Answer to Shingles?

Correct answer is D. The scenario described is consistent with shingles. Patient indicated he had suffered chicken pox as a child, a prerequisite for having shingles developed most frequently after age 50. Stress (he was vying for a Hollywood movie role to spurt his career again), some medications (do I need to specify what could have happened to an actor during a week of wild partying), and certain health conditions (actor is 70 y.o., ageing is not for the faint of heart), can reactivate the virus and trigger the symptoms of shingles. When shingles occurs more than once, doctors refer to it as recurrent shingles. Recurrent shingles is more common among people with a compromised immune system. Regardless of your knowledge of infectious diseases, the stem of the question asks for the exit of the ophthalmic division (V1) of the trigeminal nerve from the cranial vault, not the exit of V1 from the orbit. In this latter case, the correct answer would have been A.

Answer to this question is based on material presented in lecture 2 of the Head and Neck Lecture Series.