In Rocky Mountain Spotted Fever, where does the rash commonly begin?

• A. Hands, feet, wrists, and ankles
• B. Face and neck
• C. Palms and soles only
• D. Trunk first

Answer: (A)

In Rocky Mountain spotted fever the rash characteristically begins on the distal extremities, especially the wrists and ankles, and then spreads toward the trunk (often involving the palms and soles as it disseminates). This distal-to-central progression is a hallmark of RMSF, so a rash starting on the hands, feet, wrists, and ankles fits the classic pattern. Rashes that start on the face/neck or begin on the trunk first are less typical for RMSF, and a pattern limited to the palms/soles or starting only on the trunk would not match the usual evolution.