{"id":8407,"date":"2025-11-17T00:01:00","date_gmt":"2025-11-17T08:01:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=8407"},"modified":"2025-10-10T08:54:44","modified_gmt":"2025-10-10T16:54:44","slug":"usmle-step-2-ck-question-of-the-day-painful-rash","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-painful-rash","title":{"rendered":"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Painful rash"},"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-painful-rash\/#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-painful-rash\/#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-painful-rash\/#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-painful-rash\/#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-painful-rash\/#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-painful-rash\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>A 66-year-old man presents with a painful rash that&#8217;s lasted three days. He&#8217;s otherwise healthy with stable vital signs. An exam reveals a characteristic rash. Which medication should be given?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A <strong>66-year-old man<\/strong> presents to his primary care physician for evaluation of a <strong>painful rash<\/strong> for the past three days. He is otherwise <strong>healthy<\/strong> and does not take any medications daily.\u00a0<strong>Temperature\u00a0is 36\u00b0C (96.8\u00b0F), blood pressure is 137\/70 mmHg, pulse is 89\/min, respiratory rate is 16\/min, <\/strong>and <strong>oxygen saturation is 99%<\/strong> on room air. On physical examination, the patient appears <strong>uncomfortable<\/strong>. The patient\u2019s rash is shown in the image below.\u00a0<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"403\" height=\"537\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/image.png\" alt=\"\" class=\"wp-image-8411\" style=\"width:235px;height:auto\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/image.png 403w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/image.png?resize=225,300 225w\" sizes=\"auto, (max-width: 403px) 100vw, 403px\" \/><figcaption class=\"wp-element-caption\">Source: Wikipedia<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the <strong>following medications<\/strong> should be administered at this time?\u00a0<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A.<\/strong> <strong>Valganciclovir<\/strong> <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B.<\/strong> <strong>Valacyclovir<\/strong> <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Gabapentin<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Ritonavir<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Subosivir<\/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>B. Valacyclovir<\/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>A. Valganciclovir<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Valganciclovir is indicated in the management of cytomegalovirus. This patient&#8217;s presentation is consistent with herpes zoster.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Gabapentin<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Gabapentin is indicated for post-herpetic neuralgia secondary to herpes zoster; however, it is not does not treat the zoster infection.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Ritonavir<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Ritonavir is an antiviral medication used to treat HIV, not herpes zoster.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Subosivir<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Subosivir is a medication used to treat hepatitis C, not herpes zoster.<\/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<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"975\" height=\"413\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/image_e0348c.png\" alt=\"MACULOPAPULAR  or VESICULAR RASH -&gt;1-2 Adjacent dermatomes -&gt; Typically trunk or face -&gt; Herpes Zoster Infection\" class=\"wp-image-8412\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/image_e0348c.png 975w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/image_e0348c.png?resize=300,127 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/image_e0348c.png?resize=768,325 768w\" sizes=\"auto, (max-width: 975px) 100vw, 975px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">This patient&#8217;s presentation is consistent with\u00a0<strong>herpes zoster infection (shingles).<\/strong>\u00a0The most\u00a0appropriate initial\u00a0step in management<strong>\u00a0<\/strong>for patients presenting within<strong>\u00a03 days of symptom onset\u00a0<\/strong>involves administration of an antiviral medication, such as\u00a0<strong>valacyclovir.\u00a0<\/strong>\u00a0<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Herpes zoster infection, also known as shingles, occurs in individuals who have had a primary infection with the varicella-zoster virus. Following the primary infection (\u201cchickenpox\u201d), the virus&nbsp;remains&nbsp;dormant in the dorsal root ganglia of spinal nerves or the trigeminal ganglion. In times of stress or immunosuppression, the virus can reactivate and travel down the sensory neurons, causing herpes zoster.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patients with herpes zoster classically present with a&nbsp;<strong>unilateral rash that does not cross the midline&nbsp;<\/strong>that is present in<strong>&nbsp;1 or 2 adjacent dermatomes.<\/strong>&nbsp;The rash initially begins as a&nbsp;maculopapular rash that progresses to vesicles and may coalesce to bullae. The rash typically lasts between 10-15 days. Patients often describe a prodrome of malaise, headache, and&nbsp;low grade&nbsp;fever prior to the appearance of the rash.&nbsp;If individuals&nbsp;present&nbsp;within three days of rash onset, antiviral therapy with medications such as&nbsp;<strong>acyclovir, famciclovir,&nbsp;<\/strong>or<strong>&nbsp;valacyclovir<\/strong>&nbsp;can be administered. Certain patient populations are at risk for&nbsp;<strong>disseminated&nbsp;herpes zoster<\/strong>, which can present with associated hepatitis, encephalitis, or meningitis. This can occur in patients with compromised immune systems, such as those with hematopoietic stem cell transplants, uncontrolled HIV, or malignancies.<\/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>herpes zoster<\/strong> classically present with a <strong>unilateral, dermatomal rash<\/strong> that does not cross the <strong>midline<\/strong>. The <strong>acute management<\/strong> of patients who present <strong>within three days of symptom onset<\/strong> involves administration of an <strong>antiviral agent<\/strong>, such as <strong>acyclovir, famciclovir, <\/strong>or <strong>valacyclovir<\/strong>.\u00a0\u00a0<\/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> <strong><a href=\"https:\/\/www.osmosis.org\/learn\/Herpes_zoster_infection_(shingles):_Clinical_sciences\">Herpes zoster infection (shingles): Clinical sciences<\/a><\/strong><\/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>Cohen, J. Varicella-Zoster Virus (Chickenpox, Shingles) in Goldman-Cecil Medicine. 26th edition; 2192-2195.e2\u00a0<br><a href=\"https:\/\/www.clinicalkey.com\/#!\/content\/book\/3-s2.0-B9780323532662003519?scrollTo=%23hl0000094\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.clinicalkey.com\/#!\/content\/book\/3-s2.0-B9780323532662003519?scrollTo=%23hl0000094<\/a>\u00a0\u00a0<\/li>\n\n\n\n<li>Strikas, R, Orenstein, W. Varicella: Zoster in Immunization, in Goldman-Cecil Medicine, 26th edition; 59-74.e2.\u00a0<a href=\"https:\/\/www.clinicalkey.com\/#!\/content\/book\/3-s2.0-B9780323532662000151?scrollTo=%23hl0001685\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.clinicalkey.com\/#!\/content\/book\/3-s2.0-B9780323532662000151?scrollTo=%23hl0001685<\/a>\u00a0\u00a0<\/li>\n\n\n\n<li>Shaikh S, Ta CN. Evaluation and management of herpes zoster\u00a0ophthalmicus.\u00a0Am\u00a0Fam\u00a0Physician. 2002 Nov 1;66(9):1723-30. PMID: 12449270.\u00a0<a href=\"https:\/\/www.aafp.org\/pubs\/afp\/issues\/2002\/1101\/p1723.html\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.aafp.org\/pubs\/afp\/issues\/2002\/1101\/p1723.html<\/a>\u00a0\u00a0<\/li>\n\n\n\n<li>Saguil A, Kane S, Mercado M, Lauters R. Herpes Zoster and Postherpetic Neuralgia: Prevention and Management.\u00a0Am\u00a0Fam\u00a0Physician. 2017 Nov 15;96(10):656-663. PMID: 29431387.\u00a0<a href=\"https:\/\/www.aafp.org\/pubs\/afp\/issues\/2017\/1115\/p656.html\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.aafp.org\/pubs\/afp\/issues\/2017\/1115\/p656.html<\/a>\u00a0<\/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>A 66-year-old man presents with a painful, rash lasting three days. What is the best initial medication to manage his condition effectively?<\/p>\n","protected":false},"author":204,"featured_media":8409,"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":[1767,1773,1770,1766,1765,1771,1768,1772,952,1769],"class_list":["post-8407","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-antiviral-treatment","tag-clinical-medicine","tag-dermatomal-rash","tag-herpes-zoster","tag-painful-rash","tag-post-herpetic-neuralgia","tag-rash-management","tag-shingles","tag-usmle-step-2-ck","tag-viral-rash"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 2 CK Question of the Day:\u00a0Painful rash - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-painful-rash\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Painful rash - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"A 66-year-old man presents with a painful, rash lasting three days. What is the best initial medication to manage his condition effectively?\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-painful-rash\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2025-11-17T08:01:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-10-10T16:54:44+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Step-2-Question-of-the-Day-Painful-Rash.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1080\" \/>\n\t<meta property=\"og:image:height\" content=\"1080\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Rowan Bell, MD &amp; Marina Horiates Kerekes, MD\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":[\"Article\",\"BlogPosting\"],\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-painful-rash#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-painful-rash\"},\"author\":{\"name\":\"Rowan Bell, MD &amp; 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