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A 10-year-old boy presents with his mother, complaining of intense itching, worse at night, since the first week of school. He has numerous excoriations in the interdigital web spaces, wrists, and anterior axillary folds. A course of treatment for eczema with topical corticosteroids has provided little relief. His infant sister has recently developed intensely pruritic linear burrow-like lesions on her palms, soles, face, and scalp. Their mother works in a nursing home and has developed pruritus and reddish-brown nodular lesions in her axillae and perineum that have persisted several months after she treated herself with a lotion that was provided at her place of work.
The most likely ectoparasite affecting this family is: |
| | A) | Head lice (pediculosis). |
| | B) | Chiggers (mites). |
| | C) | Ticks. |
| | D) | Fleas. |
| | E) | Scabies. |
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What is the next best step in this case? |
| | A) | Removal of the individual organisms. |
| | B) | Tetracycline 10 mg/kg divided TID for all affected family members. |
| | C) | Oral ivermectin 200 mcg/kg in 1 oral dose, repeated in 2 weeks for all affected family members. |
| | D) | Symptomatic treatment with topical steroids and oral antihistamines. |
| | E) | One application of 5% permethrin cream for all family members for 8-14 hours, followed by showering and single-dose oral ivermectin 200 mcg/kg; repeated in 2 weeks for the mother. |
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3 | |
You successfully treated the whole family. They are now comfortable, happy, and totally confident in your abilities. The mother returns with her girl, who is now 3 years old, with a new complaint. Apparently, the patient has complained of her "bottom" hurting, a symptom that her mother has interpreted to mean perineal pain. The pain is worse at night and the child has awoken several nights complaining of vaginal pain. The mother thinks that she may have a bladder infection, but there are no urinary symptoms. The patient complains only of "itchy butt." The exam is normal.
What is the next best step in diagnosis of this problem? |
| | A) | Urinalysis, microscopic exam, and urine culture. |
| | B) | Speculum vaginal exam with cultures. |
| | C) | "Scotch tape" test. |
| | D) | Stool collection for ova and parasites. |
| | E) | Referral to a pediatric behavioral disorders specialist. |
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4 | |
Your "Scotch tape" test is a success, proving your clinical suspicions.
The best intervention is to: |
| | A) | Treat the patient with mebendazole 100 mg PO once, repeat in 2 weeks, and encourage good hand washing for the whole family. |
| | B) | Treat the patient and the entire family with mebendazole 100 mg PO daily for 14 days. |
| | C) | Treat the patient and the entire family with mebendazole 100 mg PO once, and repeat in 2 weeks. |
| | D) | Treat the patient with metronidazole 500 mg PO once, and repeat in 2 weeks. |
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