{"id":2246,"date":"2021-12-08T20:45:00","date_gmt":"2021-12-08T20:45:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=2246"},"modified":"2025-10-01T11:40:33","modified_gmt":"2025-10-01T19:40:33","slug":"usmle-step-1-question-of-the-day-av-block","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-av-block","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: AV Block"},"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-av-block\/#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-av-block\/#E_No_treatment_is_required\" >E. No treatment is required<\/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-av-block\/#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-av-block\/#A_Perform_invasive_electrophysiology_study\" >A. Perform invasive electrophysiology study<\/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-av-block\/#B_Recommend_decreasing_physical_activity\" >B. Recommend decreasing physical activity<\/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-av-block\/#C_Perform_transthoracic_echocardiogram\" >C. Perform transthoracic echocardiogram<\/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-av-block\/#D_Place_permanent_pacemaker\" >D. Place permanent pacemaker<\/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-av-block\/#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-av-block\/#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-av-block\/#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 20-year-old male patient with a seemingly abnormal ECG reading.&nbsp;<\/em><\/strong><strong><em>Can you figure it out?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 20-year-old male college student comes to the clinic with an ECG obtained at a health fair, where he was told the reading was abnormal. He is a competitive track and field athlete and excels in long-distance running. He denies chest pain, shortness of breath, or loss of consciousness. He has no prior medical history and takes no medications other than a daily multivitamin. He denies family history of sudden unexpected deaths. His temperature is 37.0\u00b0C (98.6\u00b0F), pulse is 65\/min, respirations are 20\/min, and blood pressure is 115\/75 mmHg. He appears thin and comfortable. Physical exam shows a normal heart rate without murmurs and 2+ regular carotid and radial pulses bilaterally. Lungs are clear. ECG shows the following:<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"900\" height=\"909\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2.jpg\" alt=\"ECG with a prolonged PR interval.\" class=\"wp-image-2248\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2.jpg 900w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2.jpg?resize=297,300 297w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2.jpg?resize=768,776 768w\" sizes=\"auto, (max-width: 900px) 100vw, 900px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Reproduced from:&nbsp;<a href=\"https:\/\/en.wikipedia.org\/wiki\/First-degree_atrioventricular_block#\/media\/File:FirstAVBlock.jpg\" target=\"_blank\" rel=\"noreferrer noopener\">Wikipedia<\/a><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following is the most appropriate management of this patient?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Perform invasive electrophysiology study<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Recommend decreasing physical activity<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Perform transthoracic echocardiogram<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Place permanent pacemaker<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. No treatment is required<\/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=\"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_No_treatment_is_required\"><\/span>E. No treatment is required<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_Perform_invasive_electrophysiology_study\"><\/span>A. Perform invasive electrophysiology study<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>In patients with isolated&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Atrioventricular_block\" target=\"_blank\" rel=\"noreferrer noopener\">first degree AV block<\/a>, an invasive electrophysiology study (EPS) is not needed for diagnosis. If a wide&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/ECG_intervals\" target=\"_blank\" rel=\"noreferrer noopener\">QRS complex<\/a>&nbsp;is present concurrently with PR prolongation, the conduction delay may be present below the AV node, and EPS may be helpful to determine the precise location.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Recommend_decreasing_physical_activity\"><\/span>B. Recommend decreasing physical activity<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Highly conditioned endurance athletes may have evidence of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Atrioventricular_block\" target=\"_blank\" rel=\"noreferrer noopener\">first degree AV block<\/a>&nbsp;because of increased vagal tone with a lower resting heart rate. In the absence of symptoms, reducing physical activity is unnecessary.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Perform_transthoracic_echocardiogram\"><\/span>C. Perform transthoracic echocardiogram<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>All patients with suspected&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Atrioventricular_block\" target=\"_blank\" rel=\"noreferrer noopener\">first degree AV blocks<\/a>&nbsp;should be questioned about a history of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Heart_blocks:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\">heart disease<\/a>. In the absence of risk factors for heart disease, in an otherwise healthy young patient with first degree AV block, an echocardiogram will not provide helpful information and is unnecessary.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Place_permanent_pacemaker\"><\/span>D. Place permanent pacemaker<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>A pacemaker is not recommended in asymptomatic patients with&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Atrioventricular_block\" target=\"_blank\" rel=\"noreferrer noopener\">first degree AV block.<\/a><\/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_0bce30.png\" alt=\"Osmosis ad to create an account\" class=\"wp-image-2249\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_0bce30.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_0bce30.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 has isolated first degree atrioventricular (AV) block on his&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/ECG_intervals\" target=\"_blank\" rel=\"noreferrer noopener\">ECG<\/a>.<a href=\"https:\/\/www.osmosis.org\/learn\/Atrioventricular_block\" target=\"_blank\" rel=\"noreferrer noopener\">&nbsp;<strong>First degree AV block<\/strong><\/a>&nbsp;is defined as a&nbsp;<strong>PR interval &gt; 200 milliseconds<\/strong>, representing prolonged conduction through the AV node:<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"737\" height=\"401\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T144815.129.png\" alt=\"ECG with Normal delay PR interval 200 ms.\" class=\"wp-image-2250\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T144815.129.png 737w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T144815.129.png?resize=300,163 300w\" sizes=\"auto, (max-width: 737px) 100vw, 737px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"741\" height=\"398\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T144959.344.png\" alt=\"ECG 1st degree AV block with prolonged PR interval.\" class=\"wp-image-2251\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T144959.344.png 741w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T144959.344.png?resize=300,161 300w\" sizes=\"auto, (max-width: 741px) 100vw, 741px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">First degree AV block may be caused by heightened&nbsp;<strong>vagal tone<\/strong>&nbsp;(e.g. highly conditioned endurance athletes),&nbsp;<strong>structural abnormalities<\/strong>&nbsp;of the AV node,&nbsp;<strong>medications<\/strong>&nbsp;that impair nodal conduction (e.g.,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Positive_inotropic_medications\" target=\"_blank\" rel=\"noreferrer noopener\">digoxin<\/a>,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Class_II_antiarrhythmics:_Beta_blockers\" target=\"_blank\" rel=\"noreferrer noopener\">beta blockers<\/a>, non-dihydropyridine&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Class_IV_antiarrhythmics:_Calcium_channel_blockers_and_others\" target=\"_blank\" rel=\"noreferrer noopener\">calcium channel blockers<\/a>), conduction pathway&nbsp;<strong>infiltration<\/strong>&nbsp;(e.g.&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Sarcoidosis\" target=\"_blank\" rel=\"noreferrer noopener\">sarcoidosis<\/a>), and&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Ischemia\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>ischemia<\/strong>&nbsp;<\/a>(e.g. inferior wall myocardial infarction, because the AV node is supplied by the right coronary artery).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The majority of cases of first degree AV block are found incidentally on ECG, are not dangerous, and do not cause symptoms. History and physical examination should be directed toward identifying any of the pathologies described above. In the absence of concerning cardiac findings on exam, asymptomatic patients like this athlete require no further workup or 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\"><strong><a href=\"https:\/\/www.osmosis.org\/learn\/Atrioventricular_block\" target=\"_blank\" rel=\"noreferrer noopener\">First degree AV block<\/a><\/strong>&nbsp;is defined on&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/ECG_intervals\" target=\"_blank\" rel=\"noreferrer noopener\">ECG&nbsp;<\/a>as a PR interval &gt; 200 milliseconds. Most cases are benign and asymptomatic, and therefore, invasive studies and pacemaker placement are not recommended.<\/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=\"Atrioventricular (AV) block - first, second, third (complete) degree\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/VWZC8QehNJc?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=\"References\"><\/span><strong>References<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Viitasalo MT, Kala R, Eisalo A. Ambulatory electrocardiographic recording in endurance athletes.&nbsp;<em>Br Heart J<\/em>. 1982;47(3):213-220.&nbsp;<a href=\"https:\/\/heart.bmj.com\/content\/47\/3\/213.short?casa_token=x9MNw2ypfW0AAAAA:UJDG0NB8KDMRXpVooCOTLebPZa0zs6CNTcCj7aveyYPdWi3Zj-Z88HnsqYT9_gtVTlsF0YPk3nI\" target=\"_blank\" rel=\"noreferrer noopener\">doi:10.1136\/hrt.47.3.213<\/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-full\"><a href=\"https:\/\/www.osmosis.org\/login?type=create\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_bd02fa.png\" alt=\"The most powerful platform for learning medicine and the health sciences Try it now button.\" class=\"wp-image-2252\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_bd02fa.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_bd02fa.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><sub>The United States Medical Licensing Examination (USMLE\u00ae) is a joint program of the Federation of State Medical Boards (FSMB\u00ae) and National Board of Medical Examiners (NBME\u00ae). Osmosis is not affiliated with NBME nor FSMB.&nbsp;<\/sub><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>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 20-year-old male patient with a seemingly abnormal ECG reading.&nbsp;Can you figure it out? A 20-year-old male college student comes to the clinic with an ECG obtained at a health fair, where he was told [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":2247,"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-2246","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: AV Block - 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-av-block\" \/>\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: AV Block - 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. Today&#8217;s case involves a 20-year-old male patient with a seemingly abnormal ECG reading.&nbsp;Can you figure it out? A 20-year-old male college student comes to the clinic with an ECG obtained at a health fair, where he was told [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-av-block\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2021-12-08T20:45:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-10-01T19:40:33+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T144607.920.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1081\" \/>\n\t<meta property=\"og:image:height\" content=\"1081\" \/>\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-av-block#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-av-block\"},\"author\":{\"name\":\"Marina Horiates Kerekes, MD &amp; 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Today's case involves a 38-year-old woman with pain in the center of her chest. The pain is slightly better when she sits up straight. 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Strengthen your clinical assessment skills and improve your understanding of managing this common genetic condition!","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 homozygous delta F508 deletion","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/homozygous-delta-f508-deletion.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/homozygous-delta-f508-deletion.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/homozygous-delta-f508-deletion.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/homozygous-delta-f508-deletion.webp 2x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/homozygous-delta-f508-deletion.webp 3x"},"classes":[]}],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/2246","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=2246"}],"version-history":[{"count":3,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/2246\/revisions"}],"predecessor-version":[{"id":6705,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/2246\/revisions\/6705"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media\/2247"}],"wp:attachment":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media?parent=2246"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/categories?post=2246"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/tags?post=2246"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}