{"id":3801,"date":"2021-03-03T20:49:00","date_gmt":"2021-03-03T20:49:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=3801"},"modified":"2025-10-01T11:42:40","modified_gmt":"2025-10-01T19:42:40","slug":"usmle-step-1-question-of-the-day-renal-cell-carcinoma","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-renal-cell-carcinoma","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Renal Cell Carcinoma"},"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-renal-cell-carcinoma\/#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-renal-cell-carcinoma\/#C_Kidney\" >C. Kidney<\/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-renal-cell-carcinoma\/#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-renal-cell-carcinoma\/#A_Bone_Marrow\" >A. Bone Marrow<\/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-renal-cell-carcinoma\/#B_Testicles\" >B. Testicles<\/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-renal-cell-carcinoma\/#D_Lung\" >D. Lung<\/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-renal-cell-carcinoma\/#E_Bone\" >E. Bone<\/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-renal-cell-carcinoma\/#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-renal-cell-carcinoma\/#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-renal-cell-carcinoma\/#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 man with pain in his scrotum. The scrotum appears to be swollen and the man&#8217;s vision has become blurrier. Can you figure it out?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 60-year-old male comes to the physician\u2019s office due to scrotal pain for the past 2 weeks. The patient describes a dull pain and noticed that his scrotum appears larger. He also felt fatigued and hot for the past 2 months and thinks that his vision has become blurrier. Medical history is significant for <a href=\"https:\/\/www.osmosis.org\/learn\/Hypertension\" target=\"_blank\" rel=\"noreferrer noopener\">hypertension<\/a> and <a href=\"http:\/\/hyperlipidemia\">hyperlipidemia<\/a>. The patient has smoked one pack of cigarettes per day for 30 years. Medications include lovastatin and ramipril. The patient\u2019s temperature is 37.7 \u00b0C (99.9 \u00b0F), pulse is 80\/min, and&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Blood_pressure,_blood_flow,_and_resistance\" target=\"_blank\" rel=\"noreferrer noopener\">blood pressure<\/a>&nbsp;is 145\/85 mmHg. Physical examination reveals facial flushing. Examination of the scrotum shows left-side swelling, which is not reduced when the patient is lying down. When light is applied to the testicle, it does not transilluminate. This patient\u2019s underlying condition most likely originated from which of the following areas?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Bone marrow<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Testicles<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Kidney<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Lung<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Bone<\/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><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><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><\/em><\/u><\/a><\/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=\"C_Kidney\"><\/span>C. Kidney<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_Bone_Marrow\"><\/span>A. Bone Marrow<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\/Polycythemia_vera_(NORD)\" target=\"_blank\" rel=\"noreferrer noopener\">Polycythemia vera<\/a>&nbsp;is a myeloproliferative disorder in which the bone marrow makes too many red blood cells. Occasionally, the condition may result in the overproduction of white blood cells and platelets as well. Although this patient\u2019s hypertension, blurry vision, and facial flushing can also be seen in polycythemia vera, varicoceles are not expected.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Testicles\"><\/span>B. Testicles<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\/Testicular_cancer\" target=\"_blank\" rel=\"noreferrer noopener\">Testicular tumors<\/a>&nbsp;also do not transilluminate, but these tumors usually present with a testicular mass rather than swelling. Also, a testicular tumor would not explain the patient\u2019s hypertension, facial flushing, and blurry vision.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Lung\"><\/span>D. Lung<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\/Lung_cancer\" target=\"_blank\" rel=\"noreferrer noopener\">Lung tumors<\/a>&nbsp;are not associated with polycythemia as a paraneoplastic syndrome, and therefore, they will not cause facial flushing or blurry vision. Also, a lung tumor would not explain the patient&#8217;s testicular findings.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Bone\"><\/span>E. Bone<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\/Bone_tumors\">Bone tumors<\/a>&nbsp;are not associated with polycythemia as a paraneoplastic syndrome, and therefore, they will not cause facial flushing or blurry vision. Also, a bone tumor would not explain the patient&#8217;s testicular findings.<\/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\">This patient has a significant&nbsp;<strong>smoking&nbsp;<\/strong>history and&nbsp;<strong>hypertension<\/strong>, and he is now presenting with&nbsp;<strong>fatigue<\/strong>,<strong>&nbsp;<\/strong><span style=\"margin: 0px;padding: 0px\"><strong>low<\/strong>&#8211;<strong>grade fever<\/strong><\/span>, and&nbsp;blurry vision. This presentation, along with the physical exam showing&nbsp;testicular swelling that is not reduced when lying,&nbsp;is suggestive of a renal tumor. Varicoceles that fail to empty when the patient is recumbent are highly suspicious for a kidney tumor that obstructs the gonadal vein where it enters the renal vein. The facial flushing, hypertension, and blurry vision are most likely secondary to ectopic production of erythropoietin by the renal tumor.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><a href=\"https:\/\/www.osmosis.org\/learn\/Renal_cell_carcinoma\" target=\"_blank\" rel=\"noreferrer noopener\">Renal cell carcinomas<\/a>&nbsp;(RCCs)<\/strong>&nbsp;are the most common primary tumors of the kidney, originating from the proximal convoluted tubules within the renal cortex. Transitional cell carcinomas of the renal pelvis are the second most common. Patients with RCC can present with a variety of symptoms, but unfortunately, such symptoms usually occur late in the course when metastasis has already occurred. The&nbsp;<strong>classic triad of RCC&nbsp;<\/strong>includes&nbsp;<strong>flank pain<\/strong>,<strong>&nbsp;hematuria<\/strong>,<strong>&nbsp;<\/strong>and&nbsp;<strong>palpable abdominal renal mass<\/strong>. Hematuria occurs when the tumor invades the collecting system. When the tumor invades the inferior vena cava, it may lead to lower extremity edema, ascites, hepatic dysfunction (related to Budd-Chiari syndrome), and pulmonary emboli. RCC can cause various paraneoplastic syndromes including polycythemia\/ erythrocytosis (due to EPO production), hypercalcemia (due to PTHrP production). Increased incidence of RCC is associated with smoking and obesity.<\/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=\"Renal cell carcinoma - causes, symptoms, diagnosis, treatment, pathology\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/P6GCoboCMFQ?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>Renal cell carcinoma<\/strong>&nbsp;is the most common primary tumor of the kidney. The classic presentation includes&nbsp;<strong>flank pain<\/strong>,<strong>&nbsp;hematuria<\/strong>,<strong>&nbsp;and palpable abdominal renal mass,<\/strong>&nbsp;but may occur late in the course. The presence of varicocele that is not reduced when the patient is recumbent is highly suspicious of malignancy of the kidney.<\/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<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/1097-0142(1971)28:5%3C1165::AID-CNCR2820280513%3E3.0.CO;2-G\" target=\"_blank\" rel=\"noreferrer noopener\">Diagnosis and management of renal cell carcinoma&nbsp;<\/a><em><a href=\"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/1097-0142(1971)28:5%3C1165::AID-CNCR2820280513%3E3.0.CO;2-G\" target=\"_blank\" rel=\"noreferrer noopener\">A clinical and pathologic study of 309 cases<\/a>.<\/em><\/li>\n<\/ul>\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;<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>&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-full\"><a href=\"https:\/\/www.osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_4aa5d5.png\" alt=\"Osmosis ad to create an account\" class=\"wp-image-3803\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_4aa5d5.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_4aa5d5.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/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 60-year-old man with pain in his scrotum. The scrotum appears to be swollen and the man&#8217;s vision has become blurrier. Can you figure it out? A 60-year-old male comes to the physician\u2019s office due [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":3802,"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-3801","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: Renal Cell Carcinoma - 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-renal-cell-carcinoma\" \/>\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: Renal Cell Carcinoma - 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 man with pain in his scrotum. The scrotum appears to be swollen and the man&#8217;s vision has become blurrier. Can you figure it out? A 60-year-old male comes to the physician\u2019s office due [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-renal-cell-carcinoma\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2021-03-03T20:49:00+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\/2024-09-19T145014.035.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1081\" \/>\n\t<meta property=\"og:image:height\" content=\"1080\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Marina Horiates Kerekes, MD &amp; Team\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":[\"Article\",\"BlogPosting\"],\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-renal-cell-carcinoma#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-renal-cell-carcinoma\"},\"author\":{\"name\":\"Marina Horiates Kerekes, MD &amp; 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