Dermatological Emergencies (SJS/TEN, DRESS, Erythroderma, Acute Pemphigus) MCQs

Dermatology · 20 free questions with answers & explanations.

1. A 35-year-old man develops widespread painful erythema with full-thickness epidermal necrosis and detachment involving 45% BSA, 12 days after starting allopurinol for gout. Nikolsky's sign is positive. The MOST important immediate prognostic scoring tool to guide ICU decision-making is:
2. DRESS syndrome is characterised by drug hypersensitivity with systemic organ involvement. The minimum latency period between drug exposure and onset of DRESS is typically:
3. A 60-year-old woman presents with generalised erythema, scaling and desquamation involving >90% BSA for 3 weeks. She has hypothermia (35.2°C) and bilateral leg oedema. This is most likely exfoliative erythroderma. The MOST common underlying cause in India is:
4. In Stevens-Johnson syndrome, the mucosal involvement is a defining feature. The conjunctival complication most feared for long-term visual morbidity is:
5. The Asboe-Hansen sign (blister extension on lateral pressure) is positive in pemphigus vulgaris. What does it reflect at the tissue level?
6. A 34-year-old woman on phenytoin for epilepsy develops widespread painful erythema with 40% skin detachment, positive Nikolsky sign, and erosions involving oral, conjunctival, and genital mucosae. The SCORTEN score is calculated at 3. Which single intervention has the strongest evidence for improving mortality in this patient?
7. DRESS syndrome is distinguished from other severe cutaneous adverse reactions by which pathognomonic feature?
8. A 62-year-old man presents with generalised exfoliative erythroderma affecting >90% BSA, pruritus, and marked scaling over 8 weeks. Lymph node biopsy shows large atypical lymphocytes with cerebriform nuclei. Blood smear reveals Sézary cells >1000/mm³. Which underlying diagnosis best explains this erythroderma?
9. In acute exacerbation of pemphigus vulgaris requiring emergency management, which parameter BEST guides the decision to initiate plasma exchange (plasmapheresis) as an adjunct?
10. Which drug combination is the most common causative regimen for DRESS syndrome in India and accounts for >30% of DRESS cases associated with antiepileptic therapy?
11. A 34-year-old woman develops widespread erythema, fever, and facial edema 4 weeks after starting carbamazepine. She has lymphadenopathy, transaminitis (ALT 280 U/L), and eosinophilia (1800/µL). Skin biopsy shows spongiosis, interface dermatitis, and eosinophilic infiltrate. Which scoring system best quantifies the likelihood of this diagnosis?
12. A patient presents with TEN covering 65% BSA. SCORTEN calculated on day 1 gives a score of 5. Which single intervention has been shown in a large retrospective study to significantly reduce mortality in TEN?
13. A 55-year-old patient develops erythroderma (>90% BSA erythema and scaling) over 6 weeks. He has pruritus, edema of legs, nail dystrophy, and a new lymphadenopathy. A skin biopsy is taken. Which histopathological feature would most strongly suggest mycosis fungoides as the underlying cause rather than psoriasis?
14. In a patient with SJS/TEN overlap (15–30% BSA detachment) who is being transferred to a burn unit, which eye management is mandated from day 1 to prevent long-term sequelae?
15. A patient with known pemphigus vulgaris (PV) presents with widespread flaccid bullae, multiple erosions, and fever. Her Nikolsky sign is strongly positive. She cannot eat due to oral pain. What is the immediate treatment priority that reduces mortality in this acute flare?
16. A 38-year-old woman develops fever, facial oedema, cervical lymphadenopathy, and an extensive morbilliform rash 4 weeks after starting carbamazepine. Blood tests show eosinophilia 18%, atypical lymphocytosis, and ALT 420 U/L. What is the single most important immediate management step after discontinuing the offending drug?
17. In Toxic Epidermal Necrolysis (TEN), the key pathological event responsible for full-thickness epidermal detachment is:
18. A 65-year-old man presents with generalised erythema involving 90% BSA, scaling, fever, and lymphadenopathy. His skin biopsy shows spongiosis with exocytosis. The MOST common underlying cause of erythroderma in adults is:
19. Which of the following scoring systems is specifically used to predict mortality in patients with Toxic Epidermal Necrolysis (TEN)?
20. A patient with known pemphigus vulgaris presents acutely with rapidly spreading erosions involving 40% BSA, fever, and dehydration. Serum albumin is 2.1 g/dL. In addition to systemic corticosteroids, which adjuvant therapy is most appropriate to reduce steroid dose and control disease?