{"id":9930,"date":"2026-05-04T00:02:56","date_gmt":"2026-05-04T08:02:56","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=9930"},"modified":"2026-05-13T09:03:55","modified_gmt":"2026-05-13T17:03:55","slug":"usmle-step-2-ck-question-of-the-day-cutaneous-findings","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-cutaneous-findings","title":{"rendered":"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Cutaneous findings"},"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-cutaneous-findings\/#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-cutaneous-findings\/#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-cutaneous-findings\/#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-cutaneous-findings\/#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-cutaneous-findings\/#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-cutaneous-findings\/#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 77-year-old woman arrives at the ED for an evaluation of pain and increased irritability over a period of three days. What&#8217;s the most likely diagnosis? Do you know the answer? Let&#8217;s find out!<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A 77-year-old woman<\/strong> was brought to the emergency department from a nursing home for evaluation of <strong>pain and increased irritability for three days.<\/strong> Medical history is notable for <strong>type II diabetes mellitus, Alzheimer dementia, and a left middle cerebral artery stroke that occurred nine-years ago.<\/strong> The patient has <strong>limited mobility and is largely bedbound.<\/strong> Temperature is 37.0\u00b0C (98.6\u00b0F), blood pressure is 129\/73 mmHg, and pulse is 83\/min. Physical examination reveals the findings seen below in the <strong>sacral region.<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"275\" height=\"353\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/05\/image_56d336.png\" alt=\"Close-up of a shallow open skin wound with a red, moist base and surrounding redness, consistent with a partial-thickness ulcer or abrasion.\" class=\"wp-image-9933\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/05\/image_56d336.png 275w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/05\/image_56d336.png?resize=234,300 234w\" sizes=\"auto, (max-width: 275px) 100vw, 275px\" \/><figcaption class=\"wp-element-caption\">Image reproduced from Wikimedia Commons<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following is the <em>most appropriate management<\/em> for this patient\u2019s cutaneous findings?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Surgical debridement<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Skin biopsy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Intravenous antibiotics<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Negative pressure dressing<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Cushioned dressings<\/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>E. Cushioned dressings<\/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. Surgical debridement<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Surgical debridement may be indicated for the management of stage III and IV pressure ulcers or to help stage wounds that cannot be visualized due to the presence of eschar. Stage III and Stage IV pressure ulcers are characterized by full-thickness skin loss and exposure of the underlying tissue (e.g., adipose, muscle, bone). This patient\u2019s pressure ulcer is a shallow lesion with partial thickness loss extending to the dermis. It is most consistent with a stage II pressure ulcer, which does not require surgical intervention.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Skin biopsy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Biopsy is not typically indicated in the management of pressure ulcers.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Intravenous antibiotics<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Local antibiotic ointments may be indicated if there is concern for concurrent cellulitis in patients with pressure ulcers. Systemic antibiotics would not be necessary in this case given the lack of severe localized infection (e.g. osteomyelitis) or systemic infection (e.g. sepsis)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Negative pressure dressing<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Negative pressure dressings help reduce bacterial growth and improve granulation tissue formation. They are used in the management of stage III and IV pressure ulcers. In contrast, this patient has a stage II pressure ulcer. Negative pressure dressings are not used in the management of stage II pressure ulcers.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"975\" height=\"832\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/05\/stages-of-pressure-ulcers.jpg\" alt=\"Educational illustration showing the four stages of pressure ulcers. Stage 1 shows intact skin with redness; stage 2 shows partial-thickness skin loss affecting the epidermis and dermis; stage 3 shows deeper tissue loss extending into subcutaneous fat; and stage 4 shows extensive damage reaching muscle and bone. Labels indicate skin layers including epidermis, dermis, subcutaneous fat, soft tissue, and bone.\" class=\"wp-image-9936\" style=\"aspect-ratio:1.1718756468104483;width:591px;height:auto\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/05\/stages-of-pressure-ulcers.jpg 975w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/05\/stages-of-pressure-ulcers.jpg?resize=300,256 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/05\/stages-of-pressure-ulcers.jpg?resize=768,655 768w\" sizes=\"auto, (max-width: 975px) 100vw, 975px\" \/><\/figure>\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\">This patient presents with a lesion demonstrating <strong>partial loss of the dermis without exposure to subcutaneous fat, muscle, or bone.<\/strong> These findings are consistent with a <strong>stage II pressure ulcer<\/strong>, which can be managed conservatively with <strong>cushioned dressings.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Pressure ulcer management depends on its staging.<\/strong> <strong>Stage I (intact skin with non-blanchable erythema and no signs of necrosis)<\/strong> and <strong>stage II wounds (shallow, open ulcer with partial thickness loss of dermis)<\/strong> require local management. Treatment involves <strong>keeping the wound moist with medicated gauze<\/strong> and <strong>decreasing pressure and friction with cushioned dressings.<\/strong> If the patient is bed or wheelchair-bound, pressure on affected areas can be reduced by <strong>frequent repositioning on specialized support surfaces such as foam wedges, cushioned seating, or water beds.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Stage III (full-thickness loss of skin and exposure to subcutaneous fat)<\/strong> and <strong>stage IV (exposure of underlying muscle, tendon, or bone)<\/strong> require more invasive therapies. Deeper wounds tend to have more <strong>fibrinous exudate and necrotic tissue<\/strong>, which requires <strong>chemical or surgical debridement to prevent infection.<\/strong> Once the wound bed is clean, a <strong>negative pressure wound dressing<\/strong> can be applied to <strong>reduce bacterial growth and promote granulation tissue formation.<\/strong> <strong>Stage IV wounds heal poorly on their own and may require an autologous tissue graft.<\/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\"><strong>Stage I and II pressure ulcers<\/strong> are managed by <strong>applying medicated dressings, cushioned dressings, and frequent repositioning.<\/strong> <strong>Stage III and IV pressure ulcers<\/strong> often <strong>require debridement, negative pressure wound dressings, and potential autologous tissue grafting.<\/strong><\/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\/Pressure-induced_skin_and_soft_tissue_injury:_Clinical_sciences\"><strong>Pressure-induced skin and soft tissue injury: Clinical sciences<\/strong><\/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>Bluestein,D., Javaheri, A. (2008) <strong>Pressure ulcers: Prevention, evaluation, and management. <\/strong>American Family Physician. 78(10), 1186-1194. PMID: 19035067.<\/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\/plans\" 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","protected":false},"excerpt":{"rendered":"<p>Review this clinical case of a cutaneous wound in an elderly patient with limited mobility, highlighting how pressure ulcer staging guides management decisions and care plans. What&#8217;s next in patient management?<\/p>\n","protected":false},"author":208,"featured_media":9934,"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":[27,10,20,16,1366,1370,45],"tags":[2979,2980,2976,2975,413,354,2977,286,2981,462,2973,2982,671,2978,2974],"class_list":["post-9930","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-clinical-skills","category-exam-prep","category-do","category-questions","category-step-2-questions","category-step-2","tag-bedbound","tag-cushioned-dressings","tag-debridement","tag-dementia","tag-documentation","tag-elderly-care","tag-negative-pressure-therapy","tag-nursing","tag-nursing-home","tag-osmosis","tag-pressure-ulcer","tag-stage-ii","tag-usmle-step-2","tag-wound-care","tag-wound-management"],"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:\u00a0Cutaneous findings - 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-cutaneous-findings\" \/>\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:\u00a0Cutaneous findings - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Review this clinical case of a cutaneous wound in an elderly patient with limited mobility, highlighting how pressure ulcer staging guides management decisions and care plans. 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