{"id":1039,"date":"2021-09-08T17:02:00","date_gmt":"2021-09-08T17:02:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=1039"},"modified":"2025-10-01T11:42:37","modified_gmt":"2025-10-01T19:42:37","slug":"usmle-step-1-question-of-the-day-scleroderma","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-scleroderma","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Scleroderma"},"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-scleroderma\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-scleroderma\/#A_Pathological_collagen_deposition\" >A. Pathological collagen deposition<\/a><\/li><\/ul><\/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-scleroderma\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-scleroderma\/#B_Herniation_of_gastroesophageal_junction\" >B. Herniation of gastroesophageal junction<\/a><\/li><li class='ez-toc-page-1 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-scleroderma\/#C_Cholesterol_deposition_in_peripheral_blood_vessels\" >C.&nbsp;Cholesterol&nbsp;deposition in peripheral blood vessels<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-scleroderma\/#D_Pathological_keratin_deposition\" >D. Pathological keratin deposition<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-scleroderma\/#E_Gram-negative_bacterial_infection\" >E. Gram-negative bacterial infection<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-scleroderma\/#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-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-scleroderma\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-scleroderma\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics. Today&#8217;s case involves a 56-year-old woman with asthma and notable skin tightening over the face, hands, and forearms.&nbsp;<\/em><\/strong><strong><em>Can you figure it out?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 56-year-old woman comes to her primary care physician for evaluation of acid reflux that began four months ago. The patient has tried ranitidine and pantoprazole; however, her symptoms have remained poorly controlled. Past medical history is notable for&nbsp;asthma, for which she is currently using an albuterol inhaler. Her temperature is 37.5\u00b0C (99.5\u00b0F) and her blood pressure is 118\/67 mmHg. Physical examination is notable for skin tightening over the face, hands, and forearms. Several ulcers are observed at the fingertips. Which of the following is the most likely explanation of the patient\u2019s presentation?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Pathological collagen deposition<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Herniation of gastroesophageal junction<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Cholesterol deposition in peripheral blood vessels<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Pathological keratin deposition<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Gram-negative bacterial infection<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><br><\/strong>Scroll down to find the answer!<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-rich is-provider-embed-handler wp-block-embed-embed-handler wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Everybody loves Osmosis.org\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/kizbJZ9cdLg?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<p class=\"has-text-align-center wp-block-paragraph\"><strong><em><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><u><em><strong>\u2192 Reinforce your understanding with more self-assessment items on Osmosis.<\/strong>\u00a0<\/em><\/u><\/a><\/em><\/strong><\/p>\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&#8217;s USMLE\u00ae Step 1 Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Pathological_collagen_deposition\"><\/span>A. Pathological collagen deposition<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the&nbsp;<strong>Main Explanation<\/strong>, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/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\">The incorrect answers to today&#8217;s USMLE\u00ae Step 1 Question are&#8230;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Herniation_of_gastroesophageal_junction\"><\/span>B. Herniation of gastroesophageal junction<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>This describes a hiatal hernia, which is a common cause of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Gastroesophageal_reflux_disease_(GERD)\" target=\"_blank\" rel=\"noreferrer noopener\">gastroesophageal reflux disease (GERD)<\/a>&nbsp;that is refractory to medical treatment. Although a hiatal hernia may explain the patient\u2019s&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Gastroesophageal_reflux_disease_(GERD)\" target=\"_blank\" rel=\"noreferrer noopener\">GERD<\/a>, it would not explain the skin tightening or fingertip ulcerations.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Cholesterol_deposition_in_peripheral_blood_vessels\"><\/span>C.&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Cholesterol_metabolism\" target=\"_blank\" rel=\"noreferrer noopener\">Cholesterol<\/a>&nbsp;deposition in peripheral blood vessels<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Severe&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Arterial_disease\" target=\"_blank\" rel=\"noreferrer noopener\">atherosclerosis<\/a>&nbsp;can reduce blood flow to the extremities and cause tissue necrosis. This may present with ulcers. However, ulcers secondary to atherosclerosis\/<a href=\"https:\/\/www.osmosis.org\/learn\/Peripheral_artery_disease\" target=\"_blank\" rel=\"noreferrer noopener\">peripheral artery disease<\/a>&nbsp;are most often found in the lower extremities. Moreover, atherosclerosis would not explain skin tightening or treatment-resistant acid reflux.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Pathological_keratin_deposition\"><\/span>D. Pathological keratin deposition<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;This describes hyperkeratosis, which may be seen in vitamin A deficiency or&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Dermatomyositis\" target=\"_blank\" rel=\"noreferrer noopener\">dermatomyositis<\/a>. The condition causes skin thickening and discomfort. However, it would be atypical for hyperkeratosis to present with fingertip ulcers or severe acid reflux.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Gram-negative_bacterial_infection\"><\/span>E. Gram-negative bacterial infection<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Infection by gram-negative bacteria, such as&nbsp;<em><a href=\"https:\/\/www.osmosis.org\/learn\/Helicobacter_pylori\" target=\"_blank\" rel=\"noreferrer noopener\">Helicobacter pylori<\/a><\/em>&nbsp;(<em>H. pylori<\/em>), can cause gastric acid overproduction. This can result in&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Peptic_ulcer\" target=\"_blank\" rel=\"noreferrer noopener\">peptic ulcer<\/a>&nbsp;formation and potentially contribute to the development of acid reflux. However, infection by&nbsp;<em>H.pylori<\/em>&nbsp;or other gram-negative pathogens would not account for the patient&#8217;s skin changes.<\/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 has&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Scleroderma\" target=\"_blank\" rel=\"noreferrer noopener\">scleroderma<\/a><\/strong>&nbsp;(also termed&nbsp;<strong>systemic sclerosis<\/strong>), an autoimmune disorder characterized by the&nbsp;<strong>replacement of normal tissue by collagen<\/strong>. Scleroderma most often affects&nbsp;<strong>women over 50 years old<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The condition can be divided into two subtypes:&nbsp;<strong>diffuse cutaneous<\/strong>&nbsp;and&nbsp;<strong>limited cutaneous systemic&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Scleroderma\" target=\"_blank\" rel=\"noreferrer noopener\">scleroderma<\/a><\/strong>. Both cause thickening and tightening of the skin. In addition, both types can cause&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Gastroesophageal_reflux_disease_(GERD)\" target=\"_blank\" rel=\"noreferrer noopener\">gastroesophageal reflux disease (GERD)<\/a>&nbsp;secondary to replacement of the esophageal sphincter muscles by collagen.<\/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=\"Scleroderma - causes, symptoms, diagnosis, treatment, pathology\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/J2SgVdhxObI?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<p class=\"wp-block-paragraph\">However, diffuse scleroderma is characterized by&nbsp;<strong>severe visceral organ involvement<\/strong>&nbsp;(e.g., renal injury, malabsorption,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Restrictive_cardiomyopathy\" target=\"_blank\" rel=\"noreferrer noopener\">restrictive cardiomyopathy<\/a>) and&nbsp;<strong>diffuse skin involvement<\/strong>. In contrast, limited scleroderma is characterized by&nbsp;<strong>mild visceral organ involvement<\/strong>&nbsp;and affects only&nbsp;the <strong>skin of the face and distal extremities<\/strong>. Of note, the patient in this vignette most likely has limited scleroderma, as she presents with skin findings localized to the face and distal upper extremities.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The pathology of this condition is not completely understood. However, it&#8217;s believed that some individuals have a&nbsp;<strong>genetic predisposition<\/strong>&nbsp;to scleroderma, which is triggered by&nbsp;<strong>external factors<\/strong>. These triggers include viral infection by&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Cytomegalovirus\" target=\"_blank\" rel=\"noreferrer noopener\">cytomegalovirus<\/a>&nbsp;and&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Parvovirus_B19\" target=\"_blank\" rel=\"noreferrer noopener\">parvovirus B19<\/a>; exposure to silica dust, organic solvents, vinyl chloride; and medication like cocaine,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Anti-tumor_antibiotics\" target=\"_blank\" rel=\"noreferrer noopener\">bleomycin<\/a>, and pentazocine.<\/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=\"Scleroderma - causes, symptoms, diagnosis, treatment, pathology\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/J2SgVdhxObI?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=\"Major_Takeaway\"><\/span><strong>Major Takeaway<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Scleroderma is characterized by&nbsp;<strong>excess collagen deposition<\/strong>. The condition can be divided into two types:&nbsp;<strong>diffuse&nbsp;<\/strong><strong><a href=\"https:\/\/www.osmosis.org\/learn\/Scleroderma\" target=\"_blank\" rel=\"noreferrer noopener\">scleroderma<\/a><\/strong><strong>&nbsp;<\/strong>and&nbsp;<strong>limited scleroderma<\/strong>. Diffuse scleroderma affects skin throughout the body and has severe visceral organ involvement. Limited sclerosis affects only skin of the face and distal extremities and has mild visceral organ involvement.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" height=\"662\" width=\"1024\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/two-types-of-scleroderma.jpg?w=1024\" alt=\"Diffuse Scleroderma - larger area of skin, progresses quicker, involves internal organs earlier, more severe symptoms. Limited scleroderma - smaller area of skin, progresses slower, involves internal organs later, formerly crest syndrome.\" class=\"wp-image-1041\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/two-types-of-scleroderma.jpg 1386w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/two-types-of-scleroderma.jpg?resize=300,194 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/two-types-of-scleroderma.jpg?resize=768,496 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/two-types-of-scleroderma.jpg?resize=1024,662 1024w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span><strong>References<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Adigun, R., Goyal, A., Bansal, P., Hariz, A. (2020)&nbsp;<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK430875\/\" target=\"_blank\" rel=\"noreferrer noopener\">Systemic sclerosis (CREST syndrome)<\/a>.&nbsp;<em>StatPearls [Internet]<\/em>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Badri, T., Hariz, A. (2020)&nbsp;<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK537335\/\" target=\"_blank\" rel=\"noreferrer noopener\">\u201cScleroderma (Systemic Sclerosis)\u201d<\/a>.&nbsp;<em>StatPearls [Internet]<\/em>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>_________________________<\/strong><br><br><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis today! Access your&nbsp;<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>&nbsp;and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-02T200211.279.png?w=700\" alt=\"\" class=\"wp-image-711\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-02T200211.279.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-02T200211.279.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><sub>The United States Medical Licensing Examination (USMLE\u00ae) is a joint program of the Federation of State Medical Boards (FSMB\u00ae) and National Board of Medical Examiners (NBME\u00ae). Osmosis is not affiliated with NBME nor FSMB.&nbsp;<\/sub><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics. Today&#8217;s case involves a 56-year-old woman with asthma and notable skin tightening over the face, hands, and forearms.&nbsp;Can you figure it out? A 56-year-old woman comes to her primary care physician for evaluation of acid reflux that began [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":1040,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[27,20,1369,44],"tags":[],"class_list":["post-1039","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-step-1-questions","category-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day: Scleroderma - 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-1-question-of-the-day-scleroderma\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day: Scleroderma - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics. Today&#8217;s case involves a 56-year-old woman with asthma and notable skin tightening over the face, hands, and forearms.&nbsp;Can you figure it out? A 56-year-old woman comes to her primary care physician for evaluation of acid reflux that began [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-scleroderma\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2021-09-08T17:02:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-10-01T19:42:37+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-scleroderma.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1081\" \/>\n\t<meta property=\"og:image:height\" content=\"1081\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Marina Horiates Kerekes, MD &amp; Team\" \/>\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-1-question-of-the-day-scleroderma#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-scleroderma\"},\"author\":{\"name\":\"Marina Horiates Kerekes, MD &amp; 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She is accompanied by her husband. Past medical history is notable for asthma and diffuse scleroderma. On arrival, her temperature is 37.6\u00b0C (99.7\u00b0F) and blood pressure is 183\/121 mmHg. 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