Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (TEN) Flashcards
Stevens-Johnson syndrome is a severe systemic reaction affecting the skin and mucosa. What is the most common cause of SJS?
1 - food allergy
2 - reactive dermatitis
3 - drug reaction
4 - animal allergy
3 - drug reaction
- almost always a drug reaction
Which of the following is NOT typically linked with causing Stevens-Johnson syndrome
1 - Antibiotics
2 - Allopurinol
3 - NSAIDs (naproxen, ibuprofen)
4 - B-blockers
5 - Anticonvulsants
6 - Sulphonamides
4 - B-blockers
- antibiotics is by far the most common, accounting for 40% of reactions
The most common cause of Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) is a drug reaction. Is this always an acute, rapid reaction?
- no
- can present 2 months after starting the drug
- most commonly acute, rapid reaction though
Stevens-Johnson syndrome is a severe systemic reaction affecting the skin and mucosa. It typically presents with maculopapular but can develop into vesicles or bullae. In extreme cases it can result in Nikolsky positive, what is this?
1 - extensive erythamatous skin changes
2 - extensive nodules appearing all over the torso
3 - skin becomes red, fluid collects underneath, skin is rubbed off leaving erythamtous under layer
4 - all of the above
3 - skin becomes red, fluid collects underneath, skin is rubbed off leaving erythamtous under layer
The skin and mucosal surfaces can be affected, but which of the following are also affected?
1 - Eyes - conjunctivitis, blepharitis
2 - Mouth - ulcers, chelitis, mucositis
3 - GI tract - oesphagitis, diarrhoea
4 - Resp – cough, ARDS
5 - Genitals - ulcers
6 - all of the above
6 - all of the above
In addition to the skin and mucosal presentation of Stevens-Johnson syndrome patients can also present with which of the following?
1 - fever
2 - arthralgia
3 - pain
4 - all of the above
4 - all of the above
Toxic epidermal necrolysis (TEN) is a potentially life-threatening condition characterised by extensive exfoliation of the epidermis and mucous membrane, and is a more severe form of Stevens-Johnson syndrome (SJS). What extent of the skin has to be involved for a patient to be diagnosed with TEN?
1 - >30%
2 - 10-30%
3 - <10%
4 - <5%
1 - >30%
- 10-30% = TEN/SJS
- <10% = SJS
If someone is having an adverse drug reaction, which of the following is the most important to do?
1 - brief history
2 - examination
3 - stop drug causing reaction
4 - call senior member of the team
3 - stop drug causing reaction
Also:
- ABCDE
- Manage any complications (commonly infection)
- Senior Support
- Specific treatments
In a patient with suspected Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS), which of the following is least important following an ABCDE approach to treating the patient?
1 - Bed rest
2 - IV fluids
3 - monitoring vital signs
4 - urine output
5 - antibiotics
5 - antibiotics
- these may be useful, but the cause needs to be identified 1st
- give analgesia as patients are in a lot of pain
In a patient with suspected Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) the barrier of the skin is compromised. There they should be given a thick 50:50 white soft paraffin:Liquid paraffin emollient how often initially?
1 - every 30 minutes
2 - every 2 hours
3 - every 4 hours
4 - every 8 hours
2 - every 2 hours
If we suspect that the cause of Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) is due to a secondary infection we should start them on which 2 of the following:
1 - anti-fungals
2 - antibiotics
3 - moderate strength topical corticosteroids
4 - thick emollients
2 - antibiotics
3 - moderate strength topical corticosteroids
Also need to do skin biopsy and take bloods as required
What scoring system can be used to assess the severity of Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS)?
1 - chadsvasc score
2 - Q-risk
3 - glasgow score
4 - SCORTEN scale
4 - SCORTEN scale
SCORTEN scale (SCORe of Toxic Epidermal Necrosis) is
