{"id":1690,"date":"2022-04-27T18:35:00","date_gmt":"2022-04-27T18:35:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=1690"},"modified":"2025-10-01T11:40:31","modified_gmt":"2025-10-01T19:40:31","slug":"usmle-step-1-question-of-the-day-syncopal-episode","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Syncopal Episode"},"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-syncopal-episode\/#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-syncopal-episode\/#A_Re-entrant_conduction_below_or_within_the_bundle_of_His\" >A.&nbsp;Re-entrant conduction below or within the bundle of His<\/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-syncopal-episode\/#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-syncopal-episode\/#B_Aberrant_conduction_through_the_bundle_of_Kent\" >B. Aberrant conduction through the bundle of Kent<\/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-syncopal-episode\/#C_Enhanced_automaticity_from_the_tricuspid_annulus\" >C. Enhanced automaticity from the tricuspid annulus<\/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-syncopal-episode\/#D_Multiple_atrial_micro-reentrant_circuits\" >D. Multiple atrial micro-reentrant circuits<\/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-syncopal-episode\/#E_Reentry_circuit_within_the_AV_node\" >E. Reentry circuit within the AV node<\/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-syncopal-episode\/#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-syncopal-episode\/#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-syncopal-episode\/#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 65-year-old man who suddenly collapsed when crossing the street. An electrocardiogram is demonstrated below.&nbsp;<\/em><\/strong><strong><em>Can you figure out which pathophysiologic process is likely the result of this cardiac activity?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 65-year-old man presents to the emergency department after a witnessed syncopal episode. According to EMS, the patient was walking across the street when he suddenly collapsed. Past medical history is notable for hypertension,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Diabetes_mellitus:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">type II diabetes mellitus<\/a>,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hyperlipidemia\" target=\"_blank\" rel=\"noreferrer noopener\">hyperlipidemia<\/a>, prior myocardial infarction, and a twenty pack-year smoking history. Temperature is 36.1\u00b0C (97.0\u00b0F), pulse is 202\/min, respirations are 22\/min, and blood pressure is 82\/62 mmHg. On physical exam, the patient is altered, pale, and has skin that is cool to the touch.&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/ECG_basics\" target=\"_blank\" rel=\"noreferrer noopener\">Electrocardiogram&nbsp;<\/a>is demonstrated below:<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"605\" height=\"186\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/electrocardiogram.png\" alt=\"\" class=\"wp-image-1692\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/electrocardiogram.png 605w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/electrocardiogram.png?resize=300,92 300w\" sizes=\"auto, (max-width: 605px) 100vw, 605px\" \/><\/figure>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\">Image reproduced from&nbsp;<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:12_lead_generated_ventricular_tachycardia.JPG\" target=\"_blank\" rel=\"noreferrer noopener\">Wikimedia Commons<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Based on this patient\u2019s clinical presentation, this cardiac activity is likely the result of which of the following pathophysiologic processes?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Re-entrant conduction below or within the bundle of His<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Aberrant conduction through the bundle of Kent<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Enhanced automaticity from the tricuspid annulus<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Multiple atrial micro-reentrant circuits<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Reentry circuit within the AV node<\/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><\/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_Re-entrant_conduction_below_or_within_the_bundle_of_His\"><\/span>A.<strong>&nbsp;<\/strong>Re-entrant conduction below or within the bundle of His<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_Aberrant_conduction_through_the_bundle_of_Kent\"><\/span>B. Aberrant conduction through the bundle of Kent<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Pre-excitation syndromes such as Wolff-Parkinson White (WPW) are characterized by an accessory bypass tract. WPW is electrocardiographically characterized by a delta wave, broad QRS complexes, and short PR interval.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Enhanced_automaticity_from_the_tricuspid_annulus\"><\/span>C. Enhanced automaticity from the tricuspid annulus<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong><a href=\"https:\/\/www.osmosis.org\/learn\/Supraventricular_arrhythmias:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\">Multifocal atrial tachycardia (MAT)<\/a>&nbsp;is defined by an irregularly irregular rhythm with varying intervals and at least 3 distinct P-wave morphologies in the same lead. Patients with underlying pulmonary disease are predisposed to this tachyarrhythmia; however, this patient\u2019s rhythm is regular, and the QRS complexes are wide.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Multiple_atrial_micro-reentrant_circuits\"><\/span>D. Multiple atrial micro-reentrant circuits<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong><a href=\"https:\/\/www.osmosis.org\/learn\/Atrial_fibrillation\" target=\"_blank\" rel=\"noreferrer noopener\">Atrial fibrillation<\/a>&nbsp;is defined electrocardiographically as irregularly irregular QRS complexes with absent p-waves; the impulse originates from multiple atrial micro-reentrant circuits. This patient&#8217;s rhythm is regular, and the QRS complexes are wide.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Reentry_circuit_within_the_AV_node\"><\/span>E. Reentry circuit within the AV node<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong><a href=\"https:\/\/www.osmosis.org\/learn\/Supraventricular_arrhythmias:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\">Paroxysmal supraventricular tachycardia<\/a>&nbsp;presents with a heart rate ranging between 150 to 250 beats per minute, a narrow QRS complex, and in some cases, absent p-waves. This patient\u2019s&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/ECG_basics\" target=\"_blank\" rel=\"noreferrer noopener\">electrocardiogram<\/a>&nbsp;demonstrates wide QRS complexes.<\/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 patient presents after a witnessed syncopal episode with unstable vital signs and electrocardiogram demonstrating&nbsp;<strong>monomorphic ventricular tachycardia<\/strong>&nbsp;in the setting of a history of coronary artery disease. Of the answer choices listed, the most likely etiology of this patient\u2019s&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Coronary_artery_disease_(CAD)_and_angina_pectoris:_Nursing_Process_(ADPIE)\" target=\"_blank\" rel=\"noreferrer noopener\">arrhythmia<\/a>&nbsp;is an&nbsp;<strong>aberrant re-entry mechanism at or below the bundle of His<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><a href=\"https:\/\/www.osmosis.org\/learn\/Ventricular_tachycardia\" target=\"_blank\" rel=\"noreferrer noopener\">Ventricular tachycardia<\/a><\/strong><strong>&nbsp;<\/strong>refers to an ectopic focus of electrical activity within the ventricle. The condition is electrocardiographically characterized by a rapid heart rate (&gt;100 beats per minute) and wide QRS complexes (&gt;120 ms). In general, ventricular tachycardia is further subdivided into monomorphic and polymorphic forms.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Monomorphic ventricular tachycardia<\/strong>&nbsp;presents with QRS complexes that have a uniform appearance&#8211;meaning all of the QRS complexes are identical. Monomorphic ventricular tachycardia is classically associated with&nbsp;<strong>myocardial scarring<\/strong>,&nbsp;<strong>acute myocardial infarction<\/strong>, or structural heart disease.&nbsp;<strong>Polymorphic ventricular tachycardia<\/strong>&nbsp;is characterized by multiple ventricular foci and resultant QRS complexes that vary in amplitude, axis, and duration. Polymorphic ventricular tachycardia can be associated with cardiac ischemia, although it is more commonly due to underlying metabolic derangements, medication toxicities, or inherited channelopathies (e.g., Brugada syndrome, Romano-Ward syndrome).<\/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=\"Ventricular tachycardia (VT) - causes, symptoms, diagnosis, treatment &amp; pathology\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/xAfj5AHxC2I?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><a href=\"https:\/\/www.osmosis.org\/learn\/Ventricular_tachycardia\" target=\"_blank\" rel=\"noreferrer noopener\">Ventricular tachycardia<\/a><\/strong>&nbsp;refers to an ectopic focus of electrical activity within the ventricle that is electrocardiographically characterized by a rapid heart rate (&gt;100 beats per minute) and wide QRS complexes (&gt;120 ms). It is most commonly due to a&nbsp;<strong>reentry mechanism at or within the bundle His<\/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\">Jameson, J.L. (2018) Harrison&#8217;s principles of internal medicine. New York: McGraw-Hill Education. ISBN: 9781259644030.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Kumar, V., Abbas, A.K., Aster, J.C., Perkins, J.A., Robbins, S.L. (2018)&nbsp;<a href=\"https:\/\/www.elsevier.com\/books\/robbins-basic-pathology\/kumar\/978-0-323-35317-5\" target=\"_blank\" rel=\"noreferrer noopener\">Robbins basic pathology (10th ed.)<\/a>. Philadelphia, PA: Elsevier. ISBN: 978-0-323-35317-5.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Walls, R., Hockberger, R., Gausche-Hill, M. (2017)&nbsp;<a href=\"https:\/\/www.elsevier.com\/books\/rosens-emergency-medicine-concepts-and-clinical-practice\/walls\/978-0-323-35479-0\" target=\"_blank\" rel=\"noreferrer noopener\">Rosen&#8217;s Emergency Medicine: Concepts and Clinical Practice<\/a>. Philadelphia, PA: Elsevier. ISBN: 978-0323354790.<\/p>\n\n\n\n<p class=\"has-text-align-center 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<p class=\"has-text-align-center wp-block-paragraph\"><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/login?type=create\" 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\/2024-09-02T195148.146.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=\"has-text-align-center wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"has-text-align-center 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\n\n\n<p class=\"wp-block-paragraph\"><\/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 65-year-old man who suddenly collapsed when crossing the street. An electrocardiogram is demonstrated below.&nbsp;Can you figure out which pathophysiologic process is likely the result of this cardiac activity? A 65-year-old man presents to the [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":1691,"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-1690","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: Syncopal Episode - 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-syncopal-episode\" \/>\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: Syncopal Episode - 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 65-year-old man who suddenly collapsed when crossing the street. An electrocardiogram is demonstrated below.&nbsp;Can you figure out which pathophysiologic process is likely the result of this cardiac activity? A 65-year-old man presents to the [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2022-04-27T18:35:00+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-step-1-question-of-the-day-syncopal-episode.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1081\" \/>\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-syncopal-episode#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode\"},\"author\":{\"name\":\"Marina Horiates Kerekes, MD &amp; Team\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/c7e60a94ecf3ec6e6cfe4855957afafc\"},\"headline\":\"USMLE\u00ae Step 1 Question of the Day: Syncopal Episode\",\"datePublished\":\"2022-04-27T18:35:00+00:00\",\"dateModified\":\"2025-10-01T19:40:31+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode\"},\"wordCount\":863,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/#organization\"},\"image\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode#primaryimage\"},\"thumbnailUrl\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-step-1-question-of-the-day-syncopal-episode.webp\",\"articleSection\":[\"Allopathic Medicine (MD)\",\"Exam Prep\",\"USMLE Step 1\",\"USMLE\u00ae Step 1\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode\",\"url\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode\",\"name\":\"USMLE\u00ae Step 1 Question of the Day: Syncopal Episode - Osmosis Blog\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode#primaryimage\"},\"image\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode#primaryimage\"},\"thumbnailUrl\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-step-1-question-of-the-day-syncopal-episode.webp\",\"datePublished\":\"2022-04-27T18:35:00+00:00\",\"dateModified\":\"2025-10-01T19:40:31+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode#primaryimage\",\"url\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-step-1-question-of-the-day-syncopal-episode.webp\",\"contentUrl\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-step-1-question-of-the-day-syncopal-episode.webp\",\"width\":1081,\"height\":1080},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/www.osmosis.org\/blog\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"USMLE\u00ae Step 1 Question of the Day: Syncopal Episode\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#website\",\"url\":\"https:\/\/www.osmosis.org\/blog\/\",\"name\":\"Osmosis Blog\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/www.osmosis.org\/blog\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#organization\",\"name\":\"Osmosis Blog\",\"url\":\"https:\/\/www.osmosis.org\/blog\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/07\/OsmosisElsevierStacked.png\",\"contentUrl\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/07\/OsmosisElsevierStacked.png\",\"width\":1276,\"height\":596,\"caption\":\"Osmosis Blog\"},\"image\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/logo\/image\/\"}},{\"@type\":\"Person\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/c7e60a94ecf3ec6e6cfe4855957afafc\",\"name\":\"Marina Horiates Kerekes, MD &amp; Team\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/c4eaddbf095676223204097f8973e0eed2b2b435a8c32f8f6b8c06da77819aa6?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/c4eaddbf095676223204097f8973e0eed2b2b435a8c32f8f6b8c06da77819aa6?s=96&d=mm&r=g\",\"caption\":\"Marina Horiates Kerekes, MD &amp; Team\"},\"description\":\"Authors: Marina Horiates Kerekes, MD &amp; Osmosis Question Writing Team\",\"url\":\"https:\/\/www.osmosis.org\/blog\/author\/marinahoriateskerekesandteam\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"USMLE\u00ae Step 1 Question of the Day: Syncopal Episode - Osmosis Blog","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode","og_locale":"en_US","og_type":"article","og_title":"USMLE\u00ae Step 1 Question of the Day: Syncopal Episode - Osmosis Blog","og_description":"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 65-year-old man who suddenly collapsed when crossing the street. An electrocardiogram is demonstrated below.&nbsp;Can you figure out which pathophysiologic process is likely the result of this cardiac activity? A 65-year-old man presents to the [&hellip;]","og_url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode","og_site_name":"Osmosis Blog","article_published_time":"2022-04-27T18:35:00+00:00","article_modified_time":"2025-10-01T19:40:31+00:00","og_image":[{"width":1081,"height":1080,"url":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-step-1-question-of-the-day-syncopal-episode.webp","type":"image\/webp"}],"author":"Marina Horiates Kerekes, MD &amp; Team","twitter_card":"summary_large_image","schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":["Article","BlogPosting"],"@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode#article","isPartOf":{"@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode"},"author":{"name":"Marina Horiates Kerekes, MD &amp; Team","@id":"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/c7e60a94ecf3ec6e6cfe4855957afafc"},"headline":"USMLE\u00ae Step 1 Question of the Day: Syncopal Episode","datePublished":"2022-04-27T18:35:00+00:00","dateModified":"2025-10-01T19:40:31+00:00","mainEntityOfPage":{"@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode"},"wordCount":863,"commentCount":0,"publisher":{"@id":"https:\/\/www.osmosis.org\/blog\/#organization"},"image":{"@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode#primaryimage"},"thumbnailUrl":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-step-1-question-of-the-day-syncopal-episode.webp","articleSection":["Allopathic Medicine (MD)","Exam Prep","USMLE Step 1","USMLE\u00ae Step 1"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode#respond"]}]},{"@type":"WebPage","@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode","url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode","name":"USMLE\u00ae Step 1 Question of the Day: Syncopal Episode - Osmosis Blog","isPartOf":{"@id":"https:\/\/www.osmosis.org\/blog\/#website"},"primaryImageOfPage":{"@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode#primaryimage"},"image":{"@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode#primaryimage"},"thumbnailUrl":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-step-1-question-of-the-day-syncopal-episode.webp","datePublished":"2022-04-27T18:35:00+00:00","dateModified":"2025-10-01T19:40:31+00:00","breadcrumb":{"@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode#primaryimage","url":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-step-1-question-of-the-day-syncopal-episode.webp","contentUrl":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-step-1-question-of-the-day-syncopal-episode.webp","width":1081,"height":1080},{"@type":"BreadcrumbList","@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-syncopal-episode#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.osmosis.org\/blog"},{"@type":"ListItem","position":2,"name":"USMLE\u00ae Step 1 Question of the Day: Syncopal Episode"}]},{"@type":"WebSite","@id":"https:\/\/www.osmosis.org\/blog\/#website","url":"https:\/\/www.osmosis.org\/blog\/","name":"Osmosis Blog","description":"","publisher":{"@id":"https:\/\/www.osmosis.org\/blog\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.osmosis.org\/blog\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/www.osmosis.org\/blog\/#organization","name":"Osmosis Blog","url":"https:\/\/www.osmosis.org\/blog\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.osmosis.org\/blog\/#\/schema\/logo\/image\/","url":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/07\/OsmosisElsevierStacked.png","contentUrl":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/07\/OsmosisElsevierStacked.png","width":1276,"height":596,"caption":"Osmosis Blog"},"image":{"@id":"https:\/\/www.osmosis.org\/blog\/#\/schema\/logo\/image\/"}},{"@type":"Person","@id":"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/c7e60a94ecf3ec6e6cfe4855957afafc","name":"Marina Horiates Kerekes, MD &amp; Team","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/c4eaddbf095676223204097f8973e0eed2b2b435a8c32f8f6b8c06da77819aa6?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/c4eaddbf095676223204097f8973e0eed2b2b435a8c32f8f6b8c06da77819aa6?s=96&d=mm&r=g","caption":"Marina Horiates Kerekes, MD &amp; Team"},"description":"Authors: Marina Horiates Kerekes, MD &amp; Osmosis Question Writing Team","url":"https:\/\/www.osmosis.org\/blog\/author\/marinahoriateskerekesandteam"}]}},"jetpack_featured_media_url":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-step-1-question-of-the-day-syncopal-episode.webp","jetpack-related-posts":[{"id":3718,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-a-syncopal-event","url_meta":{"origin":1690,"position":0},"title":"USMLE\u00ae Step 1 Question of the Day: A Syncopal Event","author":"Marina Horiates Kerekes, MD &amp; Team","date":"June 30, 2021","format":false,"excerpt":"Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics. Today's case involves a 65-year-old man after a syncopal event at home. Can you figure out the diagnosis? A 65-year-old man presents to the emergency department after a syncopal event at home. He\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 of the Day: A Syncopal Event","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T122639.841.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T122639.841.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T122639.841.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T122639.841.webp 2x"},"classes":[]},{"id":808,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-neuroleptic-malignant-syndrome","url_meta":{"origin":1690,"position":1},"title":"USMLE\u00ae Step 1 Question of the Day: Neuroleptic Malignant Syndrome","author":"Marina Horiates Kerekes, MD &amp; Team","date":"October 26, 2023","format":false,"excerpt":"Explore a USMLE\u00ae Step 1 clinical case on serotonin syndrome and discover why myoclonus distinguishes it from similar conditions like neuroleptic malignant syndrome.","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 Step 1 Question of the Day Neuroleptic Malignant Syndrome","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/neuroleptic-malignant-syndrome.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/neuroleptic-malignant-syndrome.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/neuroleptic-malignant-syndrome.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/neuroleptic-malignant-syndrome.webp 2x"},"classes":[]},{"id":2136,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-episode-of-syncope","url_meta":{"origin":1690,"position":2},"title":"USMLE\u00ae Step 1 Question of the Day: Episode of Syncope","author":"Marina Horiates Kerekes, MD &amp; Team","date":"June 22, 2022","format":false,"excerpt":"This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.\u00a0Today's case involves a 75-year-old man who lost consciousness for one minute following an episode of syncope two days ago. Can you figure out in which area\u00a0cardiac auscultation will most likely reveal a\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 of the Day: Episode of Syncope","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/99.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/99.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/99.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/99.webp 2x"},"classes":[]},{"id":3561,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-fatigue-and-progressive-dyspnea","url_meta":{"origin":1690,"position":3},"title":"USMLE\u00ae Step 1 Question of the Day: Fatigue and Progressive Dyspnea","author":"Marina Horiates Kerekes, MD &amp; Team","date":"June 29, 2022","format":false,"excerpt":"This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.\u00a0Today's case focuses on a 72-year-old man with fatigue and progressive dyspnea. Physical examination shows 3+ edema in the lower extremities and hepatomegaly.\u00a0Can you figure it out? A 72-year-old man is brought to\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-fatigue-and-progressive-dyspnea.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-fatigue-and-progressive-dyspnea.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-fatigue-and-progressive-dyspnea.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-fatigue-and-progressive-dyspnea.webp 2x"},"classes":[]},{"id":2866,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-spasms-and-syncope","url_meta":{"origin":1690,"position":4},"title":"USMLE\u00ae Step 1 Question of the Day: Spasms and Syncope","author":"Marina Horiates Kerekes, MD &amp; Team","date":"February 24, 2021","format":false,"excerpt":"For today\u2019s USMLE\u00ae Step 1-style question, we examine the case of a woman who is brought into the ER by her partner after experiencing a sudden episode of jerky movements and loss of consciousness.\u00a0 A 23-year-old woman is brought to the emergency department by her partner due to an episode\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-step-1-question-of-the-day-spasms-and-syncope.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-step-1-question-of-the-day-spasms-and-syncope.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-step-1-question-of-the-day-spasms-and-syncope.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-step-1-question-of-the-day-spasms-and-syncope.webp 2x"},"classes":[]},{"id":3538,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-causes-of-upper-gastrointestinal-bleeds","url_meta":{"origin":1690,"position":5},"title":"USMLE\u00ae Step 2 Question of the Day: Causes of Upper Gastrointestinal Bleeds","author":"Marina Horiates Kerekes, MD &amp; Team","date":"June 23, 2021","format":false,"excerpt":"A middle-aged man with cirrhosis and vomiting blood requires urgent care. Discover what the critical first step you need to take in his medical care.","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 2 Question of the Day: Causes of Upper Gastrointestinal Bleeds","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-gastrointestinal-bleeds.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-gastrointestinal-bleeds.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-gastrointestinal-bleeds.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-gastrointestinal-bleeds.webp 2x"},"classes":[]}],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/1690","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=1690"}],"version-history":[{"count":4,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/1690\/revisions"}],"predecessor-version":[{"id":6233,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/1690\/revisions\/6233"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media\/1691"}],"wp:attachment":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media?parent=1690"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/categories?post=1690"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/tags?post=1690"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}