The Daily PANCE and PANRE Extended Edition: Question 48

You diagnose a patient with shingles involving the trigeminal nerve. Since there is involvement of the tip of the nose, you examine her thoroughly to exclude concurrent involvement of the:

  1. tympanic membrane
  2. cornea
  3. nasal septum
  4. contralateral pinna
  5. ipsilateral epitrochlear node

Answer: B


This is Hutchinson's sign and suggests an involvement of the cornea with herpes. Ophthalmologic referral is indicated. (Fluorescein staining would show a dendritic lesion on the cornea).

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