NBME 22 Prescribe permethrin for the patient and his family (NBME Answers)

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submitted by ∗mcl(671)

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Scabies likes to burrow in the areas between the fingers and toes (FA 2019 161) and causes itching. Could also potentially be lice (groin involvement), but treatment for either overlaps -- gotta use permethrin.

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kchakhabar If only one person is there to see the doctor, why would the doctor prescribe medicine even for his family members who are not there? +1

mcl Unfortunately, both of these are pretty contagious conditions. FA mentions that scabies spreads via skin to skin contact, and goes on to mention that you're supposed to treat close contacts. I think in this scenario it's ok to give permethrin to the family members who are not present but affected (it's also non-prescription in some cases, I believe.) Slightly related note, similar to why you would treat the sexual partner of someone with chlamydia/gonorrhea, or close contacts of someone with n. meningitides infection. +13

teaandmusic Agree with kchakhabar. Just because pt says others in family have the same thing, doesn't mean they do, they may have a different condition (small chance, but still possible). Not to mention allergic reactions and other considerations that the Dr. isn't aware of regarding family members ... with chlamydia/gonorrhea, etc you'd have the close contact go and see a doctor and get a prescription also, you wouldn't just write out a prescription for someone you haven't seen +

madamestep @mcl You'll also treat close contacts for Enterobius vermicularis! +