{"id":7913,"date":"2025-10-20T00:01:00","date_gmt":"2025-10-20T08:01:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=7913"},"modified":"2025-10-01T16:34:22","modified_gmt":"2025-10-02T00:34:22","slug":"usmle-step-2-ck-question-of-the-day-jaundiced-skin","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-jaundiced-skin","title":{"rendered":"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Jaundiced skin"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-jaundiced-skin\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 2 Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-jaundiced-skin\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-jaundiced-skin\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-jaundiced-skin\/#Major_Takeaway\" >Major Takeaway<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-jaundiced-skin\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-jaundiced-skin\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Today, we\u2019re examining a clinical case of a 38-year-old man brought to the emergency room by EMS showing signs of intoxication. Which exam finding is most likely present and should be further assessed to determine the cause of this patient\u2019s condition?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 38-year-old man is brought to the emergency department by EMS after being found on the side of the road intoxicated from alcohol. The patient presents frequently to the emergency department with similar presentations. The patient is awake and reports an episode of blood in his vomitus that morning and an increase in abdominal girth for the past few days. Past medical history is significant for alcohol use disorder. Temperature is 37.0\u00b0C (98.6\u00b0F), pulse is 108\/min, respirations are 18\/min, blood pressure is 110\/60 mmHg, and oxygen saturation is 97% on room air. Physical examination shows jaundiced skin and icteric sclerae. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Which of the following physical examination findings is <em>most likely<\/em> to be present and should be assessed further to determine the underlying cause of this patient\u2019s presentation?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Flank dullness to percussion<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Blood per rectum on digital rectal exam<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Absent bowel sounds on auscultation<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Auspitz sign<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Jugular venous distention<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Osmosis.org at the University College London, UK\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/DIp3u0oTLo4?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_2_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 2 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Flank dullness to percussion<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Blood per rectum on digital rectal exam<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Blood per rectum on digital rectal exam is more often seen in lower gastrointestinal bleeds such as with hemorrhoids or diverticulosis or with brisk upper gastrointestinal bleeding. This patient\u2019s presentation is suggestive of cirrhosis with hematemesis and abdominal distention suggesting ascites. The abdominal distension should be further assessed with physical examination and imaging.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Absent bowel sounds on auscultation<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Absent bowel sounds on auscultation is suggestive of bowel obstruction or ileus. Although it can be present in patients with abdominal distention, this patient\u2019s presentation is more suggestive of ascites, which will manifest as flank dullness to percussion.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Auspitz sign<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> The Auspitz sign refers to the visualization of pinpoint bleeding after removal of scale overlying a psoriatic plaque. This patient\u2019s presentation does not correlate with psoriasis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E.Jugular venous distention<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Jugular venous distention is usually seen in patients with right heart failure, tension pneumothorax, or cardiac tamponade among others disease states. This patient\u2019s presentation is suggestive of cirrhosis, which does not usually cause jugular venous distention.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The patient in this vignette has concerning features for <strong>gastroesophageal varices secondary to portal hypertension from cirrhosis,<\/strong> including history of alcohol use disorder, <strong>hematemesis<\/strong>, <strong>increased abdominal girth,<\/strong> and jaundice of the skin.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patients with gastroesophageal varices caused by <strong>cirrhotic portal hypertension<\/strong> typically report symptoms like <strong>jaundice, fatigue, and abdominal swelling<\/strong>; as well as symptoms of <strong>altered mental status,<\/strong> such as confusion or disorientation. They might also have a history of cirrhosis, alcohol use disorder, or viral hepatitis. Increased abdominal girth is usually due to accumulation of fluid in the peritoneal cavity, known as <strong>ascites<\/strong>. <strong>Flank dullness to percussion<\/strong> is highly suggestive of ascites, which would suggest underlying cirrhosis and should be worked up with coagulation studies, liver function tests, and abdominal imaging. Other physical examination findings in cirrhosis include <strong>caput medusae, palmar erythema, asterixis, hepatomegaly, and splenomegaly<\/strong>.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Patients with <strong>gastroesophageal varices secondary to portal hypertension from cirrhosis <\/strong>can present with <strong>hematemesis<\/strong>, jaundice, and increased <strong>abdominal girth<\/strong>. Physical examination findings in patients with cirrhosis may include <strong>flank dullness to percussion (indicating ascites)<\/strong>, caput medusae, palmar erythema, asterixis, hepatomegaly, and splenomegaly.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch the Osmosis video:<\/strong> <a href=\"https:\/\/www.osmosis.org\/learn\/Gastroesophageal_varices:_Clinical_sciences\">Gastroesophageal varices: Clinical sciences<\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Chavez\u2010Tapia, N. C., Barrientos\u2010Gutierrez, T., Tellez\u2010Avila, F., Soares\u2010Weiser, K., Mendez\u2010Sanchez, N., Gluud, C., &amp; Uribe, M. (2011). Meta\u2010analysis: antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding\u2013an updated Cochrane review. Alimentary pharmacology &amp; therapeutics, 34(5), 509-518.<\/li>\n\n\n\n<li>Simonetto, D. A., Liu, M., &amp; Kamath, P. S. (2019, April). Portal hypertension and related complications: diagnosis and management. In Mayo Clinic Proceedings (Vol. 94, No. 4, pp. 714-726). Elsevier.<\/li>\n\n\n\n<li>Lesmana, C. R. A., Raharjo, M., &amp; Gani, R. A. (2020). Managing liver cirrhotic complications: Overview of esophageal and gastric varices. Clinical and molecular hepatology, 26(4), 444.<\/li>\n\n\n\n<li>Cattau, E. L., Benjamin, S. B., Knuff, T. E., &amp; Castell, D. O. (1982). The accuracy of the physical examination in the diagnosis of suspected ascites. Jama, 247(8), 1164-1166.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><a href=\"https:\/\/www.osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png\" alt=\"\" class=\"wp-image-5904\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 2 CK practice questions? Try Osmosis from Elsevier today! Access your&nbsp;<em><a href=\"http:\/\/osmosis.org\/create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/em>&nbsp;and discover why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Evaluate a patient presenting with jaundice and altered mental status using targeted physical exam findings to guide further diagnostic steps.<\/p>\n","protected":false},"author":204,"featured_media":8091,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,1366,1370,45],"tags":[1593,1597,1596,343,1598,1595,785,592,1594,952],"class_list":["post-7913","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-2-questions","category-step-2","tag-alcohol-use-disorder","tag-ascites","tag-cirrhosis","tag-clinical-assessment","tag-gastrointestinal-bleeding","tag-jaundice","tag-liver-disease","tag-physical-exam","tag-portal-hypertension","tag-usmle-step-2-ck"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - 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