Suez Canal University Program of MSc-Family and community health care Task no.

4 Topic Bites & Stings Objectives :The candidate should be able to 1List different types of bites 2Practice First aids for bites 3- Manege different types of bites

Teaching and learning resources Clinical problem solving MCQs quiz Books Articles Short assay

1-Clinical problem solving Case 1 A 4-year-old boy presents to the emergency department being carried by his mother. His mother reports that approximately 1 hour ago the child was “playing” with the family dog by pulling its tail and fl icking its ears while it was eating. Consequently, the dog bit the child on the hand deep enough to draw blood. She decided to bring the child into the hospital because, despite her best efforts to alleviate his pain, her son continues to cry. His vital signs are normal, and on physical exam, he appears healthy yet extremely agitated and inconsolable. His right hand is erythematous and swollen about the proximal metacarpal phalangeal joints of the second, third, and fourth digits

What is the most likely diagnosis? What is the epidemiology of this condition? What tests and/or imaging studiesare could be used to confirm the diagnosis? What is the most appropriate treatment for this condition? Case 2 The mother of a 16-year-old girl calls you when you are on call on a Saturday afternoon. The mother states that her daughter was stung by a wasp about 2 hours ago on her left arm. The patient has no known history of previous allergic reactions to insect bites or stings. She is having no difficulty breathing or swallowing, nor has she been dizzy or lightheaded. The mother’s primary concern is that the area of the sting is red and swollen. The daughter says that it hurts and itches. She says that the site of the injury was the midpoint of the forearm and there

is now redness and swelling extending in a circular pattern that is about 3 in across. The red area is hot to the touch, so the mother is concerned that it is infected. She gave her daughter some ibuprofen for the pain and would like you to phone in some antibiotic and something to prevent the reaction from spreading. ➤ Which antibiotic should you prescribe to treat this condition? ➤ What other treatments might be beneficial at this point? ➤ What immunization is appropriate for this patient? 2-MCQs Quez 1A 44-year-old woman presents to the ED with a deep puncture wound to her left forearm from a dog bite. The dog is appropriately vaccinated. Which of the following statements regarding management of animal bite wounds is true? a. Infection after dog and cat bites is rare. b. Irrigate the wound thoroughly and place deep sutures to prevent infection. c. Delayed primary closure can be used for bite wounds. d. Dog bite infections are most commonly secondary to Pasteurella multocida. e. Clindamycin is the most commonly used antibiotic for dog bites. . 2The dog bite may lead to rabies .Which of the following is (are) characteristic for symptoms of rabies A-Photophobias B-Hydrophobia C-Agoraphobia D-All of the above E-None of the above 3-

Which of the following therapeutic options is useful in treating of both bee stings and bite wounds? A. Antibiotic prophylaxis with amoxicillin-clavulanate B. Antihistamines for itching C. Tetanus vaccination D. Surgical wound debridement 4A 22-year-old woman develops a progressively enlarging red, hot area on her leg following a yellow jacket sting. She states that the sting was sharp and of brief duration and she was able to fully remove the stinger with tweezers. She did not suffer from any systemic anaphylaxis. She has no previously known allergies. She sees you in the office a day after the sting and says that the lesion is still enlarging despite using overthe- counter corticosteroid cream and a first-generation antihistamine. Which of the following is the most appropriate treatment for this patient? A. Oral prednisone B. Topical corticosteroid C. Antibiotic directed against gram positive cocci D. Portable epinephrine kit for future stings E. Reassurance 5You see a 7-year-old boy a day after he was bitten by his pet dog. According to the mother, the dog bit the child after he snuck up on the dog and grabbed its tail. The dog has had all its vaccinations, including rabies. The child has had no fever, has full movement of the injured limb, and has no sign of neurologic or vascular injury. The wound is on the child’s forearm, is not deep, and is not bleeding, but has developed about 2 cm of erythema surrounding the site. Which of the following is the most appropriate treatment? A. Hospitalization for IV antibiotic B. Oral amoxicillin-clavulanate for 3 to 5 days C. Oral amoxicillin-clavulanate for 7 to 14 days

D. Local care without any antibiotic 6You see a 43-year-old man who 2 days prior was in a fist fight and sustained a deep laceration wound around the knuckles from where he struck the face of another man. He was intoxicated at the time and upon return home he did not clean the wound and went straight to sleep. He now has purulent drainage, pain, erythema, and fever. There is no rash and he has not noted any spreading of the erythema. An x-ray of the hand shows a hairline fracture of the fifth metacarpal with swelling and bruising noted over the affected area. Which of the following is the most likely organism causing infection? A. Staphylococcus aureus B. Streptococci C. Eikenella corrodens D. Escherichia coli E. Peptostreptococcus 7A mother brings in her 6-year-old child who was bitten on the hand while playing with a rabbit that was recently obtained from a neighbor. The child’s wound is on the volar surface of the right second finger just to the proximal interphalangeal joint. Which of the following steps in the management of bite wounds is most effective in preventing wound infection? A. Tetanus prophylaxis B. Rabies prophylaxis C. Saline irrigation and wound care D. Prophylactic antibiotics E. Irrigation and primary closure 3-Please answer the following : 1-What are the three major concerns for any insect bite or sting? 2-What is the most common reaction from insect bites? 3-What are some common insects that bite/sting humans?

4-Name three insects that are commonly associated with systemic allergic reactions? 5-How many poisonous species of spiders are there in the United States? 6-Does this mean all spiders are dangerous? 7-What are the most dangerous species of spiders in the United States? 8-What type of spiders are becoming popular as pets and although rarely bite, have a bad reputation as being aggressive? 9-Are Tarantula bites poisonous? 10-What are three reactions to spider bites? 11-What are some clinical features of local reactions to spiders bites?

REFERENCES 1-Books Taylor’s manual of family medicine Rakel manual of family medicine 2-ArticleS Prevention and Treatment of Dog Bites 3-http://www.aafp.org/afp/2001/0415/p1567.html