Suez Canal University

Program of MSc-Family and community health care

Task no. 4

Topic
Bites & Stings

Objectives
:The candidate should be able to
1- List different types of bites
2- Practice 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
1-
A 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.
.
2-
The 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

4-
A 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

5-
You 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
6-
You 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

7-
A 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