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NBME 17 Answers

nbme17/Block 3/Question#13 (reveal difficulty score)
A 15-year-old girl is brought to the ...
First-degree burn ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—waitingonprometric(264)
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According to https://medlineplus.gov/ency/article/000030.htm

"There are three levels of burns:

First-degree burns affect only the outer layer of the skin. They cause pain, redness, and swelling.

Second-degree burns affect both the outer and underlying layer of skin. They cause pain, redness, swelling, and blistering. They are also called partial thickness burns.

Third-degree burns affect the deep layers of skin. They are also called full thickness burns. They cause white or blackened, burned skin. The skin may be numb."

Our patient has only redness and pain over her skin, but no blisters--therefore, she must have first-degree burns (b/c blistering begins in second-degree burns).

FYI: Rhus dermatitis is urushiol-induced contact dermatitis--i.e. poison ivy, poison oak, poison sumac. I'd never heard it called that!

Sun allergy can be used to describe a number of itchy, red skin conditions that develop after sun exposure. But, it most commonly refers to sun poisoning, which presents with itchy, tiny bumps--> this is not a finding in our patient. https://www.mayoclinic.org/diseases-conditions/sun-allergy/symptoms-causes/syc-20378077

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lucifer546  What disturbs me is the history of using the sunblock. I thought it hinted away from sun mediated damage. +1
taylor5479  The question mentioned that she used sunblock "every few hours," which isn't a reliable indicator that she was adequately protected. First, there's no definition for how many hours she considers to be a "few," (most sunblocks are supposed to be reapplied every 80 minutes or so). Second, there's no mention of the strength of sunblock (For all we know, she could've been using a super low SPF in an effort to get a tan. She was "sunbathing" after all). +3



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