{"id":4007,"date":"2021-06-02T16:37:00","date_gmt":"2021-06-02T16:37:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=4007"},"modified":"2025-10-01T11:42:40","modified_gmt":"2025-10-01T19:42:40","slug":"usmle-step-1-question-of-the-day-oral-mucosal-pallor","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-oral-mucosal-pallor","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Oral Mucosal Pallor"},"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-oral-mucosal-pallor\/#A_Fanconi_anemia\" >A. Fanconi anemia<\/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-oral-mucosal-pallor\/#B_Chronic_myeloid_leukemia\" >B. Chronic myeloid leukemia<\/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-oral-mucosal-pallor\/#C_Follicular_lymphoma\" >C. Follicular lymphoma<\/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-oral-mucosal-pallor\/#D_Polycythemia_vera\" >D. Polycythemia vera<\/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-oral-mucosal-pallor\/#E_Acute_myeloid_leukemia\" >E. Acute myeloid leukemia<\/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-oral-mucosal-pallor\/#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-oral-mucosal-pallor\/#D_Polycythemia_vera-2\" >D. Polycythemia vera<\/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-oral-mucosal-pallor\/#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-oral-mucosal-pallor\/#A_Fanconi_anemia-2\" >A.&nbsp;Fanconi anemia<\/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-oral-mucosal-pallor\/#B_Chronic_myeloid_leukemia-2\" >B. Chronic myeloid leukemia<\/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-oral-mucosal-pallor\/#C_Follicular_lymphoma-2\" >C. Follicular lymphoma<\/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-oral-mucosal-pallor\/#E_Acute_myeloid_leukemia-2\" >E. Acute myeloid leukemia<\/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-oral-mucosal-pallor\/#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-oral-mucosal-pallor\/#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-15\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-oral-mucosal-pallor\/#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 68-year-old man. Polymerase chain reaction testing reveals a mutation in a gene encoding for a non-receptor tyrosine kinase. Can you figure it out?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 68-year-old male comes to his provider\u2019s office for evaluation of fatigue, weakness, and 8 kg (17.6 lb) unintentional weight loss over the past 2 months. Moreover, the patient reports feeling bloated after eating small quantities of food during this same time period. His past medical history is notable for hypertension, and the patient is currently taking hydrochlorothiazide. Physical exam reveals oral mucosal pallor. Cardiac and pulmonary exams are non-contributory. Abdominal exam reveals hepatosplenomegaly. Laboratory testing results are as follows:<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Laboratory value<\/strong><\/td><td><strong>Result<\/strong><\/td><\/tr><tr><td>Hemoglobin<\/td><td>9.5 g\/dL<\/td><\/tr><tr><td>Hematocrit<\/td><td>28.5%<\/td><\/tr><tr><td>Leukocytes<\/td><td>2,700\/mm<sup>3<\/sup><\/td><\/tr><tr><td>Platelets<\/td><td>100,000\/mm<sup>3<\/sup><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Biopsy of the bone marrow biopsy shows increased fibrosis and reduced cell count. Polymerase chain reaction testing reveals a mutation in a gene encoding for a non-receptor tyrosine kinase. Which of the following diseases is also caused by an identical mutation?<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Fanconi_anemia\"><\/span>A. Fanconi anemia<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Chronic_myeloid_leukemia\"><\/span>B. Chronic myeloid leukemia<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Follicular_lymphoma\"><\/span>C. Follicular lymphoma<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Polycythemia_vera\"><\/span>D. Polycythemia vera<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Acute_myeloid_leukemia\"><\/span>E. Acute myeloid leukemia<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_Polycythemia_vera-2\"><\/span>D. Polycythemia vera<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_Fanconi_anemia-2\"><\/span>A.&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Fanconi_anemia\" target=\"_blank\" rel=\"noreferrer noopener\">Fanconi anemia<\/a><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\/Fanconi_anemia\" target=\"_blank\" rel=\"noreferrer noopener\">Fanconi anemia<\/a>&nbsp;is caused by defects in homologous&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/DNA_structure\" target=\"_blank\" rel=\"noreferrer noopener\">DNA recombination<\/a>. Patients with this congenital condition present at a young age with pancytopenia, short stature, microcephaly, and cafe-au-lait spots. In contrast, defects in homologous DNA recombination play no role in the pathogenesis of this patient\u2019s condition (primary&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Myelofibrosis_(NORD)\" target=\"_blank\" rel=\"noreferrer noopener\">myelofibrosis<\/a>).<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Chronic_myeloid_leukemia-2\"><\/span>B. Chronic myeloid leukemia<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\/Chronic_leukemia\">Chronic myeloid leukemia<\/a>&nbsp;(CML) is caused by a translocation between chromosomes 9 and 22. This results in fusion of the&nbsp;<em>BCR<\/em>&nbsp;and&nbsp;<em>ABL<\/em>&nbsp;gene, producing a tyrosine kinase with increased activity. However, the&nbsp;<em>JAK2<\/em>&nbsp;gene mutation responsible for this patient\u2019s condition plays no role in the pathogenesis of CML.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Follicular_lymphoma-2\"><\/span>C. Follicular lymphoma<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Follicular lymphoma is caused by a mutation in the gene encoding the&nbsp;<em>Bcl-2<\/em>&nbsp;protein. Normally&nbsp;<em>Bcl-2<\/em>&nbsp;keeps the mitochondrial membrane intact and prevents apoptosis. The mutation results in overexpression of&nbsp;<em>Bcl-2<\/em>, which prevents apoptosis and causes uncontrolled cellular proliferation. In contrast, this patient has primary myelofibrosis, which is most often secondary to a mutation in the&nbsp;<em>JAK2<\/em>&nbsp;gene.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Acute_myeloid_leukemia-2\"><\/span>E. Acute myeloid leukemia<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\/Acute_leukemia\" target=\"_blank\" rel=\"noreferrer noopener\">Acute myeloid leukemia<\/a>&nbsp;(AML) is caused by a translocation between chromosomes 15 and 17. This disrupts the retinoic acid receptor (RAR), which is needed for myeloblast maturation. As a result, there is proliferation of myeloblasts, the unipotent stem cells that can differentiate into neutrophils, eosinophils, basophils, and monocytes. However, the&nbsp;<em>JAK2<\/em>&nbsp;gene mutation responsible for this patient\u2019s condition plays no role in AML.<\/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&nbsp;<strong>primary myelofibrosis<\/strong>, which is one of the myeloproliferative disorders. These are a group of blood disorders characterized by the&nbsp;<strong>excess proliferation of cells of myeloid lineage<\/strong>. The four high-yield myeloproliferative disorders are:<strong>&nbsp;<\/strong><a href=\"https:\/\/www.osmosis.org\/learn\/Polycythemia_vera_(NORD)\" target=\"_blank\" rel=\"noreferrer noopener\">polycythemia vera<\/a>,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Essential_thrombocythemia_(NORD)\" target=\"_blank\" rel=\"noreferrer noopener\">essential thrombocythemia<\/a>, primary myelofibrosis, and&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Chronic_leukemia\" target=\"_blank\" rel=\"noreferrer noopener\">chronic myeloid leukemia<\/a>. The first three conditions are most often caused by a&nbsp;<strong><em>Janus Kinase 2<\/em>&nbsp;(<em>JAK2<\/em>) gene mutation<\/strong>. CML is caused by a t[9;22] chromosomal translocation.<\/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=\"Myelofibrosis - causes, symptoms, diagnosis, treatment, pathology\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/WTkPJH2ti_Q?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\">Primary&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Myelofibrosis_(NORD)\" target=\"_blank\" rel=\"noreferrer noopener\">myelofibrosis<\/a>&nbsp;is characterized by the&nbsp;<strong>uncontrolled proliferation of megakaryocytes<\/strong>&nbsp;and&nbsp;<strong>scar tissue deposition<\/strong>. Over time, the hematopoietic stem cells residing in the bone marrow are crowded out by scar tissue. This results in&nbsp;<strong>pancytopenia<\/strong>&nbsp;and a \u201cdry tap\u201d on bone marrow biopsy. This pancytopenia results in reduced production of red blood cells (anemia), platelets (increased bleeding) and white blood cells (increased infections). Some of the stem cells migrate to other organs (e.g., liver, spleen) and proliferate there. This is termed&nbsp;<strong>extramedullary hematopoiesis<\/strong>&nbsp;and may cause hepatosplenomegaly. The enlarged spleen and liver can compress the stomach, ultimately resulting in decreased appetite\/weight loss.<\/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>Myeloproliferative disorders<\/strong>&nbsp;are characterized by the&nbsp;<strong>excess proliferation of cells of myeloid lineage<\/strong>. They are often caused by a&nbsp;<strong><em>JAK2<\/em>&nbsp;gene mutation<\/strong>. The four high-yield myeloproliferative disorders are: polycythemia vera, essential thrombocythemia, primary myelofibrosis, and chronic myeloid leukemia.<\/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\">George, T.I., Arber, D.A. (2018)&nbsp;<em><a href=\"https:\/\/www.springer.com\/gp\/book\/9781493974672\" target=\"_blank\" rel=\"noreferrer noopener\">Atlas of bone marrow pathology<\/a><\/em>. Springer New York. ISBN: 978-1-4939-7469-6.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Meier, B., Burton, J.H. (2014)&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/25060252\/\" target=\"_blank\" rel=\"noreferrer noopener\">Myeloproliferative disorders<\/a>.&nbsp;<em>Emergency Medicine Clinics of North America<\/em>. 32(3), 597-612. Doi: 10.1016\/j.emc.2014.04.014.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Tefferi, A. (2018)&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/30039550\/\" target=\"_blank\" rel=\"noreferrer noopener\">Primary myelofibrosis<\/a>: 2019 update and diagnosis, risk-stratification and management.&nbsp;<em>American Journal of Hematology<\/em>. 93(12), 1551-1560. Doi: 10.102\/ajh.25230.<\/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<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_26b27e.png\" alt=\"The most powerful platform for learning medicine. Try it free today.\" class=\"wp-image-4009\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_26b27e.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_26b27e.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 68-year-old man. Polymerase chain reaction testing reveals a mutation in a gene encoding for a non-receptor tyrosine kinase. Can you figure it out? A 68-year-old male comes to his provider\u2019s office for evaluation of [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":4008,"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-4007","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: Oral Mucosal Pallor - 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-oral-mucosal-pallor\" \/>\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: Oral Mucosal Pallor - 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 68-year-old man. Polymerase chain reaction testing reveals a mutation in a gene encoding for a non-receptor tyrosine kinase. Can you figure it out? 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Can you identify the consequence most closely associated with this high-yield USMLE-style case?","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:\u00a0Abdominal discomfort","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/Step-1-Question-of-the-Day-abdominal-discomfort.jpg","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/Step-1-Question-of-the-Day-abdominal-discomfort.jpg 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/Step-1-Question-of-the-Day-abdominal-discomfort.jpg 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/Step-1-Question-of-the-Day-abdominal-discomfort.jpg 2x"},"classes":[]}],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/4007","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=4007"}],"version-history":[{"count":3,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/4007\/revisions"}],"predecessor-version":[{"id":6746,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/4007\/revisions\/6746"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media\/4008"}],"wp:attachment":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media?parent=4007"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/categories?post=4007"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/tags?post=4007"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}