The rash and mucous membrane lesions shown in the photograph below develop in an infant 5 days into the course of an upper respiratory infection with otitis media; the child is being treated with amoxicillin. The child’s condition is likely which of the following?
c. Stevens-Johnson syndrome
d. Kawasaki disease
e. Scarlet fever
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is c; Stevens-Johnson syndrome.
The combination of erythema multiforme and vesicular, ulcerated lesions of the mucous membranes of the eyes, mouth, anus, and urethra defines the Stevens-Johnson syndrome (erythema multiforme major). Fever is common, and even pulmonary involvement occasionally is noted; the mortality rate can approach 10%. Common complications include corneal ulceration; dehydration due to severe stomatitis, and, subsequently, poor fluid intake; and urinary retention caused by dysuria. Among the known causes of the Stevens-Johnson syndrome are allergy to various drugs (including phenytoin, barbiturates, sulfonamides, and penicillin) and infection with a variety of organisms including Mycoplasma pneumoniae or herpes type 1. Erythema multiforme is sometimes confused with urticaria early in the course because both can have a target-like lesion.
The former has a target center that contains a papule or vesicle, which progresses to blister and necrosis. In contrast, urticaria can have a bluish center, but the lesions are transient (often lasting less than 24 h) and are pruritic. Kawasaki disease is an acute febrile illness of unknown etiology, sharing many of its clinical manifestations with scarlet fever. Scarlatiniform rash, desquamation, erythema of the mucous membranes that produces an injected pharynx and strawberry tongue (but not sloughing, as in the case presentation), and cervical lymphadenopathy are prominent findings in both. Persons with rubeola develop a severe cough, coryza, photophobia, conjunctivitis, and a high fever that reaches its peak at the height of the generalized macular rash, which typically lasts for 5 days. The oral changes include Koplik spots (transient white pinpoint lesions on a bright red buccal mucosa often in the area opposite the lower molars) but not sloughing.