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Reynolds Geriatrics Series • USMLE Step 2CK Prep
“Shingles are Not Just for Roofs,” based on Question 30 of the 2010 USMLE
sample exam
Todd Kovach, Nicholas Schilling, Nathan Steele http://download.usmle.org/2010Step2CK.pdf A 56-year-old man has had the painful weeping rash shown for 2 days. He underwent chemotherapy for non-Hodgkin lymphoma 1 year ago. His temperature is 36.7°C (98°F), pulse is 80/min, and blood pressure is 138/76 mm Hg. Examination shows no other abnormalities. Which of the following is the most likely diagnosis? Texas Tech MedCast Producer: Betsy Goebel Jones, Ed.D., [email protected] Prepared for the MSIV Geriatrics Experience at Texas Tech University Health Sciences Center School of Medicine, Andrew Dentino, M.D., Course Director, [email protected] http://www.ttuhsc.edu/som/fammed/ttmedcast/gerseries/gerstep2ckprep.aspx 1. Describe the basic pathology behind zoster. 2. Identify the main risk factors for zoster. 3. Recognize the disease and understand features necessary for • Herpes Zoster is a reactivation of latent varicella-zoster virus (VZV) infection in dorsal root ganglia or cranial nerve ganglia. • Cellular immunity is important in host resistance. • Physical appearance is a unilateral dermatomal vesicular eruption. It begins as red macules and papules on a pink erythematous base evolving to pustules, crusts, and scabs. Severe cases may also present with ulcers. • 10%-20% zoster cases are herpes zoster ophthalmicus (involvement of first branch of trigeminal nerve) - rash may involve forehead, scalp, upper eyelid and nose but does not cross midline. • The diagnosis is clinical, based on unilateral dermatomal vesicular eruption, it often presents with prodromal pain. o Valacyclovir (Valtrex®) 1 g PO TID x 7 days o Famciclovir (Famvir®) 500mg po TID x 7 days o Acyclovir (Zovirax®) 800mg po 5x/day for 7-10d 1. Opstelten, W. Clinical Diagnosis of Herpes Zoster in Family Practice. Ann Fam Med 2007 Jul-Aug;5(4): 305 2. Yaun, BP. A population based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Mayo Clin Proc 2007 Nov;82(11):1341 3. Guidelines for referral and management of systemic lupus erythematosus in adults. American College of Rheumatology Ad Hoc Committee on Systemic Lupus Erythematosus Guidelines. Arthritis Rheum. 1999 Sep;42(9):1785-96. 4. Matee, Mecky. Seroprevalence of human immunodeficiency virus, hepatititis B and C viruses, and syphilis infections among blood donors at the Muhimbili Natioanl Hospital in Dar Es Salaam, Tanzania. BMC Public Health 2006 Jan 30;6:21 full-text 5. Reichrath, J. Treatment Recommendations for Pyoderma Gangrenosum. J Am Acad Dermatol 2005 Aug;53(2):273 6. Kanoh, S. Tracheobronchial Pulmonary disease associated with Pyoderma Gangrenosum. Mayo Clin Proc 2009 Jun;84(6):5 Texas Tech MedCast Producer: Betsy Goebel Jones, Ed.D., [email protected] Prepared for the MSIV Geriatrics Experience at Texas Tech University Health Sciences Center School of Medicine, Andrew Dentino, M.D., Course Director, [email protected] http://www.ttuhsc.edu/som/fammed/ttmedcast/gerseries/gerstep2ckprep.aspx

Source: http://www.pogoe.com/sites/default/files/GerPodcastEpisode10_FS30.pdf