{"id":9062,"date":"2026-01-04T00:02:18","date_gmt":"2026-01-04T08:02:18","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=9062"},"modified":"2026-06-30T14:37:38","modified_gmt":"2026-06-30T22:37:38","slug":"usmle-step-2-ck-question-of-the-day-persistent-eczema","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-persistent-eczema","title":{"rendered":"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Persistent eczema"},"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-persistent-eczema\/#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-persistent-eczema\/#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-persistent-eczema\/#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-persistent-eczema\/#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-persistent-eczema\/#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-persistent-eczema\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em><strong>A child presents with recurrent infections. Which finding from a focused history or physical examination would be most helpful in supporting a diagnosis? Do you know the answer? Let&#8217;s find out!<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 5-year-old boy&nbsp;presents&nbsp;to&nbsp;clinic&nbsp;with a parent for evaluation of persistent eczema. Medical history is significant for frequent respiratory tract infections. Birth and family histories are non-contributory. Temperature is 37\u00b0C (98.6\u00b0F), pulse is 100\/min, respirations are 22\/min, blood pressure is 96\/58 mm&nbsp;Hg, and oxygen saturation is 98% on room air. Physical examination reveals eczematous lesions over the elbows and knees&nbsp;with associated&nbsp;excoriation. No dysmorphic features are noted. Cardiopulmonary and abdominal examinations are normal. Laboratory studies are shown below.&nbsp;&nbsp;&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Laboratory value<\/strong>&nbsp;<\/td><td><strong>Result<\/strong>&nbsp;<\/td><\/tr><tr><td><strong>Serum chemistries<\/strong>&nbsp;<\/td><td>&nbsp;<\/td><\/tr><tr><td>Hemoglobin&nbsp;<\/td><td>12 g\/dL&nbsp;<\/td><\/tr><tr><td>Hematocrit&nbsp;<\/td><td>40%&nbsp;<\/td><\/tr><tr><td>Leukocyte count&nbsp;<\/td><td>9,100\/mm3&nbsp;<\/td><\/tr><tr><td>Platelet count&nbsp;<\/td><td>80,000\/mm3&nbsp;<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Chediak-Higashi syndrome<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. DiGeorge syndrome<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Hyper-IgE syndrome<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Hyper-IgM syndrome<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Wiskott-Aldrich syndrome<\/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=\"Learn with Osmosis\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/iDxHtjjCMbU?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>E. Wiskott-Aldrich syndrome<\/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. Chediak-Higashi syndrome<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Chediak-Higashi syndrome may present with recurrent infections and bleeding due to platelet dysfunction, but it is typically associated with partial oculocutaneous albinism.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. DiGeorge syndrome<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Although this patient has recurrent infections, the absence of seizures and congenital heart defects, along with the presence of eczema and thrombocytopenia, makes DiGeorge syndrome less likely.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Hyper-IgE syndrome<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Ezema is a common feature of Hyper-IgE syndrome. However, the absence of coarse facial features and the presence of thrombocytopenia are more consistent with Wiskott-Aldrich syndrome.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Hyper-IgM syndrome<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Hyper-IgM syndrome is associated with recurrent opportunistic infections and may present with osteopenia, fractures, diarrhea, or inflammatory bowel disease. Eczema and thrombocytopenia are not characteristic findings.&nbsp;<\/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=\"524\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/01\/image.png\" alt=\"Illustrated medical diagram titled \u201cEczema without coarse facial features \u2192 Consider Wiskott\u2013Aldrich syndrome.\u201d The image lists key clinical clues. On the left, a biologically male child (XY symbol) is shown with recurrent sinopulmonary infections, especially due to *Streptococcus pneumoniae* and other encapsulated bacteria. Additional findings include prolonged bleeding and bloody diarrhea. On the right, the history section notes a possible association with Epstein\u2013Barr virus\u2013related malignancies. The overall graphic emphasizes recognizing Wiskott\u2013Aldrich syndrome based on eczema, infection pattern, bleeding symptoms, and patient demographics.\n\" class=\"wp-image-9073\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/01\/image.png 975w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/01\/image.png?resize=300,161 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/01\/image.png?resize=768,413 768w\" sizes=\"auto, (max-width: 975px) 100vw, 975px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">This child&nbsp;presents with&nbsp;<strong>eczema<\/strong>&nbsp;and recurrent respiratory tract infections. The&nbsp;initial&nbsp;evaluation reveals<strong>&nbsp;normal facies,<\/strong>&nbsp;eczematous skin, and&nbsp;<strong>thrombocytopenia<\/strong>, findings consistent with&nbsp;<strong>Wiskott-Aldrich syndrome (WAS).<\/strong>&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Primary immunodeficiencies<\/strong>&nbsp;often present with recurrent, severe, or opportunistic<strong>&nbsp;infections.<\/strong>&nbsp;Additional&nbsp;clues may include an abnormal newborn screen, a personal history of autoimmune disease, or a family history of immunodeficiency. Poor growth and suboptimal weight gain may also be seen on the growth chart. When evaluating such patients, the next step is to look for&nbsp;<strong>characteristic clinical features<\/strong>&nbsp;that suggest a specific syndrome.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Eczema<\/strong>&nbsp;is seen in both Hyper-IgE syndrome and&nbsp;Wiskott-Aldrich syndrome (WAS). To help distinguish between them,&nbsp;assess for<strong>&nbsp;coarse facial features.<\/strong>&nbsp;If present, consider&nbsp;<strong>Hyper-IgE syndrome,<\/strong>&nbsp;which may also present with skin abscesses lacking overt inflammation. In contrast, eczema<strong>&nbsp;without coarse facies<\/strong>&nbsp;should raise concern for&nbsp;<strong>WAS.<\/strong>&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">WAS is an X-linked immunodeficiency characterized by&nbsp;<strong>recurrent sinopulmonary infections&nbsp;<\/strong>(particularly with&nbsp;<em>Streptococcus pneumoniae<\/em>),&nbsp;<strong>eczema, prolonged bleeding, bloody diarrhea,&nbsp;<\/strong>and&nbsp;<strong>abnormal lymphocyte function.<\/strong>&nbsp;Due to its&nbsp;<strong>X-linked recessive<\/strong>&nbsp;inheritance, most affected patients are&nbsp;<strong>biologically male.<\/strong>&nbsp;Clinical findings typically include<strong>&nbsp;eczema and purpura,<\/strong>&nbsp;and laboratory evaluation reveals&nbsp;<strong>thrombocytopenia,<\/strong>&nbsp;decreased IgM, elevated IgA and IgE, and sometimes decreased IgG. Diagnosis is confirmed with genetic analysis of the&nbsp;<em>WASP<\/em>&nbsp;gene.&nbsp;&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\">Wiskott-Aldrich syndrome (WAS) is an X-linked recessive immunodeficiency typically affecting biologically male patients. It is characterized by recurrent sinopulmonary infections, eczema, prolonged bleeding due to thrombocytopenia, and abnormal lymphocyte function. Unlike Hyper-IgE syndrome, patients with WAS do not have coarse facial features.&nbsp;<\/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: <a href=\"https:\/\/www.osmosis.org\/learn\/Approach_to_primary_immunodeficiencies:_Clinical_sciences\">Approach to primary immunodeficiencies: 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>Kliegman, RM, St&nbsp;Geme, JW, Blum, NJ, et al, eds.&nbsp;<em>Nelson Textbook of Pediatrics.<\/em>&nbsp;21st ed. Elsevier; 2020.&nbsp;&nbsp;<\/li>\n\n\n\n<li>Dosanjh A. Autoimmunity and Immunodeficiency.&nbsp;<em>Pediatr&nbsp;Rev<\/em>. 2015;36(11):489-495. doi:10.1542\/pir.36-11-489&nbsp;<\/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\/10\/Blog_Display_Ads_MD3_2023.png\" alt=\"\" class=\"wp-image-5300\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/10\/Blog_Display_Ads_MD3_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/10\/Blog_Display_Ads_MD3_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>Want more <strong>USMLE\u00ae Step 2 CK practice questions<\/strong>? Try <strong>Osmosis from Elsevier<\/strong> today! Access your&nbsp;<em><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>free trial<\/strong><\/a><\/em>&nbsp;and discover why millions of current and future <strong>clinicians and caregivers<\/strong> love learning by Osmosis.<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A child presents with eczema, frequent infections, and lab abnormalities. Recognizing key clinical signs is essential for diagnosing primary immunodeficiency syndromes.<\/p>\n","protected":false},"author":204,"featured_media":9072,"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":[2492,649,2320,2487,2485,2491,2490,717,2484,2488,2483,845,2486,1307,2489],"class_list":["post-9062","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-childhood-infections","tag-clinical-diagnosis","tag-genetic-testing","tag-immune-disorders","tag-immunodeficiency-syndromes","tag-immunoglobulin-levels","tag-immunology","tag-pediatric-care","tag-pediatric-eczema","tag-pediatric-hematology","tag-primary-immunodeficiency","tag-rare-diseases","tag-recurrent-infections","tag-thrombocytopenia","tag-x-linked-disorders"],"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:\u00a0Persistent eczema - 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-persistent-eczema\" \/>\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:\u00a0Persistent eczema - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"A child presents with eczema, frequent infections, and lab abnormalities. Recognizing key clinical signs is essential for diagnosing primary immunodeficiency syndromes.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-persistent-eczema\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2026-01-04T08:02:18+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-06-30T22:37:38+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/01\/USMLE-Step-2-CK-Question-of-the-Day-Persistent-eczema.png\" \/>\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\/png\" \/>\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-persistent-eczema#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-persistent-eczema\"},\"author\":{\"name\":\"Rowan Bell, MD &amp; 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