Quiz
Mixed diagnoses – 10 cases (5 of 11)

For each of the ten cases, study the image(s) and then answer the questions. You can click on the image to view a larger version if required.

Each case should take approximately five minutes to complete. There is a list of suggested further reading material at the end of the quiz.

When you finish the quiz, you can download a certificate.

Case 4

A few days after a skiing trip, a student presents with a painful blistered area on the upper lip. She is feeling somewhat unwell and has mild regional lymphadenopathy. She reports she has had a similar problem in the same site on two or three previous occasions over the last year or so.

What investigations should be performed?

No investigations are essential, but it may be appropriate to swab for bacterial and viral culture.

What is the likely diagnosis?

The history is characteristic of recurrent herpes simplex. Another diagnosis to consider is impetigo, but the history of previous episodes in the same site is very suggestive of herpes simplex.

What management would you advise?

Your patient should be advised of the contagious nature of the infection. Untreated, the eruption will settle within one to three weeks. Recurrence may be provoked by sun exposure, minor injury to the affected area, an upper respiratory tract infection or tiredness. In some women, exacerbation relates to the menstrual cycle. If she has prodromal tingling or irritation, she may be able to abort attacks with a topical antiviral agent such as aciclovir or penciclovir cream. Disabling attacks may be significantly lessened by prompt treatment with a five-day course of oral aciclovir 200 mg five times daily. Patients suffering frequent recurrences may benefit from prophylactic oral aciclovir 400mg bd.

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Quiz Mixed diagnoses – 10 cases (5 of 11)

Case 4

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Quiz
Mixed diagnoses – 10 cases (5 of 11)