{"id":2028,"date":"2021-07-28T17:07:00","date_gmt":"2021-07-28T17:07:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=2028"},"modified":"2025-10-01T11:42:38","modified_gmt":"2025-10-01T19:42:38","slug":"usmle-step-1-question-of-the-day-glioblastoma-multiforme","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-glioblastoma-multiforme","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Glioblastoma Multiforme"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_85 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 ' ><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-glioblastoma-multiforme\/#A_Concentrically_arranged_spindle_cells_in_a_whorled_pattern_with_areas_of_calcifications\" >A. Concentrically arranged spindle cells in a whorled pattern with areas of calcifications<\/a><\/li><li class='ez-toc-page-1 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-glioblastoma-multiforme\/#B_Hypercellular_areas_of_spindle_cells_alternating_with_hypocellular_myxoid_areas\" >B. Hypercellular areas of spindle cells alternating with hypocellular myxoid areas<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-glioblastoma-multiforme\/#C_Large_abnormal_lymphocytes_infiltrating_perivascular_spaces\" >C. Large abnormal lymphocytes infiltrating perivascular spaces&nbsp;<\/a><\/li><li class='ez-toc-page-1 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-glioblastoma-multiforme\/#D_Thin-walled_capillaries_with_minimal_intervening_parenchyma\" >D. Thin-walled capillaries with minimal intervening parenchyma<\/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-glioblastoma-multiforme\/#E_Pleomorphic_tumor_cells_surrounding_an_area_of_central_necrosis\" >E. Pleomorphic tumor cells surrounding an area of central necrosis<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-glioblastoma-multiforme\/#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-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-glioblastoma-multiforme\/#E_Pleomorphic_tumor_cells_surrounding_an_area_of_central_necrosis-2\" >E. Pleomorphic tumor cells surrounding an area of central necrosis<\/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-glioblastoma-multiforme\/#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-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-glioblastoma-multiforme\/#A_Concentrically_arranged_spindle_cells_in_a_whorled_pattern_with_areas_of_calcifications-2\" >A. Concentrically arranged spindle cells in a whorled pattern with areas of calcifications<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-glioblastoma-multiforme\/#B_Hypercellular_areas_of_spindle_cells_alternating_with_hypocellular_myxoid_areas-2\" >B. Hypercellular areas of spindle cells alternating with hypocellular myxoid areas<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-glioblastoma-multiforme\/#C_Large_abnormal_lymphocytes_infiltrating_perivascular_spaces-2\" >C. Large abnormal lymphocytes infiltrating perivascular spaces<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-12\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-glioblastoma-multiforme\/#D_Thin-walled_capillaries_with_minimal_intervening_parenchyma-2\" >D. Thin-walled capillaries with minimal intervening parenchyma<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-13\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-glioblastoma-multiforme\/#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-14\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-glioblastoma-multiforme\/#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-15\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-glioblastoma-multiforme\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics. Today&#8217;s case involves a 60-year-old man with a seizure. The man dies two days later.&nbsp;<\/em><\/strong><strong><em>Can you figure out the cause?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 60-year-old man is admitted to the emergency department due to a seizure. The patient&#8217;s wife reports that during the past 3 weeks, he has been complaining of headaches. She also notes that he has been \u201cacting strange\u201d and has had difficulty walking over the past few days. His medical history is significant for type 2&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Diabetes_mellitus\" target=\"_blank\" rel=\"noreferrer noopener\">diabetes mellitus<\/a>&nbsp;treated with&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Miscellaneous_hypoglycemics\" target=\"_blank\" rel=\"noreferrer noopener\">metformin<\/a>. Physical examination shows the patient has postictal confusion but is responsive. The patient dies two days later secondary to respiratory arrest despite appropriate interventions. An autopsy is performed, and gross examination of the brain is shown below:<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"395\" height=\"260\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/1.jpg\" alt=\"Glioblastoma Multiforme.\" class=\"wp-image-2030\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/1.jpg 395w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/1.jpg?resize=300,197 300w\" sizes=\"auto, (max-width: 395px) 100vw, 395px\" \/><\/figure>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\">Reproduced by:&nbsp;<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Glioblastoma_macro.jpg\" target=\"_blank\" rel=\"noreferrer noopener\">Wikimedia Commons<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Histopathological examination of this patient\u2019s lesion is most likely to show which of the following findings?<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Concentrically_arranged_spindle_cells_in_a_whorled_pattern_with_areas_of_calcifications\"><\/span>A. Concentrically arranged spindle cells in a whorled pattern with areas of calcifications<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Hypercellular_areas_of_spindle_cells_alternating_with_hypocellular_myxoid_areas\"><\/span>B. Hypercellular areas of spindle cells alternating with hypocellular myxoid areas<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Large_abnormal_lymphocytes_infiltrating_perivascular_spaces\"><\/span>C. Large abnormal lymphocytes infiltrating perivascular spaces&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Thin-walled_capillaries_with_minimal_intervening_parenchyma\"><\/span>D. Thin-walled capillaries with minimal intervening parenchyma<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Pleomorphic_tumor_cells_surrounding_an_area_of_central_necrosis\"><\/span>E. Pleomorphic tumor cells surrounding an area of central necrosis<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Scroll down to find the answer!<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-rich is-provider-embed-handler wp-block-embed-embed-handler wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Everybody loves Osmosis.org\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/kizbJZ9cdLg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><u><em><strong>\u2192 Reinforce your understanding with more self-assessment items on Osmosis.<\/strong>\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=\"E_Pleomorphic_tumor_cells_surrounding_an_area_of_central_necrosis-2\"><\/span>E. Pleomorphic tumor cells surrounding an area of central necrosis<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the&nbsp;<strong>Main Explanation<\/strong>, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The incorrect answers to today&#8217;s USMLE\u00ae Step 1 Question are&#8230;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Concentrically_arranged_spindle_cells_in_a_whorled_pattern_with_areas_of_calcifications-2\"><\/span>A. Concentrically arranged spindle cells in a whorled pattern with areas of calcifications<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;These histological findings are consistent with&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Adult_brain_tumors\" target=\"_blank\" rel=\"noreferrer noopener\">meningiomas<\/a>, which are common, typically benign tumors of arachnoid cell origin.&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Adult_brain_tumors\" target=\"_blank\" rel=\"noreferrer noopener\">Meningiomas<\/a>&nbsp;are extra-axial (external to brain parenchyma) and may have a dural attachment. This patient autopsy shows an intra-axial tumor with central necrosis and hemorrhage, which favors the diagnosis of glioblastoma multiforme.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Hypercellular_areas_of_spindle_cells_alternating_with_hypocellular_myxoid_areas-2\"><\/span>B. Hypercellular areas of spindle cells alternating with hypocellular myxoid areas<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;These histological findings are consistent with a&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Acoustic_neuroma_(schwannoma)\" target=\"_blank\" rel=\"noreferrer noopener\">Schwannoma<\/a>, a tumor of Schwann cell origin. It commonly arises at the cerebellopontine angle, involving both&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Cranial_nerves\" target=\"_blank\" rel=\"noreferrer noopener\">cranial nerves<\/a>&nbsp;VII and VIII, but it can occur along any peripheral nerve. Patients present with sensorineural hearing loss and tinnitus. This patient\u2019s autopsy shows an intra-axial tumor in the cerebral hemispheres with central necrosis, which favors the diagnosis of glioblastoma multiforme.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Large_abnormal_lymphocytes_infiltrating_perivascular_spaces-2\"><\/span>C. Large abnormal lymphocytes infiltrating perivascular spaces<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;These findings are consistent with primary central nervous system lymphoma, a rare form of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Non-Hodgkin_lymphoma\" target=\"_blank\" rel=\"noreferrer noopener\">non-Hodgkin lymphoma<\/a>&nbsp;seen most commonly in immunocompromised patients (e.g.&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/HIV_(AIDS)\" target=\"_blank\" rel=\"noreferrer noopener\">HIV<\/a>). Typical locations include the corpus callosum, periventricular white matter, and basal ganglia, presenting as either solitary or multiple lesions. This patient is immunocompetent with a characteristic lesion on autopsy, which favors another diagnosis.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Thin-walled_capillaries_with_minimal_intervening_parenchyma-2\"><\/span>D. Thin-walled capillaries with minimal intervening parenchyma<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;These histological findings are consistent with&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Adult_brain_tumors\" target=\"_blank\" rel=\"noreferrer noopener\">hemangioblastoma<\/a>, a tumor of blood vessel origin. These tumors most often arise in the&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Cerebellum\" target=\"_blank\" rel=\"noreferrer noopener\">cerebellum<\/a>&nbsp;and are associated with von Hippel-Lindau syndrome. This patient\u2019s tumor morphology and location favors another diagnosis.<\/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\u2019s presentation (seizures associated with progressive headache, weakness, and personality changes occurring rapidly over the course of several weeks), in addition to the characteristic gross morphology seen on autopsy, is consistent with the diagnosis of<strong>&nbsp;<\/strong><strong><a href=\"https:\/\/www.osmosis.org\/learn\/Adult_brain_tumors\" target=\"_blank\" rel=\"noreferrer noopener\">glioblastoma multiforme<\/a><\/strong><strong>&nbsp;(GBM)<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">GBM, or&nbsp;<strong>grade IV astrocytoma&nbsp;<\/strong>(astrocyte origin), is a highly malignant primary brain tumor with an approximately 1-year median survival. On histology, the tumor stains positive for&nbsp;<strong>glial fibrillary acidic protein (GFAP)&nbsp;<\/strong>and is characterized by \u201c<strong>pseudopalisading<\/strong>\u201d&nbsp;<strong>pleomorphic tumor cells&nbsp;<\/strong>bordering central areas of necrosis, hemorrhage, and\/or microvascular proliferation. On gross morphology, tumors are often large, poorly defined, and have areas of&nbsp;<strong>necrosis<\/strong>&nbsp;and&nbsp;<strong>hemorrhage<\/strong>. On imaging, GBM is seen as a&nbsp;<strong>ring-enhancing lesion<\/strong>, because the contrast-enhancing tumor cells form a ring to surround the necrotic center, which does not take up contrast. The tumor can cross the corpus callosum, leading to a midline shift and causing a mass effect (\u201c<strong>butterfly glioma<\/strong>\u201d).<\/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=\"Adult brain tumors ~high yield~\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/p0oL5vhXm9M?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\/Adult_brain_tumors\" target=\"_blank\" rel=\"noreferrer noopener\">Glioblastoma multiforme<\/a><\/strong>&nbsp;is a common, highly malignant primary brain tumor with poor survival rates. On histopathology, it stains positive for&nbsp;<strong>glial fibrillary acidic protein (GFAP)<\/strong>&nbsp;and shows \u201c<strong>pseudopalisading<\/strong>\u201d&nbsp;<strong>pleomorphic tumor cells&nbsp;<\/strong>that form a ring around a central area of&nbsp;<strong>necrosis<\/strong>&nbsp;and hemorrhage.<\/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\">Chang SM, Parney IF, Huang W, et al. Patterns of care for adults with newly diagnosed malignant glioma.&nbsp;<em>JAMA<\/em>. 2005;293(5):557\u2010564.&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/15687310\/\" target=\"_blank\" rel=\"noreferrer noopener\">doi:10.1001\/jama.293.5.557<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Valentinis L, Tuniz F, Valent F, et al. Headache attributed to intracranial tumours: a prospective cohort study.&nbsp;<em>Cephalalgia<\/em>. 2010;30(4):389\u2010398.&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/19673912\/\" target=\"_blank\" rel=\"noreferrer noopener\">doi:10.1111\/j.1468-2982.2009.01970.x<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Reuss DE, Sahm F, Schrimpf D, et al. ATRX and IDH1-R132H immunohistochemistry with subsequent copy number analysis and IDH sequencing as a basis for an &#8220;integrated&#8221; diagnostic approach for adult astrocytoma, oligodendroglioma and glioblastoma.&nbsp;<em>Acta Neuropathol<\/em>. 2015;129(1):133\u2010146.&nbsp;<a href=\"https:\/\/link.springer.com\/article\/10.1007\/s00401-014-1370-3\" target=\"_blank\" rel=\"noreferrer noopener\">doi:10.1007\/s00401-014-1370-3<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Hochberg FH, Miller DC. Primary central nervous system lymphoma.&nbsp;<em>J Neurosurg<\/em>. 1988;68(6):835\u2010853.&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/3286832\/\" target=\"_blank\" rel=\"noreferrer noopener\">doi:10.3171\/jns.1988.68.6.0835<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>_________________________<\/strong><br><br><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis today! Access your&nbsp;<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>&nbsp;and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" height=\"366\" width=\"1024\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T101549.044.png?w=1024\" alt=\"The most powerful platform for learning medicine. Try it free today.\" class=\"wp-image-1993\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T101549.044.png 1400w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T101549.044.png?resize=300,107 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T101549.044.png?resize=768,274 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T101549.044.png?resize=1024,366 1024w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><sub>The United States Medical Licensing Examination (USMLE\u00ae) is a joint program of the Federation of State Medical Boards (FSMB\u00ae) and National Board of Medical Examiners (NBME\u00ae). Osmosis is not affiliated with NBME nor FSMB.&nbsp;<\/sub><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics. Today&#8217;s case involves a 60-year-old man with a seizure. The man dies two days later.&nbsp;Can you figure out the cause? A 60-year-old man is admitted to the emergency department due to a seizure. The patient&#8217;s wife reports that [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":2029,"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-2028","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: Glioblastoma Multiforme - 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-glioblastoma-multiforme\" \/>\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: Glioblastoma Multiforme - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics. 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What is crucial to the patient's diagnosis and treatment?","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: Focused history","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-focused-history.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-focused-history.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-focused-history.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-focused-history.webp 2x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-focused-history.webp 3x"},"classes":[]},{"id":9081,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-antipsychotic-medication","url_meta":{"origin":2028,"position":3},"title":"USMLE\u00ae Step 1 Question of the Day:\u00a0Antipsychotic medication","author":"Rowan Bell, MD &amp; Marina Horiates Kerekes, MD","date":"January 14, 2026","format":false,"excerpt":"A patient with schizophrenia develops involuntary movements after antipsychotic treatment. Learn which medication carries the highest risk and how atypicals are named.","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: Antipsychotic medication","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/01\/Step-1-Question-of-the-day-Antipsychotic-medication.png","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/01\/Step-1-Question-of-the-day-Antipsychotic-medication.png 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/01\/Step-1-Question-of-the-day-Antipsychotic-medication.png 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/01\/Step-1-Question-of-the-day-Antipsychotic-medication.png 2x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/01\/Step-1-Question-of-the-day-Antipsychotic-medication.png 3x"},"classes":[]},{"id":5880,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-tramadol","url_meta":{"origin":2028,"position":4},"title":"USMLE\u00ae Step 1 Question of the Day:\u00a0Tramadol","author":"Marina Horiates Kerekes, MD &amp; Team","date":"April 23, 2025","format":false,"excerpt":"Enhance your USMLE\u00ae Step 2 CK exam preparation with today\u2019s case study of a 50-year-old woman experiencing symptoms of serotonin syndrome after tramadol use. 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Based on the findings, identify the most likely diagnosis. A 36-year-old presents to their outpatient provider for evaluation of treatment-resistant depression. 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