WBR1003

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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 came to ED 2 days back with epistaxis, while playing basketball. It was managed by Posterior Nasal packing. He was discharged home with some analgesics and instructions to visit the ED the following day, however he missed the appointment. Today he presents with following vitals:

Tempertaure 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. 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 TSS.]]
Answer B AnswerB::Desquamative rash
Answer B Explanation AnswerBExp::Consistent with features suggestive of TSS.
Answer C AnswerC::Increased platelet count
Answer C Explanation AnswerCExp::In TSS, 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 TSS.
Answer E [[AnswerE::Raised creatinine, CPK, and liver function tests]]
Answer E Explanation AnswerEExp::Consistent with features suggestive of TSS.
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:
References: ]]

Approved Approved::No
Keyword WBRKeyword::TSS
Linked Question Linked::
Order in Linked Questions LinkedOrder::