WBR1003

Author	[[PageAuthor::Vidit Bhargava, M.B.B.S [1]]]
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Internal medicine
Sub Category	SubCategory::Dermatology
Prompt	[[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 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 ?]]
Answer A	[[AnswerA::Temperature > 102 F, Systolic blood pressure < 90 mm Hg]]
Answer A Explanation	[[AnswerAExp::These are consistent with features suggestive of toxic shock syndrome.]]
Answer B	[[AnswerB::Desquamative rash]]
Answer B Explanation	AnswerBExp::Consistent with features suggestive of toxic shock syndrome.
Answer C	AnswerC::Increased platelet count
Answer C Explanation	AnswerCExp::In toxic shock syndrome, platelet counts are decreased rather than being increased.
Answer D	AnswerD::Involvement of the mucous membranes of the eye, mouth and genitals
Answer D Explanation	AnswerDExp::Consistent with features suggestive of toxic shock syndrome.
Answer E	[[AnswerE::Raised creatinine, CPK, and liver function tests]]
Answer E Explanation	[[AnswerEExp::Consistent with features suggestive of toxic shock syndrome.]]
Right Answer	RightAnswer::C
Explanation	[[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 Educational Objective: In toxic shock syndrome, platelet counts are decreased rather than being increased. References: Page 379 FA STEP2CK seventh edition]]
Approved	Approved::No
Keyword	WBRKeyword::TSS
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::