Severe Drug Reactions – Board-Style Questions

What this deck covers

Severe drug reactions in 18 board-style clinical cases with worked explanations. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong, with the guideline or textbook it follows named on the answer.

Board-style teaching questions for paediatricians and trainees preparing for paediatric board, MRCPCH and licensing examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 18 cases, in order

1. How much has lifted
2. What the pathologist saw
3. Started three weeks ago
4. Counting back from the rash
5. Six weeks after the first dose
6. Which organ decides it
7. Erosions, and almost no rash
8. The first thing to do
9. Hundreds of tiny spots
10. Where she is nursed
11. The eyes, on day one
12. What goes on the skin
13. A drug with some evidence
14. How much goes up
15. A test before the prescription
16. Which one is safe now
17. A check in the spring
18. Before she goes home

Diagnoses and management options tested

Across the 18 cases you are asked to choose between options such as: Detachment of over a third of the surface, A biopsy showing death of the full thickness of the epidermis, The valproate, which she has taken safely for the last three years, The dose, which was at the upper end of the range for her weight, The facial swelling, the eosinophil count and the involvement of the liver, Inflammation of the kidney, which is the usual cause of death in this reaction, A drug reaction, since some medicine will have been taken and then forgotten about, Stopping the antibiotics alone, since they are the commonest culprits, A pustular drug eruption, which begins within a day or two of the drug, The local paediatric ward, with the dermatology team reviewing her every day, Nothing yet, since the eye signs settle as the skin heals, Nothing applied, with the child nursed on an open bed, Ciclosporin, which several series suggest shortens the illness, The same as a burn of that area, calculated from her weight.

Clinical pearls from this deck

• The area detached places the child on the spectrum.
• Full-thickness epidermal death confirms the diagnosis.
• Fast lamotrigine on valproate is the classic culprit.
• Four to twenty-eight days is the telling interval.
• Puffy face, eosinophils and a raised transaminase.
• The liver is what grades this reaction’s severity.

Work through the deck once for recognition, then again a week later to test yourself — each question gives the answer and explains why every other option fails.

More from this system: all emergency and critical care case decks · pediatric reference values.