive oil?
7 days
mites papules?
rare
scabies infants
pustules and vesicles palms and soles
face and scalp
few burrows
nodules axillae and diaper
elderly scabies
fewer cutaneous signs (decrease immunity)
Crusted Norwegian Scabies
hands and feet
asymptomatic crusting
thick subungual keratotic nail dystrophy
wartliek formations digits and sites of truam
gray scales and thick crusts trunk and extremities
desquamation of the facial skin
shed hair
neuro or MR DOWN'S SYNDROME
itching absent or severe
scybala
scabies feces
Permethrin
Elimite cream
Acticin cream
synthetic pyrethrin
2% absorption/not significant absorption
Lindane
Kwell
gamman benzene hexachloride
scabies
CNS stimulant produces seizures and death to scabies
10% systemic absorption
attach to fat and brain tissue
no < 2 yrs, preg, HIV
Ivermectin
po scabies medicine
2 doses
Scabies treatment
1. Premethrin
2. Lindane
3. Ivermectin
4. Sulfer w petroleum jelly
5. Crotamiton (Eurax lotion)
Nodular scabies
treatment?
scrotum
intralesional scabies
Pediculosis
mites
obligate human parasites
10 days (adults) to 3 weeks (fertile eggs) off human
ectoparasites
insect
6 legs
3 types
2 mm flat wingless 3 pairs legs anterior directly behind head
3 types
pediculosis types
pediculus humanus var capitis
pediculus humanus var corporis
pthirus pubis
pediculosis size?
< 2mm

corporis > capitis > pubis
pthirus pubis
short oval body with claws
lice
feed?
engoged?
color?
life cycle?
5 x per day feed, not engorged, rust color, 30 days egg to eggs
6 eggs or nits/day, 18 days to maturity
Nits or eggs 0.8 mm firmly cemented to base hair shafts
pediculosis capitis
kids females
blacks rare back of the head and enck behind the ears
20 adult lice
sensiization 3 to 8 mths
posterior cervical adenopathy
eyelashes
lice survive off human 3 days
nits surive off human 10 days
pediculosis corporis
uncommon
typhus relapsing fever rench fever
lay eggs in seams of clothing skin only to feed
eyelashes pediculosis
kids
pediculosis pubis
most contagious STD
30% have other SD
Blacks = whites
hair around anus
iching
gray-blue macules (maculae ceruleae) 1 to 2 cm groin and sites distant from infestation
unkonwn cause alterd blood pigment
gray-blue macules
pediculosis pubis
patient witout an apparent rash and localized itching
r/o lice
nits on exam? active infestation?
nits persit for mths after successful treatment
does not indicate active infestation
live eggs lice located?
within a quarter inch of scalp
lice comb
0.2 to 0.3 mm
usually takes 1 min to find the first louse
live nits? woods lamp
live nits fluoresce
nits that contain an unborn louse flouresce white
empty nits flouresce gray
only peculicide in US not less effective tx of lice
ovide
premethrin lice
OTC treatment lic
paralyzes nerves that allow lice to breateh
lice can close down respiratory airways for 30 mins whe immersed in water
all insecticides are put on dry hair
developing eggs no CNS during first 4 days
medician must have residual activyt to be ovicidal
efficacy 95%
active for 2 weeks
do not use cream rinses 2 weeks
pyrethrin
not active for 2 weeks
lotions for body an dpubic hair
lice tx
treat once then in two weeks
malathion
ovide
only insectiside in US no loss of effectiveness
peidulicidal and ovididal
no infants
ivermectin tx lice
paralysis and death of lice
selective parasites
73% effective w one 12 mg dose adult
bactrim lice tx?
kills essential bacteria in lice gut? lice fall off and die
need additional tx in one week for eggs
one tab po BID x 3 days then repeat in one week
when can kid go back to school after pediculosis capitis?
after first topidal treatment or wet combing
even if nits
pomades tx lice?
petrolatum, manyonnaise, an dpomades
kill lice in 10 mins
must use a lot and repeat weekly for 4 weeks
eggs hatch in 8 to 10 days
eyelid lice
petrolatum, forceps, fluorescein immediate toxic effect lice
oral ivermectin resistant cases
caterpillar dermatitis
papules and vesicles on posterior neck
setae (hairs)
seasonal
mechanical stim or release of irritating substances on the hairs
windblown setae
brown tail moth
NE US
gypsy moth
NE US
hang from trees wit long threads
setae wind land on clothes hung out to dry
puss caterpillar
wooly slug
SE US
1 inch long
back and sides coveredd with fine bristles
Io moth
east of rocky mountains
2 to 3 inches
pale green wit red dish stripes
each body segment with tufts of sines
saddleback caterpillar
est of Texas and south of Massachusetts
1 inch long
green and fleshy
brown or purple saddle shape on midback
stout spines at end and along sides
spines hollwo and contain toxin
type of immune response with gypsy moth
closed patchy delayed hypersenstitivity response
type 4
similar to poison ivy
caterpillar dermatitis clinical
linear
vesicles and pustules on posterior neck
puss catapiller grid-like pattern
puss catapiller clinical?
grid-like pattern
sharp severe pain
assoc sx with caterpillar dermatitis
rhinitis, conjunctivitis, and wheezing
no deaths in US
caterpillar dermatitis tx?
resolve few days to 2 weeks
topical steroids
puss caterpillar analgesics
wooly slug
puss caterpillar
SE US
spider venom
enzyme spreading factor hyaluronidase and a toxin that is distributed by spreading factor
harmless
pain, swelling inflammation
hives satellite hives
Black Widow
Lactrodectus mactans
shoe button spider
no Alaska
lots in rural south
4 cm
lactrodectus mactans envenomation
toxin?
mechanism?
clinical sx?
only spider capable of envenomation
neurotoxin alpha-latrotoxin
binds to receptors at neuromuscular motor end plate of both sypathetic and parasympatheitc nerves increased synapti catecholamines
migratory muscle cramps and spasm nausea vomiting, HTN, maliase, treomors dayst to a week
black widow web?
crinkling crackling haphazard randomly arranged

don't bite when away from web because need stability of web
come inside w cold weather
black widow clinical
immediate sharp pain or no pain
immediate rxn minimal slight swelling small red fang marks
lymphatic absorption and vascular dissemination of lactrotoxin = LACTRODECTISM
GENERALIZED ABDOMINAL PAIN, BACK, AND LEG PAIN
15 mins to 2 hrs afte bite DULL MUSCLE CRAMPING OR SDEVERE PAIN WITH NUMBNESS gradually spreads from inoculation site to entire torso
MOST SEVERE IN ABDOMEN AND LEGS
SKELETAL MUSCLES
SURGICAL ABDOMEN without ttp and distension
INCREASE DTRs
dizziness, ha, sweating, n/v
increase severity up to 24 hrs
decrease 2 to 3 days
residual sx weakness, tingling, nervouse ness , transient muslce spams wks to mths
lactrodectism
lymphatic absorption and vascular dissemination of lactrotoxin
immunity to black widow?
yes after severe attack
convulsions, shock, and death % of black widows?
5%
black widow tx
ice (limiit spread neurotoxin)
antivenin (horse)
muscle relaxants
analgesics
black widow antivenem
animal serum?
only lactrodectus mactans?
route?
test to preform before giving?
relieves sx within time?
not effective after?
who is higher risk needs antivenem?
horse
can use on all species of lactrodectans
IM or IV for severe/< 12 yrs
eye sensitivity test
1 to 2 hrs reieves sx
give even after 90 hrs
< 16 yrs old and > 60 yrs old
muscle relaxants black widow
calcium gluconate?
IV opioids and benzodiazepines
valium
diazepam
methocarbamol
analgesics black widow
ASA
morphine careful because toxin may affect resp muscles
Brown Recluse
loxoscelidae reclusus
fiddle back spider
1.5 cm (smaller than black widow)
violin back (broad head point towards abdomen)
Southern US
loxoscelidae reclusus clinical
sharp pain bee bite
initial mild inflammation
fatty acids buttocks and thighs more cutaneous rxn
bites mc EXTREMITIES
NECROSIS WITHIN 4 HRS SEVERE BITES
LOXOSCELISM
loxoscelism
nectrotic arachnidism
rapid expansion of blue-gray macular halo aroudn puncture site
local hemolysis
violaceous skin bad = necrrosis = start early tx
severe pain
SINKING INFARCT center sinks in blue cgray macule
DEEP INDOLENT ULCER WITH RAGGED EDGES
wks to mths SCARRING
brown recluse severe progressive rxn
severe
initial erythema to pallor
within 12 to 14 hrs f/c, n/v, weakness, joingt and msuscle pains, hives or measle-liek rashes, THROMBOCYTOPENIA or HEMOLYTIC ANEMIA, GENERALIZED HEMOLYSIS, DIC, RENAL FAILURE, death
sx rxns rare
KIDS
brown reculuse preg?
no affect on fetus
most brown reculuse bites
tx?
apply ice or heat?
mild minimal swelling and erythema
rice, ASA (prevents platelet aggregation and throbosis)
TETANUS
NO HEAT MAKES LESION WORSE
mod to severe brown reculse therapy?
within 24 to 48 hrs sx
NO SURGERY
atnibiotics CEPHALOSPORINS infection prophyhlaixs ulcerating lesions
analgesics
DAPSONE (give even if after 48 hrs)
Dapsone brown recluse?
order which test?
mechanism?
order 6GPD
prevent venom induced perivasculitis with PMNs infiltration that occurs w extensive necrosis
Brown Reculuse spider progressive hemolytic anemia
size of lesion?
> 1 cm test for hemolytic anemia (free serum hg or thromocytopenia)
sx severe loxoscelism tx?
prednisone
surgery brown reculuse?
no
brown recluse spider antivenom?
yes
spider?
toxin?
MOA toxin?
area of body?
latrodectus mactens
alpha-latrotoxin
neurotoxin (increase catecholamine release)
abdomen lactodectism
spider?
toxin?
tx?
loxoscleles reclusa
sphingomyelinase-D (phyospholipase D)

tx RICE, ASA, tenanus
dapsone/antivenem used quickly
hyperbaraic O2
spider bite?
loxosceles reclusa
toxin sphingomyelinase-D (phospholipase-D)
dx?
scabies
organism?
life cycle?
how many eggs/day?
how long until the eggs marture?
incubation?
sarcoptes scabeii var hominis
30 days
2 - 3 eggs/day
2 - 4 days off of host and up to one week in oil
incubation days to months
dx?
scabies
dx?
scabies