Tiff
Forum Guru
Topics: 54
Posts: 563
|
A 77-year-old man has multiple, painful blisters located on his face, neck, and torso. The patient complains that he cannot stop itching them. Which additional finding would suggest a diagnosis of Pemphigus Vulgaris rather than Bullous Pemphigoid?
A. Denuded skin and flaccid blisters
B. Fever and anorexia
C. Intact skin and tense blisters
D. Mouth Lesions
E. Posthealing hyperpigmentation
I came across this question but the explanation confuses me. Answer is A. and here's the explanation:
The correct answer is denuded skin and flaccid blisters. In Pemphigus Vulgaris, the lesions are intraepidermal blisters secondary to IgG autoantibodies against epithelial cell desmogleins 1 and 3. When pressure is applied to these blisters, there is separation of the epidermis (positive Nikolshy's sign), which leads to flaccid blisters and denuded skin.
Goljan RR - says pemphigus vulgaris has negative Nikolsky and Bullous has positive Nikolsky sign - which contradicts this explanation. Anyone know what it is really? 
|
| hottie99
Forum Guru
Topics: 31
Posts: 604
|
it's the other way around, i dont know where or why Dr. Goljan would say that, b/c nikolsky sign is when you place ur finger and just press down and pull towards urself, the skin comes off, since pemphigus is more superficial than bullous, it has to be nikolsky positive, and therefore making bullous pemphigoid nikolsky negative since that is deeper and not as lethal (as pemphigus vulgaris is much more lethal)..
the intact skin and tense blisters i'm presuming is referring to the bullous pemphigoid lesions.. which makes sense since it has antibodies to the hemidesmesomes further down in the skin..
does that help??  i hope so! 
|
| spinal shock
Forum Senior
Topics: 12
Posts: 99
|
(A)its called posetive nickolsky sign. but mouth lesions also occur prior to other skin lesions, may be D is correct too.
___________________
we expect others wishes, we dont miss something that we dont expect to have
|
| hottie99
Forum Guru
Topics: 31
Posts: 604
|
mouth ulcerations are associated with pemphigus vulgarius, and the oral mucosa is spared in bullous pemphigoid, that is another difference btw the 2 options, so therefore D can't be right, the question is describing pemphigus vulgaris, not bullous pemphigoid. 
|
| bioguy
Forum Guru
Topics: 47
Posts: 841
|
Tiff wrote: Goljan RR - says pemphigus vulgaris has negative Nikolsky and Bullous has positive Nikolsky sign - which contradicts this explanation. Anyone know what it is really?
This entry in RR is an erratum. He rectified it on his website.
Pemphigus vulgaris - positive N. sign
Bullous Pemphigoid - negative N. sign
and attached is a complete list of errata in his RR path.
Attached Files:
Rapid Review Errata.doc (62 KB, 9 downloads)
|
| yogesh
Forum Newbie
Topics: 5
Posts: 56
|
hottie99 wrote:mouth ulcerations are associated with pemphigus vulgarius, and the oral mucosa is spared in bullous pemphigoid, that is another difference btw the 2 options, so therefore D can't be right, the question is describing pemphigus vulgaris, not bullous pemphigoid.
I am confused!! 
Doesn't this mean that ans. D can also be right??
(Oral lesions + in PV, and - in BP.. & we are talking about PV so ans. can be D)
Please someone clarify the situation.
___________________
When a person really desires something, all the universe conspires to help him realize his dreams. - Paulo Coelho.
|
| hottie99
Forum Guru
Topics: 31
Posts: 604
|
yes that is true, good point, i slipped up for a second.. let's think.. the lesions are less common with bullous, but pemphigus vulgaris is definitely nikolsky positive versus bullous is nikolsky negative.. i think the mouth ulcers shouldn't be used as the sole differentiating fact, the nikolsky is more specific.. because isn't pemphigus more lethal as well because of a higher risk of sepsis, which leads to high fever, so the fever choice could be rite?? i dont think they want us to pick apart every single factoid, just look at the bigger picture..
|
| yogesh
Forum Newbie
Topics: 5
Posts: 56
|
hottie99 wrote:yes that is true, good point, i slipped up for a second.. let's think.. the lesions are less common with bullous, but pemphigus vulgaris is definitely nikolsky positive versus bullous is nikolsky negative.. i think the mouth ulcers shouldn't be used as the sole differentiating fact, the nikolsky is more specific.. because isn't pemphigus more lethal as well because of a higher risk of sepsis, which leads to high fever, so the fever choice could be rite?? i dont think they want us to pick apart every single factoid, just look at the bigger picture..
Yes absolutely.. I definitely choose A over any other option. [And, Oral lesions are not common in BP but they CAN occur, though mild, in BP (in as many as 30% pt.)]
___________________
When a person really desires something, all the universe conspires to help him realize his dreams. - Paulo Coelho.
|
| hottie99
Forum Guru
Topics: 31
Posts: 604
|
yes that is what i had mentioned also, that they are 'less common' meaning it's not that common 
|
| yogesh
Forum Newbie
Topics: 5
Posts: 56
|
hottie99 wrote:yes that is what i had mentioned also, that they are 'less common' meaning it's not that common
Do you also wonder why we are repeating this stuff again and again??
___________________
When a person really desires something, all the universe conspires to help him realize his dreams. - Paulo Coelho.
|
| hottie99
Forum Guru
Topics: 31
Posts: 604
|
im thinking so that we are content with our own selves that we've said it in the manner in which we understand and at the same time hope we answered the initial person's question, haha... but that is just my own thoughts on that, i dont know what anyone else is thinking (wish i had esp) hahaha.. study hard!! back to goljan ugghh... 
|
| Tiff
Forum Guru
Topics: 54
Posts: 563
|
Thanks guys. It's all clear to me now.
|
| Tiff
Forum Guru
Topics: 54
Posts: 563
|
bioguy wrote:Tiff wrote: Goljan RR - says pemphigus vulgaris has negative Nikolsky and Bullous has positive Nikolsky sign - which contradicts this explanation. Anyone know what it is really? This entry in RR is an erratum. He rectified it on his website. Pemphigus vulgaris - positive N. sign Bullous Pemphigoid - negative N. sign and attached is a complete list of errata in his RR path.
Thanks for the attachment. RR sure does have a lot of errors. That's disconcerting.
|
| macintosh
Forum Elite
Topics: 38
Posts: 178
|
You have a lot of friends to help you Tiff. Oooh I envy you 
|
| new_n_lost
Politically InCorrect
Topics: 653
Posts: 6,083
|
Yup its one of the corrections and mistake that i had to go and look back.
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
|
| |
| | | | | | | | | | | | | | | |
