General practice & prim · UKMLA & AKT
Shingles (Herpes Zoster)
A free high-yield preview for the UKMLA Applied Knowledge Test. Below are the key points to recognise shingles (herpes zoster) — the full SA Note notes add investigations, management, complications and 10 practice questions.
Key high-yield points
- Prodrome (2-3 days before rash): burning/stabbing pain, hyperaesthesia localised to a single dermatome - often misattributed to MSK or cardiac causes
- Rash: erythematous macules/papules → vesicles → pustules → crusting, strictly unilateral, does not cross midline
- Distribution: thoracic dermatomes (T1-L2) most common
- Herpes zoster ophthalmicus (HZO): ophthalmic division (V1) of trigeminal nerve - periorbital vesicular rash, eye pain, redness, reduced visual acuity; Hutchinson's sign (vesicles on tip/side of nose) indicates nasociliary branch involvement and predicts intraocular complications
- Ramsay Hunt syndrome: geniculate ganglion (CN VII) - ipsilateral LMN facial palsy, vesicles in external auditory canal/soft palate, sensorineural hearing loss/vertigo
- Clinical diagnosis - do not wait for rash to initiate treatment if suspicion is high
Shingles in a young adult (<50) without obvious cause should prompt HIV testing - it is an HIV indicator condition.
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