Question of the Week # 37

Archer USMLE Step 3

A 34 year old man with no significant past medical history is seen in your office for a painful blister that appeared on his lower lip yesterday. He compians of burning and itching in the area. He never had similar lesions in the past. He denies any fever or chills. Vital signs reveal a temperature of 98.4, HR 88, RR18 and BP of 120/76. On physical examination a lesion is seen on his lower lip as shown in the picture. rest of the physical examination is benign.

Archer USMLE Step 3

The most appropriate next step in management is:

A) Oral Acyclovir

B) Re-assurance

C) Topical Penciclovir

D) Cold compresses

E) Oral Cephalosporin

27 Thoughts on “Question of the Week # 37”

  2. Manoj Dobariya on August 23, 2010 at 3:24 am said:

    A) Oral Acyclovir

    Reply↓
  4. usmlegalaxy on September 9, 2010 at 2:25 am said:

    Ans. is C Topical penciclovir

    The patient has Herpes Labialis:Caused by Herpes simplex Virus Type I. Most people are asymptomatic but only few people have recurrent outbreaks. Triggers for outbreak are cold weather, stress, trauma.

    Treatment: Topical Penciclovir as your first choice.
    Recurrent severe cases can be treated with oral Acyclovir.

    Ans. A is incorrect. Oral acyclovir is the treatment option for severe or recurrent herpes labialis.

    Ans. B is incorrect. This patient requires topical penciclovir.

    Ans. D is sub-optimal management.

    Ans. E is incorrect. This is not suggestive of a bacterial infection.

    Reply↓
  5. screamer on August 5, 2011 at 6:32 pm said:

    If only we apply anti-herpetic medication before vesicular eruption could limit the duration and severity of the crops. Once there is erruption, no medication can help but the nature. Using unnecessary medication would increase the cost of treatment. Simple reassurance and avoiding contact, giving rather Tylenol for pain and fever!might help in this case.

    Reply↓
  6. %usmle%, %galaxy% via Facebook on December 24, 2012 at 5:33 am said:

    HSv

    Reply↓
  8. %usmle%, %galaxy% via Facebook on December 24, 2012 at 5:43 am said:

    B

    Reply↓
  9. %usmle%, %galaxy% via Facebook on December 24, 2012 at 6:13 am said:

    HSV (i guess)……

    Reply↓
  10. %usmle%, %galaxy% via Facebook on December 24, 2012 at 6:18 am said:

    re assurance is more reliable option

    Reply↓
  11. ibrahim on December 24, 2012 at 6:43 am said:

    now, systemic antiherpetic drugs used for treatment of HSV-1,2 and VZV to;1)decrease viral shedding 2)decrease constitutional symptoms 3)decrease recurrence so,oral acyclovir is appropriate

    Reply↓
  12. %usmle%, %galaxy% via Facebook on December 24, 2012 at 7:32 am said:

    C

    Reply↓
  14. %usmle%, %galaxy% via Facebook on December 24, 2012 at 7:48 am said:

    ^ don’t people read the Q?

    Reply↓
  16. %usmle%, %galaxy% via Facebook on December 24, 2012 at 9:16 am said:

    Option C

    Reply↓
  20. %usmle%, %galaxy% via Facebook on December 24, 2012 at 1:18 pm said:

    herpes labialis….

    Reply↓
  23. %usmle%, %galaxy% via Facebook on December 25, 2012 at 5:24 pm said:

    hsv type1 and c

    Reply↓
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    Reply↓
  26. %usmle%, %galaxy% via Facebook on January 29, 2013 at 5:35 am said:

    C….The patient has Herpes Labialis:Caused by Herpes simplex
    Treatment: Topical Penciclovir as your first choice.
    Recurrent severe cases can be treated with oral Acyclovir.

    Reply↓
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