Dermatopathology, Pathology, USMLE Step 1 - Full Vignette with Extended Explanations скачать в хорошем качестве

Dermatopathology, Pathology, USMLE Step 1 - Full Vignette with Extended Explanations

A 57-year-old man develops fever, painful targetoid macules, and widespread epidermal detachment shortly after starting a new medication, with significant oral, ocular, and genital mucosal involvement. What key clinical and laboratory features should guide your evaluation in patients with acute skin failure and mucosal erosions? How do you prioritize urgent interventions and avoid potentially harmful treatments in the absence of clear infection? VIDEO INFO Category: Dermatopathology, Pathology, USMLE Step 1 Difficulty: Expert - Expert level - For those seeking deep understanding Question Type: Contraindications Case Type: Emergency - Emergency scenario requiring urgent decision-making Explore more ways to learn on this and other topics by going to https://endlessmedical.academy/auth?h... QUESTION A 57-year-old man is brought to the emergency department with 2 days of fever and painful dusky targetoid macules that coalesce into sheets of epidermal detachment over the trunk and face after starting lamotrigine 3 weeks ago. He reports painful oral erosions and eye irritation. He has a history of childhood vesicoureteral reflux; he stopped alcohol 5 years ago and currently smokes 3 packs/day.... OPTIONS A. Starting routine prophylactic systemic antibiotics without documented clinical or microbiologic evidence of active infection. B. Immediate cessation of lamotrigine, admission to a burn/ICU setting, and goal-directed crystalloids with early enteral nutrition. C. Urgent ophthalmology management with ocular lubrication and early amniotic membrane placement to prevent symblepharon. D. Nonadherent dressings with gentle removal of clearly necrotic tissue while avoiding sharp debridement of viable epidermis. CORRECT ANSWER A. Starting routine prophylactic systemic antibiotics without documented clinical or microbiologic evidence of active infection. EXPLANATION The correct answer is "Starting routine prophylactic systemic antibiotics without documented clinical or microbiologic evidence of active infection." In SJS/TEN, early withdrawal of the culprit drug, burn/ICU-level supportive care, meticulous wound care, and urgent ophthalmology interventions are foundational. Prophylactic systemic antibiotics increase risks of resistance, Clostridioides difficile, and drug reactions without reducing mortality when infection is not present. This patient is hemodynamically stable, has no focal infectious source, clear chest radiograph, bland urinalysis, and is already undergoing appropriate supportive measures. "Immediate cessation of lamotrigine, admission to a burn/ICU setting, and goal-directed crystalloids with early enteral nutrition." is essential standard care. "Urgent ophthalmology management with ocular lubrication and early amniotic membrane placement to prevent symblepharon." is time-critical to preserve ocular surface. "Nonadherent dressings with gentle removal of clearly necrotic tissue while avoiding sharp debridement of viable epidermis." reflects best practices to protect the dermal template and minimize infection risk. In summary, avoid routine prophylactic systemic antibiotics in SJS/TEN absent proven infection; prioritize drug cessation and multidisciplinary supportive care. Primary teaching point: Prophylactic systemic antibiotics are contraindicated in SJS/TEN without infection. Secondary teaching point: Early ophthalmology involvement and ocular surface protection prevent vision-threatening sequelae. Tertiary teaching point: Supportive burn-unit care (fluids, nutrition, nonadherent dressings) improves outcomes. Further reading: Links to sources are provided for optional further reading only. The questions and explanations are independently authored and do not reproduce or adapt any specific third-party text or content. --------------------------------------------------- Our cases and questions come from the https://EndlessMedical.Academy quiz engine - multi-model platform. Each question and explanation is forged by consensus between multiple top AI models (i.e. Open AI GPT, Claude, Grok, etc.), with automated web searches for the latest research and verified references. Calculations (e.g. eGFR, dosages) are checked via code execution to eliminate errors, and all references are reviewed by several AIs to minimize hallucinations. Important note: This material is entirely AI-generated and has not been verified by human experts; despite stringent consensus checks, perfect accuracy cannot be guaranteed. Exercise caution - always corroborate the content with trusted references or qualified professionals, and never apply information from this content to patient care or clinical decisions without independent verification. Clinicians already rely on AI and online tools - myself included - so treat this content as an additional focused aid, not a replacement for proper medical education. Visit https://endlessmedical.academy for more AI-supported resources and cases. This material