{"id":3410,"date":"2021-05-05T18:37:00","date_gmt":"2021-05-05T18:37:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=3410"},"modified":"2025-10-01T11:42:39","modified_gmt":"2025-10-01T19:42:39","slug":"usmle-step-1-question-of-the-day-dyspnea-on-exertion","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-dyspnea-on-exertion","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Dyspnea on Exertion"},"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\/#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\/#B_Ischemic_heart_disease\" >B. Ischemic heart disease&nbsp;<\/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\/#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\/#A_Long-standing_untreated_hypertension\" >A. Long-standing untreated hypertension<\/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\/#C_Repetitive_vasoconstriction_of_pulmonary_vasculature\" >C. Repetitive vasoconstriction of pulmonary vasculature<\/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\/#D_Alcohol_consumption\" >D. Alcohol consumption<\/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\/#E_Infection_with_a_positive-sense_single-stranded_RNA_virus\" >E. Infection with a positive-sense single-stranded RNA virus<\/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\/#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\/#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\/#References\" >References&nbsp;<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\">A 70-year-old woman comes to the emergency department due to a three week history of worsening fatigue, dyspnea on exertion, and lower extremity swelling. Her past medical history is significant for&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hypertension:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">hypertension<\/a>&nbsp;and&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hyperlipidemia\" target=\"_blank\" rel=\"noreferrer noopener\">hyperlipidemia<\/a>, but notes no recent travel, sick contacts, or illnesses. She recalls one episode of nausea and diaphoresis while she was lifting boxes at home approximately one month ago, but she does not recall any chest pain or shortness of breath at that time. She is a life-time non-smoker and reports drinking one glass of wine every night with dinner. Her temperature is 37.2\u00b0C (98.9\u00b0 F), pulse is 75\/min, respirations are 18\/min, and blood pressure is 142\/82 mmHg. Physical examination shows 2+ pitting edema of the lower extremities and prominent jugular veins. An additional heart sound is heard just after S2, and faint bibasilar crackles are heard on auscultation of the lungs. Transthoracic echocardiography demonstrates a dilated left ventricle and increased&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Abnormal_heart_sounds\" target=\"_blank\" rel=\"noreferrer noopener\">end-diastolic volume<\/a>, and wall motion abnormalities are noted along the anterolateral heart border. Ejection fraction by visualization is estimated at 34%. Which of the following best describes the underlying cause of this patient\u2019s symptoms?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Long-standing untreated hypertension&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Ischemic heart disease&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Repetitive vasoconstriction of pulmonary vasculature&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Alcohol consumption&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Infection with a positive-sense single-stranded RNA virus<\/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=\"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 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=\"B_Ischemic_heart_disease\"><\/span>B. Ischemic heart disease&nbsp;<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_Long-standing_untreated_hypertension\"><\/span>A. Long-standing untreated hypertension<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Long standing untreated hypertension typically results in findings of diastolic&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Heart_failure\" target=\"_blank\" rel=\"noreferrer noopener\">heart failure<\/a>&nbsp;due to concentric hypertrophy. Findings include a preserved ejection fraction and a normal end-diastolic volume. The patient in this vignette has an increased end diastolic volume and a reduced ejection fraction making an etiology of systolic heart failure more likely.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Repetitive_vasoconstriction_of_pulmonary_vasculature\"><\/span>C. Repetitive vasoconstriction of pulmonary vasculature<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>This answer choice describes the pathophysiology of chronic smoking and COPD leading to&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Cor_pulmonale\" target=\"_blank\" rel=\"noreferrer noopener\">cor pulmonale<\/a>&nbsp;or isolated right sided heart failure. Prolonged vasoconstriction of pulmonary vasculature increases demand on the right heart, eventually leading to peripheral edema and hepatic congestion without&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Pulmonary_edema\" target=\"_blank\" rel=\"noreferrer noopener\">pulmonary edema<\/a>. The patient in this vignette has findings of pulmonary edema and is not a smoker, making this diagnosis less likely.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Alcohol_consumption\"><\/span>D. Alcohol consumption<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Alcohol can cause&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Dilated_cardiomyopathy\" target=\"_blank\" rel=\"noreferrer noopener\">dilated cardiomyopathy<\/a>&nbsp;and systolic heart failure; however, this occurs only with heavy consumption. The patient in this vignette is described as consuming within the recommended drink limit per day, making this diagnosis unlikely.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Infection_with_a_positive-sense_single-stranded_RNA_virus\"><\/span>E. Infection with a positive-sense single-stranded RNA virus<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>This question stem describes the pathophysiology of a dilated cardiomyopathy from coxsackie B virus, which can cause systolic heart failure (as seen in this patient). This answer choice is less likely in this patient without a recent history of infectious illness.<\/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\"><strong>Systolic heart failure&nbsp;<\/strong>is most commonly due to&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Ischemia\" target=\"_blank\" rel=\"noreferrer noopener\">ischemia<\/a>&nbsp;<\/strong>or<strong>&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Myocardial_infarction\" target=\"_blank\" rel=\"noreferrer noopener\">myocardial infarction<\/a><\/strong>, which causes decreased&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Cardiac_contractility\" target=\"_blank\" rel=\"noreferrer noopener\">cardiac contractility<\/a>&nbsp;that leads to systolic dysfunction. The inability of the heart to effectively pump blood forward through circulation results in clinical features of left-sided heart failure causing pulmonary edema:&nbsp;<strong>fatigue<\/strong>,<strong>&nbsp;dyspnea<\/strong>,<strong>&nbsp;orthopnea<\/strong>,<strong>&nbsp;paroxysmal nocturnal dyspnea<\/strong>, as well as&nbsp;<strong>bibasilar crackles<\/strong>&nbsp;and an<strong>&nbsp;S3 heart sound (ventricular gallop)&nbsp;<\/strong>on examination. This often progresses to right-sided heart failure, resulting in<strong>&nbsp;jugular venous distention (JVD)<\/strong>,<strong>&nbsp;pitting edema<\/strong>, and&nbsp;<strong>hepatic congestion<\/strong>. The patient in this question likely suffered an atypical or silent myocardial infarction while she was moving boxes several weeks ago, and without appropriate treatment, she has now developed systolic heart failure. Other causes of systolic heart failure include etiologies of dilated cardiomyopathy including alcohol, coxsackie B virus infection, chronic cocaine use, or&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Trypanosoma_cruzi_(Chagas_disease)\" target=\"_blank\" rel=\"noreferrer noopener\">Chagas disease<\/a>. Echocardiography typically shows an&nbsp;<strong>increased end diastolic volume (EDV)<\/strong>,&nbsp;<strong>decreased contractility<\/strong>&nbsp;(or wall motion abnormalities), and&nbsp;<strong>reduced ejection fraction (EF)<\/strong>.<\/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\">\nhttps:\/\/youtu.be\/lnYqZZgqxNs\n<\/div><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">In contrast to systolic heart failure,&nbsp;<strong>diastolic heart failure<\/strong>&nbsp;is most commonly due to&nbsp;<strong>cardiac hypertrophy&nbsp;<\/strong>from long-standing,<strong>&nbsp;untreated hypertension.&nbsp;<\/strong>It presents with the same clinical features as systolic heart failure. Echocardiographic findings generally demonstrate a&nbsp;<strong>preserved EF&nbsp;<\/strong>and a&nbsp;<strong>normal EDV<\/strong>. Patients with diastolic heart failure will also have&nbsp;<strong>decreased compliance (increased end diastolic pressure)&nbsp;<\/strong>due to stiff ventricular walls. Other etiologies of diastolic heart failure include infiltrative diseases such as&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Amyloidosis\" target=\"_blank\" rel=\"noreferrer noopener\">amyloidosis<\/a>,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Sarcoidosis\" target=\"_blank\" rel=\"noreferrer noopener\">sarcoidosis<\/a>, or post-radiation fibrosis. &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;<\/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>Systolic heart failure&nbsp;<\/strong>is most commonly due to&nbsp;<strong>ischemia<\/strong>&nbsp;or prior&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Myocardial_infarction\" target=\"_blank\" rel=\"noreferrer noopener\">myocardial infarction<\/a><\/strong>. It presents with all the typical clinical features of heart failure, and will demonstrate&nbsp;<strong>increased end-diastolic volume&nbsp;<\/strong>and a&nbsp;<strong>reduced ejection fraction<\/strong>&nbsp;on echocardiography.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span><strong>References&nbsp;<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.worldcat.org\/title\/robbins-basic-pathology\/oclc\/960844656\" target=\"_blank\" rel=\"noreferrer noopener\">Robbins basic pathology (10th ed.)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/19017683\/\" target=\"_blank\" rel=\"noreferrer noopener\">Dilated cardiomyopathy: a review<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27912983\/\" target=\"_blank\" rel=\"noreferrer noopener\">Hypertrophic obstructive cardiomyopathy<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.ahajournals.org\/doi\/10.1161\/cir.0b013e31829e8807\" target=\"_blank\" rel=\"noreferrer noopener\">AHA guideline for the management of heart failure<\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em><strong>_________________________<\/strong><br><br><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis today! Access your&nbsp;<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>&nbsp;and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/learning-medicine-banner.png?w=700\" alt=\"\" class=\"wp-image-3413\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/learning-medicine-banner.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/learning-medicine-banner.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><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><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A 70-year-old woman comes to the emergency department due to a three week history of worsening fatigue, dyspnea on exertion, and lower extremity swelling. Her past medical history is significant for&nbsp;hypertension&nbsp;and&nbsp;hyperlipidemia, but notes no recent travel, sick contacts, or illnesses. She recalls one episode of nausea and diaphoresis while she was lifting boxes at home [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":3411,"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-3410","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 - 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\" \/>\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 - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"A 70-year-old woman comes to the emergency department due to a three week history of worsening fatigue, dyspnea on exertion, and lower extremity swelling. Her past medical history is significant for&nbsp;hypertension&nbsp;and&nbsp;hyperlipidemia, but notes no recent travel, sick contacts, or illnesses. She recalls one episode of nausea and diaphoresis while she was lifting boxes at home [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-dyspnea-on-exertion\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2021-05-05T18:37:00+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\/usmle-dyspnea-on-exertion.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1080\" \/>\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-dyspnea-on-exertion#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-dyspnea-on-exertion\"},\"author\":{\"name\":\"Marina Horiates Kerekes, MD &amp; 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Can you figure out in which area\u00a0cardiac auscultation will most likely reveal a\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 of the Day: Episode of Syncope","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/99.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/99.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/99.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/99.webp 2x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/99.webp 3x"},"classes":[]},{"id":6011,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-rbc-transfusion","url_meta":{"origin":3410,"position":4},"title":"USMLE\u00ae Step 2 CK Question of the Day:\u00a0RBC transfusion","author":"Marina Horiates Kerekes, MD &amp; Team","date":"May 14, 2025","format":false,"excerpt":"Explore today's clinical case on managing red blood cell transfusion complications and the critical steps for patient care.","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 2 CK Question of the Day RBC transfusion","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/05\/Step2_QOTD_Q1_RBCTransfusion_2025_SM.png","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/05\/Step2_QOTD_Q1_RBCTransfusion_2025_SM.png 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/05\/Step2_QOTD_Q1_RBCTransfusion_2025_SM.png 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/05\/Step2_QOTD_Q1_RBCTransfusion_2025_SM.png 2x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/05\/Step2_QOTD_Q1_RBCTransfusion_2025_SM.png 3x"},"classes":[]},{"id":2718,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-right-leg-pain","url_meta":{"origin":3410,"position":5},"title":"USMLE\u00ae Step 1 Question of the Day: Right Leg Pain","author":"Marina Horiates Kerekes, MD &amp; Team","date":"March 10, 2021","format":false,"excerpt":"Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics. 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