{"id":10359,"date":"2026-07-06T00:15:17","date_gmt":"2026-07-06T08:15:17","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=10359"},"modified":"2026-06-30T12:30:11","modified_gmt":"2026-06-30T20:30:11","slug":"usmle-step-1-question-of-the-day-abdominal-discomfort","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-abdominal-discomfort","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day:\u00a0Abdominal discomfort"},"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-1-question-of-the-day-abdominal-discomfort\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 1 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-1-question-of-the-day-abdominal-discomfort\/#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-1-question-of-the-day-abdominal-discomfort\/#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-1-question-of-the-day-abdominal-discomfort\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/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-1-question-of-the-day-abdominal-discomfort\/#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-1-question-of-the-day-abdominal-discomfort\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em><strong>Today\u2019s USMLE\u00ae Step 1 question of the day features a 47-year-old patient with abdominal discomfort and short-term weight gain. Which conditions is the patient  at an increased risk of developing? Let\u2019s find out!<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 47-year-old woman comes to the office because of&nbsp;<strong>weight gain<\/strong>&nbsp;and&nbsp;<strong>abdominal discomfort<\/strong>. The patient reports mild, diffuse abdominal discomfort for the past week and a weight gain of 10&nbsp;lbs&nbsp;(4.5 kg) over the past month. She does not have nausea, vomiting, constipation, or diarrhea. The patient is a truck driver and has not seen a physician in years. She drinks a&nbsp;<strong>6-pack of beer<\/strong>&nbsp;per night. Temperature is 36.9\u00b0C (98.5\u00b0F), pulse is&nbsp;92\/min, respirations are&nbsp;14\/min, and blood pressure is&nbsp;108\/68&nbsp;mmHg. Physical examination shows&nbsp;<strong>jaundice<\/strong>,&nbsp;<strong>hepatosplenomegaly<\/strong>, a&nbsp;<strong>flapping hand tremor<\/strong>&nbsp;on wrist extension, and a&nbsp;<strong>positive fluid wave<\/strong>.&nbsp;The&nbsp;<strong>hepatic venous pressure gradient<\/strong>&nbsp;is 14 mmHg.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>The patient is at increased risk of developing which of the following secondary to her current condition?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Splenic vein thrombosis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Unilateral left-sided ankle swelling<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Rectal varices<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Varicocele<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Mallory-Weiss tear<\/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_1_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Rectal varices<\/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. Splenic vein thrombosis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect: <\/strong>While portal hypertension can cause blood to back up into the spleen leading to congestive splenomegaly (enlarged spleen), splenic vein thrombosis is most commonly associated with pancreatic inflammation.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Unilateral left-sided ankle swelling<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect: <\/strong>Unilateral lower-extremity swelling suggests localized venous obstruction (such as deep venous thrombosis), while portal hypertension more commonly causes bilateral lower-extremity edema.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Varicocele<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Varicoceles are caused by dilation of the pampiniform plexus, often due to impaired drainage of the left gonadal vein. They are associated with nutcracker syndrome or renal vein compression and are not part of the portal venous system.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Mallory-Weiss tear<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Mallory-Weiss tears are mucosal lacerations near the gastroesophageal junction caused by forceful retching or vomiting. In contrast, the upper gastrointestinal bleeding seen in association with portal hypertension is due to bleeding esophageal varices.<\/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<p class=\"wp-block-paragraph\">This patient\u2019s presentation with&nbsp;<strong>ascites<\/strong>,&nbsp;<strong>jaundice<\/strong>,&nbsp;<strong>asterixis<\/strong>,&nbsp;<strong>hepatosplenomegaly<\/strong>, and an&nbsp;<strong>elevated hepatic venous pressure gradient<\/strong>&nbsp;is consistent with&nbsp;<strong>portal hypertension<\/strong>&nbsp;due to&nbsp;<strong>cirrhosis<\/strong>,&nbsp;most likely secondary&nbsp;to&nbsp;<strong>chronic alcohol use disorder<\/strong>.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Portal hypertension<\/strong>&nbsp;is defined as elevated pressure within the portal venous system due to increased resistance to portal blood flow. Clinically significant portal hypertension typically occurs when the hepatic venous pressure gradient exceeds 10\u201312 mmHg.&nbsp;It is&nbsp;most commonly caused&nbsp;by&nbsp;<strong>liver cirrhosis<\/strong>&nbsp;but can also be caused by&nbsp;<strong>vascular obstruction<\/strong>&nbsp;(e.g., portal vein thrombosis, Budd-Chiari syndrome, and schistosomiasis).&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Portal hypertension leads to the formation of&nbsp;<strong>portosystemic shunts<\/strong>, which is when blood is diverted away from the portal venous system and backs up into systemic veins at the sites called&nbsp;<strong>portal-systemic anastomoses\/portocaval&nbsp;anastomosis<\/strong>. These include:&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Lower esophagus:&nbsp;leading&nbsp;to&nbsp;<strong>esophageal varices<\/strong>&nbsp;<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>In the rectum and anal&nbsp;canal:&nbsp;leading&nbsp;to&nbsp;anorectal&nbsp;varices&nbsp;(i.e.&nbsp;<strong>hemorrhoids)<\/strong>&nbsp;<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Veins of the anterior abdominal wall, which anastomose with the paraumbilical&nbsp;veins:&nbsp;leading&nbsp;to&nbsp;<strong>caput medusae<\/strong>&nbsp;<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"936\" height=\"633\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/image_d9d615.png\" alt=\"Table titled \u201cPortocaval Anastomoses\u201d showing connections between the portal and systemic venous circulations and their associated clinical manifestations. It lists esophageal varices (left gastric vein to esophageal veins), anorectal varices (superior rectal vein to middle and inferior rectal veins), and caput medusae (paraumbilical veins to superficial and inferior epigastric veins).\" class=\"wp-image-10362\" style=\"aspect-ratio:1.4786628362496737;width:503px;height:auto\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/image_d9d615.png 936w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/image_d9d615.png?resize=300,203 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/image_d9d615.png?resize=768,519 768w\" sizes=\"auto, (max-width: 936px) 100vw, 936px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Portal hypertension<\/strong>&nbsp;develops when there is increased resistance to portal blood flow, most commonly due to&nbsp;<strong>cirrhosis<\/strong>. It can lead to the&nbsp;formation of&nbsp;<strong>portosystemic shunts<\/strong>&nbsp;at sites called&nbsp;<strong>portal-systemic anastomoses<\/strong>, resulting in&nbsp;<strong>esophageal varices<\/strong>,<strong>&nbsp;anorectal varices (hemorrhoids)<\/strong>, and<strong>&nbsp;caput medusae<\/strong>.&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 this Osmosis video:<\/strong> <a href=\"https:\/\/www.osmosis.org\/learn\/Portal_hypertension\">Portal hypertension<\/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>Garc\u00eda-Pag\u00e1n, J. C., Gracia-Sancho, J., &amp; Bosch, J. (2012). <strong>Functional aspects on the pathophysiology of portal hypertension in cirrhosis.<\/strong> Journal of&nbsp;hepatology, 57(2), 458-461.&nbsp;<\/li>\n\n\n\n<li><strong>Portal hypertension.<\/strong> Jameson J, &amp; Fauci A.S., &amp; Kasper D.L., &amp; Hauser S.L., &amp; Longo D.L., &amp; Loscalzo J(Eds.), (2020). Harrison&#8217;s Manual of Medicine,&nbsp;20e. McGraw-Hill.&nbsp;<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><a href=\"http:\/\/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?w=700\" 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>Want more <strong>USMLE\u00ae Step 1<\/strong> <strong>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 <\/strong>and <strong>caregivers <\/strong>love <strong>learning by Osmosis<\/strong>.<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A patient with signs of advanced liver disease develops complications related to increased portal pressure. Can you identify the consequence most closely associated with this high-yield USMLE-style case?<\/p>\n","protected":false},"author":208,"featured_media":10363,"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":[27,20,16,1366,1369,44],"tags":[1593,1597,2967,1596,3108,2026,3201,3200,3177,785,84,462,1282,1594,664],"class_list":["post-10359","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-1-questions","category-step-1","tag-alcohol-use-disorder","tag-ascites","tag-board-exam-prep","tag-cirrhosis","tag-clinical-vignette","tag-esophageal-varices","tag-gastrointestinal-medicine","tag-hepatology","tag-internal-medicine","tag-liver-disease","tag-medical-education","tag-osmosis","tag-pathophysiology","tag-portal-hypertension","tag-usmle-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - 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