View source for WBR1003

{{WBRQuestion
|QuestionAuthor={{VB}}
|ExamType=USMLE Step 2 CK
|MainCategory=Internal medicine
|SubCategory=Dermatology, Dermatology
|MainCategory=Internal medicine
|SubCategory=Dermatology, Dermatology
|MainCategory=Internal medicine
|SubCategory=Dermatology, Dermatology
|MainCategory=Internal medicine
|MainCategory=Internal medicine
|SubCategory=Dermatology, Dermatology
|MainCategory=Internal medicine
|SubCategory=Dermatology, Dermatology
|MainCategory=Internal medicine
|SubCategory=Dermatology, Dermatology
|MainCategory=Internal medicine
|SubCategory=Dermatology, Dermatology
|MainCategory=Internal medicine
|MainCategory=Internal medicine
|SubCategory=Dermatology, Dermatology
|Prompt=A 20 yr old male presented to emergency department 2 days back with [[epistaxis]], while playing basketball. It was managed by [[Posterior Nasal packing]] at the time of presentation. He was discharged home with some [[analgesics]] and instructions to visit the emergency department the following day, however he missed the appointment. Today he presents with following vitals:
 
* Temperature 103 F <br> 
* Pulse 120/min
* Blood pressure 78/60 mmHg
*Respiratory rate 24/min

Labs were ordered, nasal pack was removed and he was diagnosed with [[Toxic shock syndrome]] (TSS). Which of the following features is not consistent with the diagnosis ?
|Explanation=Toxic shock syndrome is caused by [[staphylococcus]] attached to a foreign body, such as nasal packing or surgical sutures retained anywhere in the body. The features characteristic of this syndrome are: 
:* Fever > 102 F
:* Systolic blood pressure < 90 
:* Desquamative rash 
:* Vomiting
:* Involvement of the mucous membranes of the eye, mouth and genitals
:* Raised [[creatinine]], [[CPK]], and [[liver function tests]]
:* Lowered platelet count
:* Central nervous dysfunction such as confusion
|AnswerA=Temperature > 102 F, Systolic blood pressure < 90 mm Hg
|AnswerAExp=These are consistent with features suggestive of [[TSS|toxic shock syndrome]].
|AnswerB=[[Desquamative rash]]
|AnswerBExp=Consistent with features suggestive of toxic shock syndrome.
|AnswerC=Increased platelet count
|AnswerCExp=In toxic shock syndrome, platelet counts are decreased rather than being increased.
|AnswerD=Involvement of the mucous membranes of the eye, mouth and genitals
|AnswerDExp=Consistent with features suggestive of toxic shock syndrome.
|AnswerE=Raised [[creatinine]], [[CPK]], and [[liver function tests]]
|AnswerEExp=Consistent with features suggestive of [[toxic shock syndrome]].
|EducationalObjectives=In [[toxic shock syndrome]], platelet counts are decreased rather than being increased.
|References=Page 379 FA STEP2CK
|RightAnswer=C
|WBRKeyword=TSS
|Approved=No
}}