Health Care > EXAM > ROSH REVIEW Emergency Medicine| 412 QUESTIONS| WITH COMPLETE SOLUTIONS (All)

ROSH REVIEW Emergency Medicine| 412 QUESTIONS| WITH COMPLETE SOLUTIONS

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A 14-year-old boy presents complaining of intense pruritus in his groin, axillae, and between his fingers after returning home from summer camp 1 week ago. He reports several other campers had similar... symptoms. On exam, you note excoriations in the inguinal region and axillae surrounding scattered, erythematous papules. Which of the following is the most appropriate treatment? Ketoconazole Lindane Permethrin Prednisone Correct Answer: Correct Answer ( C ) Explanation: This patient has scabies; a pruritic dermatitis caused by cutaneous infection with the mite Sarcoptes scabei, var hominis. Scabies is spread by skin-to-skin contact and should be considered in patients with generalized pruritus, especially when exposure to others with similar symptoms is reported. The rash of scabies involves papules, which are often excoriated. Burrows are pathognomonic but not uniformly present. Unless previously infected, pruritus generally takes 3-6 weeks to develop because symptoms are due to delayed (Type IV) sensitivity reaction. The pruritus is classically worse at night and affects the web spaces of the fingers, flexor aspect of the wrists, axillae, groin, nipples, and the periumbilical region. Except in cases involving an immunocompromised host, the scalp and face are generally spared. Diagnosis is clinical but can be confirmed by placing scrapings collected with a #15 blade scalpel in mineral oil for microscopic examination. The treatment of choice for primary scabies infection is the application of topical scabicidal agents, with repeat application in 7 days. The treatment of choice is permethrin 5% lotion. Individuals affected by scabies should avoid skin-to-skin contact with others. Patients with typical scabies may return to school or work 24 hours after the first treatment. Should family members of an infected individual also be treated for scabies? Correct Answer: Yes, family members and sexual contacts. Scabies Correct Answer: Sarcoptes scabiei Pruritic rash worse at night Linear burrows Interdigital spaces of hands/feet, penis, breasts Permethrin (first line) Ivermectin **head and back are sparred (head involved in children) An 18-month-old boy presents to the emergency department with worsening shortness of breath. The parents report he has had a cough, runny nose, and fussiness for the past five days. On exam, the patient demonstrates subcostal retractions, [Show More]

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