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NBME 1,Block 3,Q38 - 2stepcs
#1
38. A 37-year-old woman comes to the physician because of an itchy rash over her trunk for 2 weeks. She has not had fever, chills, shortness of breath, chest pain, or gastrointestinal symptoms. She has a history of recurrent urinary tract infections and has been taking trimethoprim-sulfamethoxazole prophylaxis for the past year. She is in mild distress. Her temperature is 37.5 C (99.5 F), blood pressure is 96/62 mm Hg, pulse is 78/min, and respirations are 14/min. Examination shows a maculopapular erythematous rash over the trunk. Laboratory studies show:

Leukocyte count 10,500/mm3
Segmented neutrophils 72%
Bands 1%
Eosinophils 15%
Lymphocytes 4%
Monocytes 8%
Serum
Urea nitrogen (BUN) 12 mg/dL
Creatinine 0.9 mg/dL
Urine
WBC 2/hpf
RBC 2/hpf

Which of the following is the most likely cause of these findings?

A
) Eczema

B
) Medication adverse effect

C
) Staphylococcal skin infection

D
) Streptococcal skin infection

E
) Urinary tract infection
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#2
anyone pl z?
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#3
Answer B.

Reason: Eczema is so rare after 30....and sulfa drugs are well known for this kind of side effect!
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#4
she is taking sulfa drugs past 1 yr ,
this rash is acute for 2 weeks ????
still confuse Sad
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#5
anyone ?
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#6
I'd go with B, mostly because new onset eczema is unlikely at her age compared to a drug reaction.
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#7
most comm a/e of tmp-sm is rash..and also her in the diff count eosinophils elevatede-15% which is morethan normal less than 5%
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#8
BB - eosinophils elevated, most likely drug induced.
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