HWK SB5 (-6) Flashcards
W# HWK blocks (74-85,B1-B3) Missing blocks 74,75,76,77,78,79
1
Q
what kidney condition will not improve w/ IVF?
A
hepatorenal synd
2
Q
what do the labs look like in renal hypoperfusion?
A
- AKI
- decr uNa (<10 mEq/L)
- no casts, protein or blood in urine
3
Q
when should you suspect prerenal cause of AKI?
A
- low BP
- dehydrated state
- BUN:Cr > 20
4
Q
sudden onset resp distress (coughing, choking, wheezing) + air trapping on CXR are suspicious for what?
A
foreign body aspiration
5
Q
what are the radiographical signs of air trapping?
A
unilat hyperinflation + mediastinal shift away from blocked side
6
Q
what test confirms/tx foreign body aspiration?
A
immediate rigid bronchoscopy
7
Q
how does fibromuscular dysplasia present on P/E?
A
- abd bruit
- subauricular bruit
8
Q
what are 2 common presenting s/s in fibromuscular dysplasia?
A
- HA (2/2 internal carotid a. stenosis)
- 2* HTN (RAS)
9
Q
what presents w/ internal male genitalia, external female genitalia, female phenotype @ birth and virulization @ puberty?
A
5-alpha-reductase def
10
Q
why do m w/ 5-alpha-reductase def only develop internal male genitalia?
A
have T –> nL internal genitalia development
can’t make DHT –> no external genitalia or prostate development
11
Q
what conditions can present w/ pulsus bisferiens (biphasic pulse)?
A
- severe AR
- HOCM
- large PDA
12
Q
viral myocarditis + large pericardial effusion 2/2 viral infx both present w/ h/o recent infx, fatigue, SOB, incr JVP and cardiomegally. how do you distinguish the 2 on p/e?
A
viral myocarditis –> S3 + vasc congestion on CXR
Lg pleural effusion –> clear lungs + nonpalp PMI
13
Q
what is erythema toxicum neonatum?
A
-benign neonatal rash w/ blanching red papules/pustules
14
Q
how do you tx erythema toxicum neonatum?
A
you don’t. it’s seld-limiting and w/ resolve w/in 2 wks of birth
15
Q
what is enthesitis?
A
achilles tendon inflammation/pain
16
Q
outside of the triad (can’t see, pee, or climb a tree), what symp are common in reactive arthritis?
A
- enthesitis
- mucocutaneous lesions (oral ulcers)
17
Q
when should you suspect reactive arthritis?
A
asymmetric oligoarthritis assoc w/ urethritis, conjunctivitis and/or mouth ulcers
18
Q
what is the 1st line tx for reactive arthritis?
A
NSAIDS
19
Q
how long does it usually take an MS flare to resolve?
A
days –> weeks
20
Q
what LE condition can present like MS but resolves in a few hours?
A
common peroneal neuropathy (2/2 n. compression)
21
Q
how does common peroneal neuropathy present?
A
- foot drop + decr sensation of dorsal foot and lat. shin
- decr dorsiflexion
- decr big toe extension
- nL plantar flexion
- nL DTRs
22
Q
chlordiazepoxide and diazepam are C/I in ____?
A
liver dz
23
Q
what are the IV benzos?
A
- lorazepam
- diazepam
- midazolam
24
Q
what causes menieres dz?
A
incr vol or pressure of endolymph
25
how does menieres dz present?
- episodic vertigo
- sensorineural hearing loss
- tinnitis or ear fullness
26
what causes benign positional vertigo?
Ca debris in semicircular canals
27
how do you tx SSRI induced mania?
1. D/C the offending SSRI
| 2. tx underlying bipolar disorder if needed
28
meth use during pregnancy can cause ___.
- spontaneous abortion
- pre-term labor
- IUGR
- pre-eclampsia
- placental abruption
29
randomization is use to control for what?
confounders during study design
30
when does selective survival bias occur?
- case control studies
| - cases chosen from entire pop instead of newly dx cases only
31
how do simple renal cysts typically present?
- asymp
| - can cause HTN, flank pain, hematuria, or proteinuria if very Lg
32
how do simple renal cysts look on imaging?
boring (round, monochromatic, unilocular)
33
how do malig renal masses look on imaging?
- multi-locular
- irreg walls
- thick septae
- contrast enhancement
34
which benzos do you give an alcoholic w/ liver dz?
LOT
Lorazepam
Oxazepam
Temazepam
35
what do you not do if you suspect a pt is presenting w/ toxic megacolon?
-colonoscopy
-enema
(both incr risk of perforation)
36
what are the most likely causes of brain mets?
lung > breast > unknown 1* > melanoma > colon
37
which Ca --> mult lesion brain mets?
- lung
| - malig melanoma
38
what does lung Ca brain mets typically look like on imaging?
multiple well circumscribed lesions w/ vasogenic edema @ grey-white matter junction
39
how does toxic megacolon present?
- systemic toxicity (incr HR, low BP, F)
- bloody diarrhea
- abd distension/ peritonitis
- marked colonic distension on imaging
40
what is the MCC death in ESRD?
cardiovascular dz
41
cardiovascular dz vs infx account for what % of cause of mortality in ESRD?
cardiovasc = 50%
| infx >20%
42
what cause of joint pain presents w/ F + D + wt loss + PAS+ staining mphages?
whipple's dz
| infx that causes malabsorption and arthritis
43
seeing straight gridlines are curved suggests what?
decr fine visual acuity 2/2 macular degeneration
44
when does the pt lose the right to refuse tx?
when doing so poses a serious threat to public health and wellbeing
45
which vessels are occluded if inferior MI?
RCA or LCX
46
STEMI leads 2, 3, avF. what additional findings would suggest RCA occlusion?
ST depression in leads 1 and avL
47
STEMI leads 2, 3, avF. what additional findings would suggest LCX occlusion?
ST elevations in leads 1 and avL
48
how do you distinguish between RCA and LCX occlusion w/ STE of leads 2, 3, avF?
look at leads 1 and avL
| if elevated = LCX. if depressed = RCA
49
what clinical symp are associated w/ inf. STEMI?
low BP, low HR, AV block
50
what meds have been show to decr mortality in pts w/ severe PCP infx?
corticosteroids
51
when do you give corticosteroids in PCP?
paO2 < 70 mmHg on room air
| A-a > 35 mmHg on room air
52
how do you manage uncomplicated low back pain?
1. NSAIDS
2. m. relaxers
* *continue nL/moderate activities
53
what gifts are OK to accept from a 3rd party?
gifts that are non-monetary, low value and of direct benefit to pts
54
what is the most likely cause of pancytopenia if no splenomegally and no abn cells on peripheral smear?
aplastic anemia
55
what will be found on P/E if pancytopenia is 2/2 myelofibrosis (i.e. incr collagen or reticulin deposition in BM)?
hepatosplenomegally (2/2 extramedullary hematopoeisis)
56
when is prosthetic joint infx more likely to be caused by s. aureus than s. epidermidis?
< 3mos s/p implantation
| > 12mos s/p implantation
57
clinically, how can you distinguish s. aureus prosthetic joint infx from s epidermidis infx?
s aureus = SICK (F + hot, red joint)
| s epi = nL looking pt w/ chronic pain
58
what meds are associated w/ acute angle-closure glaucoma?
anti-cholinergics used for parkinson's dz
59
what is trihexyphenidyl?
- an anticholinergic used to tx parkinson's dz
| - can cause glaucoma
60
what are the clinical features of GAD?
- excessive, incontrollable worry (mult. issues) >= 6 mos
| - physical s/s >=3 mos (restlessness, fatigue, irritability, decr concentration, muscle tension, sleep disturbance)
61
what are the physical manifestations of GAD?
- restlessness
- fatigue
- irritability
- decr concentration
- m. tension
- sleep disturbance
62
what is the sole focus of social anxiety disorder?
fear of negative evaluation by society
63
what do kids w/ GAD present w/ ?
GI upset
64
what is subconjunctival hemorrhage?
- completely asymp red eye 2/2 minor injury/bruising
| - MC self-resolves in 24-28 hrs
65
how does glaucoma present?
- vision loss
- dilated pupils
- erythema
- hard on palpation
- incr IOP
66
in the 1st 2yrs s/p kidney transplant, what condition might occur leading to decr renal f(x)?
RAS of the allograft
67
how does RAS present?
- HTN
- decr renal f(x) w/ onset of ACEi use
- abd bruit
- recurrent flash pulm edema
68
how will pt present if kidney transplant rejection is occurring?
AKI + F + graft site tenderness
69
what are the steps for the precocious puberty w/u?
1. xray (will see advanced bone age)
2. check LH (incr LH = central PP)
3. if decr LH, do GnRH stim test
(incr LH = central PP. decr LH = peripheral PP)
4. imaging (brain MRI for central. Abd CT/pelvic U/S for peripheral)
70
you should have high suspicion for what condition if pt has jejunal ulcers?
zollinger ellison synd
71
when should you suspect ZES?
- multiple refrac duodenal ulcers
- jejunal ulcers
- ulcers + chronic diarrhea
72
what causes malabsorption in ZES?
incr stomach acid --> inactivation of pancreatic enzymes
73
how does Gilbert syndrome present?
jaundice provoked by stress
74
gilbert synd and G6PD def both present w/ jaundice provoked by stress. how do you distinguish between the two?
G6PD def = hemolytic anemia (low Hgb, incr LDH)
| Gilbert synd = inability to conj bili (nL Hgb, nL LDH)
75
what are the labs for Gilbert synd?
- incr total (unconj) bili
- nL direct (conj) bili
- nL LFTs
76
direct hyperbilirubinemias that present w/ nL AST, ALT, and ALP = ?
- Dubin johnson synd
| - rotor synd
77
elevated conj bili in urine suggests what?
- defect in bilirubin excretion
| - hepatobilliary dz
78
what is dubin johnson synd?
- benign hereditary condition
| - defect in hepatic excretion of conj bilirubin
79
how does hemochromotosis present?
- fatigue, arthralgias, hyperglycemia, skin hyperpigmentation
- abn LFTs
80
which chronic liver condition leads to black liver w/ pigments on bx?
dubin johnson synd
81
which organs are typically affected by graft vs host dz?
skin, intestine, liver
82
what causes graft vs host dz?
donor T cells attack recipient major and minor HLA antigens
83
how does acute interstitial nephritis present?
- AKI + F + rash + pyuria
- U/A = eosinophilia + WBC casts
- WILL NOT SEE FLANK PAIN OR WT LOSS
84
how will renal/perinephric abscesses present?
- F + flank pain + wt loss
| - h/o UTI (=< 1-2 mos ago)
85
what features will 2* reynauds present w/ to distinguish it from 1* reynauds?
+ tissue injury (finger ulcers)
| + incr ANA and ESR
86
how do you w/u 2* reynauds?
- CBC, CMP
- U/A
- ANA, RF
- ESR, C3/C4
87
rare pts w/ cirrhosis may develop what condition?
cirrhosis --> ascites + sm defects in diaphragm --> hepatic hydrothorax
88
what pts are at low risk (<10%) for CAD?
- asymp (all ages)
| - atypical chest pain F < 50 yo
89
what pts are at high risk (>90%) for CAD?
- typical angina M > 40 yo
| - typical angina F >= 60 yo
90
what are the 3 features of classic angina?
- typical pain (substernal, dull ache/pressure, duration)
- provoked by exercise or emotional stress
- relieved by rest/nitroglycerin use
91
what electrolyte abn are common in chronic EtOH?
- low Mg
- low K
- low phos
92
how does Mg affect management of K?
inhibits renal K excretion
| so low Mg --> incr K excretion and low serum K
93
low K that is difficult to replenish w/ K replacement is likely 2/2 what?
low Mg
94
type 1 and 2 RTA cause low K and are typically assoc w/ what metabolic derangement?
met acidosis
95
in met acidosis what do you expect bicarb level to be?
decr HCO3-
96
what is likely causing the esophagitis in an HIV pt if there is NO dysphagia and NO oral thrush seen on exam?
viral cause = CMV or HSV
97
what should be suspected if infective endocarditits pt developes an AV block?
perivalvular abscess
98
how does renal vein thrombosis present?
flank pain + hematuria + scrotal edema
99
why might you see scrotal edema in a M pt w/ nephropathy?
nephropathy --> decr antithrombin 3 --> hypercoag state --> renal v. thrombosis
100
what are the CI for the rotavirus vaccine?
- anaphylaxis to active ingredient
- h/o intussusception
- h/o uncorrected GI malformation
- SCID
101
can vaccines be given safely during minor infx (URI)?
yes
102
sudden onset SOB + CP + tachy w/ NO consolidation on CXR = ?
PE
103
what lung condition can cause unilat/bilat pleural effusions (typically sm. exudative and bloody)
PE
104
how do malig pulm effusions typically present?
- large volume
- progressive SOB
- take days--> wks to develope (subacute)
105
what are vascular rings?
congenital anomaly where the aortic arch vessels wrap around the trachea and/or esophagus
106
GERD predisposes to what 3 complaints?
1. barrett's esophagus
2. erosive esophagitis
3. esophageal stricture formation
107
how does PCKD present?
- HTN
- polyuria
- flank pain
- renal dysf(x)
- liver cysts
- cerebral aneurysms
108
what unilat flank mass typically presents w/ hematuria, F, and wt loss?
RCC
109
how does cryptosporidium infx present?
- large volume watery diarrhea
- no blood in diarhea
- low fever
- wt loss
110
how does MAC diarrhea present?
- watery diarrhea
- HIGH fever (>102.2)
- wt loss
111
what systems does CMV typically attack in AIDS pts CD4 < 50?
- retina
- neuro
- GI
112
how does GI CMV infx present in AIDS pt?
- freq sm vol bloody diarrhea
- abd pain
- low fever
- wt loss
113
which organism will cause bloody diarrhea in an AIDs pt?
CMV
114
how do you tx cervicofacial actinomyces?
- penicillin 2-6 mos
| - sx (severe dz only)
115
what types of infx are tx w/ metronidazole?
- anaerobic infx
| - parasitic infx
116
what is the tx for TCA OD?
- NaHCO3- (for heart)
| - Benzos (for seizures)
117
why is nL/incr K seen in HHS/DKA despite total body K deficit?
intracellular K shifts into s in an attempt t replace the K being peed out (looks deceptively high)
118
why do HSS/DKA pts develop total body K deficit?
glucosuria induced osmotic diuresis --> incr u K
119
in HSS, will ADH be incr or decr?
incr (triggered by low BP and incr K 2/2 shift)
120
what metabolic derangement is to be expected w/ ASA OD?
anion gap metabolic acidosis + resp alkalosis (comp)
121
what are the clinical features of OCD?
obsessions + compulsions
122
what are the obsessions that are seen in OCD?
recurrent, intrusive, anxiety producing urges or images (can mimic psychosis)
123
what are compulsions? (hint: think OCD)
- response to obsessions w/ repeated behaviors or mental acts
- behaviors won't realistically prevent the feared event but still serve to calm anxiety
124
what are the 1st and 2nd line pharm tx for OCD?
1. SSRI
| 2. gen 2 antipsychotics
125
what is the 1st line tx for OCD?
exposure and response prevention based CBT
126
what is the tx for severe low Na w/o seizures?
NS + freq Na level rechecks
127
when would you give 3% hypertonic saline for low Na?
- pt presents w/ seizures
| - low Na 2/2 SIADH
128
what is the tx for severe low Na in SIADH?
3% hypertonic saline
129
why do you give 3% saline for low Na 2/2 SIADH?
IVF [electrolyte] > urinary [electrolyte] to correct problem
130
what are the approx osm of NS and 1/2 NS?
- NS ~300 mOSM / kg H20
| - 1/2 NS ~150 mOSM / kg H2O
131
when do you suspect HIT?
- on day 5-10 of heparin therapy
| - pt presents w/ low plt + thrombus + > 50% reduc in plt from pre-heparin tx baseline
132
which is more likely to cause HIT enoxaparin or unfractionated heparin?
unfractionated heparin
133
what labs will be seen 2/2 cell lysis in tumor lysis synd?
- incr K, incr phos, incr uric acid
| - decr Ca (2/2 phosphate binding)
134
pain w/ ejaculation suggests what?
chronic prostatitis
135
how does chronic prostatitis present?
- pain w/ ejaculation
- recurrent UTI
- tender prostate (+/-)
136
what is GGT?
marker of liver and bile duct damage
137
what is GGT used for?
- to detect liver and bile duct damage
| - to r/o bone source of incr ALP
138
what GGT values are expected if cause of incr ALP is boney vs liver/biliary?
```
boney = nL ALP
liver/biliary = incr GGT
```
139
what is LFCN compression called and how does it present?
- meralgia parasthetica
- lateral thigh pain, numbness, or parasthesia.
- NO weakness
140
what are some causes of incr maternal serum AFP?
- mult. gestation pregnancy
- open neural tube defect (anencephally and open spina bifida)
- ventral wall defects (omphalocele and gastroschesis)
141
what are some causes of low maternal serum AFP?
aneuploides (trisomy 18 and 21)
142
when do you check maternal AFP and what do you do if its elevated?
- wks 15-20 (ideal = wks 16-18)
| - if elevated do thorough U/S looking for anatomical defects
143
what is the underlying pathological process/state of wegner's?
vasculitis of sm and med-sized vessels
144
how does wegner's present?
upper and lower resp tract granulomatous inflam + rapidly progressive glomerulonephritis
145
what is gluconeogenesis and why is it important?
- process by which alanine, glutamine, lactate and G3-phosphate are converted to glucose
- after 24 hrs of fasting, gluconeogenesis is the body's sole source of glucose production
146
why are benzos C/I in elderly pts?
- incr risk s/e (withdrawal, dependence, motor impairment)
- can worsen aggitation
- very long lasting (old ppl metabolize benzos slowly)
147
how does cryptosporidium diarrhea present?
- self-limited if CD4 > 180. chronic if CD4 < 180.
- large volume watery diarrhea
- low fever
- wt loss
- NO blood in stool. NO pain
148
what ABX = 1st line in suspected pneumococcal PNA?
1. macrolides
2. fluoroquinolones
3. doxycycline
149
how does s pneumo PNA present?
F + pleuritic CP + SOB + productive cough w/ rusty sputum
150
which congenital heart defect exhibits a heart that looks like a boot on CXR?
ToF
151
is K incr/decr in met alkalosis 2/2 extensive emesis?
decr
152
pt presents w/ 5/7 of the MDD dx criteria. what is your 1st Q?
are they suicidal
153
what is the tx for PID?
```
outpt = IM ceftriaxone + PO doxy
inpt = IV cefoxitin or cefotetan + PO doxy
```
154
why can gastrectomy --> vit B12 def?
decr parietal cells --> decr intrinsic factor --> decr vit B12 absorption
155
how does SAH present?
- HA (sudden onsent = thunderclap)
- neck pain/stiffness (meningeal irritation)
- FND = uncommon
156
what is diabetic nephropathy?
incr GFR (hyperfiltration) --> decr GFR w/ incr Cr + incr u. protein
157
how do you tx diabetic nephropathy?
- ACEi / ARB (slow progression)
| - strict BG control (target HgA1c < 7%)
158
which presents w/ skin findings ehlers danlos or marfans?
ehlers danlos = stretchy skin that bruises easily +/- velvety w/ atrophy/scarring
(marfans only presents w/ striae)
159
what are the distinguishing MSK features of ehlers danlos vs marfans?
```
ED = high arched palate
marfans = tall w/ long extremities
```
160
which presents w/ eye issues, aortic root dilation and spontaneous PTX, marfans or ehlers danlos?
marfans
161
which presents w/ hernias +/- uterine prolapse, marfans or ehlers danlos?
ehlers danlos
162
what is selection bias?
nonrandom sampling/tx allocation --> study population that is not representative of target pop
163
what is power?
= the probability that the test rejects the null hypothesis appropriately
= likelihood of avoiding a type 2 error
164
what is a type 1 error?
- FALSE POS conclusion
- diff in tx where there is not
- rejecting the null hypoth when you shouldn't
165
what is a type 2 error?
- FALSE NEG conclusion
- no diff in tx when there is
- not rejecting the null hypoth when you should
166
what statistical value = % of T1 error occuring in a particular study?
p-value
167
power = ?
1 - type 2 error (B)
168
what is the defect in Dubin Johnson synd?
liver can't excrete conj bilirubin into the biliary system
169
what are the expected labs in dubin johnson?
- incr direct (conj) bili
- nL LFTs
- nL ALP
170
what is the defect in Gilberts?
can't conjugate bilirubin
171
what are the expected labs in gilberts?
-incr total (unconj) bilirubin
172
what will the synovial fluid look like in gouty arthritis?
- crystals (neg birefringent needle shaped)
- nonpurulent
- neg G stain
173
what is alcoholic ketoacidosis?
an acute metabolic acidosis 2/2 recent binge drinking + little/no nutritional intake
174
what reproductive system abn is seen in CF?
infertility (M > 95%, F ~20%)
175
what vit def = common in CF?
vit ADEK def
| 2/2 pancreatic insufficiency
176
why are most M w/ CF infertile?
absent vas deferens (azospermia)
177
how do you distinguish 1* ciliary dyskinesia from CF considering they present w/ the same resp s/s?
1* CD - 50 % situs invertus + immotile sperm + nL growth
| CF - pancreatic inuff + azospermia + FTT
178
how does pheochromocytoma present?
- paroxysmal severe HTN
- HA
- pallor
- sinus tachy
179
what can trigger pheochromocytoma s/s?
- sx
- induction of anesthesia
- nonselective BB
- incr intrabd pressure (tumor palpation, positional changes)
180
how do you tx kawasaki dz?
ASA + IVIG
181
what is another name for NG tube placement?
nasogastric intubation
182
what are the s/e of thiazide diuretics?
```
HyperGLUC + decr Na/K/Mg
High BG
High lipids
High uric acid
High Ca
Decr Na
Decr K
Decr Mg
```
183
what is migratory superficial thrombophlebitis (trousseau synd)?
hypercoag disorder that presents w/ unexplained superficial venous thrombosis @ unusual sites (arm and chest = common)
184
what is migratory superficial thrombophlebitis (trousseau synd) commonly assoc w/ ?
pancreatic ca > acute leukemias, lung, prostate, stomach, and colon ca
185
how does peripheral septic thrombophlebitis present?
- F + pain + edema @ infected site
| - recent h/o catheter, venipuncture or IV injections
186
what are the MCCs of sinus infx?
* *s pneumo**
- h influ
- m caterhallis
187
what caues a hydrocele?
1. patent processus vaginalis
| 2. failure of fluid w/in the tunica vaginalis to reabsorb after obliteration of the processus vaginalis
188
what does a patent processus vaginalis lead to?
communicating hydrocele
189
pt presents w/ decr ulnar n. distribution sensation + pain @ elbow. dx = ?
ulnar n. entrapment @ elbow
190
what is the MC sire of ulnar n. entrapment?
elbow (@ medial epicondylar groove) >> wrist > forearm
191
what comorbidity increases the likelihood of ulnar n entrapement in the forearm?
diabetes melitus
192
what lab abnormalities can hypothyroidism cause?
| hint: think lipids
- incr total cholesterol
- incr LDL
- incr TG
193
your trauma pt is declared brain dead. what do you do?
- inform the family (empathetically) and answer any questions they may have. mention organ donation
- contact organ donor ppl to get them on board ASAP
194
what is the tx for menigococcal meningitis?
- Gen3 cephalosporin (ceftriaxone) + vanc
| - NO steroids (WILL NOT help)
195
how should resp contacts be ppx for meningococcal meningitis?
rifampin + ciprofloxacin + ceftriaxone
196
how do you tx asymp UTI in pregnancy?
- nitrofurantoin
- amoxicillin
- cephalexin
197
how do you tx IBS?
1. TCA (amitriptyline, nortriptyline)
2. SSRI
* *add on anti-diarrheal meds and/or anti-constipation meds as needed
198
how does hereditary hemachromatosis present?
- bronze diabetes
- joint pain
- incr LFTs --> cirrhosis --> HCC
- 2* hypogonadism
- 2* hypothyroidism
- restrictive/dilated cardiomyopathy and conduction abn
- incr listeria, vibrio vulnificus and yersinia enterolitica infx
199
how do you decr risk of cirrhosis and HCC in hemachromatosis pts?
serial phlebotomy (drain excess Fe)
200
what is the best test for dx diverticulosis/diverticulitis?
abd CT
201
when is colonoscopy used to dx diverticulosis/itis?
- incidentally
| - to find source of a GI bleed
202
what is toxic epidermal necrolysis?
severe synd w/ sudden onset mucocutaneous lesions + skin sloughing + systemic toxicity
203
what most commonly triggers TEN?
- ABX (sulfonamides)
- anticonvulsants
- allopurinol
204
which anticonvulsants trigger TEN?
- carbemazepine
- lamotrigine
- phenytoin
205
how do you distinguish between steven-johnson synd and toxic epidermal necrolysis?
SJS < 10% BSA affected
overlap synd = 10-30% BSA affected
TEN > 30% BSA affected
