{"id":3561,"date":"2022-06-29T14:34:00","date_gmt":"2022-06-29T14:34:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=3561"},"modified":"2025-10-01T11:40:34","modified_gmt":"2025-10-01T19:40:34","slug":"usmle-step-1-question-of-the-day-fatigue-and-progressive-dyspnea","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-fatigue-and-progressive-dyspnea","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Fatigue and Progressive Dyspnea"},"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-fatigue-and-progressive-dyspnea\/#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-fatigue-and-progressive-dyspnea\/#B_Constrictive_pericarditis\" >B. Constrictive pericarditis<\/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-fatigue-and-progressive-dyspnea\/#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-fatigue-and-progressive-dyspnea\/#A_Cardiac_myxoma\" >A. Cardiac myxoma<\/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-fatigue-and-progressive-dyspnea\/#C_Dilated_cardiomyopathy\" >C. Dilated cardiomyopathy<\/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-fatigue-and-progressive-dyspnea\/#D_Hypertrophic_obstructive_cardiomyopathy\" >D. Hypertrophic obstructive cardiomyopathy<\/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-fatigue-and-progressive-dyspnea\/#E_Restrictive_cardiomyopathy\" >E. Restrictive cardiomyopathy<\/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-fatigue-and-progressive-dyspnea\/#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-fatigue-and-progressive-dyspnea\/#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-fatigue-and-progressive-dyspnea\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;<\/em><\/strong><strong><em>Today&#8217;s case focuses on a 72-year-old man with fatigue and progressive dyspnea. Physical examination shows 3+ edema in the lower extremities and hepatomegaly.&nbsp;<strong><em>Can you figure it out?<\/em><\/strong><\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 72-year-old man is brought to the clinic from a nearby homeless shelter due to fatigue and progressive dyspnea. The patient states he had a remote history of night sweats and coughing up blood many years ago that resolved with a prolonged course of medications received at a clinic. Temperature is 36\u00b0C (97.4\u00b0F), pulse is 122\/min, respirations are 16\/min, and blood pressure is 120\/60 mmHg. Physical examination shows 3+ edema in the lower extremities and hepatomegaly. Examination of the neck reveals jugular venous distention that fails to subside on inspiration. Cardiac monitor shows a prominent x and y descent in the jugular venous pulse tracing. A chest x-ray is obtained and shown below:<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"325\" height=\"325\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/chest-xray.png\" alt=\"A chest x-ray \" class=\"wp-image-3563\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/chest-xray.png 325w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/chest-xray.png?resize=150,150 150w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/chest-xray.png?resize=300,300 300w\" sizes=\"auto, (max-width: 325px) 100vw, 325px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Reproduced from:&nbsp;<a href=\"https:\/\/radiopaedia.org\/cases\/constrictive-pericarditis-9?lang=us\" target=\"_blank\" rel=\"noreferrer noopener\">Radiopaedia<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following is the most likely cause of this patient&#8217;s condition?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Cardiac myxoma<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Constrictive pericarditis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Dilated cardiomyopathy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Hypertrophic obstructive cardiomyopathy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Restrictive cardiomyopathy<\/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><figcaption class=\"wp-element-caption\"><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><\/figcaption><\/figure>\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_Constrictive_pericarditis\"><\/span>B. Constrictive pericarditis<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the Main Explanation, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The incorrect answers to today&#8217;s USMLE\u00ae Step 1 Question are&#8230;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Cardiac_myxoma\"><\/span>A. Cardiac myxoma<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect: <\/strong><a href=\"https:\/\/www.osmosis.org\/learn\/Cardiac_and_vascular_tumors:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\">Cardiac myxoma<\/a>&nbsp;is the most common cardiac tumor in adults. Myxomas are typically described as a \u201cball-valve\u201d mass found in the&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Introduction_to_the_cardiovascular_system\" target=\"_blank\" rel=\"noreferrer noopener\">left atrium<\/a>. Patients often present with fever, weight loss, and possible syncopal episodes. Cardiac auscultation may reveal an early diastolic \u201ctumor plop\u201d sound. Cardiac myxoma, however, does not cause calcifications of the myocardium or jugular venous pulse changes, as seen in this patient.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Dilated_cardiomyopathy\"><\/span>C. Dilated cardiomyopathy<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong><a href=\"https:\/\/www.osmosis.org\/learn\/Dilated_cardiomyopathy\" target=\"_blank\" rel=\"noreferrer noopener\">Dilated cardiomyopathy<\/a>&nbsp;can also present with dyspnea, chest pain, and edema. Causes of dilated cardiomyopathy include genetics, substance abuse (e.g., alcohol, cocaine), and certain infections. Dilated cardiomyopathy, however, does not cause calcifications of the myocardium or jugular venous pulse changes, as seen in this patient.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Hypertrophic_obstructive_cardiomyopathy\"><\/span>D. Hypertrophic obstructive cardiomyopathy<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong><a href=\"https:\/\/www.osmosis.org\/learn\/Hypertrophic_cardiomyopathy\" target=\"_blank\" rel=\"noreferrer noopener\">Hypertrophic obstructive cardiomyopathy&nbsp;<\/a>is the most common cause of death in young athletes. It is caused by hypertrophy of the myocardium. Patients often present with a harsh systolic ejection murmur and a palpable apical impulse, neither of which are seen in this patient.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Restrictive_cardiomyopathy\"><\/span>E. Restrictive cardiomyopathy<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>The presentation of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Restrictive_cardiomyopathy\" target=\"_blank\" rel=\"noreferrer noopener\">restrictive cardiomyopathy<\/a>&nbsp;is very similar to constrictive pericarditis, including chest pain, dyspnea, edema, fatigue, and exercise intolerance due to elevations in filling pressures. The history and physical examination may differentiate the cause. Causes of restrictive cardiomyopathy include post-radiation fibrosis, L\u00f6ffler endocarditis, amyloidosis, sarcoidosis, and hemochromatosis. In contrast to constrictive pericarditis, restrictive cardiomyopathy presents with prominent y descent but blunting of the x descent in the jugular venous pulse. Additionally, an echocardiogram may reveal an increase in wall thickness rather than the calcifications on the chest radiograph seen in this patient.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\/md\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_b69893.png?w=700\" alt=\"\" class=\"wp-image-3443\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_b69893.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_b69893.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&#8217;s presentation is consistent with&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Pericardial_disease:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\">constrictive pericarditis<\/a><\/strong>, a condition characterized by incomplete filling of the cardiac chambers due to&nbsp;<strong>thickening of the pericardium&nbsp;<\/strong>(seen as a line of calcifications over the heart border on the chest radiograph). This patient experiencing homelessness likely had a previous history of&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Mycobacterium_tuberculosis_(Tuberculosis)\" target=\"_blank\" rel=\"noreferrer noopener\">tuberculosis infection<\/a>&nbsp;<\/strong>(hemoptysis, night sweats), a common cause of constrictive pericarditis. Other causes of constrictive cardiomyopathy include post-cardiac surgery or radiation, connective tissue disorder, and miscellaneous causes (e.g., malignancy, trauma, drug-induced sarcoidosis, uremic pericarditis). Note that some of the causes are common to both restrictive cardiomyopathy and constrictive pericarditis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The fibrous thickening of the pericardium forms a rigid, noncompliant cover of the heart, resulting in progressive impairment in cardiac filling with subsequent low cardiac output. The impaired heart filling leads to progressive signs and symptoms of predominantly right heart failure (e.g., pitting edema of the lower extremities and hepatomegaly). Patients often present with fluid overload, ranging from peripheral edema to anasarca, and symptoms related to low cardiac output, such as fatigue and dyspnea on exertion. On physical examination, the majority of patients display elevated jugular venous pressure. Other less common features include pulsus paradoxus,&nbsp;<strong>Kussmaul sign&nbsp;<\/strong>(increase or lack of decrease in JVP during inspiration), pericardial knock, peripheral edema, ascites, and\/or cachexia.&nbsp;<strong>Pericardial knock<\/strong>&nbsp;is a unique feature that can be heard during early diastole. The sound corresponds to the abrupt cessation of ventricular filling due to a constrictive pericardium. Jugular venous pulse tracing typically reveals&nbsp;<strong>prominent x and y descent,<\/strong>&nbsp;correlating with the downward displacement of closed tricuspid valves during rapid ventricular ejection and right atrial emptying, respectively.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The diagnosis of constrictive pericarditis is commonly made using echocardiography in patients presenting with high clinical suspicion. Depending on the severity, patients may be treated with medications aimed at reducing inflammation (<a href=\"https:\/\/www.osmosis.org\/learn\/Antigout_medications\" target=\"_blank\" rel=\"noreferrer noopener\">colchicine&nbsp;<\/a>and&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Antigout_medications\" target=\"_blank\" rel=\"noreferrer noopener\">NSAIDs<\/a>) or pericardiectomy surgery.<\/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\/Pericardial_disease:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\">Constrictive pericarditis<\/a><\/strong>&nbsp;is a condition characterized by impaired filling of the heart due to thickening of the pericardium. Patients often present with signs of right heart failure, including&nbsp;<strong>fatigue<\/strong>,&nbsp;<strong>edema<\/strong>,&nbsp;<strong>hepatomegaly<\/strong>, and&nbsp;<strong>dyspnea<\/strong>. On imaging,&nbsp;<strong>calcifications&nbsp;<\/strong>and thickening of the pericardium may be seen.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span><strong>References<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Geske, J. B., Anavekar, N. S., Nishimura, R. A., Oh, J. K., &amp; Gersh, B. J. (2016, November 21).&nbsp;<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0735109716353074\" target=\"_blank\" rel=\"noreferrer noopener\">Differentiation of Constriction and Restriction: Complex Cardiovascular Hemodynamics.<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Welch, T. D., &amp; Oh, J. K. (2017). Constrictive Pericarditis. Cardiology Clinics, 35(4), 539\u2013549.&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29025545\/\" target=\"_blank\" rel=\"noreferrer noopener\">doi:10.1016\/j.ccl.2017.07.007<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>_________________________<\/strong><br><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis today! Access your&nbsp;<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>&nbsp;and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-1\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png?w=700\" alt=\"The Ultimate Guide to the USMLE Step 1: Everything you need to know\" class=\"wp-image-760\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><figcaption class=\"wp-element-caption\"><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><\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case focuses on a 72-year-old man with fatigue and progressive dyspnea. Physical examination shows 3+ edema in the lower extremities and hepatomegaly.&nbsp;Can you figure it out? A 72-year-old man is brought to the clinic from a nearby [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":3562,"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-3561","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: Fatigue and Progressive Dyspnea - 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-fatigue-and-progressive-dyspnea\" \/>\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: Fatigue and Progressive Dyspnea - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case focuses on a 72-year-old man with fatigue and progressive dyspnea. Physical examination shows 3+ edema in the lower extremities and hepatomegaly.&nbsp;Can you figure it out? 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