{"id":36882,"date":"2026-05-29T00:11:51","date_gmt":"2026-05-28T18:41:51","guid":{"rendered":"https:\/\/atsixty.com\/?p=36882"},"modified":"2026-05-30T07:57:12","modified_gmt":"2026-05-30T02:27:12","slug":"dermatology-drug-reactions-cutaneous-side-effects","status":"publish","type":"post","link":"https:\/\/atsixty.com\/index.php\/neet-pg\/dermatology-drug-reactions-cutaneous-side-effects\/","title":{"rendered":"Dermatology: Drug Reactions &amp; Cutaneous Side Effects"},"content":{"rendered":"\n\n\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:ital,wght@0,400;0,600;0,700;1,400;1,600&#038;family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&#038;display=swap\" rel=\"stylesheet\">\n<style>\n\/* All styles namespaced to #drxn01 -- no bleed into WordPress theme *\/\n#drxn01 *,#drxn01 *::before,#drxn01 *::after{box-sizing:border-box;margin:0;padding:0}\n#drxn01{\n  --ter:#8B3D20;--ter-light:#B85A38;--ter-pale:#FDF0EB;--ter-dark:#6B2D14;\n  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Display',serif;font-size:0.92rem;font-weight:700;cursor:pointer}\n#drxn01 .mr-retry:hover{background:var(--ter);color:#FFFDF9}\n@media(max-width:480px){#drxn01 .mr-title{font-size:1.4rem}#drxn01 .mr-num{font-size:1.7rem}#drxn01 .mr-stem{font-size:0.9rem}#drxn01 .mr-opt-text{font-size:0.86rem}}\n<\/style>\n\n<div id=\"drxn01\">\n\n  <div class=\"mr-header\">\n    <div class=\"mr-eyebrow\">Morning Rounds &middot; Daily Clinical Quiz<\/div>\n    <div class=\"mr-title\">\n      Dermatology<br><em>Drug Reactions &amp; Cutaneous Side Effects<\/em>\n    <\/div>\n    <div class=\"mr-subtitle\">Five high-yield clinical cases &middot; +4 \/ &minus;1 scoring &middot; NEET-PG and INI-CET<\/div>\n    <div class=\"mr-chips\">\n      <span class=\"mr-chip\">5 Cases<\/span>\n      <span class=\"mr-chip\">+4 \/ &minus;1 scoring<\/span>\n      <span class=\"mr-chip\">Options reshuffled<\/span>\n    <\/div>\n  <\/div>\n\n  <div class=\"mr-sentinel\" id=\"drxn01-sentinel\"><\/div>\n\n  <div class=\"mr-progress\" id=\"drxn01-progress\">\n    <div class=\"mr-prog-inner\">\n      <div class=\"mr-pips\" id=\"drxn01-pips\"><\/div>\n    <\/div>\n  <\/div>\n\n  <div class=\"mr-body\">\n    <div id=\"drxn01-cases\"><\/div>\n    <div class=\"mr-submit-wrap\">\n      <button class=\"mr-btn\" id=\"drxn01-submit\">Submit for Debrief<\/button>\n    <\/div>\n    <div class=\"mr-score\" id=\"drxn01-score\">\n      <div class=\"mr-score-in\">\n        <div class=\"mr-score-ey\">Round Complete<\/div>\n        <div class=\"mr-ring\" id=\"drxn01-ring\">\n          <div class=\"mr-ring-in\">\n            <span class=\"mr-ring-pct\" id=\"drxn01-pct\">0%<\/span>\n            <span class=\"mr-ring-sub\">net<\/span>\n          <\/div>\n        <\/div>\n        <div class=\"mr-score-title\">Your Debrief<\/div>\n        <div class=\"mr-score-net\" id=\"drxn01-net\"><\/div>\n        <div class=\"mr-verdict\" id=\"drxn01-verdict\"><\/div>\n        <div class=\"mr-bands\">\n          <span class=\"mr-band mr-band-c\" id=\"drxn01-ct-c\"><\/span>\n          <span class=\"mr-band mr-band-w\" id=\"drxn01-ct-w\"><\/span>\n          <span class=\"mr-band mr-band-s\" id=\"drxn01-ct-s\"><\/span>\n        <\/div>\n        <button class=\"mr-retry\" id=\"drxn01-retry\">&#8635; New Round<\/button>\n      <\/div>\n    <\/div>\n  <\/div>\n<\/div>\n\n<script>\n(function () {\n  'use strict';\n\n  var NS    = 'drxn01';\n  var TOTAL = 5;\n  var MAX   = 20;\n  var LTRS  = ['A','B','C','D'];\n\n  \/* ================================================================\n     QUESTION BANK -- Dermatology: Drug Reactions & Cutaneous Side Effects\n     NEET-PG level. No superspeciality depth.\n     ================================================================\n\n     Q1  FIXED DRUG ERUPTION (Easy-Medium)\n         Single or few well-defined, round\/oval, erythematous to\n         violaceous plaques that recur at EXACTLY the same site\n         on re-exposure to the causative drug.\n         Heals with residual hyperpigmentation (post-inflammatory).\n         Common sites: genitalia, lips, perianal area, hands.\n         Most common causes: cotrimoxazole (sulphonamides),\n           NSAIDs (especially nimesulide, naproxen),\n           metronidazole, tetracyclines, paracetamol.\n         Generalised bullous FDE: widespread bullous lesions from\n           FDE -- can mimic TEN but lesions are at prior FDE sites\n           and history helps.\n         Answer: fixed drug eruption -- recurs at identical site;\n                 cotrimoxazole most common cause; residual\n                 hyperpigmentation after resolution\n\n     Q2  DRESS SYNDROME (Hard -- but NEET-PG level)\n         Drug Reaction with Eosinophilia and Systemic Symptoms.\n         Onset: 2-8 WEEKS after starting the drug (long latency\n           distinguishes it from urticaria\/maculopapular rash).\n         Features: morbilliform rash (often starting on face),\n           fever, lymphadenopathy, facial oedema,\n           EOSINOPHILIA, atypical lymphocytosis,\n           liver (most common organ), kidney, lung, heart involvement.\n         HHV-6 reactivation is a consistent feature.\n         Most common causes: aromatic antiepileptics (phenytoin,\n           carbamazepine, phenobarbitone), allopurinol,\n           sulphonamides, dapsone, minocycline.\n         Treatment: stop drug, systemic corticosteroids.\n         Mortality: ~10% from organ failure.\n         Cross-reactivity among aromatic AEDs (phenytoin,\n           carbamazepine, phenobarbitone) -- do not substitute\n           one for another.\n         Answer: DRESS -- 2-8 week latency, eosinophilia,\n                 systemic organ involvement, HHV-6 reactivation,\n                 aromatic AEDs most common cause\n\n     Q3  SJS vs TEN -- DRUG CAUSES & SCORTEN (Medium)\n         Stevens-Johnson Syndrome (SJS): <10% BSA detachment\n         SJS\/TEN overlap: 10-30% BSA\n         TEN: >30% BSA detachment\n         Both: mucosal involvement (2+ sites), fever, prodrome.\n         Most common drug causes:\n           Allopurinol (most common worldwide), sulphonamides,\n           aromatic AEDs (carbamazepine, phenytoin),\n           NSAIDs (oxicam group), nevirapine.\n         SCORTEN score: 7 variables predict mortality in TEN.\n           1 variable = ~3%; 5+ variables = ~90%.\n         Management: ICU\/burns unit, stop drug, IV fluids,\n           wound care, ophthalmology review.\n         Role of corticosteroids: controversial\/avoid in TEN;\n           may use early in SJS.\n         IVIG and cyclosporine: evidence-based alternatives.\n         Allopurinol association strong with HLA-B*58:01\n           (Han Chinese, Thai) -- pharmacogenomics.\n         Answer: TEN >30% BSA; allopurinol most common cause\n                 worldwide; SCORTEN predicts mortality;\n                 stop drug is the single most important step\n\n     Q4  PHOTOSENSITIVITY REACTIONS (Medium)\n         Phototoxic (more common):\n           Non-immunological; occurs on first exposure.\n           Exaggerated sunburn in sun-exposed areas only.\n           Any person with sufficient drug + UV dose.\n           Drugs: tetracyclines (doxycycline most common),\n             fluoroquinolones (especially sparfloxacin),\n             amiodarone, NSAIDs (naproxen, piroxicam),\n             thiazides, psoralens (PUVA therapy).\n         Photoallergic:\n           Type IV hypersensitivity (delayed, T-cell mediated).\n           Requires prior sensitisation.\n           Can spread beyond sun-exposed areas.\n           Drugs: sulphonamides, sunscreens (PABA),\n             phenothiazines, griseofulvin.\n         Amiodarone: slate-grey\/blue-grey discolouration\n           of sun-exposed skin (phototoxic + lipofuscin\n           deposition); also causes corneal microdeposits\n           and thyroid dysfunction.\n         Answer: phototoxic -- non-immunological, first exposure,\n                 sun-exposed areas only; photoallergic -- Type IV,\n                 requires sensitisation, can spread beyond\n                 sun-exposed skin\n\n     Q5  DRUG-INDUCED PIGMENTATION (Medium)\n         High-yield drug-pigment associations for NEET-PG:\n           Amiodarone: slate-grey\/blue-grey (sun-exposed)\n           Minocycline: blue-grey (skin, teeth, sclerae, bone)\n           Clofazimine: reddish-brown (diffuse) + ichthyosis\n           Chlorpromazine\/phenothiazines: slate-grey\n             (sun-exposed); also corneal deposits\n           Bleomycin: flagellate hyperpigmentation\n             (linear whip-like streaks on trunk after scratching)\n           Busulfan: diffuse hyperpigmentation\n             (Addisonian-like pigmentation)\n           Hydroxychloroquine\/chloroquine: blue-grey\n             pigmentation + corneal deposits + retinopathy\n           Silver (argyria): permanent grey-blue discolouration\n             (sun-exposed > general); no treatment\n           Gold (chrysiasis): blue-grey (sun-exposed)\n         Answer: bleomycin -- flagellate hyperpigmentation;\n                 minocycline -- blue-grey of skin, teeth, bones;\n                 clofazimine -- reddish-brown + ichthyosis\n     ================================================================ *\/\n\n  var QS = [\n\n    \/* ---- Q1 : Fixed Drug Eruption ---- *\/\n    {\n      id:      1,\n      tag:     'Drug Reactions &mdash; Fixed Drug Eruption',\n      stem:    'A <strong>30-year-old man<\/strong> develops a <strong>solitary, well-defined, dark violaceous plaque on his glans penis<\/strong> each time he takes a tablet for a urinary tract infection. The lesion resolves leaving <strong>residual hyperpigmentation<\/strong>, and reappears at the exact same site on re-exposure. The most likely drug class responsible and the characteristic feature that defines this reaction are:',\n      correct: 'Cotrimoxazole (sulphonamide-trimethoprim combination); recurrence at the identical site on re-exposure is the defining feature of fixed drug eruption',\n      opts: [\n        'Cotrimoxazole (sulphonamide-trimethoprim combination); recurrence at the identical site on re-exposure is the defining feature of fixed drug eruption',\n        'Nitrofurantoin; recurrence at a new site on each exposure is the defining feature of a maculopapular drug rash',\n        'Ciprofloxacin; the genital site indicates a phototoxic reaction confined to sun-exposed areas',\n        'Amoxicillin; widespread urticarial wheals appearing within minutes indicate a Type I IgE-mediated reaction'\n      ],\n      exp:     '<strong>Fixed drug eruption (FDE)<\/strong> is defined by its cardinal feature: <strong>recurrence at the exact same anatomical site on every re-exposure<\/strong> to the causative drug. The lesion begins as an erythematous to violaceous, oedematous plaque; it may blister, then resolve leaving characteristic <strong>residual post-inflammatory hyperpigmentation<\/strong> (the &ldquo;fixed&rdquo; grey-brown stain that persists between episodes). <strong>Common sites:<\/strong> genitalia (most classic), lips, perianal area, hands and feet. <strong>Most common causes:<\/strong> <em>cotrimoxazole<\/em> (most common overall), NSAIDs (nimesulide, naproxen, aspirin), metronidazole, tetracyclines, paracetamol. <strong>Mechanism:<\/strong> CD8+ T cells resident in the skin at prior FDE sites are rapidly reactivated on systemic drug re-exposure &mdash; explaining the site specificity. <strong>Extra point:<\/strong> <em>Generalised bullous FDE<\/em> can mimic TEN clinically, but the history of recurrence at prior sites, fewer systemic features, and less mucosal involvement help distinguish them. Patch testing at the previously affected site (not on uninvolved skin) is the specific diagnostic test for FDE.'\n    },\n\n    \/* ---- Q2 : DRESS Syndrome ---- *\/\n    {\n      id:      2,\n      tag:     'Drug Reactions &mdash; DRESS Syndrome',\n      stem:    'A <strong>22-year-old man<\/strong> started on <strong>carbamazepine<\/strong> for newly diagnosed epilepsy develops fever, a widespread morbilliform rash starting on the face, and marked <strong>facial oedema<\/strong> at <strong>five weeks<\/strong> after starting the drug. Investigations reveal eosinophilia, elevated liver enzymes, and atypical lymphocytosis. The diagnosis, the laboratory hallmark, and the most important cross-reactivity concern are:',\n      correct: 'DRESS syndrome; eosinophilia is the laboratory hallmark; carbamazepine, phenytoin, and phenobarbitone cross-react and must not be substituted for each other',\n      opts: [\n        'DRESS syndrome; eosinophilia is the laboratory hallmark; carbamazepine, phenytoin, and phenobarbitone cross-react and must not be substituted for each other',\n        'Stevens-Johnson syndrome; neutropenia is the laboratory hallmark; valproate is a safe alternative with no cross-reactivity',\n        'Serum sickness-like reaction; hypocomplementaemia is the laboratory hallmark; no cross-reactivity with other antiepileptics',\n        'Maculopapular exanthem; thrombocytopenia is the laboratory hallmark; levetiracetam has the same cross-reactivity profile as carbamazepine'\n      ],\n      exp:     '<strong>DRESS syndrome<\/strong> (Drug Reaction with Eosinophilia and Systemic Symptoms) is distinguished from other drug eruptions by its <strong>long latency of 2&ndash;8 weeks<\/strong> after drug initiation (compared to hours to days for urticaria or maculopapular rash). <strong>Laboratory hallmark: eosinophilia<\/strong> (often &gt;1500\/&mu;L), frequently with atypical lymphocytosis. Systemic organ involvement is mandatory: <em>liver<\/em> is most commonly affected (hepatitis, transaminitis); others include kidney, lung, and heart. <strong>HHV-6 reactivation<\/strong> is a consistent feature, thought to drive the systemic inflammation. Facial oedema is a characteristic clinical clue. <strong>Cross-reactivity:<\/strong> the three <em>aromatic antiepileptics<\/em> &mdash; <strong>phenytoin, carbamazepine, and phenobarbitone<\/strong> &mdash; share an aromatic ring metabolised to reactive arene oxide intermediates by cytochrome P450. If a patient develops DRESS to one, <em>all three are contraindicated<\/em>. Safe alternatives: valproate, levetiracetam, lamotrigine (though lamotrigine has its own SJS risk at higher initial doses). <strong>Extra point:<\/strong> other common causes of DRESS include allopurinol (most common non-AED cause), sulphonamides, dapsone, and minocycline. Stop the drug, start systemic corticosteroids, and monitor organ function closely. Mortality is approximately 10%.'\n    },\n\n    \/* ---- Q3 : SJS vs TEN ---- *\/\n    {\n      id:      3,\n      tag:     'Drug Reactions &mdash; SJS and TEN',\n      stem:    'A <strong>58-year-old man<\/strong> with gout started on <strong>allopurinol<\/strong> three weeks ago develops a painful rash with skin tenderness. Within 48 hours, <strong>widespread dusky-red macules coalesce<\/strong> and the epidermis begins to peel in sheets; involvement covers <strong>40% of body surface area<\/strong>. There are erosions on oral, ocular, and genital mucosae. The diagnosis, the single most important immediate management step, and the mortality prediction tool are:',\n      correct: 'Toxic Epidermal Necrolysis (>30% BSA detachment); stopping allopurinol immediately is the single most important step; SCORTEN score predicts mortality',\n      opts: [\n        'Toxic Epidermal Necrolysis (>30% BSA detachment); stopping allopurinol immediately is the single most important step; SCORTEN score predicts mortality',\n        'Stevens-Johnson Syndrome (<10% BSA detachment); continuing allopurinol with dose reduction is appropriate; APACHE II score predicts mortality',\n        'Generalised bullous fixed drug eruption; identifying and avoiding prior FDE sites guides treatment; no validated mortality scoring exists',\n        'Staphylococcal Scalded Skin Syndrome; IV antibiotics targeting Staphylococcus aureus are the most important intervention; no mortality tool needed'\n      ],\n      exp:     '<strong>Toxic Epidermal Necrolysis (TEN)<\/strong>: epidermal detachment &gt;30% BSA. <strong>SJS<\/strong>: &lt;10% BSA. <strong>SJS\/TEN overlap<\/strong>: 10&ndash;30%. Both require mucosal involvement (&ge;2 sites) for diagnosis. <strong>Allopurinol<\/strong> is the <em>most common cause of TEN worldwide<\/em>, with a particularly strong association with <strong>HLA-B*58:01<\/strong> allele (prevalent in Han Chinese, Thai, Korean populations) &mdash; prospective HLA screening before allopurinol is now recommended in high-risk populations. <strong>The single most important intervention is stopping the causative drug<\/strong> &mdash; every day of continued drug exposure worsens outcome significantly. Management: ICU or specialised burns unit; aggressive IV fluid and electrolyte replacement; wound care (non-adhesive dressings); ophthalmology review (ocular sequelae are the most debilitating long-term complication). <strong>SCORTEN score<\/strong> uses 7 variables (age, malignancy, heart rate, BSA detachment, serum urea, glucose, bicarbonate) to predict mortality from approximately 3% (1 point) to &gt;90% (5+ points). <strong>Extra point:<\/strong> the role of systemic corticosteroids in TEN is controversial and generally avoided; <strong>cyclosporine<\/strong> and <strong>IVIG<\/strong> have the best evidence as adjunctive immunomodulatory therapies.'\n    },\n\n    \/* ---- Q4 : Photosensitivity Reactions ---- *\/\n    {\n      id:      4,\n      tag:     'Drug Reactions &mdash; Photosensitivity',\n      stem:    'A <strong>45-year-old man<\/strong> on long-term <strong>amiodarone<\/strong> for atrial fibrillation develops a <strong>slate-grey discolouration<\/strong> of his face and the backs of his hands after years of treatment. He also reports increased sensitivity to sun. A <strong>28-year-old woman<\/strong> on <strong>doxycycline<\/strong> for acne develops an exaggerated sunburn confined strictly to sun-exposed skin after her first beach visit since starting treatment. Which pair of statements correctly classifies both reactions?',\n      correct: 'Amiodarone causes phototoxic reaction plus lipofuscin deposition producing slate-grey pigmentation of sun-exposed skin; doxycycline causes a phototoxic reaction that is non-immunological and occurs on first exposure in any individual',\n      opts: [\n        'Amiodarone causes phototoxic reaction plus lipofuscin deposition producing slate-grey pigmentation of sun-exposed skin; doxycycline causes a phototoxic reaction that is non-immunological and occurs on first exposure in any individual',\n        'Amiodarone causes a photoallergic reaction requiring prior sensitisation; doxycycline causes a Type I IgE-mediated urticarial reaction in sun-exposed skin',\n        'Both reactions are photoallergic (Type IV hypersensitivity); both require patch testing under UV light for confirmation',\n        'Amiodarone causes a fixed drug eruption at sun-exposed sites; doxycycline causes a photoallergic reaction that spreads to sun-protected areas'\n      ],\n      exp:     '<strong>Phototoxic reactions<\/strong> are <em>non-immunological<\/em> &mdash; they occur in <em>any person<\/em> given sufficient drug concentration and UV exposure, even on first exposure. The reaction is strictly confined to <strong>sun-exposed areas<\/strong> and resembles an exaggerated sunburn. <strong>Common phototoxic drugs:<\/strong> tetracyclines (especially doxycycline), fluoroquinolones (sparfloxacin most notorious), amiodarone, thiazides, NSAIDs (naproxen, piroxicam), psoralens. <strong>Photoallergic reactions<\/strong> are <em>Type IV cell-mediated<\/em> hypersensitivity &mdash; require prior sensitisation, can spread beyond sun-exposed areas, and occur only in sensitised individuals. Drugs: sulphonamides, phenothiazines, sunscreens (PABA), griseofulvin. <strong>Amiodarone<\/strong> deserves special mention: it causes phototoxicity <em>and<\/em> accumulates as <strong>lipofuscin<\/strong> in lysosomes of dermal macrophages, producing permanent <strong>slate-grey\/blue-grey discolouration<\/strong> of sun-exposed skin. Other amiodarone effects: corneal microdeposits (nearly universal, usually asymptomatic), thyroid dysfunction (hypo or hyper), pulmonary fibrosis, hepatotoxicity. <strong>Extra point:<\/strong> the key clinical discriminator between phototoxic and photoallergic reactions is the <em>sharp cutoff at clothing lines<\/em> in phototoxic reactions vs the possible involvement of covered areas in photoallergic reactions.'\n    },\n\n    \/* ---- Q5 : Drug-Induced Pigmentation ---- *\/\n    {\n      id:      5,\n      tag:     'Drug Reactions &mdash; Drug-Induced Pigmentation',\n      stem:    'A <strong>35-year-old man<\/strong> being treated for multibacillary leprosy develops a <strong>diffuse reddish-brown discolouration<\/strong> of his entire skin. A <strong>40-year-old woman<\/strong> receiving chemotherapy for lymphoma develops unusual <strong>linear, whip-like streaks of hyperpigmentation<\/strong> on her trunk after scratching. The drug responsible for each pigmentation pattern and the mechanism in the second case are:',\n      correct: 'Clofazimine causes reddish-brown diffuse pigmentation; bleomycin causes flagellate hyperpigmentation, where scratching distributes drug-laden macrophages along scratch lines triggering localised melanin stimulation',\n      opts: [\n        'Clofazimine causes reddish-brown diffuse pigmentation; bleomycin causes flagellate hyperpigmentation, where scratching distributes drug-laden macrophages along scratch lines triggering localised melanin stimulation',\n        'Dapsone causes reddish-brown pigmentation; busulfan causes flagellate hyperpigmentation through diffuse Addisonian-like melanocyte stimulation',\n        'Rifampicin causes reddish-brown pigmentation of skin and body fluids; methotrexate causes flagellate pigmentation through folate depletion in melanocytes',\n        'Clofazimine causes blue-grey pigmentation in sun-exposed areas; bleomycin causes diffuse Addisonian-like pigmentation without a linear pattern'\n      ],\n      exp:     '<strong>Clofazimine<\/strong> (used in MB-MDT for leprosy, and in ENL) causes <strong>reddish-brown to orange diffuse pigmentation<\/strong> of skin, conjunctivae, and body fluids, along with <em>ichthyosis<\/em>. The pigmentation is due to drug crystal deposition in skin macrophages and is the most common reason for poor compliance with leprosy treatment in fair-skinned patients. It reverses slowly after stopping the drug. <strong>Bleomycin<\/strong> causes <strong>flagellate hyperpigmentation<\/strong> &mdash; linear, whip-like streaks of hyperpigmentation on the trunk, classically appearing after scratching. The proposed mechanism: bleomycin accumulates in skin and triggers inflammatory cytokines; mechanical trauma from scratching distributes the drug-containing inflammatory cells along scratch lines, causing localised melanocyte stimulation. <strong>Extra point &mdash; complete drug pigmentation table for NEET-PG:<\/strong> <em>Amiodarone<\/em> &mdash; slate-grey, sun-exposed; <em>Minocycline<\/em> &mdash; blue-grey of skin, teeth, sclerae, bone; <em>Clofazimine<\/em> &mdash; reddish-brown diffuse + ichthyosis; <em>Bleomycin<\/em> &mdash; flagellate linear streaks; <em>Busulfan<\/em> &mdash; diffuse Addisonian-like hyperpigmentation; <em>Hydroxychloroquine<\/em> &mdash; blue-grey + corneal deposits + retinopathy; <em>Silver (argyria)<\/em> &mdash; permanent grey-blue, sun-exposed predominantly, no treatment. This table covers all high-frequency drug-pigment questions at NEET-PG level.'\n    }\n\n  ];\n  \/* ================================================================\n     END OF CONTENT -- engine logic below, do not edit\n     ================================================================ *\/\n\n  var answers  = {};\n  var answered = 0;\n  var shuffled = {};\n  var done     = false;\n\n  function byId(id) { return document.getElementById(id); }\n  function gid(sfx) { return byId(NS + '-' + sfx); }\n\n  function shuffleArr(arr) {\n    var a = arr.slice(), i, j, t;\n    for (i = a.length - 1; i > 0; i--) {\n      j = Math.floor(Math.random() * (i + 1));\n      t = a[i]; a[i] = a[j]; a[j] = t;\n    }\n    return a;\n  }\n\n  function countVal(val) {\n    var k, n = 0;\n    for (k in answers) {\n      if (answers.hasOwnProperty(k) && answers[k] === val) n++;\n    }\n    return n;\n  }\n\n  function buildPips() {\n    var cont = gid('pips'), i, q, wl, wp, line, pip;\n    if (!cont) return;\n    cont.innerHTML = '';\n    for (i = 0; i < QS.length; i++) {\n      q = QS[i];\n      if (i > 0) {\n        wl = document.createElement('div'); wl.className = 'mr-pip-wrap';\n        line = document.createElement('div'); line.className = 'mr-pip-line';\n        line.id = NS + '-pl' + q.id;\n        wl.appendChild(line); cont.appendChild(wl);\n      }\n      wp = document.createElement('div'); wp.className = 'mr-pip-wrap';\n      pip = document.createElement('div'); pip.className = 'mr-pip';\n      pip.id = NS + '-pip' + q.id; pip.textContent = String(q.id);\n      wp.appendChild(pip); cont.appendChild(wp);\n    }\n  }\n\n  function build() {\n    var cont, i, q, opts, card, top, nd, meta, tg, st,\n        rule, od, ed, lb, tx, j, oe, ls, ts;\n    cont = gid('cases');\n    if (!cont) return;\n    cont.innerHTML = '';\n    answers = {}; answered = 0; shuffled = {}; done = false;\n    if (gid('score')) gid('score').style.display = 'none';\n    buildPips();\n    for (i = 0; i < QS.length; i++) {\n      q    = QS[i];\n      opts = shuffleArr(q.opts);\n      shuffled[q.id] = opts;\n      card = document.createElement('div'); card.className = 'mr-case';\n      top  = document.createElement('div'); top.className  = 'mr-case-top';\n      nd   = document.createElement('div'); nd.className   = 'mr-num';\n      nd.textContent = q.id < 10 ? 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No drug reaction catches you off guard.'],\n      [4, 'Strong \\u2014 one reaction pattern to revisit before exam day.'],\n      [3, 'Solid base \\u2014 the pigmentation table in Q5 rewards a second read.'],\n      [2, 'Halfway there \\u2014 the debrief panels have everything you need.'],\n      [0, 'Drug reactions reward careful reading. 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Cutaneous Side Effects<\/a><\/li>\n<li><a class=\"wp-block-latest-posts__post-title\" href=\"https:\/\/atsixty.com\/index.php\/neet-pg\/dermatology-histopathology-diagnostic-tests\/\">Dermatology: Histopathology &amp; Diagnostic Tests<\/a><\/li>\n<li><a class=\"wp-block-latest-posts__post-title\" href=\"https:\/\/atsixty.com\/index.php\/neet-pg\/pigmentary-disorders\/\">Pigmentary Disorders<\/a><\/li>\n<\/ul>","protected":false},"excerpt":{"rendered":"<p>Morning Rounds &middot; Daily Clinical Quiz DermatologyDrug Reactions &amp; Cutaneous Side Effects Five high-yield clinical cases &middot; +4 \/ &minus;1 scoring &middot; NEET-PG and INI-CET 5 Cases +4 \/ &minus;1 scoring Options reshuffled Submit for Debrief Round Complete 0% net Your Debrief &#8635; New Round<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[70,68,74,24],"tags":[],"class_list":["post-36882","post","type-post","status-publish","format-standard","hentry","category-clinical","category-dermatology","category-morning-rounds","category-neet-pg"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Dermatology: Drug Reactions &amp; 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