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Self-Assessment Questions

Family Medicine

Herpes Zoster: Review Questions

Paul F. Roberts, MD

Dr. Roberts is an assistant professor of family medicine, Mayo Clinic, Jacksonville, FL.

Choose the single best answer for each question.

Figure 1

Questions 1 to 3 refer to the following case.

A 72-year-old man in good health presents to his family physician with fever and malaise that have lasted for several days. He also reports that he has developed an itchy, burning rash on the right side of his chest and back. All vital signs are within normal limits. Physical examination reveals an erythematous maculopapular rash with vesicles on the right side of the patient’s back and chest wall (Figure). Based on history and physical examination, the patient is diagnosed with herpes zoster infection.

1. Which of the following will this patient most likely experience as a result of herpes zoster infection?

  1. Cellulitis
  2. Encephalitis
  3. Muscular weakness
  4. Postherpetic neuralgia
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2. Herpes zoster ophthalmicus is a serious condition with a threat of visual loss. The physician further evaluates the patient for visual and otologic complications related to herpes zoster infection; there is no eye redness, facial lesions, or external auditory canal lesions. If the examination had revealed evidence of herpes zoster ophthalmicus, which of the following cranial nerves would be involved?

  1. Facial nerve
  2. Oculomotor nerve
  3. Trigeminal nerve
  4. Trochlear nerve
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3.  Which of the following is a major otologic complication of herpes zoster infection?

  1. Alport’s syndrome
  2. Cellulitis
  3. Ramsay Hunt syndrome
  4. Tinnitus
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  Questions 4 and 5 refer to the following case.

A 70-year-old woman presents to her family physician requesting more information about the herpes zoster vaccine. Her friends have told her about the new vaccine, and she wants to know if she is a candidate to receive it. She had chicken pox as a child but has not had shingles. She notes that she is concerned about shingles because of the debilitating pain associated with this condition.

4. Use of the herpes zoster vaccine is recommended in which of the following age-groups?

  1. Persons aged ≥ 40 years
  2. Persons aged ≥ 50 years
  3. Persons aged ≥ 60 years
  4. Persons aged ≥ 70 years
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5. The herpes zoster vaccine is made from which of the following components?

  1. Inactivated virus
  2. Live attenuated virus
  3. Polysaccharides
  4. Toxoid
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6. The incidence of herpes zoster is higher among patients who are immunocompromised. What is the approximate incidence of herpes zoster in HIV- infected patients compared with the general population?

  1. 5 times higher
  2. 15 times higher
  3. 25 times higher
  4. 30 times higher
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7. Which of the following antiviral drugs used to manage acute herpes zoster infection has the lowest bioavailability?

  1. Acyclovir
  2. Famciclovir
  3. Ganciclovir
  4. Valacyclovir
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