An 18-Month-Old Girl Is Brought to the Office by Her

question 425

Multiple Choice

An 18-month-old girl is brought to the office by her parents due to a rash and blisters that started this morning.  Yesterday, the child was very fussy, particularly when her parents picked her up.  The patient also had a fever that responded well to ibuprofen.  This morning, the parents noted erythema and peeling skin around her mouth, axillae, and inguinal areas.  Medical history is significant for otitis media 6 months ago.  Vaccinations are up to date, and the patient takes no daily medications.  Temperature is 39 C (102.2 F) , blood pressure is 89/52 mm Hg, pulse is 145/min, and respirations are 28/min.  Examination reveals an irritable child who cries with any attempt to move her.  Superficial flaccid bullae and an erythematous rash are diffusely distributed over the body.  Slight focal pressure to the back results in sloughing of the top layer of skin with underlying erythema.  The face appears edematous, with perioral crusting.  A single pustule is noted under the left naris, but no mucosal lesions are seen.  Which of the following is the most likely diagnosis in this patient?

• A)Bullous impetigo
• B)Erysipelas
• C)Erythema multiforme
• D)Scarlet fever
• E)Staphylococcal scalded skin syndrome
• F)Toxic epidermal necrolysis

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Definitions:

Middle Score

The median value in a set of numbers, representing the point at which half of the figures are above and half are below.

Median

A statistical measure indicating the middle value in a set of data when the values are arranged in ascending or descending order, effectively dividing the dataset into two equal halves.

Values

Fundamental beliefs or standards of an individual or society, shaping attitudes and behaviors.

Mean

The mean value of a collection of numbers, determined by adding all the numbers together and then dividing that total by the quantity of numbers in the collection.