SJS/TEN

Question 1

What distinguishes SJS, SJS/TEN overlap, and TEN based on the percentage of body surface area (BSA) affected?
A. SJS: <5%, SJS/TEN overlap: 5–20%, TEN: >20%
B. SJS: <10%, SJS/TEN overlap: 10–30%, TEN: >30%
C. SJS: <15%, SJS/TEN overlap: 15–25%, TEN: >25%
D. SJS: <20%, SJS/TEN overlap: 20–40%, TEN: >40%

Answer 1

B. SJS: <10%, SJS/TEN overlap: 10–30%, TEN: >30%

• SJS - the total body surface area of blistering and eventual detachment is <10%
• Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) overlap - with 10–30% epidermal detachment
• Toxic epidermal necrolysis (TEN) - describe cases with >30% detachment

Question 2

Which of the following best differentiates between SJS and TEN?
A. Presence of dermal inflammation
B. Presence of mucosal involvement
C. Percentage of total body surface area (BSA) affected by epidermal detachment
D. Type of causative drug

Answer 2

C. Percentage of total body surface area (BSA) affected by epidermal detachment

Question 3

What is the most common initial clinical presentation of SJS/TEN?
A. Severe urticarial eruptions with pruritus
B. Fever >39°C, sore throat, conjunctivitis, and painful dusky target-like lesions
C. Diffuse erythema without mucosal involvement
D. Gradual onset of vesicular eruptions

Answer 3

B. Fever >39°C, sore throat, conjunctivitis, and painful dusky target-like lesions

Question 4

Which of the following is a poor prognostic factor for SJS/TEN?
A. Young age
B. Limited epidermal detachment
C. Upper respiratory tract involvement
D. Early diagnosis

Answer 4

C. Upper respiratory tract involvement

Question 5

Which drugs are most commonly associated with the onset of SJS/TEN?
A. ACE inhibitors, statins, and aspirin
B. Beta-lactam antibiotics, sulfonamides, allopurinol, antiepileptics, and NSAIDs
C. Insulin, metformin, and thiazolidinediones
D. Antihistamines, H2 blockers, and proton pump inhibitors

Answer 5

B. Beta-lactam antibiotics, sulfonamides, allopurinol, antiepileptics, and NSAIDs

Question 6

What is the recommended initial management step in suspected SJS/TEN?
A. Immediate initiation of high-dose systemic corticosteroids
B. Empiric antibiotic therapy
C. Discontinuation of the suspected causative drug and supportive care
D. Administration of intravenous immunoglobulin (IVIG)

Answer 6

C. Discontinuation of the suspected causative drug and supportive care

Question 7

What is the fluid requirement for the first 24 hours in a patient with extensive SJS/TEN involvement?
A. 1 mL/kg/BSA percent affected
B. 2 mL/kg/BSA percent affected
C. 3 mL/kg/BSA percent affected
D. 5 mL/kg/BSA percent affected

Answer 7

B. 2 mL/kg/BSA percent affected

Question 8

What is the estimated caloric requirement during the catabolic phase of SJS/TEN?
A. 10–15 kcal/kg per day
B. 15–20 kcal/kg per day
C. 20–25 kcal/kg per day
D. 25–30 kcal/kg per day

Answer 8

C. 20–25 kcal/kg per day

Question 9

Which systemic agent has been utilized in the treatment of SJS/TEN but is not universally established as effective?
A. IV immunoglobulin (IVIG)
B. Antibiotics
C. Antihistamines
D. Beta blockers

Answer 9

A. IV immunoglobulin (IVIG)

Question 10

Which supportive measure is critical for managing a patient with SJS/TEN?
A. Administering high-dose systemic antibiotics
B. Maintaining room temperature between 28–32°C (82.4–89.6°F)
C. Limiting nutritional supplementation during the acute phase
D. Delaying fluid resuscitation until detachment subsides

Answer 10

B. Maintaining room temperature between 28–32°C (82.4–89.6°F)