ESIC Nursing Officer -2019 (Shift -1)
Medical & Surgical Nursing
Easy
The group at the increased risk for herpes zoster is:
Appeared in: ESIC Nursing Officer -2019 (Shift -1)
Explanation
- Herpes zoster (shingles) is a reactivation of the latent varicella-zoster virus (VZV).
- The primary risk factor for reactivation is a decline in cell-mediated immunity.
- This decline is a natural part of aging (immunosenescence), making advanced age the most significant risk factor.
- The incidence of herpes zoster increases sharply after the age of 50, with most cases occurring in older adults.
Why Other Options Were Wrong
- Option A: Pregnancy is not a primary risk factor for VZV reactivation (zoster). The greater concern is primary varicella (chickenpox) infection during pregnancy.
- Option B: Herpes zoster is extremely rare in infants. Congenital varicella syndrome is a distinct condition caused by maternal chickenpox during pregnancy.
- Option D: Atopic dermatitis itself does not increase the risk of herpes zoster. The risk would only increase if the patient were on systemic immunosuppressive therapy for the condition.
Related Visual
- Visual 1: Diagram - A flowchart showing the progression from primary VZV infection (chickenpox) to latency in the dorsal root ganglion and subsequent reactivation as herpes zoster (shingles).
- Visual 2: Image - A clinical photograph showing the characteristic unilateral, dermatomal vesicular rash of herpes zoster on a patient's torso.
- Visual 3: Graph - A bar chart illustrating the incidence of herpes zoster per 1,000 person-years, with age groups on the x-axis, clearly showing a dramatic increase in older age brackets.
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Risk factors for herpes zoster (shingles) as background academic context rather than a clinical decision trigger.
- Nurses play a crucial role in educating older adults about the risk of shingles and the benefits of vaccination. The recombinant zoster vaccine (Shingrix) is highly effective and recommended for adults 50 years and older.
- Recognizing the characteristic rash and associated pain is vital for prompt diagnosis and initiation of antiviral therapy (e.g., acyclovir, valacyclovir) within 72 hours to reduce severity and the risk of post-herpetic neuralgia (PHN).
- What if the patient was a 35-year-old with newly diagnosed Hodgkin lymphoma? In this case, their immunocompromised state from the cancer and its treatment would make them a high-risk individual for herpes zoster, despite their younger age. The underlying risk factor is always the state of the immune system.
How to Approach the Question
- First, identify the core concept of the question: risk factors for herpes zoster.
- Recall that herpes zoster (shingles) is a reactivation of the varicella-zoster virus (VZV), not a new infection.
- Consider the pathophysiology: What allows a latent virus to reactivate? The answer is a weakened immune system.
- Evaluate each option in the context of immune function:
- A) Pregnant women: Immunity is altered, but they are not the primary risk group for zoster.
- B) Infants: Have immature immune systems, but zoster is very rare in this group.
Concept Tested & Keywords
- Concept Tested: Risk factors for herpes zoster (shingles)
- Stem keywords: increased risk, herpes zoster
- Lead-in keywords: is
- Negative lead-in flag: false
Question ID
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Practise the full ESIC Nursing Officer -2019 (Shift -1)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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