Paediatric infections: staphylococcal scalded skin syndrome: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Paediatric infections: staphylococcal scalded skin syndrome

Sample item

A 3-year-old with fever and irritability has perioral erythema, then large sheets of skin that peel off when gently rubbed. The oral mucosa is spared. What is the mechanism?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Exfoliative toxin cleaving desmoglein 1 in the upper epidermis

Staphylococcal scalded skin syndrome is due to exfoliative toxins A and B of Staphylococcus aureus, which cleave desmoglein 1 in the stratum granulosum, so the split is superficial and mucosa is spared. The Nikolsky sign is positive. Treatment is an anti-staphylococcal antibiotic and supportive skin care.

Option by option

  • A. Autoantibodies to desmoglein 3 in the lower epidermis

    Antibodies to desmoglein 3 cause pemphigus vulgaris, which involves mucosa.

  • B. Streptococcal pyrogenic exotoxin acting as a superantigen

    Streptococcal superantigen is the mechanism of scarlet fever and toxic shock, not epidermal splitting.

  • C. Drug-induced keratinocyte apoptosis with mucosal involvement

    Drug-induced toxic epidermal necrolysis involves mucosal surfaces and deeper full-thickness necrosis.

  • D. Exfoliative toxin cleaving desmoglein 1 in the upper epidermis (correct)

    Correct. Exfoliative toxin splits the granular layer through desmoglein 1.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is D, Exfoliative toxin cleaving desmoglein 1 in the upper epidermis. Staphylococcal scalded skin syndrome is due to exfoliative toxins A and B of Staphylococcus aureus, which cleave desmoglein 1 in the stratum granulosum, so the split is superficial and mucosa is spared.

Why is "Autoantibodies to desmoglein 3 in the lower epidermis" not the answer?

Antibodies to desmoglein 3 cause pemphigus vulgaris, which involves mucosa.

Why is "Streptococcal pyrogenic exotoxin acting as a superantigen" not the answer?

Streptococcal superantigen is the mechanism of scarlet fever and toxic shock, not epidermal splitting.

Why is "Drug-induced keratinocyte apoptosis with mucosal involvement" not the answer?

Drug-induced toxic epidermal necrolysis involves mucosal surfaces and deeper full-thickness necrosis.

What concept does this question test?

It tests Paediatric infections: staphylococcal scalded skin syndrome in Pediatrics. The Nikolsky sign is positive. Treatment is an anti-staphylococcal antibiotic and supportive skin care.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric infections: staphylococcal scalded skin syndrome?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.