{"id":2107,"date":"2022-06-08T18:43:00","date_gmt":"2022-06-08T18:43:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=2107"},"modified":"2025-10-01T11:40:32","modified_gmt":"2025-10-01T19:40:32","slug":"usmle-step-1-question-of-the-day-dyspnea-on-exertion-and-fatigue","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-dyspnea-on-exertion-and-fatigue","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Dyspnea on Exertion and Fatigue"},"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-dyspnea-on-exertion-and-fatigue\/#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-dyspnea-on-exertion-and-fatigue\/#C_Myocardial_fibrosis\" >C. Myocardial fibrosis<\/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-dyspnea-on-exertion-and-fatigue\/#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-dyspnea-on-exertion-and-fatigue\/#A_Global_dilation_of_the_heart_chambers\" >A. Global dilation of the heart chambers<\/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-dyspnea-on-exertion-and-fatigue\/#B_Myocardial_amyloid_deposition\" >B. Myocardial amyloid deposition<\/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-dyspnea-on-exertion-and-fatigue\/#D_Granulomatous_disease\" >D. Granulomatous disease<\/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-dyspnea-on-exertion-and-fatigue\/#E_Myocardial_iron_deposition\" >E. Myocardial iron deposition<\/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-dyspnea-on-exertion-and-fatigue\/#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-dyspnea-on-exertion-and-fatigue\/#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-dyspnea-on-exertion-and-fatigue\/#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 68-year-old woman complaining of dyspnea on exertion, fatigue, and chest pain. Past medical history includes carcinoma of the breast. Can you figure this one out?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 68-year-old woman comes to the clinic complaining of dyspnea on exertion, fatigue, and chest pain. She also states that she has to use 3 pillows at night when she sleeps. Past medical history includes carcinoma of the breast, for which she received surgery and adjuvant radiation therapy but no chemotherapy. Temperature is 37.2\u00b0C (98.9\u00b0F), pulse is 80\/min, respirations are 20\/min, and blood pressure is 100\/68. Physical exam shows jugular venous distension and bilateral leg edema. Cardiac auscultation shows S3 and S4 heart sounds. Electrocardiogram (ECG) shows low amplitude signals.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"605\" height=\"349\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/ecg.png\" alt=\"\" class=\"wp-image-2111\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/ecg.png 605w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/ecg.png?resize=300,173 300w\" sizes=\"auto, (max-width: 605px) 100vw, 605px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following is the most likely cause of this patient\u2019s disease?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Global dilation of the heart chambers<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Myocardial amyloid deposition<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Myocardial fibrosis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Granulomatous disease<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. &nbsp;Myocardial iron deposition<\/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 with 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=\"C_Myocardial_fibrosis\"><\/span>C. Myocardial fibrosis<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=\"A_Global_dilation_of_the_heart_chambers\"><\/span>A. Global dilation of the heart chambers<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Global dilation of the heart chambers is associated with dilated cardiomyopathy. Dilated cardiomyopathy is associated with chemotherapy (<a href=\"https:\/\/www.osmosis.org\/learn\/Anti-tumor_antibiotics\" target=\"_blank\" rel=\"noreferrer noopener\">doxorubicin<\/a>), not radiation therapy. This patient has restrictive cardiomyopathy.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Myocardial_amyloid_deposition\"><\/span>B. Myocardial amyloid deposition<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Myocardial amyloid deposition is a cause of restrictive cardiomyopathy, but this patient\u2019s history of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Breast_cancer\" target=\"_blank\" rel=\"noreferrer noopener\">breast cancer<\/a>&nbsp;with radiation therapy suggests post-radiation myocardial fibrosis as the most likely cause.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Granulomatous_disease\"><\/span>D. Granulomatous disease<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\/Chronic_granulomatous_disease\" target=\"_blank\" rel=\"noreferrer noopener\">Granulomatous disease<\/a>&nbsp;of the heart associated with&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Sarcoidosis\" target=\"_blank\" rel=\"noreferrer noopener\">sarcoidosis&nbsp;<\/a>is a cause of restrictive cardiomyopathy, but this patient\u2019s history of breast cancer with radiation therapy suggests post-radiation myocardial fibrosis as the most likely cause.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Myocardial_iron_deposition\"><\/span>E. Myocardial iron deposition<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Myocardial iron deposition associated with hereditary&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hemochromatosis\" target=\"_blank\" rel=\"noreferrer noopener\">hemochromatosis&nbsp;<\/a>is a cause of restrictive cardiomyopathy, but this patient\u2019s history of breast cancer with radiation therapy suggests post-radiation myocardial fibrosis as the most likely cause.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\/md\" 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\/image_46a25e.png?w=700\" alt=\"\" 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<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 with dyspnea on exertion, orthopnea, chest pain, past medical history of breast cancer treated with radiation therapy, and low amplitude electrocardiogram most likely has&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Restrictive_cardiomyopathy\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>restrictive cardiomyopathy<\/strong>&nbsp;<\/a>due to&nbsp;<strong>post-radiation myocardial fibrosis<\/strong>. Radiation generates reactive oxygen species in the tissue; over time, this leads to inflammation and can cause myocardial fibrosis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Restrictive cardiomyopathy, which is the least common type of cardiomyopathy, is characterized by rigid ventricles which are unable to stretch appropriately and fill with blood. Therefore, the patient will have&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Heart_failure:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>diastolic dysfunction<\/strong>&nbsp;<\/a>with normal systolic function.<\/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=\"Cardiomyopathies ~high yield~\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/ZQBODF1MZyc?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><figcaption class=\"wp-element-caption\">What are cardiomyopathies? Cardiomyopathies are diseases of the heart muscle and are classified into dilated, hypertrophic, and restrictive cardiomyopathy.<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Causes of restrictive cardiomyopathy include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Genetic: Familial amyloid cardiomyopathy (genetic mutation transthyretin protein)<\/li>\n\n\n\n<li>Infiltrative: Senile cardiac&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Amyloidosis\" target=\"_blank\" rel=\"noreferrer noopener\">amyloidosis<\/a>&nbsp;(transthyretin misfolding with age), iron (hemochromatosis), sarcoidosis<\/li>\n\n\n\n<li>Other: Post-radiation myocardial fibrosis,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Scleroderma\" target=\"_blank\" rel=\"noreferrer noopener\">scleroderma<\/a><\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" height=\"578\" width=\"1024\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/cardiomyopathy-ultrasound-findings.jpg?w=1024\" alt=\"\" class=\"wp-image-2112\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/cardiomyopathy-ultrasound-findings.jpg 1386w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/cardiomyopathy-ultrasound-findings.jpg?resize=300,169 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/cardiomyopathy-ultrasound-findings.jpg?resize=768,433 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/cardiomyopathy-ultrasound-findings.jpg?resize=1024,578 1024w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Diagnosis of restrictive cardiomyopathy is achieved via&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/ECG_basics\" target=\"_blank\" rel=\"noreferrer noopener\">electrocardiogram&nbsp;<\/a><\/strong><strong>(ECG)<\/strong>, which shows&nbsp;<strong>low amplitude signals<\/strong>&nbsp;and short&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/ECG_QRS_transition\" target=\"_blank\" rel=\"noreferrer noopener\">QRS complexes<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Treatment of restrictive cardiomyopathy includes treatment of the underlying cause if possible, loop diuretics,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Adrenergic_antagonists:_Beta_blockers\" target=\"_blank\" rel=\"noreferrer noopener\">beta blockers<\/a>,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Calcium_channel_blockers\" target=\"_blank\" rel=\"noreferrer noopener\">calcium channel blockers<\/a>, and angiotensin converting enzyme inhibitors. However, heart transplant is the only definitive treatment.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span><strong>Major Takeaway<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Restrictive cardiomyopathy, which is the least common cause of cardiomyopathy, is characterized by increased rigidity of the ventricles and diastolic dysfunction. Electrocardiogram shows low amplitude signals and short QRS complexes. Treatment varies based on cause and disease severity.<\/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\">Taunk NK, Haffty BG, Kostis JB, Goyal S. Radiation-induced heart disease: pathologic abnormalities and putative mechanisms. Front Oncol. 2015 Feb 18;5:39. doi:&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/25741474\/\" target=\"_blank\" rel=\"noreferrer noopener\">10.3389\/fonc.2015.00039<\/a>. PMID: 25741474; PMCID: PMC4332338.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Yusuf SW, Sami S, Daher IN. Radiation-induced heart disease: a clinical update. Cardiol Res Pract. 2011 Feb 27;2011:317659. doi:&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/21403872\/\" target=\"_blank\" rel=\"noreferrer noopener\">10.4061\/2011\/317659.<\/a>&nbsp;PMID: 21403872; PMCID: PMC3051159.<\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28857066\/\" target=\"_blank\" rel=\"noreferrer noopener\">.<\/a><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><a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-1\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><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\/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<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 focuses on a 68-year-old woman complaining of dyspnea on exertion, fatigue, and chest pain. Past medical history includes carcinoma of the breast. Can you figure this one out? A 68-year-old woman comes to the clinic complaining [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":2108,"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-2107","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: Dyspnea on Exertion and Fatigue - 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-dyspnea-on-exertion-and-fatigue\" \/>\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: Dyspnea on Exertion and Fatigue - 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 68-year-old woman complaining of dyspnea on exertion, fatigue, and chest pain. Past medical history includes carcinoma of the breast. Can you figure this one out? 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