Animal bites, arthropod bites and zoonoses: Viva

Branch 1: Recognising the two linked risks

The candidate should immediately separate the two children into two distinct risk profiles. The boy has a cat bite to the hand, which is the bite most likely to become infected because a cat's long narrow teeth produce a deep puncture that seals over and seeds Pasteurella and oral anaerobes into the tendon sheath or joint capsule. The girl has a scratch from a flying fox, which in Australia is an Australian bat lyssavirus exposure until public health clears it, regardless of how trivial the scratch appears. ^[1]

The candidate should state that the brother's wound needs prophylaxis and careful assessment for deep structure involvement, while the sister needs urgent rabies and Australian bat lyssavirus post-exposure prophylaxis begun without delay. Both children also need a tetanus assessment, and the candidate should frame the whole encounter around a structured exposure history covering the animal, the mechanism, the geography, the time elapsed, and each child's vaccination and immune status. ^[2]