{"id":1403,"date":"2022-07-06T15:46:00","date_gmt":"2022-07-06T15:46:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=1403"},"modified":"2025-10-01T11:40:31","modified_gmt":"2025-10-01T19:40:31","slug":"usmle-step-1-question-of-the-day-excessive-fatigue-and-constipation","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-excessive-fatigue-and-constipation","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Excessive Fatigue and Constipation"},"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-excessive-fatigue-and-constipation\/#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-excessive-fatigue-and-constipation\/#A_Positive_antimicrosomal_antibodies\" >A. Positive antimicrosomal antibodies<\/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-excessive-fatigue-and-constipation\/#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-excessive-fatigue-and-constipation\/#B_Human_leukocyte_antigen_DQ8_positivity\" >B. Human leukocyte antigen DQ8 positivity<\/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-excessive-fatigue-and-constipation\/#C_Decreased_thyroid_stimulating_hormone_levels\" >C. Decreased thyroid stimulating hormone levels<\/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-excessive-fatigue-and-constipation\/#D_Diffuse_uptake_of_radioactive_iodine_on_thyroid_scintigraphy\" >D. Diffuse uptake of radioactive iodine on thyroid scintigraphy<\/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-excessive-fatigue-and-constipation\/#E_Positive_TSH-receptor_antibodies\" >E. Positive TSH-receptor antibodies<\/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-excessive-fatigue-and-constipation\/#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-excessive-fatigue-and-constipation\/#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-excessive-fatigue-and-constipation\/#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 41-year-old woman with excessive fatigue and constipation. Can you figure it out?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 41-year-old woman comes to the physician complaining of excessive fatigue for the last 2 weeks. She states that 1 month ago, she had experienced episodes of palpitations and diarrhea, but those symptoms have now resolved. Past medical history is significant for type I diabetes mellitus, which is treated with insulin. She also has been taking a laxative several times a week to help with new-onset constipation, which started 3 weeks ago. Temperature is 36.5\u00b0C (97.7\u00b0F), pulse is 48\/min, blood pressure is 124\/88 mm Hg, and BMI is 22 kg\/m<sup>2<\/sup>. Physical examination shows cold, dry skin and thinning hair on the scalp. There is 1+ non-pitting edema on both lower extremities.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following additional findings is likely present in this patient?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Positive antimicrosomal antibodies<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Human leukocyte antigen DQ8 positivity<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Decreased thyroid stimulating hormone levels<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Diffuse uptake of radioactive iodine on thyroid scintigraphy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Positive TSH-receptor antibodies<\/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=\"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_Positive_antimicrosomal_antibodies\"><\/span><strong>A. Positive antimicrosomal antibodies<\/strong><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_Human_leukocyte_antigen_DQ8_positivity\"><\/span>B. Human leukocyte antigen DQ8 positivity<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect<\/strong>: Human leukocyte antigen (HLA) DQ8 positivity is associated with celiac disease. Although this patient had episodes of diarrhea several weeks ago, the spontaneous resolution makes this diagnosis unlikely. This patient\u2019s signs and symptoms make chronic autoimmune thyroiditis (<a href=\"https:\/\/www.osmosis.org\/learn\/Hypothyroidism_and_thyroiditis:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">Hashimoto thyroiditis<\/a>) more likely, which is associated with HLA-DR5 positivity.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Decreased_thyroid_stimulating_hormone_levels\"><\/span>C. Decreased thyroid stimulating hormone levels<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect<\/strong>: This patient is presenting with signs and symptoms of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hypothyroidism\" target=\"_blank\" rel=\"noreferrer noopener\">hypothyroidism&nbsp;<\/a>(e.g., bradycardia, fatigue, hair thinning, non-pitting edema). The previous symptoms of palpitations and diarrhea were likely caused by autoimmune destruction of thyroid follicular cells and subsequent release of preformed T4 and T3. Therefore, the likely primary hypothyroidism seen in this patient would cause a resultant increase in thyroid stimulating hormone levels, not decrease.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Diffuse_uptake_of_radioactive_iodine_on_thyroid_scintigraphy\"><\/span>D. Diffuse uptake of radioactive iodine on thyroid scintigraphy<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect<\/strong>: Thyroid scintigraphy is an imaging technique that demonstrates the structure and function of thyroid tissue based on the selective uptake of radioactive iodine (RAI). Normally, only the functional part of the thyroid gland takes up RAI. In patients with a hyperfunctioning thyroid gland (e.g.&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Graves_disease\" target=\"_blank\" rel=\"noreferrer noopener\">Graves disease<\/a>), there would be an enlarged thyroid gland with diffuse uptake of RAI. However, in this patient currently presenting with hypothyroidism, there would be decreased uptake.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Positive_TSH-receptor_antibodies\"><\/span>E. Positive TSH-receptor antibodies<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect<\/strong>: TSH-receptor antibodies are present in patients with&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Graves_disease\" target=\"_blank\" rel=\"noreferrer noopener\">Graves disease<\/a>. The circulating TSH-receptor autoantibodies cause overstimulation of the thyroid gland, leading to excess production of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Thyroid_hormones\" target=\"_blank\" rel=\"noreferrer noopener\">thyroid hormone<\/a>, resulting in signs of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hyperthyroidism\" target=\"_blank\" rel=\"noreferrer noopener\">hyperthyroidism<\/a>. In contrast, this patient is presenting with classical signs and symptoms of hypothyroidism, hence making Graves disease and the presence of TSH-receptor antibodies unlikely.<\/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\">This middle-aged female is presenting with constipation, dry skin, thinning hair, and non-pitting edema in the lower extremities. She most likely has&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Hypothyroidism:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\">hypothyroidism<\/a><\/strong>. Taking into account the history of a previously diagnosed autoimmune condition (e.g.&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Diabetes_mellitus\" target=\"_blank\" rel=\"noreferrer noopener\">type I diabetes mellitus<\/a>) as well as prior symptoms of hyperthyroidism (e.g. episodes of palpitations and diarrhea), she most likely has&nbsp;<strong>chronic autoimmune thyroiditis<\/strong>&nbsp;(<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Hashimoto_thyroiditis\" target=\"_blank\" rel=\"noreferrer noopener\">Hashimoto thyroiditis<\/a><\/strong>).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.osmosis.org\/learn\/Hashimoto_thyroiditis\" target=\"_blank\" rel=\"noreferrer noopener\">Hashimoto thyroiditis<\/a>&nbsp;is the leading cause of hypothyroidism in the United States; it is autoimmune-mediated, and thus it tends to occur in patients with other underlying autoimmune conditions such as type I diabetes mellitus and vitiligo. Although the etiology is not fully understood, there is&nbsp;<strong>autoimmune-mediated lymphocytic inflammation<\/strong>&nbsp;and destruction of the thyroid tissue. This destruction of the follicular cells results in release of preformed thyroid hormones, which usually presents as an initial phase of hyperthyroidism. Patients subsequently progress to hypothyroidism as the thyroid parenchyma is destroyed and fibrosed.<\/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=\"Hashimoto&#039;s thyroiditis - causes, symptoms, diagnosis, treatment, pathology\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/7MfNDfr6H1g?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\">Diagnosis is based on thyroid function tests, as well as the presence of antibodies, such as&nbsp;<strong>anti-thyroid peroxidase (anti-microsomal)<\/strong>&nbsp;and&nbsp;<strong>antithyroglobulin antibodies<\/strong>. Treatment is primarily with levothyroxine to replete the thyroid hormone deficiency.<\/p>\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><a href=\"https:\/\/www.osmosis.org\/learn\/Hashimoto_thyroiditis\" target=\"_blank\" rel=\"noreferrer noopener\">Hashimoto thyroiditis<\/a><\/strong>&nbsp;is the result of an autoimmune-mediated lymphocytic inflammation and destruction of the thyroid tissue. Diagnosis is based on thyroid function tests, as well as the presence of certain antibodies, such as<strong>&nbsp;anti-thyroid peroxidase (anti-microsomal)<\/strong>&nbsp;and&nbsp;<strong>anti-thyroglobulin<\/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\">Caturegli, P., De Remigis, A., Rose, N.R. (2014) Hashimoto thyroiditis: clinical and diagnostic criteria.&nbsp;<em>Autoimmunity Reviews<\/em>. 13(4-5), 391\u2013397. Doi:&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24434360\/\" target=\"_blank\" rel=\"noreferrer noopener\">10.1016\/j.autrev.2014.01.007<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Chaker, L., Bianco, A.C., Jonklaas, J., Peeters, R.P. (2017) Hypothyroidism.&nbsp;<em>Lancet<\/em>. 390(10101), 1550-1562. Doi:&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28336049\/\" target=\"_blank\" rel=\"noreferrer noopener\">10.1016\/S0140-6736(17)30703-1<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Fr\u00f6hlich E., Wahl R. (2017) Thyroid autoimmunity: Role of anti-thyroid antibodies in thyroid and extra-thyroidal diseases.&nbsp;<em>Frontiers in Immunology<\/em>. 8, 521. Doi:&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28536577\/\" target=\"_blank\" rel=\"noreferrer noopener\">10.3389\/fimmu.2017.00521<\/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><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/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\"><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 41-year-old woman with excessive fatigue and constipation. Can you figure it out? A 41-year-old woman comes to the physician complaining of excessive fatigue for the last 2 weeks. She states that 1 month ago, [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":1404,"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":[27,20,1369,44],"tags":[],"class_list":["post-1403","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: Excessive Fatigue and Constipation - 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-excessive-fatigue-and-constipation\" \/>\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: Excessive Fatigue and Constipation - 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 41-year-old woman with excessive fatigue and constipation. Can you figure it out? A 41-year-old woman comes to the physician complaining of excessive fatigue for the last 2 weeks. She states that 1 month ago, [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-excessive-fatigue-and-constipation\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2022-07-06T15:46:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-10-01T19:40:31+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-excessive-fatigue-constipation.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1080\" \/>\n\t<meta property=\"og:image:height\" content=\"1080\" \/>\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-excessive-fatigue-and-constipation#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-excessive-fatigue-and-constipation\"},\"author\":{\"name\":\"Marina Horiates Kerekes, MD &amp; 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A 55-year-old man presents\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":"","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-diverticulum-formation.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-diverticulum-formation.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-diverticulum-formation.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-diverticulum-formation.webp 2x"},"classes":[]},{"id":855,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-social-anxiety","url_meta":{"origin":1403,"position":5},"title":"USMLE\u00ae Step 1 Question of the Day: Social anxiety","author":"Marina Horiates Kerekes, MD &amp; Team","date":"February 1, 2023","format":false,"excerpt":"This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics. Today's case involves a 25-year-old woman who has concerns about being socially withdrawn and has been avoiding social events at her job. Past medical history is noncontributory. Which of the following is\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":"","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/social-anxiety.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/social-anxiety.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/social-anxiety.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/social-anxiety.webp 2x"},"classes":[]}],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/1403","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/users\/202"}],"replies":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/comments?post=1403"}],"version-history":[{"count":5,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/1403\/revisions"}],"predecessor-version":[{"id":5708,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/1403\/revisions\/5708"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media\/1404"}],"wp:attachment":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media?parent=1403"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/categories?post=1403"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/tags?post=1403"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}