Texas Tech MedCast Podcast Episode Fact Sheet 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
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