Quiz week 40

Q1. A 27-year-old lady comes to you to show a lesion on her skin that she noticed yesterday but is growing in size. You examine it and see that it is a tick. What is the best option at this point?

1. Put alcohol on the tick
2. Apply petroleum jelly and smother the tick
3. Apply a burning matchstick close to the tick - avoiding any harm to the patient
4. Use a tweezers and pull it off from the top with a jerk
5. Use a tweezers and go as close to the skin surface to pull it out with gentle pressure

The answer is choice 1. No - I am just joking. Almost everyone got it right - Choice 5 is the right answer. Gently pull off the tick as close to the skin surface as possible. Everything else is less effective in successfully removing the mouth parts of the tick from the skin.

Q 2. You manage to safely remove the tick. What should your next step be?

1. Draw blood for baseline investigations
2. Educate the patient about possible symptoms and treat only if they occur
3. Administer a prophylactic dose of Doxycycline
4. Administer a prophylactic dose of IM Ceftriaxone
5. Check blood at intervals of 1, 2, 4 & 12 weeks sequentially

The answer really is choice 2. Just educate the patient about the possible symptoms of rash and arthralgia and let the patient go home. Patient returns only if he/she has symptoms. Less than 1/100 tick bites gets inoculated with something like Lymes disease or even more rarely a Rickettsia. Thus there is no point trying to treat prophylactically.