ditch doctor
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A 42yo male construction worker presents to a “doc-in-the-box” for treatment after stepping on a rusty nail. He is otherwise healthy, has no past medical history and takes no medications except a daily multi-vitamin. The wound is irrigated, cleaned and dressed. The man remembers an incident where he lacerated his hand “a little while back” but since he works construction he is “getting cut all the time at work”. You notice many unsuspicious scars on the extensor surface of his arms, consistent with previously sutured, minor work related trauma. He cannot remember when his last “tetanus shot” was. You give a DTaP in his left deltoid, warn him of some possible discomfort, and then discharge him with appropriate instructions and a prescription for 3 days worth of acetaminophen with codeine to be taken PRN. The man returns about 6 hours later complaining that his injection site is extremely painful. On examination you see a moderately edematous left shoulder extending to the elbow, 2cm induration and oozing of blood at the injection site. The man also complains of chills and weariness. After proper treatment, you advise the man that he should not receive the DTaP more than once every 10 years, even if he has another laceration or puncture wound. When presenting this case at the weekly conference, you mention interestingly that this person most likely has a similar pathology as a:
A. Male that has the triple response of Lewis 10 minutes after taking penicillin
B. Female that presents with double vision, weakness that is worse at night and ameliorates overnight
C. Female that presents with malar rash, joint pain, hematuria, mouth ulcers
D. Male that presents with hemoptysis, anemia, hematuria and acute renal failure
E. Male that has headache, coughing, itchy eyes, runny nose and conjunctivitis when exposed to pollen
F. Child that becomes hypotensive with wheezing after a bee sting
G. Homeless man with a chronic productive cough that has a positive Mantoux test
Edited by ditch doctor on 07/16/06 - 06:37 AM
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| drk1980
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A. Male that has the triple response of Lewis 10 minutes after taking penicillin --TYPE I
B. Female that presents with double vision, weakness that is worse at night and ameliorates overnight --TYPE II
C. Female that presents with malar rash, joint pain, hematuria, mouth ulcers --TYPE III
D. Male that presents with hemoptysis, anemia, hematuria and acute renal failure --TYPE II
E. Male that has headache, coughing, itchy eyes, runny nose and conjunctivitis when exposed to pollen --TYPE I
F. Child that becomes hypotensive with wheezing after a bee sting --TYPE I
G. Homeless man with a chronic productive cough that has a positive Mantoux test --TYPE IV
Type III?? ..the time is too less for it to be type IV. (iam sure there is a better reasoning)
correct me.
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| achilles
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E ?
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| cyra
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C
Arthus reaction in this case...a type III hypersensitivity reaction(pathology similar to what you'd see in SLE).
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| ditch doctor
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cyra wrote:
C
Arthus reaction in this case...a type III hypersensitivity reaction(pathology similar to what you'd see in SLE).
C is correct! I would explain it, but you pretty much nailed it and drk1980 explained why all the wrong answers are wrong as well. This is a classical presentation of an Arthus rxn, a local vasculitis due to immune complex deposition and complement activation. Arthus rxn's are rare, but "common enough" with DTaP vaccinations that you should be able to recognize them if they do happen. If they do, just like the question stem, you should aviod getting more than one DTaP every 10 years, even if you get a wound the would otherwise require it. Arthus reaction is a type III hypersensitivity, so remember that's the one with immune complex deposition.
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| MAZI
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great
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