A patient presents with swelling following a suspected spider bite. What is the appropriate management?

Correct answer: B. Refer to a physician for evaluation

• A. A topical steroid and reassurance is inadequate for a lesion that could be the early phase of dermonecrosis or systemic envenomation.
• B. CORRECT. A spider bite is outside the dental scope of practice, and the two medically significant bites in North America both need physician management. A brown recluse bite produces progressive dermonecrosis with a central eschar and can cause systemic haemolysis, while a black widow bite produces severe muscle cramping, abdominal rigidity and autonomic instability. Neither can be assessed or managed with dental resources, and both can deteriorate.
• C. Antibiotics treat secondary bacterial infection but do nothing for envenomation, and prescribing them delays a proper evaluation of a lesion that may be evolving.
• D. Incising a necrotising bite lesion enlarges the wound and worsens tissue loss without addressing the venom-mediated process. Early surgical intervention in a brown recluse lesion is specifically discouraged.

Note: The general rule this question is testing: when a presenting complaint is non-odontogenic and outside your training, referral IS the treatment. Recognising the limit of your scope is itself a competency, and the exam rewards it.