Systemic paediatrics: Stevens-Johnson 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 · Systemic paediatrics: Stevens-Johnson syndrome

Sample item

A 9-year-old with epilepsy started carbamazepine 12 days ago and now has fever, painful oral and conjunctival erosions and targetoid skin lesions with blistering over 8 percent of the body surface. What is the most important first step?

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

The answer and the reasoning

A. Stop the suspected drug and give supportive care

Stevens-Johnson syndrome is a severe drug reaction, often to aromatic antiseizure drugs, sulfonamides and allopurinol. The key step is to stop the culprit immediately, then give supportive care with fluids, nutrition, eye and mucosal care and a burns-style approach.

Option by option

  • A. Stop the suspected drug and give supportive care (correct)

    Correct. Prompt withdrawal of the culprit drug and supportive care are the priority.

  • B. Debride all the blistered skin

    Blistered skin is left in place as a biological dressing in most guidelines and not debrided routinely.

  • C. Start prophylactic broad-spectrum antibiotics

    Prophylactic antibiotics are not recommended and are given only for proven infection.

  • D. Substitute phenytoin for carbamazepine

    Phenytoin is also an aromatic antiseizure drug with cross-reactivity, so switching to it is unsafe.

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 A, Stop the suspected drug and give supportive care. Stevens-Johnson syndrome is a severe drug reaction, often to aromatic antiseizure drugs, sulfonamides and allopurinol.

Why is "Debride all the blistered skin" not the answer?

Blistered skin is left in place as a biological dressing in most guidelines and not debrided routinely.

Why is "Start prophylactic broad-spectrum antibiotics" not the answer?

Prophylactic antibiotics are not recommended and are given only for proven infection.

Why is "Substitute phenytoin for carbamazepine" not the answer?

Phenytoin is also an aromatic antiseizure drug with cross-reactivity, so switching to it is unsafe.

What concept does this question test?

It tests Systemic paediatrics: Stevens-Johnson syndrome in Pediatrics. The key step is to stop the culprit immediately, then give supportive care with fluids, nutrition, eye and mucosal care and a burns-style approach.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Systemic paediatrics: Stevens-Johnson 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.