NBME 6 q 38 - droneday

[ArchivalUser]

38. A 37-year-old woman comes to the physician because of an itchy rash over her trunk for 2 weeks. She has not had fever, chills, shortness of breath, chest pain, or gastrointestinal symptoms. She has a history of recurrent urinary tract infections and has been taking trimethoprim-sulfamethoxazole prophylaxis for the past year. She is in mild distress. Her temperature is 37.5 C (99.5 F), blood pressure is 96/62 mm Hg, pulse is 78/min, and respirations are 14/min. Examination shows a maculopapular erythematous rash over the trunk. Laboratory studies show:

Leukocyte count 10,500/mm3
Segmented neutrophils 72%
Bands 1%
Eosinophils 15%
Lymphocytes 4%
Monocytes 8%
Serum
Urea nitrogen (BUN) 12 mg/dL
Creatinine 0.9 mg/dL
Urine
WBC 2/hpf
RBC 2/hpf

Which of the following is the most likely cause of these findings?

A) Eczema
B) Medication adverse effect
C) Staphylococcal skin infection
D) Streptococcal skin infection
E) Urinary tract infection

key B, how can it be, she been taking the drug over for year?

[ArchivalUser]

B is correct.

TMP SMX can cause SJS TEN.
so, it can cause that rash on the trunk.

Why so late? probably took it off and on, body became sensitized.

https://www.aad.org/quiz/drug-eruptions-learners

[ArchivalUser]

@monter, thanks