Rosh Emergency Medicine Practice Test

A 20-year-old man with intense itching and a vesicular rash is most likely suffering from which condition?

1. Contact dermatitis

2. Impetigo

3. Pemphigus

4. Varicella zoster virus

The correct answer is: Varicella zoster virus

The scenario described—a 20-year-old man with intense itching and a vesicular rash—aligns closely with infections caused by the varicella zoster virus, commonly known as chickenpox. This virus is characterized by an itchy vesicular rash that begins as small red spots, which then progress to fluid-filled blisters that eventually crust over. The intense itching is a hallmark symptom of chickenpox, making it distinctive among other conditions. Moreover, the vesicular nature of the rash is especially characteristic of varicella, as the blisters form following the initial rash, often in waves. In contrast, while other conditions like contact dermatitis can cause itching and rashes, they typically present differently and do not often involve vesicular lesions to the same extent. Impetigo usually presents with honey-colored crusts and is not primarily itchy. Pemphigus is also a vesicular condition, but it typically presents with more significant blistering, often accompanied by systemic symptoms, and usually occurs in older individuals rather than young adults. Thus, the combination of age, symptoms of intense itching, and the presence of a vesicular rash strongly points towards a diagnosis of varicella zoster virus infection.