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Questions and Answers
A 4-year-old presents with an intensely pruritic rash, especially at night, with linear tracks in the interdigital spaces. His mother has a history of eczema. What is the most appropriate next step in confirming the suspected diagnosis?
A 4-year-old presents with an intensely pruritic rash, especially at night, with linear tracks in the interdigital spaces. His mother has a history of eczema. What is the most appropriate next step in confirming the suspected diagnosis?
- Administer a trial of topical corticosteroids to rule out eczema.
- Perform a potassium hydroxide (KOH) examination of skin scrapings to rule out fungal infection.
- Directly visualize mites, eggs, or feces using a dermatoscope. (correct)
- Order a complete blood count (CBC) to evaluate for signs of systemic infection.
A 26-year-old male presents with a 1-week history of a pruritic rash appearing as small, red 'bumps' in a linear pattern. The itching is worse at night, and his roommates have developed similar rashes. Which of the following interventions is most appropriate for both the patient and his asymptomatic roommates?
A 26-year-old male presents with a 1-week history of a pruritic rash appearing as small, red 'bumps' in a linear pattern. The itching is worse at night, and his roommates have developed similar rashes. Which of the following interventions is most appropriate for both the patient and his asymptomatic roommates?
- Prescription of oral antibiotics to cover any potential secondary bacterial infections.
- Topical permethrin 5% lotion for all individuals, regardless of symptoms. (correct)
- Topical corticosteroids for symptomatic relief of itching.
- Oral antihistamines to reduce pruritus, combined with improved household hygiene.
What immunological mechanism is primarily responsible for the intense pruritus associated with scabies infestations?
What immunological mechanism is primarily responsible for the intense pruritus associated with scabies infestations?
- Type I hypersensitivity reaction mediated by IgE antibodies.
- Type III hypersensitivity reaction involving immune complex deposition.
- Type IV delayed-type hypersensitivity reaction. (correct)
- Type II cytotoxic hypersensitivity reaction involving IgG and IgM antibodies.
Why is thorough washing of textiles and treatment of close contacts crucial in managing scabies?
Why is thorough washing of textiles and treatment of close contacts crucial in managing scabies?
Which of the following clinical features is LEAST likely to be associated with a scabies infestation?
Which of the following clinical features is LEAST likely to be associated with a scabies infestation?
What is the rationale behind the recommendation to treat all household contacts prophylactically when a case of scabies is diagnosed?
What is the rationale behind the recommendation to treat all household contacts prophylactically when a case of scabies is diagnosed?
In managing scabies, when might oral ivermectin be considered as an alternative to topical permethrin?
In managing scabies, when might oral ivermectin be considered as an alternative to topical permethrin?
A patient is diagnosed with scabies after presenting with a rash and intense itching. Despite thorough treatment with topical permethrin, the itching persists for several weeks. What is the most likely explanation for this persistent pruritus?
A patient is diagnosed with scabies after presenting with a rash and intense itching. Despite thorough treatment with topical permethrin, the itching persists for several weeks. What is the most likely explanation for this persistent pruritus?
Which demographic group is particularly vulnerable to developing crusted scabies, a severe form of scabies infestation?
Which demographic group is particularly vulnerable to developing crusted scabies, a severe form of scabies infestation?
Upon microscopic examination of skin scrapings, what morphological characteristics would confirm a diagnosis of scabies?
Upon microscopic examination of skin scrapings, what morphological characteristics would confirm a diagnosis of scabies?
Flashcards
What is Scabies?
What is Scabies?
A skin infestation caused by the mite Sarcoptes scabiei, highly contagious through direct skin contact.
Symptoms of Scabies
Symptoms of Scabies
Pimple-like rash, burrows, and intense itching, especially at night.
Common Scabies Locations
Common Scabies Locations
Interdigital folds (between fingers), male genitalia.
How to Confirm Scabies
How to Confirm Scabies
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First-Line Scabies Treatment
First-Line Scabies Treatment
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Scabies Alternative treatment
Scabies Alternative treatment
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Scabies Prevention
Scabies Prevention
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Scabies Rash Appearance
Scabies Rash Appearance
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Why Scabies Itch?
Why Scabies Itch?
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Prophylactic Scabies Treatment
Prophylactic Scabies Treatment
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Study Notes
- Scabies is caused by the pathogen Sarcoptes scabiei.
- Scabies is highly contagious and transmitted through direct physical contact, including skin-to-skin or sexual contact.
- The excretions and decomposing bodies of the mites contain antigens, leading to a type IV hypersensitivity reaction.
- Symptoms include a pimple-like rash, burrows, and intense itching that worsens at night.
- Common sites for scabies include interdigital folds and male genitalia.
- Scabies is confirmed through direct visualization of the mites, eggs, or feces using a dermatoscope.
- Medical treatment involves topical application of permethrin 5% lotion.
- Alternative treatment options include oral ivermectin.
- Prevention includes washing all textiles and treating all contacts within the household, even if asymptomatic.
Case Study 1
- A 4-year-old boy presents with a 2-week history of intensely pruritic rash, especially at night, on his hands and feet.
- The boy has no fever, headache, or diarrhea.
- Mother has a history of eczema.
- Temperature is 37.0°C (98.6°F).
- Examination reveals a maculopapular rash with linear tracks in the interdigital spaces of fingers and toes.
Case Study 2
- A 26-year-old man presents with a 1-week hx of pruritic rash.
- He initially noticed small, red bumps in a linear pattern on his arm.
- Similar lesions appeared in clusters on his back.
- Itching worsens at night.
- Roommates also developed similar rashes since moving into a new apartment in San Francisco 2 weeks ago.
- The apartment has no pets.
- Temperature is 36.8°C (98.4°F), pulse is 70/min, and blood pressure is 108/70 mm Hg.
- Diagnosis: Scabies.
- Diagnosis confirmed: Direct visualization of mites or eggs/feces using dermatoscope.
- First-line treatment: Topical permethrin.
- Prophylactic treatment of all close contacts is advised.
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Description
Scabies is caused by Sarcoptes scabiei and is highly contagious through direct contact. Symptoms include an itchy rash, especially at night, with common sites including interdigital folds. Diagnosis involves direct visualization, and treatment includes permethrin lotion or oral ivermectin.
