Clinical Quiz 024

FACEM VAQ Exam 2011.2 – Question 8

• The overall pass rate for this question was 58/81 (71.6%)
• Pass Criteria (in red)
  
  • Description: Painful oral mucosal lesions characterised by haemorrhagic blistering and ulceration. Symmetrical  xtensor target lesions of arms with some facial involvement.
  • Diagnosis:  Erythema Multiforme Major on basis of skin plus mucosal lesions affecting at least one site, Stevens Johnson Syndrome less likely– more widespread, multiple mucosal involvement expected
  • Aetiology:  Idiopathic (50%), infections (herpes, mycoplasma), drugs (antibiotics, anticonvulsants, NSAIDS), malignancy, immunological diseases
  • Differential Diagnoses: Toxic Epidermal Necrolysis – extensive skin loss and abnormal vitals. Other conditions – disseminated herpes infection, pemphigus, drug reactions
• Features of unsuccessful answers
  • Failure to mention “target’ lesions on upper limbs or to note the combination of skin and mucosal lesions
  • Failure to recognise diagnosis as EM major or Stevens Johnson Syndrome
  • Failure to mention infections and drugs as possible causes