36 YEAR OLD ITCHY RASH ENCOUNTER
CLASS 6512 FINAL STUDY GUIDE 2026
QUESTIONS WITH ANSWERS GRADED A+
⩥ Stevens-Johnson Syndrome (aka EM Major)
(sulfa, allopurinol, anticonvulsant/psychotics)
Tx:supportive. Answer: 57 year old male presents to your clinic with a
rash. In the history, he states that he has recently been prescribed
anticonvulsant medication. On physical exam, you note an elevated body
temperature, multiple bullae, and sloughing of his skin with mucosal
involvement (cracked lips, oral lesions, conjunctivitis). These lesions
span approximately 8% of his body surface area.
⩥ Toxic Epidermal Necrolysis
Tx:Fluids! need burn unit and IVIG. Answer: Patient is brought into the
ER too weak and in too much pain to talk. His spouse stated that he has
been on an antibiotic for an infection (SMX-TPM). He has never taken
this medicine before. On physical exam, you note sloughing of skin over
a massive portion of his body (approx 40%). You also note mucosal
involvement.
,⩥ Staph Scalded Skin Syndrome (SSSS)
S.aureus exotoxin
Tx: Naficillin, Dicloxacillin. Answer: 9-1-1 was called by childcare
workers in a daycare because they found "burns on the baby's back", and
they were accusing the parents of child abuse. On physical exam, the
child is running an elevated temperature. You note large, tender
erythemic lesions on the child's back along with flacid/nikolsky positive
bullae and sloughing of the skin. No mucosal involvement is noted.
⩥ Necrotising fasciitis
Strep progenies
MRSA
Tx: Broad spec Abx: Clindamycin (which actually stops the toxin
production). Answer: Patient presents to the ER complaining of shin
pain a few days after getting a cut on his shin. Upon examination, you
notice a 2cm laceration that appears to be infected with pus coming out
and what appears to be bruising around the injury site. The patient
practically jumps out of his ER cot, in pain, after the slightest touch. He
demands pain medication before you touch him again. At first you think
he's just seeking pain meds, but you decide to xray his leg to be sure.
, ⩥ toxic shock syndrome
non-invasive Exotoxin+ negative bld Cx =Staph
Positive Bld Cx, invasive toxin =Strep. Answer: 28 y/o female pt was
transferred to your psychiatric unit from the ER. homeless +Hx
schizophrenia + drug abuse. She came into the ER very combative and
ER resident decided to sedate her. The next morning, she is still out of it
but is running a fever and is hypotensive. she has red skin lesions on her
body and hands that look like bad sun burn. skin on her hands are
sloughing off. note +mucosal involvement. notice a tampon that appears
to have been in place for awhile.
⩥ purpura fulminans (Neiserria/meningococcus) hemorrhagic vesicles.
Pt has fevers and is hypotensive-> test for adrenal insufficiency
Tx:ceftriaxone. Answer: An 18 y/o female college student was brought
into the ER by two friends from her dorm floor. She is very ill-appearing
with a sever headache and associated neck pain. You notice non-
blanching purpuric lesions on her leg. She has a positive brudinski and
kernig sign.
⩥ Rockey Mountain Spotted Fever
CLASS 6512 FINAL STUDY GUIDE 2026
QUESTIONS WITH ANSWERS GRADED A+
⩥ Stevens-Johnson Syndrome (aka EM Major)
(sulfa, allopurinol, anticonvulsant/psychotics)
Tx:supportive. Answer: 57 year old male presents to your clinic with a
rash. In the history, he states that he has recently been prescribed
anticonvulsant medication. On physical exam, you note an elevated body
temperature, multiple bullae, and sloughing of his skin with mucosal
involvement (cracked lips, oral lesions, conjunctivitis). These lesions
span approximately 8% of his body surface area.
⩥ Toxic Epidermal Necrolysis
Tx:Fluids! need burn unit and IVIG. Answer: Patient is brought into the
ER too weak and in too much pain to talk. His spouse stated that he has
been on an antibiotic for an infection (SMX-TPM). He has never taken
this medicine before. On physical exam, you note sloughing of skin over
a massive portion of his body (approx 40%). You also note mucosal
involvement.
,⩥ Staph Scalded Skin Syndrome (SSSS)
S.aureus exotoxin
Tx: Naficillin, Dicloxacillin. Answer: 9-1-1 was called by childcare
workers in a daycare because they found "burns on the baby's back", and
they were accusing the parents of child abuse. On physical exam, the
child is running an elevated temperature. You note large, tender
erythemic lesions on the child's back along with flacid/nikolsky positive
bullae and sloughing of the skin. No mucosal involvement is noted.
⩥ Necrotising fasciitis
Strep progenies
MRSA
Tx: Broad spec Abx: Clindamycin (which actually stops the toxin
production). Answer: Patient presents to the ER complaining of shin
pain a few days after getting a cut on his shin. Upon examination, you
notice a 2cm laceration that appears to be infected with pus coming out
and what appears to be bruising around the injury site. The patient
practically jumps out of his ER cot, in pain, after the slightest touch. He
demands pain medication before you touch him again. At first you think
he's just seeking pain meds, but you decide to xray his leg to be sure.
, ⩥ toxic shock syndrome
non-invasive Exotoxin+ negative bld Cx =Staph
Positive Bld Cx, invasive toxin =Strep. Answer: 28 y/o female pt was
transferred to your psychiatric unit from the ER. homeless +Hx
schizophrenia + drug abuse. She came into the ER very combative and
ER resident decided to sedate her. The next morning, she is still out of it
but is running a fever and is hypotensive. she has red skin lesions on her
body and hands that look like bad sun burn. skin on her hands are
sloughing off. note +mucosal involvement. notice a tampon that appears
to have been in place for awhile.
⩥ purpura fulminans (Neiserria/meningococcus) hemorrhagic vesicles.
Pt has fevers and is hypotensive-> test for adrenal insufficiency
Tx:ceftriaxone. Answer: An 18 y/o female college student was brought
into the ER by two friends from her dorm floor. She is very ill-appearing
with a sever headache and associated neck pain. You notice non-
blanching purpuric lesions on her leg. She has a positive brudinski and
kernig sign.
⩥ Rockey Mountain Spotted Fever
