Return to Scenario ListShow Learning Points most relevant to Phase 1:


Clinical Discipline(s)/Organ System(s)
Clinical Pharmacology, Dermatology, Immunology
Progress Test Topic(s)
A 75 year old Chinese man presents to the Emergency Department in winter with blisters and a red blotchy rash. Ten days ago he was started on carbamazepine for painful diabetic neuropathy.
Progress Test-Type Questions:   Question 1
Applied Science for Medicine 
   - Microanatomy of the dermis and epidermis
   - Pathogenesis of the different types of cutaneous drug reactions
   - Pathogenesis of autoimmune bullous disease (bullous pemphigoid and pemphigus)
   - Physiological effects of significant skin loss from cutaneous drug reactions
   - Pharmacogenetic variability; recognise genetic susceptibility to drug reactions
   - Explain the effect of a sensory neuropathy on the skin
Clinical and Communication Skills 
   - Take an effective history being mindful of the differential diagnosis of acute and non-acute blistering diseases and the importance of an accurate drug history
   - When necessary identify the need for the use of an interpreter
   - Examination of a patient with blisters noting site, size, flaccidity, distribution of blisters, signs of mucous membrane and systemic involvement
   - Describe cutaneous features in dermatological terminology
   - Outline appropriate investigations including the importance of skin biopsy and immunofluorescence for accurate diagnosis
   - Manage, report and avoid adverse drug reactions; use of medic alert bracelet, automated computer alerts; notification to Centre for Adverse Reactions Monitoring (CARM)
   - Provide the patient with verbal and written information about the skin disorder diagnosed
Personal and Professional Skills 
   - Principles of prevention of adverse drug reactions
   - Establish a multidisciplinary approach to severe drug eruptions with the involvement of dermatology, general medicine, ophthalmology, gynaecology and intensivists
   - Liaise effectively with family/whānau and allied health professionals for an assessment of the home environment
Hauora Māori 
   - Culturally safe engagement with this patient and whānau
   - Consideration of access to cultural / spiritual support for patient and whānau
Population Health 
   - Pharmacogenetic screening for susceptibility to drug reactions where needed
Conditions to be considered relating to this scenario
drug eruption (mild), erythema ab igne, herpes zoster (shingles)
Less common but 'important not to miss'
drug eruption (major), Stevens Johnson syndrome, toxic epidermal necrolysis, erythema multiforme, drug hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DRESS)
bullous pemphigoid, pemphigus vulgaris, dermatitis herpetiformis, cutaneous vasculitis +/- systemic involvement
Related Scenarios
[Adult eczema]