American Board of Internal Medicine (ABIM) Certification Practice Exam

Which characteristic rash location is associated with Rocky Mountain spotted fever?

1. Palms and soles

2. Back and abdomen

3. Arms and thighs

4. Face and neck

The correct answer is: Palms and soles

The characteristic rash location associated with Rocky Mountain spotted fever (RMSF) is typically found on the palms and soles. This is notable because RMSF is a tick-borne illness caused by the bacteria Rickettsia rickettsii, and its presentation often includes a petechial or maculopapular rash that can begin on extremities, including palms and soles, before spreading to other areas of the body. The distinctive aspect of RMSF is that while many other febrile illnesses have rashes that appear first on the torso or face, the involvement of palms and soles is more specific to RMSF. This can help in differentiating it from other conditions that might present with similar symptoms or rash but do not exhibit this unique pattern. Understanding the typical presentation of the rash aids healthcare providers in early diagnosis and treatment, which is crucial in managing this potentially life-threatening condition.