{"id":3661,"date":"2021-11-24T17:48:00","date_gmt":"2021-11-24T17:48:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=3661"},"modified":"2025-10-01T11:40:34","modified_gmt":"2025-10-01T19:40:34","slug":"usmle-step-1-question-of-the-day-dizziness-episodes","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-dizziness-episodes","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Dizziness Episodes"},"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-dizziness-episodes\/#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-dizziness-episodes\/#D_Debris_within_the_semicircular_canal\" >D. Debris within the semicircular canal<\/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-dizziness-episodes\/#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-dizziness-episodes\/#A_Depletion_of_body_fluids\" >A. Depletion of body fluids<\/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-dizziness-episodes\/#B_Arterial_insufficiency\" >B. Arterial insufficiency<\/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-dizziness-episodes\/#C_Inflammation_of_the_vestibulocochlear_nerve_CN_VIII\" >C. Inflammation of the vestibulocochlear nerve (CN VIII)<\/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-dizziness-episodes\/#E_Excessive_build-up_of_the_endolymph_fluid\" >E. Excessive build-up of the endolymph fluid<\/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-dizziness-episodes\/#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-dizziness-episodes\/#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-dizziness-episodes\/#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 60-year-old woman with episodes of dizziness for the past month. The episodes usually occur when she gets up from bed, gets up from a seated position, or turns her head, and it lasts for approximately 30 seconds.<\/em><\/strong><strong><em>&nbsp;<\/em><\/strong><strong><em>Can you figure it out?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 60-year-old woman comes to the clinic complaining of episodes of dizziness for the past month. The patient reports that the dizziness usually occurs when she gets up from bed, gets up from a seated position, or turns her head, and it lasts for approximately 30 seconds. During these episodes, she feels as though the room is spinning around her, which is accompanied by nausea. Medical history is significant for hypertension, which is treated with hydrochlorothiazide. Vital signs are within normal limits. Physical examination shows right-beating and torsional nystagmus. Hearing is intact, and the rest of the physical examination shows no abnormalities. Which of the following is most likely responsible for this patient&#8217;s presentation?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Depletion of body fluids<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Arterial insufficiency<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Inflammation of the vestibulocochlear nerve (CN VIII)<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Debris within the semicircular canal<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Excessive build-up of the endolymph fluid<\/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=\"D_Debris_within_the_semicircular_canal\"><\/span>D. Debris within the semicircular canal<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_Depletion_of_body_fluids\"><\/span>A. Depletion of body fluids<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>This answer choice refers to&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Orthostatic_hypotension\" target=\"_blank\" rel=\"noreferrer noopener\">orthostatic hypotension<\/a>, which is diagnosed when a person&#8217;s blood pressure falls upon standing or sitting. Although&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Thiazide_and_thiazide-like_diuretics\" target=\"_blank\" rel=\"noreferrer noopener\">hydrochlorothiazide&nbsp;<\/a>use does increase the risk for orthostatic hypotension, this phenomenon would not cause nystagmus or vertigo.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Arterial_insufficiency\"><\/span>B. Arterial insufficiency<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Rotational vertebral artery syndrome refers to a phenomenon of symptomatic posterior circulation ischemia from the compression of the vertebral arteries by bony elements of the spine (usually at CI-C2) which occurs upon head rotation. Patients may present with recurrent syncope,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Vertigo:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\">vertigo<\/a>,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Dizziness_and_vertigo:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">nystagmus, ataxia, diplopia, nausea, dysarthria, or dysphagia<\/a>. Although some of this patient\u2019s symptoms overlap with rotational vertebral artery syndrome, standing would not cause the symptoms.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Inflammation_of_the_vestibulocochlear_nerve_CN_VIII\"><\/span>C. Inflammation of the vestibulocochlear nerve (CN VIII)<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Inflammation of the eighth cranial nerve causes vestibular&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Labyrinthitis\" target=\"_blank\" rel=\"noreferrer noopener\">neuritis or labyrinthitis<\/a>. It is thought to be a viral or post-viral inflammatory disorder which leads to inflammation of the vestibular portion of the nerve. Patients often present with severe vertigo and possibly hearing loss and tinnitus. It typically occurs as an acute attack that lasts for days. This patient\u2019s presentation and duration of symptoms favor another diagnosis.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Excessive_build-up_of_the_endolymph_fluid\"><\/span>E. Excessive build-up of the endolymph fluid<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Excessive build-up of the endolymph fluid, also known as&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Dizziness_and_vertigo:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">endolymphatic hydrops<\/a>, describes the hypothesis behind M\u00e9ni\u00e8re disease. The condition is characterized by episodic vertigo, tinnitus, and hearing loss. It is thought to occur due to an abnormality in the flow of endolymph or in the resorption of endolymph. The increased volume of the endolymph can lead to damage of the&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Anatomy_of_the_inner_ear\" target=\"_blank\" rel=\"noreferrer noopener\">cochlea and the vestibular system of the inner ear<\/a>. This patient\u2019s presentation and intact hearing 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_bd3e8f.png\" alt=\"osmosis ad to download usmle step 1 guide\" class=\"wp-image-3663\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_bd3e8f.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_bd3e8f.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, who presents with isolated complaints of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Vertigo:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>vertigo<\/strong>&nbsp;<\/a>that occurs mainly with&nbsp;<strong>head rotation and position changes,&nbsp;<\/strong>most likely has<strong>&nbsp;<\/strong><strong><a href=\"https:\/\/www.osmosis.org\/learn\/Dizziness_and_vertigo:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">benign paroxysmal positional vertigo<\/a><\/strong><strong>&nbsp;(BPPV)<\/strong>. The diagnosis of BPPV can be confirmed by the&nbsp;<strong>Dix-Hallpike maneuver<\/strong>, in which the physician extends the patient&#8217;s neck and turns it to one side while the patient is sitting, followed by rapidly placing them in a supine position so that their head hangs over the edge of the bed. On a positive test there will be nystagmus or vertigo.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">BPPV is one of the most common causes of peripheral vertigo; it is characterized by episodes of spinning sensation provoked by head rotation and position changes which last approximately 30 seconds. The condition is attributed to&nbsp;<strong>calcium debris&nbsp;<\/strong>within the<strong>&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Anatomy_of_the_inner_ear\" target=\"_blank\" rel=\"noreferrer noopener\">semicircular canals<\/a><\/strong>, known as canalithiasis. This debris likely represents loose calcium carbonate crystals originating from the utricular sac. Under normal conditions, the semicircular canals detect angular head accelerations. Debris accumulation in the canal causes inappropriate movement of the endolymph with linear accelerations, creating a false sensation of spinning when the head shifts. While symptoms can be disabling, the disorder typically responds to treatment with particle-repositioning maneuvers (<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Vertigo:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\">Epley maneuver<\/a><\/strong>) in the office upon diagnosis.<\/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=\"Vertigo ~high yield~\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/fCX5cyMDZuw?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<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\/Dizziness_and_vertigo:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">Benign paroxysmal positional vertigo<\/a><\/strong>&nbsp;(BPPV) refers to episodic vertigo sensation caused by&nbsp;<strong>calcium debris&nbsp;<\/strong>within the<strong>&nbsp;semicircular canals<\/strong>. Episodes are typically<strong>&nbsp;provoked by head rotation and position changes<\/strong>. In contrast to other causes of vertigo, hearing and other neurologic symptoms are not 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\">Kim JS, Zee DS. Clinical practice. Benign paroxysmal positional vertigo.&nbsp;<em>N Engl J Med<\/em>. 2014;370(12):1138-1147.&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24645946\/\" target=\"_blank\" rel=\"noreferrer noopener\">doi:10.1056\/NEJMcp1309481<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Coelho DH, Lalwani AK. Medical management of M\u00e9ni\u00e8re&#8217;s disease.&nbsp;<em>Laryngoscope<\/em>. 2008;118(6):1099-1108.&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18418279\/\" target=\"_blank\" rel=\"noreferrer noopener\">doi:10.1097\/MLG.0b013e31816927f0<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Dabus G, Gerstle RJ, Parsons M, et al. Rotational vertebrobasilar insufficiency due to dynamic compression of the dominant vertebral artery by the thyroid cartilage and occlusion of the contralateral vertebral artery at C1-2 level.&nbsp;<em>J Neuroimaging<\/em>. 2008;18(2):184-187.&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18298678\/\" target=\"_blank\" rel=\"noreferrer noopener\">doi:10.1111\/j.1552-6569.2007.00177.x<\/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_b50546.png\" alt=\"The most powerful platform for learning medicine and the health sciences Try it now button.\" class=\"wp-image-3664\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_b50546.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_b50546.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 60-year-old woman with episodes of dizziness for the past month. The episodes usually occur when she gets up from bed, gets up from a seated position, or turns her head, and it lasts for [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":3662,"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-3661","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: Dizziness Episodes - 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-dizziness-episodes\" \/>\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: Dizziness Episodes - 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 60-year-old woman with episodes of dizziness for the past month. The episodes usually occur when she gets up from bed, gets up from a seated position, or turns her head, and it lasts for [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-dizziness-episodes\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2021-11-24T17:48:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-10-01T19:40:34+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T114818.288.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1081\" \/>\n\t<meta property=\"og:image:height\" content=\"1081\" \/>\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-dizziness-episodes#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-dizziness-episodes\"},\"author\":{\"name\":\"Marina Horiates Kerekes, MD &amp; 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Today's case focuses on a 6-month-old infant facing poor weight gain, weak cry, and muscle hypotonia. With genetic work-up pointing to a PDHA1 gene mutation and elevated serum lactate levels, can you\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: Sleep episodes","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T152206.380.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T152206.380.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T152206.380.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T152206.380.webp 2x"},"classes":[]},{"id":3524,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-focused-history","url_meta":{"origin":3661,"position":5},"title":"USMLE\u00ae Step 2 Question of the Day: Focused history","author":"Marina Horiates Kerekes, MD &amp; Team","date":"October 18, 2023","format":false,"excerpt":"A patient presents with anxiety and recent episodes of loss of consciousness. What is crucial to the patient's diagnosis and treatment?","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 2 Question of the Day: Focused history","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-focused-history.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-focused-history.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-focused-history.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-focused-history.webp 2x"},"classes":[]}],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/3661","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=3661"}],"version-history":[{"count":3,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/3661\/revisions"}],"predecessor-version":[{"id":6706,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/3661\/revisions\/6706"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media\/3662"}],"wp:attachment":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media?parent=3661"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/categories?post=3661"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/tags?post=3661"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}