{"id":3146,"date":"2021-05-19T13:32:00","date_gmt":"2021-05-19T13:32:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=3146"},"modified":"2025-10-01T11:42:39","modified_gmt":"2025-10-01T19:42:39","slug":"usmle-step-1-question-of-the-day-urinary-incontinence","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-urinary-incontinence","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Urinary Incontinence"},"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-urinary-incontinence\/#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-urinary-incontinence\/#A_Impaired_parasympathetic_innervation_of_the_bladder\" >A. Impaired parasympathetic innervation of the bladder<\/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-urinary-incontinence\/#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-urinary-incontinence\/#B_Impaired_sympathetic_innervation_of_the_bladder\" >B. Impaired sympathetic innervation of the bladder<\/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-urinary-incontinence\/#C_Peripheral_vascular_disease_causing_reduced_blood_supply_to_the_urethra\" >C. Peripheral vascular disease causing reduced blood supply to the urethra<\/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-urinary-incontinence\/#D_Abnormal_connection_between_the_bladder_and_vagina\" >D. Abnormal connection between the bladder and vagina<\/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-urinary-incontinence\/#E_Pelvic_floor_musculature_weakness_causing_hypermobile_urethra\" >E.&nbsp;Pelvic floor&nbsp;musculature weakness causing hypermobile urethra<\/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-urinary-incontinence\/#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-urinary-incontinence\/#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-urinary-incontinence\/#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 55 year-old female patient with urinary incontinence. Her past medical history is notable for type 2 diabetes mellitus and hypertension. Can you figure it out?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 55 year-old female comes to her outpatient physician because of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Urinary_incontinence\" target=\"_blank\" rel=\"noreferrer noopener\">urinary incontinence<\/a>. The patient reports a sense of fullness in the bladder and continuous dribbling of urine over the past two months. Past medical history is notable for type 2 diabetes mellitus and&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hypertension\" target=\"_blank\" rel=\"noreferrer noopener\">hypertension<\/a>. However, the patient reports being inconsistent in taking her medications. Her temperature is 37.1\u00b0C (98.8\u00b0F), blood pressure is 158\/91 mmHg, and pulse is 75\/min. Physical exam reveals decreased sensation to soft touch and pinprick in the distal arms and legs. Laboratory results are as follows:<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Laboratory value<\/strong><\/td><td><strong>Result<\/strong><\/td><\/tr><tr><td>Glucose<\/td><td>167 mg\/dL<\/td><\/tr><tr><td>HbA1c<\/td><td>8.1%<\/td><\/tr><tr><td>Postvoid residual volume<\/td><td>&nbsp;170 ml<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following best describes the pathophysiology of this patient\u2019s symptoms?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Impaired parasympathetic innervation of the bladder<br><\/strong><strong>B. Impaired sympathetic innervation of the bladder<br><\/strong><strong>C. Peripheral vascular disease causing reduced blood supply to the urethra<br><\/strong><strong>D. Abnormal connection between the bladder and vagina<br><\/strong><strong>E. Pelvic floor musculature weakness causing hypermobile urethra<\/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=\"A_Impaired_parasympathetic_innervation_of_the_bladder\"><\/span>A. Impaired parasympathetic innervation of the bladder<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=\"B_Impaired_sympathetic_innervation_of_the_bladder\"><\/span>B. Impaired sympathetic innervation of the bladder<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>This patient has symptoms of overflow incontinence such as bladder fullness, continuous dribbling of urine, and an ultrasound showing an increased postvoid residual volume. The&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Sympathetic_nervous_system\" target=\"_blank\" rel=\"noreferrer noopener\">sympathetic nervous system<\/a>&nbsp;prevents micturition by contracting the internal urethral sphincter and relaxing the detrusor. As a result, reduced sympathetic innervation would cause increased detrusor activity and reduced sphincter tone, resulting in symptoms more consistent with those of urge incontinence.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Peripheral_vascular_disease_causing_reduced_blood_supply_to_the_urethra\"><\/span>C. Peripheral vascular disease causing reduced blood supply to the urethra<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Poorly controlled&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Diabetes_mellitus\" target=\"_blank\" rel=\"noreferrer noopener\">diabetes mellitus<\/a>&nbsp;can lead to&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Peripheral_artery_disease\" target=\"_blank\" rel=\"noreferrer noopener\">peripheral vascular disease<\/a>. In healthy patients, increased blood supply to the urethra increases intraurethral pressure and prevents urinary loss. In contrast, reduced blood flow would cause a decrease in intraurethral pressure, ultimately causing symptoms similar to those seen in stress incontinence.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Abnormal_connection_between_the_bladder_and_vagina\"><\/span>D. Abnormal connection between the bladder and vagina<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;This describes a vesicovaginal fistula. In patients with this condition, urine from the bladder can pass through the fistula and leak into the vagina, resulting in continuous incontinence. Having an elevated postvoid residual volume or sense of pubic fullness would be atypical in patients with a vesicovaginal fistula.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Pelvic_floor_musculature_weakness_causing_hypermobile_urethra\"><\/span>E.&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Pelvic_floor\" target=\"_blank\" rel=\"noreferrer noopener\">Pelvic floor<\/a>&nbsp;musculature weakness causing hypermobile urethra<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>A hypermobile urethra can cause stress incontinence. This is because increases in abdominal pressure will be transmitted more to the bladder and less to the urethra. As a result, pressure within the bladder will exceed that within the urethra, resulting in urine expulsion. Stress incontinence typically presents as loss of urine with activities that increase intra-abdominal pressure (e.g., coughing, sneezing, laughing), which is inconsistent with this patient\u2019s presentation.<\/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 has&nbsp;<strong>overflow incontinence<\/strong>&nbsp;secondary to&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Diabetic_nephropathy?from=\/foundational-sciences\/pathology\/renal-system\/bladder-and-urethral-disorders\/urinary-incontinence\" target=\"_blank\" rel=\"noreferrer noopener\">diabetic neuropathy<\/a><\/strong>. To understand the mechanism behind the patient\u2019s condition, it is important to first understand urinary tract and pelvic physiology.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The bladder is connected to the urethra via the urethrovesical junction. At the junction are two sphincters, the&nbsp;<strong>internal sphincter&nbsp;<\/strong>which is regulated by the autonomic nervous system, and&nbsp;<strong>external sphincter&nbsp;<\/strong>which is regulated by the somatic nervous system.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Neurological control of the bladder and internal urethral sphincter is provided by both the sympathetic and parasympathetic nervous system.<strong>&nbsp;<\/strong><strong><a href=\"https:\/\/www.osmosis.org\/learn\/Sympathetic_nervous_system\" target=\"_blank\" rel=\"noreferrer noopener\">Sympathetic<\/a><\/strong><strong>&nbsp;signals ensure continence&nbsp;<\/strong>by preventing detrusor muscle contraction and promoting internal sphincter contraction (increases bladder outlet resistance). In contrast,&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Parasympathetic_nervous_system\" target=\"_blank\" rel=\"noreferrer noopener\">parasympathetic<\/a><\/strong><strong>&nbsp;signals promote micturition<\/strong>&nbsp;by inducing contraction of the detrusor and relaxing the internal sphincter.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Another line of regulation involves controlling&nbsp;<strong>blood flow to the urethra<\/strong>. Increased urethral blood flow increases intraurethral pressure, ultimately preventing urine loss.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In this vignette, the patient has poorly controlled diabetes that has caused somatic and autonomic neuropathy. The patient\u2019s symptoms of suprapubic fullness, continuous dribbling of urine, and increased postvoid residual volume are consistent with those of overflow incontinence. This condition would manifest if&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Parasympathetic_nervous_system\" target=\"_blank\" rel=\"noreferrer noopener\">parasympathetic<\/a><\/strong><strong>&nbsp;signals<\/strong>&nbsp;had difficulty reaching the bladder or urethra, resulting in a lack of detrusor contraction and urethral sphincter relaxation.<\/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\">The&nbsp;<strong>detrusor muscle<\/strong>&nbsp;and&nbsp;<strong>internal urethral sphincter&nbsp;<\/strong>are innervated by both the sympathetic and parasympathetic nervous systems.&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Sympathetic_nervous_system\" target=\"_blank\" rel=\"noreferrer noopener\">Sympathetic<\/a><\/strong><strong>&nbsp;activity prevents urination<\/strong>&nbsp;by preventing detrusor contraction and promoting internal urethral sphincter contraction.<strong>&nbsp;<\/strong><strong><a href=\"https:\/\/www.osmosis.org\/learn\/Parasympathetic_nervous_system\" target=\"_blank\" rel=\"noreferrer noopener\">Parasympathetic<\/a><\/strong><strong>&nbsp;activity promotes urination<\/strong>&nbsp;by inducing detrusor contraction and relaxing the internal urethral sphincter.<\/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<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/books.google.mw\/books?id=asruAQAACAAJ&amp;printsec=frontcover#v=onepage&amp;q&amp;f=false\" target=\"_blank\" rel=\"noreferrer noopener\">Blueprints Obstetrics &amp; Gynecology<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.elsevier.com\/books\/grays-anatomy-for-students\/drake\/978-0-323-39304-1\" target=\"_blank\" rel=\"noreferrer noopener\">Gray\u2019s Anatomy for Students 4th Edition<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/30352207\/\" target=\"_blank\" rel=\"noreferrer noopener\">Diabetic bladder dysfunction: A review<\/a><\/li>\n<\/ul>\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;<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>&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\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_7ea6e6.png\" alt=\"1800 + fun bite-sized videos break down lectures in minutes. Try it free today button.\" class=\"wp-image-3148\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_7ea6e6.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_7ea6e6.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 55 year-old female patient with urinary incontinence. Her past medical history is notable for type 2 diabetes mellitus and hypertension. Can you figure it out? A 55 year-old female comes to her outpatient physician [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":3147,"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-3146","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: Urinary Incontinence - 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-urinary-incontinence\" \/>\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: Urinary Incontinence - 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 55 year-old female patient with urinary incontinence. Her past medical history is notable for type 2 diabetes mellitus and hypertension. Can you figure it out? 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Today's case involves a young girl who is worried because of recent urinary issues and weight loss. These symptoms are upsetting her because she is trying to keep a certain weight for boxing\u2026","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"USMLE\u00ae Step 1 Question: Human Leukocyte Antigen Complex","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T181141.939.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T181141.939.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T181141.939.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T181141.939.webp 2x"},"classes":[]},{"id":4200,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-high-blood-pressure","url_meta":{"origin":3146,"position":5},"title":"USMLE\u00ae Step 2 Question of the Day: High blood pressure","author":"Marina Horiates Kerekes, MD &amp; Team","date":"September 4, 2024","format":false,"excerpt":"Prepare for your USMLE Step 2 with this case: A 55-year-old woman presents with stage 1 hypertension and occasional headaches. Her 24-hour blood pressure monitoring and low ASCVD risk score point to a critical next step in management.A 55-year-old woman presents to her primary care physician for a follow-up appointment\u2026","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-high-blood-pressure.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-high-blood-pressure.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-high-blood-pressure.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-high-blood-pressure.webp 2x"},"classes":[]}],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/3146","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=3146"}],"version-history":[{"count":2,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/3146\/revisions"}],"predecessor-version":[{"id":6748,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/3146\/revisions\/6748"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media\/3147"}],"wp:attachment":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media?parent=3146"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/categories?post=3146"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/tags?post=3146"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}