{"id":1977,"date":"2022-08-17T15:50:00","date_gmt":"2022-08-17T15:50:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=1977"},"modified":"2026-06-30T15:15:40","modified_gmt":"2026-06-30T23:15:40","slug":"usmle-step-1-question-of-the-day-adrenal-insufficiency","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-adrenal-insufficiency","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Adrenal Insufficiency"},"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-adrenal-insufficiency\/#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-adrenal-insufficiency\/#A_Chronic_mycobacterial_infection\" >A. Chronic mycobacterial infection<\/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-adrenal-insufficiency\/#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-adrenal-insufficiency\/#B_Infection_with_a_gram-negative_diplococci\" >B. Infection with a gram-negative diplococci<\/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-adrenal-insufficiency\/#C_Disseminated_histoplasmosis\" >C. Disseminated&nbsp;histoplasmosis<\/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-adrenal-insufficiency\/#D_Presence_of_HLA-B8\" >D. Presence of HLA-B8<\/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-adrenal-insufficiency\/#E_Metastatic_lung_malignancy\" >E.&nbsp;Metastatic lung malignancy<\/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-adrenal-insufficiency\/#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-adrenal-insufficiency\/#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-adrenal-insufficiency\/#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.&nbsp;<\/em><\/strong><strong><em>Today&#8217;s case focuses on a 56-year-old man who has recently immigrated from Vietnam. He experiences worsening fatigue and decreasing exercise tolerance.&nbsp;<\/em><\/strong><strong><em>Can you figure it out?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 56-year-old man presents to his primary care physician with worsening fatigue, decreasing exercise tolerance and a 15 pound weight loss over the past two months. The patient additionally has a chronic cough, low grade fevers, and cravings for salty foods. He currently lives in Ohio but recently immigrated from Vietnam, where he worked as a nurse. He has a history of type II diabetes mellitus and a ten pack year smoking history, but he does not use alcohol or other illicit substances. Temperature is 37.0\u00b0C (98.6 \u00b0F), pulse is 65\/min, respirations are 16\/min, blood pressure is 100\/72 mmHg, and oxygen saturation is 95% on room air. Physical examination demonstrates a thin, fatigued male in no acute distress with facial hyperpigmentation. A screening PPD test is positive. Which of the following is the most likely etiology of this patient\u2019s clinical presentation?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Chronic mycobacterial infection<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Infection with a gram-negative diplococci<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Disseminated histoplasmosis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Presence of HLA-B8<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Metastatic lung malignancy<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down to find the answer!<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Learn with Osmosis\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/iDxHtjjCMbU?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<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_Chronic_mycobacterial_infection\"><\/span>A. Chronic mycobacterial infection<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_Infection_with_a_gram-negative_diplococci\"><\/span>B. Infection with a gram-negative diplococci<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Infection with&nbsp;<em><a href=\"https:\/\/www.osmosis.org\/learn\/Neisseria_meningitidis\" target=\"_blank\" rel=\"noreferrer noopener\">Neisseria meningitidis<\/a><\/em><em>&nbsp;<\/em>can result in&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Waterhouse-Friderichsen_syndrome\" target=\"_blank\" rel=\"noreferrer noopener\">Waterhouse-Friderichsen syndrome<\/a>&nbsp;and bilateral adrenal hemorrhage. Clinically, this complication presents with acute disseminated intravascular coagulation and refractory shock, which are absent in this patient.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Disseminated_histoplasmosis\"><\/span>C. Disseminated&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Histoplasmosis\" target=\"_blank\" rel=\"noreferrer noopener\">histoplasmosis<\/a><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Disseminated histoplasmosis can cause primary adrenal insufficiency. However, it is not the most common etiology of adrenal insufficiency in patients from developing countries. Furthermore, disseminated histoplasmosis rarely manifests in immunocompetent patients.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Presence_of_HLA-B8\"><\/span>D. Presence of HLA-B8<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Autoimmune adrenalitis is associated with the HLA-B8 serotype. Given the patient\u2019s risk factors and clinical features consistent with&nbsp;<em>Mycobacterium tuberculosis<\/em>&nbsp;infection, this diagnosis is less likely.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Metastatic_lung_malignancy\"><\/span>E.&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Lung_cancer\" target=\"_blank\" rel=\"noreferrer noopener\">Metastatic lung malignancy<\/a><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Metastatic malignancies can cause primary adrenal insufficiency when tumor burden spreads to the adrenal glands. Although this patient does smoke, his positive PPD test makes mycobacterial infection a more likely cause of his adrenal insufficiency.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/www.osmosis.org\/plans\/md\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_46a25e.png\" alt=\"The most powerful platform for learning medicine and the health sciences Osmosis sign up ad\" class=\"wp-image-1979\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_46a25e.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_46a25e.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\/plans\/md\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/p>\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 with worsening fatigue, low grade fevers, weight loss, and skin hyperpigmentation. In addition, he has a history of working as a nurse in a country endemic to&nbsp;<strong><em><a href=\"https:\/\/www.osmosis.org\/learn\/Mycobacterium_tuberculosis_(Tuberculosis)\" target=\"_blank\" rel=\"noreferrer noopener\">Mycobacterium tuberculosis<\/a><\/em><\/strong>, which is the most common etiology<strong>&nbsp;<\/strong>of primary adrenal insufficiency in the developing world. His screening&nbsp;<strong>PPD test is positive<\/strong>, which further supports this diagnosis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><a href=\"https:\/\/www.osmosis.org\/learn\/Primary_adrenal_insufficiency\" target=\"_blank\" rel=\"noreferrer noopener\">Primary adrenal insufficiency<\/a><\/strong>&nbsp;refers to decreased production of both&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Mineralocorticoids_and_mineralocorticoid_antagonists\" target=\"_blank\" rel=\"noreferrer noopener\">mineralocorticoids<\/a>&nbsp;and glucocorticoids due to adrenal gland dysfunction. This disease is further divided into acute and chronic<strong>&nbsp;<\/strong>forms, with acute disease characterized by refractory shock due to&nbsp;<strong>adrenal hemorrhage<\/strong><em>&nbsp;<\/em>from acute infectious etiologies, thrombosis, or trauma.<\/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=\"Primary Adrenal Insufficiency (Addison&#039;s Disease)\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/V-00gg0DTv4?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\">Chronic adrenal insufficiency is characterized by indolent symptoms that commonly include fatigue, weight loss, salt craving, and non-specific gastrointestinal complaints. Patients will frequently have signs of hypotension, skin hyperpigmentation, and electrolyte abnormalities of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hyponatremia\" target=\"_blank\" rel=\"noreferrer noopener\">hyponatremia<\/a>,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hyperkalemia\" target=\"_blank\" rel=\"noreferrer noopener\">hyperkalemia<\/a>, and&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Metabolic_acidosis\" target=\"_blank\" rel=\"noreferrer noopener\">metabolic acidosis<\/a>. Etiologies of chronic adrenal insufficiency are divided into autoimmune causes, infectious etiologies, drugs, and metastatic disease. In the&nbsp;<strong>developed world<\/strong>,&nbsp;<strong>autoimmune adrenalitis<\/strong>&nbsp;is the most common cause of primary adrenal insufficiency, whereas in the&nbsp;<strong>developing world<\/strong>&nbsp;the most common etiology is chronic<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Mycobacterium_tuberculosis_(Tuberculosis)\" target=\"_blank\" rel=\"noreferrer noopener\">&nbsp;<em>Mycobacterium tuberculosis<\/em><\/a><\/strong>&nbsp;infection.infection.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"972\" height=\"603\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T095542.743.png\" alt=\"Osmosis illustration of Adrenal Insufficiency.\" class=\"wp-image-1980\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T095542.743.png 972w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T095542.743.png?resize=300,186 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T095542.743.png?resize=768,476 768w\" sizes=\"auto, (max-width: 972px) 100vw, 972px\" \/><\/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\/Primary_adrenal_insufficiency\" target=\"_blank\" rel=\"noreferrer noopener\">Primary adrenal insufficiency<\/a><\/strong>&nbsp;is divided into acute and chronic forms. In the&nbsp;<strong>developing world<\/strong>, the most common etiology of primary adrenal insufficiency is&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Mycobacterium_tuberculosis_(Tuberculosis)\" target=\"_blank\" rel=\"noreferrer noopener\"><strong><em>Mycobacterium tuberculosis<\/em><\/strong><em>&nbsp;<\/em>infection<\/a>.<\/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\">Bancos, I., Hahner, S., Tomlinson, J., Arlt, W. (2015) Diagnosis and management of adrenal insufficiency.&nbsp;<em>The Lancet Diabetes &amp; Endocrinology<\/em>. 3(3), 216\u2010226.&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/25098712\/\" target=\"_blank\" rel=\"noreferrer noopener\">Doi: 10.1016\/S2213-8587(14)70142-1.<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Charmandari, E., Nicolaides, N.C., Chrousos, G.P. (2014) Adrenal insufficiency.&nbsp;<em>Lancet<\/em>. 383(9935), 2152\u20102167.&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24503135\/\" target=\"_blank\" rel=\"noreferrer noopener\">Doi: 10.1016\/S0140-6736(13)61684-0.<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Herndon, J., Nadeau, A.M., Davidge-Pitts, C.J., Young, W.F., Bancos, I. (2018) Primary adrenal insufficiency due to bilateral infiltrative disease.&nbsp;<em>Endocrine<\/em>. 62(3), 721\u2010728.&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/30178435\/\" target=\"_blank\" rel=\"noreferrer noopener\">Doi: 10.1007\/s12020-018-1737-7.<\/a><\/p>\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) Robbins basic pathology (10th ed.). Philadelphia, PA: Elsevier. ISBN: 978-0-323-35317-5.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pulzer, A., Burger-Stritt, S., Hahner, S. (2016). Morbus Addison: Prim\u00e4re Nebenniereninsuffizienz [Addison&#8217;s disease : Primary adrenal insufficiency].&nbsp;<em>Der Internist<\/em>. 57(5), 457\u2010469.&nbsp;<a href=\"https:\/\/www.infona.pl\/resource\/bwmeta1.element.springer-doi-10_1007-S00108-016-0054-6\" target=\"_blank\" rel=\"noreferrer noopener\">Doi: 10.1007\/s00108-016-0054-6.<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>_________________________<\/strong><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-full\"><a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-1\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_ac73e3.png\" alt=\"The ultimate guide to the USMLE step 1: EVERYTHING YOU NEED TO KNOW\" class=\"wp-image-1981\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_ac73e3.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_ac73e3.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\/ultimate-guide\/usmle-step-1\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/p>\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 focuses on a 56-year-old man who has recently immigrated from Vietnam. He experiences worsening fatigue and decreasing exercise tolerance.&nbsp;Can you figure it out? A 56-year-old man presents to his primary care physician with worsening fatigue, decreasing [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":1978,"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-1977","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: Adrenal Insufficiency - 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-adrenal-insufficiency\" \/>\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: Adrenal Insufficiency - 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 focuses on a 56-year-old man who has recently immigrated from Vietnam. He experiences worsening fatigue and decreasing exercise tolerance.&nbsp;Can you figure it out? 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