a 42-year-old man with a rash

A 52-year-old man comes in with a rash…

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These days, I've been working as a freelance writer. Mostly, I write medical test questions for review prep companies. I'm a student's second-to-worst nightmare! (Worst being the actual exams themselves… and the evil authors that write them.)

Here's an example…

A 52-year-old man visits his family doctor for a painful rash on his left arm. He has had the rash for one week, and recalls no food or environmental exposure that triggered its appearance. The rash is pictured below:

a 42-year-old man with a rash

His complete blood count is normal. Which of the following is the most appropriate next step in managing this patient?

A. skin culture

B. oral valacyclovir

C. topical triamcinolone

D. skin biopsy

 

……

………

 

Correct Answer: B! [did you get it right? wink]

 

The depicted rash along with the clinical picture are indicative of herpes zoster (shingles) – an erythematous, papulo-vesicular, often linear rash that appears on one side of the body. The rash is often accompanied by burning, tingling, numbness, or painful sensation. Herpes zoster most commonly appears in adults over the age of 50. Conservative management of herpes zoster includes the use of NSAIDs and wet dressings or lotions for topical relief. Oral steroids can be prescribed but are controversial. Oral antiviral agents can decrease the length of time for new vesicle formation, the number of days to attain complete crusting, and the days of acute discomfort. They should be administered early on, ideally within 72 hours after symptom onset. http://emedicine.medscape.com/article/1132465-overview

 

Incidentally, I've gotten shingles before, and it's not great. Apparently, you don't need to be over 50 for it to happen to you!

 

Featured Photo: Source

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