Question of the Week # 34

•A 10 y/o boy is brought by his mother for extensive rash on his lower extremities that started one day ago and has been worsening. There is no history of fever . The family just returned four days ago from a camping trip and the mother does not recall any exposure to ticks except that the boy stepped in to a bush while walking downhill. On examination, there is extensive erythema along with vesicles and bullae on the front and the back of bilateral lower extremities up until the level of the knees. The upper portion of the lower extremities is unaffected. The rest of the physical examination is normal. The best treatment for the management of this child’s condition is : •

A. Topical triamcinolone •

B. Prednisone orally •

C. Ceftriaxone intra-muscular •

D. Diphenhydramine •

E. Observation

Copy Rights: USMLEGalaxy

3 Responses

  1. Its mostly a case of poison ivy. Because the lesion is extensive with bullous formation, treat with Oral prednisone (B).

  2. Ans. B
    Oral Prednisone

    This is poison Ivy or contact dermatitis. Contact dermatitis involving more than 10% of total body surface area or associated with extensive bullae is considered severe.

    Oral prednisone (Ans.b) is the treatment of choice here since the boy has greater than 10% involvement of total body surface area and also, extensive bullae.

    The lesions are too extensive for Topical steroid use and can not be addressed with topical triamcinolone (Ans. A is incorrect). If the lesions are involving less than 10% body area, topical steroid is the first step.

    Ceftriaxone ( Answer.C) is the treatment for Lyme Disease not for poison Ivy

    Diphenhydramine may provide symptomatic relief but will not address the underlying pathology ( Answer D is incorrect)

    Observation ( Answer.E) is incorrect as patient needs treatment.

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