{"id":3336,"date":"2021-03-31T17:26:00","date_gmt":"2021-03-31T17:26:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=3336"},"modified":"2025-10-01T11:42:39","modified_gmt":"2025-10-01T19:42:39","slug":"usmle-step-1-question-of-the-day-bilateral-pitting-ankle-edema","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-bilateral-pitting-ankle-edema","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Bilateral Pitting Ankle Edema"},"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-bilateral-pitting-ankle-edema\/#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-bilateral-pitting-ankle-edema\/#C_Proteinuria\" >C. Proteinuria<\/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-bilateral-pitting-ankle-edema\/#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-bilateral-pitting-ankle-edema\/#A_Elevated_fasting_blood_glucose\" >A. Elevated fasting blood glucose<\/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-bilateral-pitting-ankle-edema\/#B_Neutropenia\" >B. Neutropenia<\/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-bilateral-pitting-ankle-edema\/#D_Thrombocytosis\" >D. Thrombocytosis<\/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-bilateral-pitting-ankle-edema\/#E_Uremia\" >E. Uremia&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-bilateral-pitting-ankle-edema\/#F_Elevated_cardiac_troponin_T\" >F. Elevated cardiac troponin T<\/a><\/li><\/ul><\/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-bilateral-pitting-ankle-edema\/#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-10\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-bilateral-pitting-ankle-edema\/#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-11\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-bilateral-pitting-ankle-edema\/#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 38-year-old woman with pain in the center of her chest. The pain is slightly better when she sits up straight. Physical examination shows conjunctival pallor and bilateral pitting ankle edema.&nbsp;<\/em><\/strong><strong><em><strong><em><strong><em>Can you figure it out?<\/em><\/strong><\/em><\/strong><\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 38-year-old woman presents to the emergency department with chest pain for the past two days. The pain started gradually and is located in the center of her chest. It is slightly better when she sits up straight, and it is not affected by exertion or rest. The patient also reports feeling fatigued, achy, and feverish for the past few months. She takes no medications, and her family history is non-contributory. The patient does not drink alcohol or smoke cigarettes. The patient\u2019s temperature is 38.6\u00b0C (101.5\u00b0F), pulse is 104\/min, respirations are 22\/min, and blood pressure is 153\/97 mmHg. She appears anxious and uncomfortable. Physical examination shows conjunctival pallor and bilateral pitting ankle edema, and a scratching extra heart sound between the apex and sternum is heard on auscultation. Laboratory studies show the following:<\/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>Sodium<\/td><td>132 mEq\/L<\/td><\/tr><tr><td>Potassium<\/td><td>4.2 mEq\/L<\/td><\/tr><tr><td>Chloride<\/td><td>&nbsp;95 mEq\/L<\/td><\/tr><tr><td>Hemoglobin<\/td><td>7.2 g\/dL<\/td><\/tr><tr><td>Reticulocyte count<\/td><td>4.5%<\/td><\/tr><tr><td>Aspartate aminotransferase<\/td><td>20 U\/L<\/td><\/tr><tr><td>Alanine aminotransferase<\/td><td>18 U\/L<\/td><\/tr><tr><td>Bilirubin, Total<\/td><td>3.4<\/td><\/tr><tr><td>Bilirubin, Direct<\/td><td>0.3<\/td><\/tr><tr><td>Lactate dehydrogenase<\/td><td>368 U\/L<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">ECG shows the following:<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"605\" height=\"291\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_cdb98f.png\" alt=\"ECG retrieved from Wikipedia\" class=\"wp-image-3338\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_cdb98f.png 605w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_cdb98f.png?resize=300,144 300w\" sizes=\"auto, (max-width: 605px) 100vw, 605px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Reproduced from:&nbsp;<\/em><a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?sort=relevance&amp;search=pericarditis+ecg&amp;title=Special:Search&amp;profile=advanced&amp;fulltext=1&amp;advancedSearch-current=%7B%7D&amp;ns0=1&amp;ns6=1&amp;ns12=1&amp;ns14=1&amp;ns100=1&amp;ns106=1&amp;searchToken=9zqyntnmcv7vnkzn51g34j4i0#%2Fmedia%2FFile%3APericarditis10.JPG\" target=\"_blank\" rel=\"noreferrer noopener\"><em>Wikimedia Commons<\/em><\/a><strong>&nbsp;&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following additional laboratory findings is most likely to be present in this patient\u2019s condition?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Elevated fasting blood glucose<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Neutropenia<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Proteinuria<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Thrombocytosis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Uremia<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>F. &nbsp;Elevated cardiac troponin T&nbsp;<\/strong>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=\"C_Proteinuria\"><\/span>C. Proteinuria<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_Elevated_fasting_blood_glucose\"><\/span><strong>A. Elevated fasting blood glucose<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect<\/strong>: Although&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Diabetes_mellitus\" target=\"_blank\" rel=\"noreferrer noopener\">diabetes<\/a>&nbsp;can cause renal damage over time, it would not explain this patient\u2019s&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Pericarditis_and_pericardial_effusion\" target=\"_blank\" rel=\"noreferrer noopener\">pericarditis<\/a>&nbsp;or hemolytic anemia. Elevated blood sugar level is not associated with systemic lupus erythematosus (SLE).<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Neutropenia\"><\/span><strong>B. Neutropenia<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect<\/strong>: Although SLE may cause leukopenia and lymphopenia, a low neutrophil count (neutropenia) in isolation is not specifically associated with SLE.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Thrombocytosis\"><\/span><strong>D. Thrombocytosis<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect<\/strong>: Hematologic effects of SLE include leukopenia, thrombocytopenia, and autoimmune hemolysis. SLE is not associated with increased hematologic cell counts, including platelets.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Uremia\"><\/span><strong>E. Uremia&nbsp;<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect<\/strong>: Although increased serum urea nitrogen might result from a decreased glomerular filtration rate in the setting of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Lupus_nephritis\" target=\"_blank\" rel=\"noreferrer noopener\">lupus nephritis<\/a>, elevated urea nitrogen itself is not associated with SLE.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"F_Elevated_cardiac_troponin_T\"><\/span>F. Elevated cardiac troponin T<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect<\/strong>: Any patient with concerning chest pain should have an ECG done and cardiac troponin drawn to rule out an acute coronary syndrome. However, this patient\u2019s ECG shows diffuse PR depressions and ST elevations without reciprocal changes that are most consistent with pericarditis, which does not elevate troponin levels.<\/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 is most consistent with&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Systemic_lupus_erythematosus\" target=\"_blank\" rel=\"noreferrer noopener\">systemic lupus erythematosus<\/a>&nbsp;(SLE)<\/strong>. The classic presentation of SLE is a reproductive-age woman with arthralgias, fevers, and rash; however, because autoantibodies can attack and damage any organ system in the body, there is a wide range of symptoms and laboratory findings that can suggest a diagnosis of SLE, as seen with this patient. This patient\u2019s chest pain is most likely due to&nbsp;<strong>pericarditis<\/strong>, as evidenced by the constant nature, improvement with sitting up, and pericardial friction rub on auscultation. The laboratory studies demonstrate&nbsp;<strong>hemolytic anemia<\/strong>&nbsp;as suggested by the reticulocytosis, elevated lactate dehydrogenase, and unconjugated (indirect) hyperbilirubinemia.<\/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=\"Systemic lupus erythematosus ~high yield~\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/YXGQCorab8I?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\">In general, the possible clinical manifestations of SLE include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Fever<\/li>\n\n\n\n<li>Hematologic<\/li>\n\n\n\n<li>Neuropsychiatric<\/li>\n\n\n\n<li>Mucocutaneous<\/li>\n\n\n\n<li>Serosal<\/li>\n\n\n\n<li>Musculoskeletal<\/li>\n\n\n\n<li>Renal<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"503\" height=\"312\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_03c33a.png\" alt=\"Osmosis illustration of Diagnosed when 4\/11 criteria are met. Malar rash, discoid rash, photosensitivity, hematologic conditions, antinuclear antibodies, another type of autoantibody, arthritis, renal involvement, neuropsychiatric conditions, oral nasal ulcers, serositis.\" class=\"wp-image-3339\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_03c33a.png 503w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_03c33a.png?resize=300,186 300w\" sizes=\"auto, (max-width: 503px) 100vw, 503px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">This patient exhibits 1) fever, 2) hematologic involvement, 3) serosal involvement (pericarditis), and likely 4) renal involvement, given her edema, which would be evidenced by proteinuria and a low serum protein level. Together, these findings make SLE the most likely diagnosis.<\/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>Systemic lupus erythematosus<\/strong>&nbsp;can be associated with the following: malar rash, discoid rash, photosensitivity, ulcers, serositis, renal disorders, neurologic disorders, arthritis, hematologic disorders, antinuclear antibodies, and other immunologic antibodies.<\/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:\/\/accessmedicine.mhmedical.com\/content.aspx?bookid=2129&amp;sectionid=192284866\" target=\"_blank\" rel=\"noreferrer noopener\">Harrison\u2019s Principles of Internal Medicine<\/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;<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\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_dab7df.png\" alt=\"Osmosis Let's get visual. Sign up now button.\" class=\"wp-image-3340\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_dab7df.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_dab7df.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><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 38-year-old woman with pain in the center of her chest. The pain is slightly better when she sits up straight. Physical examination shows conjunctival pallor and bilateral pitting ankle edema.&nbsp;Can you figure it out? [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":3337,"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-3336","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: Bilateral Pitting Ankle Edema - 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-bilateral-pitting-ankle-edema\" \/>\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: Bilateral Pitting Ankle Edema - 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 38-year-old woman with pain in the center of her chest. The pain is slightly better when she sits up straight. Physical examination shows conjunctival pallor and bilateral pitting ankle edema.&nbsp;Can you figure it out? [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-bilateral-pitting-ankle-edema\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2021-03-31T17:26:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-10-01T19:42:39+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T112652.031.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1081\" \/>\n\t<meta property=\"og:image:height\" content=\"1080\" \/>\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-bilateral-pitting-ankle-edema#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-bilateral-pitting-ankle-edema\"},\"author\":{\"name\":\"Marina Horiates Kerekes, MD &amp; 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