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QUESTION 2
A 70 year-old female in excellent health (HIV negative) had 3-day history of stabbing pain and itching in her right ear.
On the second day of the pain she developed pain in her right jaw, spreading to her right cheek. Chewing caused some pain in the right cheek and she had some difficulty swallowing.
On exam, she was afebrile, alert and oriented and had erythematous vesicles and moistness in the right external auditory canal plus some flattening of the nasolabial fold and lesser smile on the right.
The tympanic membrane could not be visualized because of edema in the canal lining and pain on otoscopy.
The diagnostic test most likely to yield the correct diagnosis is which of the following:
(1) Routine bacterial culture of the right ear exudate
(2) Mycobacterial culture of the right ear exudate
(3) Anaerobic culture of the right ear exudate
(4) PCR of ear lesion swab for VZV
(5) Fungal culture of the middle ear scraping
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