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Dentistry · Oral medicine and oral cancer: herpes zoster of the trigeminal nerve
Sample itemA 58-year-old has 2 days of severe unilateral toothache in the upper molars, but the teeth are sound and vital. The next day clusters of vesicles appear on one half of the hard palate, stopping at the midline. What is the diagnosis?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
B. Herpes zoster of the maxillary division of the trigeminal nerve
Zoster can cause pain that mimics toothache before the vesicles appear, and the unilateral distribution that stops at the midline follows the nerve. Treatment is early oral aciclovir or valaciclovir.
Option by option
A. Herpangina
Herpangina affects the soft palate and tonsillar pillars of children, bilaterally.
B. Herpes zoster of the maxillary division of the trigeminal nerve (correct)
Correct. Unilateral vesicles on the palate following a nerve division indicate zoster.
C. Recurrent herpes labialis
Herpes labialis affects the lip border and does not stop at a midline on the palate.
D. Hand, foot and mouth disease
Hand, foot and mouth disease is bilateral with lesions on the hands and feet.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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