WBR1044

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Author [[PageAuthor::Ahmed Zaghw, M.D. [1]]]
Exam Type USMLE Step 2 CK
Main Category Internal medicine
Sub Category Dermatology, Musculoskeletal/Rheumatology
Prompt [[Prompt::A 17 year old adult came to the emergency department because he is not feeling well. He has painful joints all over his body with pinky rash over his abdomen and extremities. The vital signs was normal; 120/80 for blood pressure and 80 for heart rate. HE got admitted for further investigation. On the the next two day he developed severe blistering rash all over his body with mild temperature. The examination of the blisters shows positive Nikolsky’s sign and total coverage over than 35% of total body surface area. He had a mitral valve replacement 5 months ago for a rheumatic mitral stenosis. He is on warfarin 5 ug since then. His family reports that he has done 2 molar tooth extraction three weeks ago, after which he has been prescribed ibubrofen 300 mg three time a day. The dentist prescribed him 2 gm Ampicillin tablet once before the procedure. His history is significant for penicillin for the last 10 years before the valve surgery. One month ago he was diagnosed with gonorrhea contracted from unprotected sexual relationship. It was treated with Zithromax 500 mg and Ceftriaxone 1 gm once. He smokes marijuana and drink 3 beers every day. Which of the following represents the most likely underlying pathology?
Epidermal sloughing.png
]]
Answer A IgM intercellular junctions of epidermal cells
Answer A Explanation [[AnswerAExp::Correct-[[]].]]
Answer B IgG intercellular junctions of epidermal cells
Answer B Explanation [[AnswerBExp::Incorrect-[[]]]]
Answer C IgM Antibodies to epidermal basement membrane
Answer C Explanation [[AnswerCExp::Correct-[[]]]]
Answer D IgG Antibodies to epidermal basement membrane
Answer D Explanation [[AnswerDExp::Incorrect-[[]].]]
Answer E IgM Antibodies to dermal epidermal junction
Answer E Explanation [[AnswerEExp::Incorrect-[[]]]]
Right Answer C
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