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Self-Assessment Questions

Internal Medicine

Antiviral Treatment of Herpes Zoster: Review Questions

Kenneth J. Smith, MD, FACP

Dr. Smith is Associate Program Director, Internal Medicine and Transitional Residency Programs, Mercy Hospital of Pittsburgh, Pittsburgh, PA,
and a member of the Hospital Physician Editorial Board.

Choose the single best answer for each question.

1. A 55-year-old woman presents to her physician with complaints of a moderately painful rash that she first noticed the previous day. On examination, a band of grouped erythematous vesicles is noted over the right flank in the T12 dermatome. Reasonable treatment options at this time (either alone or in combination with other agents) include all of the following EXCEPT:
  1. Prednisone
  2. Acyclovir
  3. Carbamazepine
  4. Opiate analgesics
  5. Valacyclovir
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2. A 72-year-old man presents with severe left thigh pain in the area of a rash that began approximately 10 days prior to presentation. A crusting, linear, erythematous rash is present on his anterior thigh, with areas of dysesthesia around the rash. Healing herpes zoster is diagnosed. All of the following are appropriate treatments at this time EXCEPT:

  1. Opiate analgesics
  2. Famciclovir
  3. Amitriptyline
  4. Topical lidocaine
  5. Gabapentin
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3. Which of the following statements regarding antiviral treatment of herpes zoster is true?

  1. Acyclovir is less effective than famciclovir or valacyclovir in preventing postherpetic neuralgia.
  2. Antiviral agents are effective when administered within 5 days of rash onset.
  3. Duration of postherpetic neuralgia is decreased by prompt antiviral therapy of herpes zoster.
  4. Antiviral therapy is not effective against acute pain caused by herpes zoster.
  5. Antiviral treatment of herpes zoster leads to antiviral resistance in the varicella virus.
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4. All of the following factors are associated with an increased risk of development of postherpetic neuralgia EXCEPT:
  1. Immunosuppression
  2. Increasing patient age
  3. Ophthalmic distribution of herpes zoster
  4. Severe acute herpes zoster pain
  5. Premonitory pain prior to herpes zoster rash
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5. In which of the following immunocompetent patients presenting within 24 hours of rash onset should antiviral therapy NOT be considered?

  1. A 30-year-old nonpregnant woman with severely symptomatic acute herpes zoster
  2. A 40-year-old man with mildly symptomatic acute herpes zoster
  3. A 50-year-old woman with severely symptomatic acute herpes zoster
  4. A 60-year-old man with mildly symptomatic acute herpes zoster
  5. A 70-year-old asymptomatic woman with a few herpes zoster lesions on her right cheek
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6. Oral antiviral medications for herpes zoster can be used in which of the following patients?

  1. In patients older than age 75 years
  2. In patients with creatinine levels greater than 1.5 mg/dL
  3. In patients with hepatic dysfunction
  4. In patients with platelet counts less than 100,000/mm3
  5. All of the above
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Updated 1/04/08 • kkj