{"id":3718,"date":"2021-06-30T18:26:00","date_gmt":"2021-06-30T18:26:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=3718"},"modified":"2025-10-01T11:42:40","modified_gmt":"2025-10-01T19:42:40","slug":"usmle-step-1-question-of-the-day-a-syncopal-event","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-a-syncopal-event","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: A Syncopal Event"},"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 ' ><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-a-syncopal-event\/#A_Renal_colic\" >A. Renal colic<\/a><\/li><li class='ez-toc-page-1 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-a-syncopal-event\/#B_Acute_pancreatitis\" >B. Acute pancreatitis<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-a-syncopal-event\/#C_Bowel_obstruction\" >C. Bowel obstruction<\/a><\/li><li class='ez-toc-page-1 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-a-syncopal-event\/#D_Abdominal_aortic_aneurysm\" >D. Abdominal aortic aneurysm<\/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-a-syncopal-event\/#E_Cholangitis\" >E. Cholangitis<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-a-syncopal-event\/#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-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-a-syncopal-event\/#D_Abdominal_aortic_aneurysm-2\" >D. Abdominal aortic aneurysm<\/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-a-syncopal-event\/#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-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-a-syncopal-event\/#A_Renal_colic-2\" >A. Renal colic<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-a-syncopal-event\/#B_Acute_pancreatitis-2\" >B.&nbsp;Acute pancreatitis<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-a-syncopal-event\/#C_Bowel_obstruction-2\" >C.&nbsp;Bowel obstruction<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-12\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-a-syncopal-event\/#E_Cholangitis-2\" >E. Cholangitis<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-13\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-a-syncopal-event\/#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-14\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-a-syncopal-event\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-15\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-a-syncopal-event\/#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 65-year-old man after a syncopal event at home. Can you figure out the diagnosis?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 65-year-old man presents to the emergency department after a syncopal event at home. He has had two hours of left-sided flank pain radiating to the groin, which is associated with nausea and vomiting. Prior to this episode, he reports vague back pain and fatigue over the past several months. His past medical history is significant for 80-pack-year smoking history, hypercholesterolemia, and hypertension. He has had no previous abdominal surgeries. His BMI is 30 kg\/m<sup>2<\/sup>. His temperature is 37.0 \u00b0C (98.6 \u00b0F), pulse is 100\/min, respirations are 20\/min, blood pressure is 90\/60 mmHg, and O<sub>2<\/sub>&nbsp;saturation is 95% on room air. Abdominal examination shows distension and diffuse tenderness on palpation, and cardiovascular examination shows a 1+ dorsalis pedis pulse in the left foot and 2+ pulse in the right foot. Laboratory findings show a WBC of 12,000\/mm<sup>3<\/sup>. Which of the following is the most likely diagnosis?<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Renal_colic\"><\/span><strong>A. Renal colic<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Acute_pancreatitis\"><\/span><strong>B. Acute pancreatitis<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Bowel_obstruction\"><\/span><strong>C. Bowel obstruction<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Abdominal_aortic_aneurysm\"><\/span><strong>D. Abdominal aortic aneurysm<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Cholangitis\"><\/span><strong>E. Cholangitis<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\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><\/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_Abdominal_aortic_aneurysm-2\"><\/span>D. Abdominal aortic aneurysm<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_Renal_colic-2\"><\/span>A. Renal colic<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Renal colic commonly causes flank pain radiating to the groin with associated nausea and vomiting; however, it rarely causes syncope. Patients commonly describe sharp severe flank pain with associated urinary symptoms, including dysuria and hematuria.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Acute_pancreatitis-2\"><\/span>B.&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Acute_pancreatitis\" target=\"_blank\" rel=\"noreferrer noopener\">Acute pancreatitis<\/a><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Pancreatitis can present with nausea and vomiting, but it is also commonly associated with distinct mid-epigastric pain radiating to the back and a history of chronic right upper quadrant pain due to&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Gallstones\" target=\"_blank\" rel=\"noreferrer noopener\">gallstones<\/a>&nbsp;or recent alcohol use, neither of which this patient endorses.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Bowel_obstruction-2\"><\/span>C.&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Bowel_obstruction\" target=\"_blank\" rel=\"noreferrer noopener\">Bowel obstruction<\/a><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Bowel obstructions may present with abdominal distension and pain, as well as nausea and vomiting. They are most commonly associated with a history of adhesions from prior abdominal surgeries. This patient has no past surgical history, making this diagnosis less likely.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Cholangitis-2\"><\/span>E. Cholangitis<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Cholangitis refers to an ascending infection of the biliary tree. This disease classically presents with right upper quadrant tenderness, fever, and<a href=\"https:\/\/www.osmosis.org\/learn\/Jaundice\" target=\"_blank\" rel=\"noreferrer noopener\">&nbsp;jaundice<\/a>, referred to as Charcot\u2019s triad. While the patient in this vignette has signs of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Sepsis\" target=\"_blank\" rel=\"noreferrer noopener\">sepsis<\/a>&nbsp;including&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hypotension\" target=\"_blank\" rel=\"noreferrer noopener\">hypotension<\/a>&nbsp;and tachycardia, there is no evidence of fever or jaundice, making this diagnosis less likely.<\/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><a href=\"https:\/\/www.osmosis.org\/learn\/Aortic_aneurysms_and_dissections:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">Abdominal aortic aneurysms<\/a><\/strong><strong>&nbsp;(AAA)&nbsp;<\/strong>should be considered in any older individual presenting with sudden onset abdominal, low back, or flank pain and a history of syncope with hypotension. Risk factors for AAA include significant&nbsp;<strong>age &gt;65 years<\/strong>,&nbsp;<strong>smoking<\/strong>,<strong>&nbsp;male gender<\/strong>,&nbsp;<strong>family history&nbsp;<\/strong>of AAA<strong>,<\/strong>&nbsp;and other risk factors for coronary artery disease or&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Peripheral_artery_disease\" target=\"_blank\" rel=\"noreferrer noopener\">peripheral vascular disease<\/a>&nbsp;including hypertension and hypercholesterolemia. Abdominal aortic aneurysms are<strong>&nbsp;true aneurysms,&nbsp;<\/strong>meaning all three layers of the blood vessel &#8211; the intima, media, and adventitia &#8211; are dilated. The pathophysiology of abdominal aortic aneurysms is a complex, multifactorial process that involves alterations in the structure of the vascular wall due to inflammatory changes, abnormal collagen remodeling and cross-linking, as well as loss of elastin and smooth muscle cells. This ultimately results in progressive thinning and weakening of the aortic wall and enlargement of the aortic diameter to a dilation&nbsp;<strong>50% greater than the normal diameter<\/strong>&nbsp;of the aorta.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">AAAs commonly occur at the<strong>&nbsp;infrarenal&nbsp;<\/strong>level, or below the level of the renal arteries. People with near rupture or rapid expansion of an AAA commonly present with sudden onset back, flank, or abdominal pain and associated symptoms such as nausea and vomiting, mimicking a myriad of other conditions. Other associated symptoms may include&nbsp;<strong>diminished peripheral pulses<\/strong>&nbsp;due to expansion of the aneurysm compressing the internal iliac arteries. Although a&nbsp;<strong>pulsatile abdominal mass&nbsp;<\/strong>is a classic presentation, it may not always be detectable, especially if the patient is obese, such as in this vignette. If left untreated, AAAs can rupture, leading to severe hypotension, hemodynamic instability, and death. In a case where rupture has not occurred,&nbsp;<strong>repair<\/strong>&nbsp;should be offered when the aneurysm is&nbsp;<strong>&gt;5 cm.<\/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\">\n<iframe loading=\"lazy\" title=\"Aortic dissection and aneurysms ~high yield~\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/6LnNQu-0eQo?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&nbsp;<\/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\/Aortic_aneurysms_and_dissections:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">Abdominal aortic aneurysms<\/a><\/strong><strong>&nbsp;(AAA)&nbsp;<\/strong>classically present with a triad of&nbsp;<strong>hypotension<\/strong>,<strong>&nbsp;abdominal, low back<\/strong>, or<strong>&nbsp;flank pain<\/strong>,<strong>&nbsp;<\/strong>and a<strong>&nbsp;palpable pulsatile mass<\/strong>, although the findings of all three is a rare clinical occurrence. Primary risk factors include<strong>&nbsp;age &gt;65 years<\/strong>,<strong>&nbsp;smoking<\/strong>,<strong>&nbsp;male gender<\/strong>, and a<strong>&nbsp;family history&nbsp;<\/strong>of AAA<strong>.&nbsp;<\/strong>Treatment should be offered to patients with AAA<strong>&nbsp;&gt;5 cm<\/strong>, as risk of rupture increases exponentially beyond this value.<\/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\">Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm.&nbsp;<em>J Vasc Surg<\/em>. 2018;67(1):2\u201077.e2. doi:<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0741521417323698\" target=\"_blank\" rel=\"noreferrer noopener\">10.1016\/j.jvs.2017.10.044<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Kumar, V., Abbas, A. K., Aster, J. C., &amp; Robbins, S. L. (2013).&nbsp;<a href=\"https:\/\/www.elsevier.com\/books\/robbins-basic-pathology\/kumar\/978-0-323-35317-5\" target=\"_blank\" rel=\"noreferrer noopener\"><em>Robbins Basic Pathology<\/em>&nbsp;Philadelphia: Elsevier\/Saunders<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Abdominal Aortic Aneurysms, K. Craig Kent, M.D.November 27, 2014 N Engl J Med 2014; 371:2101-2108 DOI:&nbsp;<a href=\"https:\/\/www.nejm.org\/doi\/10.1056\/NEJMcp1401430\" target=\"_blank\" rel=\"noreferrer noopener\">10.1056\/NEJMcp1401430<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Curry, M. (2017, May 18). Rosen&#8217;s Emergency Medicine: Concepts and Clinical Practice. Retrieved from&nbsp;<a href=\"https:\/\/www.us.elsevierhealth.com\/rosens-emergency-medicine-concepts-and-clinical-practice-9780323354790.html\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.us.elsevierhealth.com\/rosens-emergency-medicine-concepts-and-clinical-practice-9780323354790.html<\/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><\/p>\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 65-year-old man after a syncopal event at home. Can you figure out the diagnosis? A 65-year-old man presents to the emergency department after a syncopal event at home. He has had two hours of [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":3721,"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-3718","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: A Syncopal Event - 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-a-syncopal-event\" \/>\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: A Syncopal Event - 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 65-year-old man after a syncopal event at home. Can you figure out the diagnosis? A 65-year-old man presents to the emergency department after a syncopal event at home. He has had two hours of [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-a-syncopal-event\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2021-06-30T18:26:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-10-01T19:42:40+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T122639.841.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1080\" \/>\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-a-syncopal-event#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-a-syncopal-event\"},\"author\":{\"name\":\"Marina Horiates Kerekes, MD &amp; 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Explore the medical history and symptoms that led to a concerning diagnosis. Learn about the histological findings that indicate irreversible cellular injury in the affected extremity.\u00a0Find out more here. A 57-year-old man presents\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: Lower extremity pain","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T144807.542.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T144807.542.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T144807.542.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T144807.542.webp 2x"},"classes":[]},{"id":3801,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-renal-cell-carcinoma","url_meta":{"origin":3718,"position":4},"title":"USMLE\u00ae Step 1 Question of the Day: Renal Cell Carcinoma","author":"Marina Horiates Kerekes, MD &amp; Team","date":"March 3, 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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