Primary Care Network

Reducing the Burden of Shingles and Postherpetic Neuralgia

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Post Test

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Bonnie is 85. She has enjoyed relatively good health but had a bout of shingles in the left T-6 dermatome six months ago. She has had a difficult time managing the post-herpetic neuralgia (PHN) that set in when the rash resolved. Her 55-year-old daughter from out of state comes in with her for a recheck and is demanding answers about her mom’s problem, especially why you haven’t “cured” this problem! Of the following possible statements you could make to her, which are true?

A. Shingles is due to reactivation of the chickenpox virus (herpes zoster) and half of those living to age 85 will ultimately develop shingles

B. PHN is just as likely to occur in a patient who has had a mild case of shingles as it is in the patient who had a severe case of shingles

C. PHN incidence, duration, and pain all increase with the age of the patient

D. Antiviral therapy and corticosteroids can both reduce the risk of PHN if given early in the course of shingles

E. A and C

F. B and D

G. All of the above

Bonnie’s daughter is worried about her dad, Bonnie’s husband. He is 81, enjoys reasonably good health but has a very low pain tolerance. She is worried that if he had to go through what her mom has endured with PHN that it would kill him. He has had chickenpox, but never shingles. Her grandchildren have just had the “chickenpox shot” and she heard that there is something similar to prevent shingles that is new. She wants you to tell her all about it. Of the following possible statements you could make to her, which are true?

A. The zoster vaccine recently approved is the same strain as that used in the “chickenpox shot,” is a live attenuated virus, and the vaccine is more potent than the “chickenpox shot”

B. Studies have shown approximately a 50% reduction in the incidence of shingles and in those that developed shingles a 65% reduction in PHN incidence

C. There would be no reason to vaccinate anyone over age 80, so he really would not be a candidate

D. A and B

E. B and C

F. All of the above