{"id":3627,"date":"2021-12-29T17:16:00","date_gmt":"2021-12-29T17:16:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=3627"},"modified":"2025-10-01T11:40:34","modified_gmt":"2025-10-01T19:40:34","slug":"usmle-step-1-question-of-the-day-progressive-lethargy","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-progressive-lethargy","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Progressive Lethargy"},"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-progressive-lethargy\/#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-progressive-lethargy\/#B_Ependymoma\" >B. Ependymoma<\/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-progressive-lethargy\/#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-progressive-lethargy\/#A_Craniopharyngioma\" >A. Craniopharyngioma<\/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-progressive-lethargy\/#C_Medulloblastoma\" >C. Medulloblastoma<\/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-progressive-lethargy\/#D_Pilocytic_astrocytoma\" >D. Pilocytic astrocytoma<\/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-progressive-lethargy\/#E_Oligodendroglioma\" >E. Oligodendroglioma<\/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-progressive-lethargy\/#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-progressive-lethargy\/#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-progressive-lethargy\/#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 4-year-old boy with progressive lethargy, headaches, and worsening vision. A brain MRI shows a lesion in the fourth ventricle with dilated ventricles.<\/em><\/strong><strong><em>&nbsp;<\/em><\/strong><strong><em>Can you figure the most likely diagnosis?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 4-year-old boy is brought to the emergency department due to progressive lethargy, drowsiness and vomiting. His parents state he had been complaining of progressive headaches and worsening vision for the past several months. Height, weight and head circumference are at the 50th percentile for age. His temperature is 37.0\u00b0C (98.6\u00b0F), pulse is 80\/min, and blood pressure is 125\/85 mmHg. On physical examination, the patient appears drowsy. Fundoscopic examination reveals bilateral papilledema. A brain MRI shows a lesion in the fourth ventricle with dilated ventricles. A stereotactic biopsy is performed, and the hematoxylin and eosin (H&amp;E) stained sample is shown below.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"785\" height=\"633\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_3c26ea.png\" alt=\"A stereotactic biopsy is performed, and the hematoxylin and eosin (H&amp;E) stained sample\" class=\"wp-image-3629\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_3c26ea.png 785w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_3c26ea.png?resize=300,242 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_3c26ea.png?resize=768,619 768w\" sizes=\"auto, (max-width: 785px) 100vw, 785px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Reproduced from:&nbsp;<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Ependymoma_intermed_mag.jpg\" target=\"_blank\" rel=\"noreferrer noopener\">Wikimedia Commons<\/a><\/strong>What is the most likely diagnosis in this patient?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Craniopharyngioma<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Ependymoma<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Medulloblastoma<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Pilocytic astrocytoma<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Oligodendroglioma<\/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=\"B_Ependymoma\"><\/span>B. Ependymoma<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_Craniopharyngioma\"><\/span>A. Craniopharyngioma<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Pediatric_brain_tumors:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\">Craniopharyngiomas<\/a>, while common, would be located in the pituitary fossa. Patients may present with&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Bitemporal_hemianopsia\" target=\"_blank\" rel=\"noreferrer noopener\">bitemporal hemianopsia<\/a>&nbsp;due to compression of the optic chiasm. Calcifications are often seen on imaging. On&nbsp;<a href=\"https:\/\/www.osmosis.org\/pdf\/61549493?source=coursedocument\" target=\"_blank\" rel=\"noreferrer noopener\">light microscopy<\/a>, keratin pearls and cysts filled with cholesterol crystals (\u201cmotor oil\u201d-like) are expected. The location and histology findings of this patient\u2019s tumor favors another diagnosis.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Medulloblastoma\"><\/span>C. Medulloblastoma<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\/Pediatric_brain_tumors:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\">Medulloblastomas<\/a>&nbsp;are poorly-differentiated, highly-malignant tumors seen exclusively in children. These tumors commonly arise from the cerebellum and are characterized by Homer-Wright rosettes on histology. Common symptoms are ataxia, slurred speech, nystagmus, positive Romberg sign, and intention tremor. This patient\u2019s imaging and histological findings favor another diagnosis.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Pilocytic_astrocytoma\"><\/span>D. Pilocytic astrocytoma<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Pediatric_brain_tumors:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\">Pilocytic astrocytoma<\/a>, the most common pediatric primary brain tumor, is a benign low-grade tumor that usually arises in the cerebellar hemispheres or around the<a href=\"https:\/\/www.osmosis.org\/learn\/Anatomy_of_the_ventricular_system\" target=\"_blank\" rel=\"noreferrer noopener\">&nbsp;third ventricle<\/a>. On imaging, cystic and solid components can be seen. Under light microscopy, it stains positive for glial fibrillary acidic protein (GFAP) and shows eosinophilic corkscrew fibers (Rosenthal fibers). The location and histology findings of this patient\u2019s tumor favors another diagnosis.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Oligodendroglioma\"><\/span>E. Oligodendroglioma<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\/Adult_brain_tumors:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\">Oligodendrogliomas<\/a>&nbsp;are malignant tumors that generally occur in adults. They are rare tumors of oligodendrocyte origin that often grow in the frontal lobes. On histology, cells have round nuclei with clear cytoplasm forming a \u201cfried egg\u201d appearance and the capillaries of the tumor are arranged in a \u201cchicken-wire\u201d pattern. Calcifications may also be seen on imaging. The location, patient age, and histology findings favor another diagnosis.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-1\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_eb813e.png\" alt=\"osmosis ad to download usmle step 1 guide\" class=\"wp-image-3630\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_eb813e.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_eb813e.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\">The progressive symptoms of&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Hydrocephalus:_Nursing_Process_(ADPIE)\" target=\"_blank\" rel=\"noreferrer noopener\">hydrocephalus<\/a><\/strong><strong>&nbsp;<\/strong>(lethargy, nausea, vomiting), the location of the tumor (<strong>4th ventricle<\/strong>), and the characteristic&nbsp;<strong>perivascular pseudorosettes&nbsp;<\/strong>in the biopsy specimen all point to an&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Pediatric_brain_tumors:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\">ependymoma<\/a><\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ependymomas are invasive primary brain tumors that arise from the glial cells lining the ventricular system. Most commonly they occur in the 4th ventricle, leading to hydrocephalus. Ependymomas have the potential to disseminate throughout the central nervous system (CNS). Similar to medulloblastoma, the tumor can send metastasis to the spinal cord; however, on histology, the tumor is distinguished by perivascular pseudorosettes, not Homer-Wright rosettes (as seen in medulloblastoma).&nbsp;<strong>Pseudorosettes&nbsp;<\/strong>are neoplastic cells arranged around a blood vessel, while Homer-Wright rosettes are instead arrangements of small blue cells around a central core.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Resection and adjuvant radiation therapy are the mainstays of treatment, except in very young patients. Chemotherapy is used only in very young children, patients with bulky residual disease, and recurrent or refractory tumors.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"605\" height=\"329\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_b3ec03.png\" alt=\"Illustration of Ependymomas with tumor cells, centralized blood vessel and perivascular pseudorosette.\" class=\"wp-image-3631\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_b3ec03.png 605w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_b3ec03.png?resize=300,163 300w\" sizes=\"auto, (max-width: 605px) 100vw, 605px\" \/><\/figure>\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\"><a href=\"https:\/\/www.osmosis.org\/learn\/Pediatric_brain_tumors:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\">Ependymomas&nbsp;<\/a>are invasive brain tumors that arise from the&nbsp;<strong>glial cells<\/strong>&nbsp;lining the ventricular system. Most commonly they occur in the&nbsp;<strong>4th ventricle<\/strong>, leading to hydrocephalus. On histology, cells form characteristic&nbsp;<strong>perivascular&nbsp;<\/strong><strong>pseudorosettes<\/strong>.<\/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\">Shuangshoti S, Rushing EJ, Mena H, Olsen C, Sandberg GD. Supratentorial extraventricular ependymal neoplasms: a clinicopathologic study of 32 patients.&nbsp;<em>Cancer<\/em>. 2005;103(12):2598-2605. doi:<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/15861411\/\" target=\"_blank\" rel=\"noreferrer noopener\">10.1002\/cncr.21111<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>_________________________<\/strong><br><br><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis today! Access your&nbsp;<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>&nbsp;and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\"><br><\/a><\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/www.osmosis.org\/login?type=create\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_ddb23c.png\" alt=\"Osmosis ad to create an account\" class=\"wp-image-3632\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_ddb23c.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_ddb23c.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><br><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 4-year-old boy with progressive lethargy, headaches, and worsening vision. A brain MRI shows a lesion in the fourth ventricle with dilated ventricles.&nbsp;Can you figure the most likely diagnosis? A 4-year-old boy is brought to [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":3628,"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-3627","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: Progressive Lethargy - 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-progressive-lethargy\" \/>\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: Progressive Lethargy - 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 4-year-old boy with progressive lethargy, headaches, and worsening vision. A brain MRI shows a lesion in the fourth ventricle with dilated ventricles.&nbsp;Can you figure the most likely diagnosis? 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