{"id":1326,"date":"2022-08-03T17:50:00","date_gmt":"2022-08-03T17:50:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=1326"},"modified":"2025-10-01T11:40:30","modified_gmt":"2025-10-01T19:40:30","slug":"usmle-step-1-question-of-the-day-increased-urination-and-thirst","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-increased-urination-and-thirst","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Increased Urination and Thirst"},"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-increased-urination-and-thirst\/#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-increased-urination-and-thirst\/#A_Resistance_of_kidney_V2_receptors_to_antidiuretic_hormone_ADH\" >A. Resistance of kidney V2 receptors to antidiuretic hormone (ADH)<\/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-increased-urination-and-thirst\/#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-increased-urination-and-thirst\/#B_Inadequate_ADH_secretion_from_the_pituitary_gland\" >B. Inadequate ADH secretion from&nbsp;the pituitary gland<\/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-increased-urination-and-thirst\/#C_Increased_presence_of_osmotically-active_substances_in_the_urine\" >C. Increased presence of osmotically-active substances in the urine<\/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-increased-urination-and-thirst\/#D_Reduced_antidiuretic_hormone_production_in_response_to_excessive_fluid_intake\" >D. Reduced antidiuretic hormone production in response to excessive fluid intake<\/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-increased-urination-and-thirst\/#E_Glomerular_hyperfiltration\" >E. Glomerular hyperfiltration<\/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-increased-urination-and-thirst\/#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-increased-urination-and-thirst\/#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-increased-urination-and-thirst\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.<\/em><\/strong><strong><em>&nbsp;Today&#8217;s case involves a 33-year-old man with increased urination and constant thirst.&nbsp;<\/em><\/strong><strong><em>Can you figure it out?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 33-year-old man comes to the emergency department because of increased urination and constant thirst despite drinking more than 7 liters of water each day. The symptoms began two weeks ago. Past medical history is notable for&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Bipolar_disorder\" target=\"_blank\" rel=\"noreferrer noopener\">bipolar disorder&nbsp;<\/a>and&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Diabetes_mellitus\" target=\"_blank\" rel=\"noreferrer noopener\">type 2 diabetes mellitus<\/a>. The patient takes lithium and metformin. At the time of arrival, temperature is 37.0\u00b0C (98.6\u00b0F), pulse is 75\/min, and blood pressure is 125\/78 mmHg. The remainder of the examination is noncontributory. Laboratory results are as follows:<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Laboratory value<\/strong><\/td><td><strong>Result<\/strong><\/td><\/tr><tr><td>Sodium<\/td><td>154 mEq\/L<\/td><\/tr><tr><td>Potassium<\/td><td>3.9 mEq\/L<\/td><\/tr><tr><td>Glucose<\/td><td>118 mg\/dL<\/td><\/tr><tr><td>Creatinine<\/td><td>0.9 mg\/dL<\/td><\/tr><tr><td>HbA1c<\/td><td>6.7%<\/td><\/tr><tr><td>Serum Osmolarity<\/td><td>&nbsp;287 mOsm\/kg<\/td><\/tr><tr><td>Urine Osmolality<\/td><td>115 mOsm\/kg<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">A trial of vasopressin is administered. However, there is no significant increase in urine osmolality within 2 hours. Which of the following best describes the most likely pathophysiology of this patient\u2019s presentation?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Resistance of kidney V2 receptors to antidiuretic hormone (ADH)<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Inadequate ADH secretion from the pituitary gland<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Increased presence of osmotically-active substances in the urine<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Reduced antidiuretic hormone production in response to excessive fluid intake<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Glomerular hyperfiltration<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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=\"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><\/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_Resistance_of_kidney_V2_receptors_to_antidiuretic_hormone_ADH\"><\/span>A. Resistance of kidney V2 receptors to antidiuretic hormone (ADH)<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the Main Explanation, 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_Inadequate_ADH_secretion_from_the_pituitary_gland\"><\/span>B. Inadequate ADH secretion from&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Pituitary_gland_histology\" target=\"_blank\" rel=\"noreferrer noopener\">the pituitary gland<\/a><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>This answer describes central diabetes insipidus (DI). Individuals with central DI often exhibit a greater than 50% increase in urine osmolality after administration of vasopressin (since their kidneys are capable of responding to the hormone by increasing water reuptake). In contrast, the patient in this vignette had no significant increase in urine osmolality, making nephrogenic DI more likely.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Increased_presence_of_osmotically-active_substances_in_the_urine\"><\/span>C. Increased presence of osmotically-active substances in the urine<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Osmotic diuresis can sometimes be seen in patients with uncontrolled diabetes. While this patient has diabetes, his<a href=\"https:\/\/www.osmosis.org\/learn\/Blood_glucose_testing:_Clinical_skills_notes\" target=\"_blank\" rel=\"noreferrer noopener\">&nbsp;blood sugar level&nbsp;<\/a>is not significantly elevated. Moreover, even in patients with poorly-controlled diabetes, an increase in urine osmolality would be expected after vasopressin administration, since the kidneys should be capable of responding to the hormone.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Reduced_antidiuretic_hormone_production_in_response_to_excessive_fluid_intake\"><\/span>D. Reduced antidiuretic hormone production in response to excessive fluid intake<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>This answer describes primary polydipsia. Patients with this condition consume excessive fluids even in the absence of physiologic stimuli to drink. Primary polydipsia is often associated with psychiatric conditions, such as&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Schizophrenia_spectrum_disorders:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">schizophrenia&nbsp;<\/a>or&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Anxiety_disorders:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">anxiety disorder<\/a>. Patients with psychogenic polydipsia have both reduced serum osmolality (due to increased water content) and urine osmolality (since the body is trying to eliminate surplus water via urine).<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Glomerular_hyperfiltration\"><\/span>E. Glomerular hyperfiltration<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Glomerular hyperfiltration is the hallmark of early&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Diabetic_nephropathy\" target=\"_blank\" rel=\"noreferrer noopener\">diabetic nephropathy.<\/a>&nbsp;It arises secondary to non-enzymatic glycation of tissue proteins in patients with chronic hyperglycemia. It is generally asymptomatic and is diagnosed based on laboratory abnormalities (e.g. elevated GFR).<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-1\" 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\/the-ultimate-guide-usmle-step-1-banner.png?w=700\" alt=\"The Ultimate Guide to the USMLE Step 1: Everything you need to know\" class=\"wp-image-760\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span><strong>Main Explanation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The clinical findings of&nbsp;<strong>polydipsia<\/strong>&nbsp;and&nbsp;<strong>polyuria<\/strong>&nbsp;in a patient taking&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Lithium\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>lithium<\/strong>&nbsp;<\/a>should raise the suspicion of&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Diabetes_insipidus\" target=\"_blank\" rel=\"noreferrer noopener\">diabetes insipidus (DI)<\/a><\/strong>. The inability to raise urine osmolality after a trial of vasopressin makes the diagnosis of&nbsp;<strong>nephrogenic DI<\/strong>&nbsp;most likely.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" height=\"617\" width=\"1024\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/table-diabetes-insipidus.png?w=1024\" alt=\"\" class=\"wp-image-1328\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/table-diabetes-insipidus.png 1386w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/table-diabetes-insipidus.png?resize=300,181 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/table-diabetes-insipidus.png?resize=768,463 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/table-diabetes-insipidus.png?resize=1024,617 1024w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>DI<\/strong>&nbsp;is characterized by excessive<strong>&nbsp;urination, thirst,&nbsp;<\/strong>and an<strong>&nbsp;inability to concentrate the urine<\/strong>&nbsp;due to a lack of, or poor response to,&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Antidiuretic_hormone\" target=\"_blank\" rel=\"noreferrer noopener\">antidiuretic hormone (ADH)<\/a><\/strong>. It is categorized into&nbsp;<strong>nephrogenic DI<\/strong>&nbsp;and&nbsp;<strong>central DI<\/strong>. Nephrogenic DI occurs when V2 receptors develop resistance to ADH. It is often caused by medications (e.g. lithium, demeclocycline) and electrolyte anomalies (e.g.&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hypokalemia\" target=\"_blank\" rel=\"noreferrer noopener\">hypokalemia<\/a>,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hypercalcemia\" target=\"_blank\" rel=\"noreferrer noopener\">hypercalcemia<\/a>). In contrast, central DI is caused by a lack of ADH secretion from the posterior pituitary. It can be idiopathic or secondary to brain malignancies, pituitary ischemia or CNS infections.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Individuals with DI present with&nbsp;<strong>mildhypernatremia<\/strong>,&nbsp;<strong>high-normal serum osmolality,&nbsp;<\/strong>and&nbsp;<strong>low urine osmolality<\/strong>.&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Medications_for_antidiuretic_hormone_(ADH)_disorders:_Nursing_Pharmacology\" target=\"_blank\" rel=\"noreferrer noopener\">A trial of desmopressin<\/a>&nbsp;(an ADH analog) administration helps in differentiating central from nephrogenic DI. In the former, the urine osmolality tends to rise after administering&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Medications_for_antidiuretic_hormone_(ADH)_disorders:_Nursing_Pharmacology\" target=\"_blank\" rel=\"noreferrer noopener\">desmopressin<\/a>, while there is no change in the latter. This patient\u2019s persistently low urine osmolality and high serum osmolality after administration of desmopressin is consistent with&nbsp;<strong>nephrogenic DI<\/strong>.<\/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=\"Diabetes insipidus - causes, symptoms, diagnosis, treatment, pathology\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/75JrAx4hBC0?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\"><strong>Nephrogenic DI&nbsp;<\/strong>occurs when V2 receptors in the kidneys become resistant to&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Antidiuretic_hormone\" target=\"_blank\" rel=\"noreferrer noopener\">ADH<\/a>. Common causes of the condition include medications (e.g.&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Lithium\" target=\"_blank\" rel=\"noreferrer noopener\">lithium<\/a>) and electrolyte anomalies. Symptoms of both&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Diabetes_insipidus\" target=\"_blank\" rel=\"noreferrer noopener\">nephrogenic and central DI<\/a>&nbsp;include&nbsp;<strong>polyuria<\/strong>,&nbsp;<strong>polydipsia<\/strong>, and an&nbsp;<strong>inability to concentrate urine<\/strong>.<\/p>\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\">Bockenhauer D., Bichet, D.G. (2015) Pathophysiology, diagnosis and management of nephrogenic diabetes insipidus.&nbsp;<em>Nature Review Nephrolog<\/em>y. 11, 576-588. Doi:&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/26077742\/\" target=\"_blank\" rel=\"noreferrer noopener\">10.1038\/nrneph.2015.89.<\/a><br>Iorgi, N.D., Napoli, F., Allegri, A.E.M., Olivieri, I., Bertelli, E., Gallizia, A., Rossi, A., Maghnie, M. (2012) Diabetes insipidus- Diagnosis and management.&nbsp;<em>Hormone Research in Paediatrics<\/em>. 77, 69-84. Doi:&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/22433947\/\" target=\"_blank\" rel=\"noreferrer noopener\">10.1159\/000336333.<\/a><\/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;<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>&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\/login?type=create\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-02T195148.146.png?w=700\" alt=\"Osmosis ad\" class=\"wp-image-701\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-02T195148.146.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-02T195148.146.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><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>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case involves a 33-year-old man with increased urination and constant thirst.&nbsp;Can you figure it out? A 33-year-old man comes to the emergency department because of increased urination and constant thirst despite drinking more than 7 liters of [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":1327,"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-1326","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: Increased Urination and Thirst - 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-increased-urination-and-thirst\" \/>\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: Increased Urination and Thirst - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case involves a 33-year-old man with increased urination and constant thirst.&nbsp;Can you figure it out? 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These symptoms are upsetting her because she is trying to keep a certain weight for boxing\u2026","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"USMLE\u00ae Step 1 Question: Human Leukocyte Antigen Complex","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T181141.939.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T181141.939.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T181141.939.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T181141.939.webp 2x"},"classes":[]},{"id":3146,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-urinary-incontinence","url_meta":{"origin":1326,"position":3},"title":"USMLE\u00ae Step 1 Question of the Day: Urinary Incontinence","author":"Marina Horiates Kerekes, MD &amp; Team","date":"May 19, 2021","format":false,"excerpt":"Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics. 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