Examl 2:l NSG554/l NSGl 554l (NEWl 2025/l
2026l Update)l Primaryl Carel Il Guide|l
Questionsl &l Answers|l Gradel A|l 100%l
Correctl (Verifiedl Solutions)-l Wilkes
QUESTION
Vitiligo
Answer:
isl al multifactoriall autoimmunel disorderl characterizedl byl depigmentationl ofl thel skinl duel
tol thel destructionl ofl melanocytes,l leadingl tol well-defined,l oftenl symmetrical,l whitel
patches.l Whilel thel exactl etiologyl ofl vitiligol isl unknown,l itl isl believedl tol involvel al
combinationl ofl geneticl predisposition,l autoimmunel mechanisms,l oxidativel stress,l andl
environmentall triggers.l Studiesl suggestl thel involvementl ofl bothl cellularl andl humorall
immunel responses,l withl cytotoxicl Tl lymphocytesl targetingl melanocytesl andl
autoantibodiesl directedl againstl melanocytel antigensl contributingl tol theirl destruction.l Thel
clinicall coursel ofl vitiligol variesl widely,l rangingl froml stable,l focall lesionsl tol rapidlyl
progressing,l widespreadl depigmentation
Vitiligol typicallyl presentsl withl asymptomaticl depigmentedl maculesl andl patches,l milkl orl
chalkl whitel inl color,l thatl lackl clinicall signsl ofl inflammationl (picturel 1).l Severel
sunburn,l pregnancy,l skinl trauma,l and/orl emotionall stressl mayl precedel thel diseasel onsetl
[71].l Lesionsl canl appearl atl anyl agel andl anywherel onl thel body,l withl al predilectionl forl
thel facel andl areasl aroundl thel orifices,l genitals,l andl hands.l Theyl varyl inl sizel froml al
fewl millimetersl tol manyl centimetersl andl usuallyl havel convexl bordersl well-demarcatedl
froml thel surroundingl normall skin.
Vitiligol mayl showl morel thanl onel colorl shade.l Trichromel lesionsl arel characterizedl byl
zonesl ofl white,l light-brown,l andl normall skinl colorl andl arel mostl oftenl observedl inl
individualsl withl darklyl pigmentedl skin.l Quadrichromel lesionsl mayl havel al perifollicularl
orl marginall hyperpigmentation,l whereasl pentachromel lesionsl presentl alsol al bluel huel
[12,72].l Anotherl clinicall variantl isl thel so-calledl vitiligol ponctué,l whichl exhibitsl tiny,l
confetti-likel depigmentedl macules.
QUESTION
Vitiligol Tx
Answer:
,Midpotencyl topicall corticosteroidl therapyl (mometasone)l isl firstl linel orl withl NBUVBl
(phototherapy)
QUESTION
HSVl typel 1l andl 2
Answer:
Herpesl simplexl virusl (HSV)l infectionl isl al prevalentl virall conditionl thatl manifestsl inl
twol mainl forms:l herpesl simplexl virusl typel 1l (HSV-1)l andl herpesl simplexl virusl typel 2l
(HSV-2).l HSV-1l commonlyl causesl orall herpes,l characterizedl byl coldl soresl orl feverl
blistersl aroundl thel mouth,l whilel HSV-2l typicallyl leadsl tol genitall herpes,l resultingl inl
painfull genitall ulcers.l However,l bothl typesl ofl HSVl canl causel infectionsl atl eitherl
location.l HSVl infectionsl arel highlyl contagiousl andl canl bel transmittedl throughl directl
contactl withl infectedl lesionsl orl mucosall surfaces,l asl welll asl throughl salival orl genitall
secretions.l Oncel acquired,l HSVl establishesl lifelongl latencyl inl sensoryl nervel ganglia,l
withl periodicl reactivationl leadingl tol recurrentl outbreaksl ofl symptoms
groupedl 2l tol 4l mml vesiclesl withl associatedl underlyingl erythemal thatl progressl tol
vesicopustules,l erosions,l andl ulcerations.l Vesiclesl andl pustulesl mayl exhibitl al centrall
depression,l referredl tol asl anl "umbilicated"l appearance.l Erosionsl andl ulcerationsl oftenl
havel scallopedl borders.
Systemicl symptoms,l includingl fever,l headache,l malaise,l andl myalgiasl (67l percent)
Locall painl andl itchingl (98l percent)
Dysurial (63l percent)
Tenderl lymphadenopathyl (80l percent)
Individualsl withl HSV-2l havel al higherl riskl ofl HIVl infection
QUESTION
HSVl dx
Answer:
Polymerasel chainl reactionl —l Whilel virall culturel hasl remainedl thel standardl diagnosticl
methodl forl isolatingl HSV,l real-timel HSVl PCRl assaysl havel emergedl asl al morel
sensitivel methodl tol confirml HSVl infectionl inl clinicall specimensl obtainedl froml genitall
ulcersl andl mucocutaneousl sites;l PCRl isl thel testl ofl choicel forl cerebrospinall fluid
Virall culture(goldl standard)l —l Ifl activel genitall lesionsl arel present,l thel vesiclel shouldl
bel unroofedl forl samplingl ofl vesicularl fluidl forl culture.l However,l thel overalll sensitivityl
ofl virall culturel ofl genitall lesionsl isl onlyl approximatelyl 50l percentl .l Thel diagnosticl
yieldl ofl culturel isl highestl inl thel earlyl stagesl ofl disease,l whenl lesionsl arel typicallyl
vesicular,l andl declinesl rapidlyl asl thel lesionsl beginl tol heal.l Virall isolationl ratesl arel alsol
,higherl withl primaryl comparedl tol recurrentl genitall herpes,l particularlyl inl thel settingl ofl
asymptomaticl recurrencesl withl subclinicall shedding.
QUESTION
HSVl tx
Answer:
Acyclovir:l 400l mgl fivel timesl dailyl (safel inl pregnancy)
Famciclovir:l 250l mgl threel timesl daily
Valacyclovir:l 1000l mgl twicel daily
Alll forl 5-7l days
Psychologicall distress,l severel physcall pain,l orl pregnantl womenl afterl 36l weeksl gestation.l
Supressionl dosel ofl acyclovirl 400l mgl BIDl daily
Topicall agentsl mayl bel usedl suchl asl topicall acyclovirl orl opthalmicl solutions
l topicall analgesicsl suchl asl lidocainel 2%l orl 5%l helpl reducel pain
QUESTION
Shingles
Answer:
Herpesl zosterl ,l isl al virall infectionl causedl byl thel reactivationl ofl thel varicella-zosterl
virusl ,l thel samel virusl responsiblel forl chickenpox.l Afterl primaryl infectionl withl VZV,l
typicallyl duringl childhood,l thel virusl remainsl dormantl inl sensoryl nervel ganglia.l
However,l itl canl reactivatel laterl inl life,l leadingl tol thel developmentl ofl shingles.l Thisl
reactivationl isl oftenl triggeredl byl factorsl suchl asl aging,l immunosuppression,l orl stress.l
Shinglesl typicallyl presentsl asl al painful,l unilaterall rashl withl fluid-filledl blistersl alongl al
dermatomall distribution.l Thel mostl commonl complicationl ofl shinglesl isl postherpeticl
neuralgia,l characterizedl byl persistentl painl inl thel affectedl areal evenl afterl thel rashl hasl
resolved
Rashl —l Thel rashl startsl asl erythematousl papules,l typicallyl inl al singlel dermatomel orl
severall contiguousl dermatomes.l Thel dermatomall distributionl ofl thel vesicularl rashl ofl
herpesl zosterl correspondsl tol thel sensoryl fieldsl ofl thel ganglionl (orl neighboringl ganglia)l
involved.
Withinl severall days,l groupedl vesiclesl orl bullael arel thel predominantl manifestation.l
Withinl threel tol fourl days,l thel rashl becomesl pustular.l Thel rashl canl bel hemorrhagicl inl
immunosuppressedl peoplel andl peoplel ofl advancedl age.
Inl immunocompetentl hosts,l thel lesionsl crustl byl 7l tol 10l daysl andl arel nol longerl
consideredl infectiousl .l Scarringl andl hypo-l orl hyperpigmentationl mayl persistl monthsl tol
yearsl afterl herpesl zosterl hasl resolvedl .l Thel developmentl ofl newl lesionsl morel thanl al
, weekl afterl presentationl shouldl raisel concernsl regardingl possiblel underlyingl
immunodeficiency.
Althoughl thel rashl canl occurl inl anyl dermatome,l thel thoracicl andl lumbarl dermatomesl
arel mostl commonlyl involvedl .l Somel patientsl mayl alsol havel al fewl scatteredl vesiclesl
locatedl atl somel distancel awayl froml thel involvedl dermatome,l probablyl reflectingl thel
presencel ofl varicella-zosterl virusl viremial earlyl inl herpesl zosterl .
QUESTION
Complicationsl ofl shingles
Answer:
Mostl common
Postherpeticl neuralgial —l Postherpeticl neuralgial (PHN)l isl frequentlyl definedl asl
significantl painl persistingl forl 90l daysl afterl thel onsetl ofl rash.l Significantl painl isl
consideredl al painl levell 3l orl higherl onl al painl scalel ofl 1l tol 10.l Sensoryl symptomsl canl
alsol includel numbness,l dysesthesias,l pruritus,l andl allodynial inl thel affectedl dermatome.l
Al morel detailedl discussionl ofl thel clinicall manifestationsl andl diagnosisl ofl PHNl isl
presentedl inl al separatel topicl review.l (Seel "Postherpeticl neuralgia".)
Approximatelyl 10l tol 15l percentl ofl patientsl withl herpesl zosterl willl developl PHNl
[107,108];l individualsl olderl thanl 60l yearsl ofl agel accountl forl 50l percentl ofl thesel casesl
[45].l Inl onel study,l thel percentagel ofl patientsl withl herpesl zosterl whol developedl PHNl
increasedl froml 5l percentl inl thosel youngerl thanl 60l yearsl tol 20l percentl inl thosel agedl
80l yearsl orl olderl [109].l Immunosuppressedl patientsl alsol havel al higherl incidence.l Byl
contrast,l patientsl whol receivel eitherl thel livel attenuatedl orl recombinantl herpesl zosterl
vaccinesl arel lessl likelyl tol developl PHN,l evenl ifl herpesl zosterl occurs
QUESTION
Shinglesl Riskl factors
Answer:
Increasingl agel >50
Immunosupression
Physicall Trauma
Female
QUESTION
Otherl characteristicl ofl shingles
2026l Update)l Primaryl Carel Il Guide|l
Questionsl &l Answers|l Gradel A|l 100%l
Correctl (Verifiedl Solutions)-l Wilkes
QUESTION
Vitiligo
Answer:
isl al multifactoriall autoimmunel disorderl characterizedl byl depigmentationl ofl thel skinl duel
tol thel destructionl ofl melanocytes,l leadingl tol well-defined,l oftenl symmetrical,l whitel
patches.l Whilel thel exactl etiologyl ofl vitiligol isl unknown,l itl isl believedl tol involvel al
combinationl ofl geneticl predisposition,l autoimmunel mechanisms,l oxidativel stress,l andl
environmentall triggers.l Studiesl suggestl thel involvementl ofl bothl cellularl andl humorall
immunel responses,l withl cytotoxicl Tl lymphocytesl targetingl melanocytesl andl
autoantibodiesl directedl againstl melanocytel antigensl contributingl tol theirl destruction.l Thel
clinicall coursel ofl vitiligol variesl widely,l rangingl froml stable,l focall lesionsl tol rapidlyl
progressing,l widespreadl depigmentation
Vitiligol typicallyl presentsl withl asymptomaticl depigmentedl maculesl andl patches,l milkl orl
chalkl whitel inl color,l thatl lackl clinicall signsl ofl inflammationl (picturel 1).l Severel
sunburn,l pregnancy,l skinl trauma,l and/orl emotionall stressl mayl precedel thel diseasel onsetl
[71].l Lesionsl canl appearl atl anyl agel andl anywherel onl thel body,l withl al predilectionl forl
thel facel andl areasl aroundl thel orifices,l genitals,l andl hands.l Theyl varyl inl sizel froml al
fewl millimetersl tol manyl centimetersl andl usuallyl havel convexl bordersl well-demarcatedl
froml thel surroundingl normall skin.
Vitiligol mayl showl morel thanl onel colorl shade.l Trichromel lesionsl arel characterizedl byl
zonesl ofl white,l light-brown,l andl normall skinl colorl andl arel mostl oftenl observedl inl
individualsl withl darklyl pigmentedl skin.l Quadrichromel lesionsl mayl havel al perifollicularl
orl marginall hyperpigmentation,l whereasl pentachromel lesionsl presentl alsol al bluel huel
[12,72].l Anotherl clinicall variantl isl thel so-calledl vitiligol ponctué,l whichl exhibitsl tiny,l
confetti-likel depigmentedl macules.
QUESTION
Vitiligol Tx
Answer:
,Midpotencyl topicall corticosteroidl therapyl (mometasone)l isl firstl linel orl withl NBUVBl
(phototherapy)
QUESTION
HSVl typel 1l andl 2
Answer:
Herpesl simplexl virusl (HSV)l infectionl isl al prevalentl virall conditionl thatl manifestsl inl
twol mainl forms:l herpesl simplexl virusl typel 1l (HSV-1)l andl herpesl simplexl virusl typel 2l
(HSV-2).l HSV-1l commonlyl causesl orall herpes,l characterizedl byl coldl soresl orl feverl
blistersl aroundl thel mouth,l whilel HSV-2l typicallyl leadsl tol genitall herpes,l resultingl inl
painfull genitall ulcers.l However,l bothl typesl ofl HSVl canl causel infectionsl atl eitherl
location.l HSVl infectionsl arel highlyl contagiousl andl canl bel transmittedl throughl directl
contactl withl infectedl lesionsl orl mucosall surfaces,l asl welll asl throughl salival orl genitall
secretions.l Oncel acquired,l HSVl establishesl lifelongl latencyl inl sensoryl nervel ganglia,l
withl periodicl reactivationl leadingl tol recurrentl outbreaksl ofl symptoms
groupedl 2l tol 4l mml vesiclesl withl associatedl underlyingl erythemal thatl progressl tol
vesicopustules,l erosions,l andl ulcerations.l Vesiclesl andl pustulesl mayl exhibitl al centrall
depression,l referredl tol asl anl "umbilicated"l appearance.l Erosionsl andl ulcerationsl oftenl
havel scallopedl borders.
Systemicl symptoms,l includingl fever,l headache,l malaise,l andl myalgiasl (67l percent)
Locall painl andl itchingl (98l percent)
Dysurial (63l percent)
Tenderl lymphadenopathyl (80l percent)
Individualsl withl HSV-2l havel al higherl riskl ofl HIVl infection
QUESTION
HSVl dx
Answer:
Polymerasel chainl reactionl —l Whilel virall culturel hasl remainedl thel standardl diagnosticl
methodl forl isolatingl HSV,l real-timel HSVl PCRl assaysl havel emergedl asl al morel
sensitivel methodl tol confirml HSVl infectionl inl clinicall specimensl obtainedl froml genitall
ulcersl andl mucocutaneousl sites;l PCRl isl thel testl ofl choicel forl cerebrospinall fluid
Virall culture(goldl standard)l —l Ifl activel genitall lesionsl arel present,l thel vesiclel shouldl
bel unroofedl forl samplingl ofl vesicularl fluidl forl culture.l However,l thel overalll sensitivityl
ofl virall culturel ofl genitall lesionsl isl onlyl approximatelyl 50l percentl .l Thel diagnosticl
yieldl ofl culturel isl highestl inl thel earlyl stagesl ofl disease,l whenl lesionsl arel typicallyl
vesicular,l andl declinesl rapidlyl asl thel lesionsl beginl tol heal.l Virall isolationl ratesl arel alsol
,higherl withl primaryl comparedl tol recurrentl genitall herpes,l particularlyl inl thel settingl ofl
asymptomaticl recurrencesl withl subclinicall shedding.
QUESTION
HSVl tx
Answer:
Acyclovir:l 400l mgl fivel timesl dailyl (safel inl pregnancy)
Famciclovir:l 250l mgl threel timesl daily
Valacyclovir:l 1000l mgl twicel daily
Alll forl 5-7l days
Psychologicall distress,l severel physcall pain,l orl pregnantl womenl afterl 36l weeksl gestation.l
Supressionl dosel ofl acyclovirl 400l mgl BIDl daily
Topicall agentsl mayl bel usedl suchl asl topicall acyclovirl orl opthalmicl solutions
l topicall analgesicsl suchl asl lidocainel 2%l orl 5%l helpl reducel pain
QUESTION
Shingles
Answer:
Herpesl zosterl ,l isl al virall infectionl causedl byl thel reactivationl ofl thel varicella-zosterl
virusl ,l thel samel virusl responsiblel forl chickenpox.l Afterl primaryl infectionl withl VZV,l
typicallyl duringl childhood,l thel virusl remainsl dormantl inl sensoryl nervel ganglia.l
However,l itl canl reactivatel laterl inl life,l leadingl tol thel developmentl ofl shingles.l Thisl
reactivationl isl oftenl triggeredl byl factorsl suchl asl aging,l immunosuppression,l orl stress.l
Shinglesl typicallyl presentsl asl al painful,l unilaterall rashl withl fluid-filledl blistersl alongl al
dermatomall distribution.l Thel mostl commonl complicationl ofl shinglesl isl postherpeticl
neuralgia,l characterizedl byl persistentl painl inl thel affectedl areal evenl afterl thel rashl hasl
resolved
Rashl —l Thel rashl startsl asl erythematousl papules,l typicallyl inl al singlel dermatomel orl
severall contiguousl dermatomes.l Thel dermatomall distributionl ofl thel vesicularl rashl ofl
herpesl zosterl correspondsl tol thel sensoryl fieldsl ofl thel ganglionl (orl neighboringl ganglia)l
involved.
Withinl severall days,l groupedl vesiclesl orl bullael arel thel predominantl manifestation.l
Withinl threel tol fourl days,l thel rashl becomesl pustular.l Thel rashl canl bel hemorrhagicl inl
immunosuppressedl peoplel andl peoplel ofl advancedl age.
Inl immunocompetentl hosts,l thel lesionsl crustl byl 7l tol 10l daysl andl arel nol longerl
consideredl infectiousl .l Scarringl andl hypo-l orl hyperpigmentationl mayl persistl monthsl tol
yearsl afterl herpesl zosterl hasl resolvedl .l Thel developmentl ofl newl lesionsl morel thanl al
, weekl afterl presentationl shouldl raisel concernsl regardingl possiblel underlyingl
immunodeficiency.
Althoughl thel rashl canl occurl inl anyl dermatome,l thel thoracicl andl lumbarl dermatomesl
arel mostl commonlyl involvedl .l Somel patientsl mayl alsol havel al fewl scatteredl vesiclesl
locatedl atl somel distancel awayl froml thel involvedl dermatome,l probablyl reflectingl thel
presencel ofl varicella-zosterl virusl viremial earlyl inl herpesl zosterl .
QUESTION
Complicationsl ofl shingles
Answer:
Mostl common
Postherpeticl neuralgial —l Postherpeticl neuralgial (PHN)l isl frequentlyl definedl asl
significantl painl persistingl forl 90l daysl afterl thel onsetl ofl rash.l Significantl painl isl
consideredl al painl levell 3l orl higherl onl al painl scalel ofl 1l tol 10.l Sensoryl symptomsl canl
alsol includel numbness,l dysesthesias,l pruritus,l andl allodynial inl thel affectedl dermatome.l
Al morel detailedl discussionl ofl thel clinicall manifestationsl andl diagnosisl ofl PHNl isl
presentedl inl al separatel topicl review.l (Seel "Postherpeticl neuralgia".)
Approximatelyl 10l tol 15l percentl ofl patientsl withl herpesl zosterl willl developl PHNl
[107,108];l individualsl olderl thanl 60l yearsl ofl agel accountl forl 50l percentl ofl thesel casesl
[45].l Inl onel study,l thel percentagel ofl patientsl withl herpesl zosterl whol developedl PHNl
increasedl froml 5l percentl inl thosel youngerl thanl 60l yearsl tol 20l percentl inl thosel agedl
80l yearsl orl olderl [109].l Immunosuppressedl patientsl alsol havel al higherl incidence.l Byl
contrast,l patientsl whol receivel eitherl thel livel attenuatedl orl recombinantl herpesl zosterl
vaccinesl arel lessl likelyl tol developl PHN,l evenl ifl herpesl zosterl occurs
QUESTION
Shinglesl Riskl factors
Answer:
Increasingl agel >50
Immunosupression
Physicall Trauma
Female
QUESTION
Otherl characteristicl ofl shingles
