John Cafaro MD

Back to Basics: Pemphigus Vulgaris

Pathology: Chronic autoimmune mucocutaneous disease against desmosomes in epidermis

Clinical:

  • painful; rarely pruritic; afebrile
  • flaccid bullae but may start tense, +Nikolsky's sign
  • mucosal involvement common 
  • Bullous pemphigus: Have tense bullae (may start with urticarial lesions), negative Nikolsky's sign, mucosal involvement less likely

Diagnosis: clinical; biopsy is gold standard. 

Management:

Category (Day): 

Board Review: Skin and Soft Tissue Infections

A 32 year old male history of IV drug use presents for redness to his right arm extending the antecubital fossa. He has pain out of proportion to the area and pain outside of the erythematous margins. He is febrile to 103.2 F, heart rate is 125, blood pressure is 80/40. Patient is given normal saline. Vancomycin and Cefepime are started. What is the next step in management? 

A. Immediate Surgical Consult and Clindamycin. 

B. Draw labs to risk stratify via the LRINEC score and a CT scan

C. Immediate Surgical Consult and a CT scan. 

Category (Day): 

Board Review: Epistaxis

A 30 year old male with no past medical history presents to the ED for epistaxis. You notice actice bleeding from right nare but cannot determine the exact source. Direct pressure was attempted for 20 minutes followed by application of a topical vasoconstrictor bleeding persists. What is the next best step in management of this patient's epistaxis? 

A. Irrigation

B. Posterior Packing

C. Anterior Packing

D. Cautery with silver nitrate 

 

 

 

 

 

Answer: C - Anterior Packing

Topic: 
Category (Day): 

Board Review: Dental Problems

A 35 year old female presents to the Emergency Department with sudden onset of right lower dental pain. Patient had a dental extraction for a dental carie 5 days ago. What is the most likely diagnosis?

A. Acute Necrotizing Ulcerative Gingivitis 

B. Pulpitis 

C. Dental Abscess

D. Alveolar Osteitis 

E. Post-Extraction Pain

 

 

 

 

 

 

 

Answer is D - Alveolar Osteitis (Dry Socket)

 

Loss of healing clot leads to pain and inflammation 3-5 days post extraction. 

Topic: 
Category (Day): 

Board Review: Anaphylaxis

A 50 year old male with history of atrial fibrillation and a seafood allergy presents after eating seafood. He is on a beta-blocker for rate control. He has facial swelling, hives, trouble breathing and nausea. You give epinephrine x 2 intramuscularly but the patient is not improving. What is your next step in management. 

A. Epinephrine IM

B. Epinephrine IV

C. Glucagon

D. Glucocorticoid 

E. Pepcid

 

 

 

 

 

Answer: C - Glucagon

Topic: 
Category (Day): 

Board Review: Toxicology

A 25 year old female presents with plaquenil overdose. She is hypotensive with a systolic blood pressure of 70. She complains of dizziness. EKG shows QRS widening. You initiate 2L of normal saline but her systolic blood pressure persists in the 70s. What is your vasopressor of choice? 

A. Norepinephrine

B. Epinephrine

C. Dobutamine

D. Phenylephrine.

 

 

 

 

 

 

 

 

 

Answer: B - Epinephrine

Topic: 
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