{"id":5020,"date":"2024-12-04T03:36:00","date_gmt":"2024-12-04T11:36:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=5020"},"modified":"2025-10-01T11:38:24","modified_gmt":"2025-10-01T19:38:24","slug":"usmle-step-1-question-of-the-day-cardiac-catheterization","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Cardiac catheterization"},"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-cardiac-catheterization\/#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><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/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-cardiac-catheterization\/#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-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization\/#Major_Takeaway\" >Major Takeaway<\/a><ul class='ez-toc-list-level-3' ><li class='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-cardiac-catheterization\/#References\" >References<\/a><\/li><\/ul><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Prepare for your USMLE Step 1 with a question focusing on Eisenmenger syndrome. Can you summarize the pathophysiology of this condition and recognize its key clinical features? Sharpen your understanding of this critical cardiovascular topic!<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 25-year-old man is referred to a cardiologist for evaluation for intermittent cyanosis and exercise intolerance. Symptoms began around six months ago, and they have progressively worsened. Past medical history is notable for a congenital heart defect, which was diagnosed shortly after birth. However, he was subsequently lost to follow-up and was not treated for this condition. The patient smokes half a pack of cigarettes per day. Physical exam is notable for cyanosis of the lips and clubbing of the fingers. Cardiac catheterization is performed, and oxygen saturation in the cardiac chambers and outflow tracts are shown below:<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter\"><img decoding=\"async\" src=\"https:\/\/osmose-it.s3.amazonaws.com\/VKpW6wHhQHOfauWCfacQ1YVEQfO56LVS\/_.png\" alt=\"An illustration outlining the percentage level of oxygen saturation in each area of the heart.\"\/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following is the most likely explanation of these findings?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Impaired growth of the septum primum<br><br>B. Impaired closure of the foramen ovale<br><br>C. Reversal of long-standing left-to-right shunt<br><br>D. Hyperplasia of bronchial mucus-secreting glands<br><br>E. Fluid accumulation in the lung parenchyma &nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Scroll down for the correct answer!<\/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<p class=\"wp-block-paragraph\"><strong>C. Reversal of long-standing left-to-right shunt<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the Main Explanation, 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\"><strong>A. Impaired growth of the septum primum<br><\/strong><br><strong>Incorrect:<\/strong>&nbsp;This pathology would result in an atrial septal defect (ASD). ASDs are a type of left-to-right shunt. Cardiac catheterization will show increased oxygen saturation in the right atrium, ventricle, and pulmonary artery. Even with Eisenmenger syndrome, ASD would lead to a decrease in saturation in the left atrium (not the ventricle).<br><br><strong>B. Impaired closure of the foramen ovale<br><br>Incorrect:<\/strong>&nbsp;A patent foramen ovale (PFO) can cause transient right-to-left shunting of blood. Cardiac catheterization may show reduced oxygen saturation in the left atrium, ventricle, and aorta. In contrast, this patient\u2019s catheterization does not demonstrate this finding.<br><br><strong>D. Hyperplasia of bronchial mucus-secreting glands<br><br>Incorrect:<\/strong>&nbsp;This answer describes chronic obstructive pulmonary disorder (COPD). COPD can result in a productive cough, barrel chest, cyanosis, and nail clubbing. Patients with a smoking history are at increased risk. Although this patient has a smoking history, he is relatively young and lacks a history of cough characteristic of COPD.<br><br><strong>E. Fluid accumulation in the lung parenchyma<br><br>Incorrect:<\/strong>&nbsp;This answer describes pulmonary edema. The accumulation of fluids in the lung parenchyma can reduce oxygen exchange and cause cyanosis. However, blood in this patient\u2019s left atrium has high oxygen saturation, suggesting that gas exchange is normal.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient has&nbsp;Eisenmenger syndrome, which is when an uncorrected left-to-right shunt reverses direction and becomes a&nbsp;right-to-left shunt. In this patient\u2019s case, the condition most likely arose secondary to an&nbsp;uncorrected&nbsp;ventricular septal defect, given the catheterization finding of decreased saturation in the left ventricle.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Eisenmenger syndrome occurs as a result of the constant shunting of blood to the right heart, which increases pulmonary blood flow. This high flow state triggers&nbsp;vascular remodeling&nbsp;in the lungs, which is characterized by increased proliferation of vascular smooth muscle and&nbsp;narrowing of pulmonary artery lumen. As a result, the right heart must pump against greater resistance, so it too undergoes remodeling in the form of&nbsp;right ventricular hypertrophy. This growth causes the pressure in the right heart to increase and exceed that of the left heart, ultimately switching the shunt\u2019s direction.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Clinically, Eisenmenger syndrome presents with&nbsp;cyanosis,&nbsp;hypoxia, and&nbsp;clubbing&nbsp;of the fingers and toes. In addition, patients can develop&nbsp;polycythemia&nbsp;since hypoxia increases kidney erythropoietin production.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter is-resized\"><img decoding=\"async\" src=\"https:\/\/osmose-it.s3.amazonaws.com\/Fk4jJbdcRVmNEcyyTPvrXSKQR9u5RlaG\/_.png\" alt=\"Left-to-Right Shunt Not Corrected\nEisenmenger Syndrome\n- Constant shunting of blood to right heart --&gt; Increase in pulmonary flow --&gt; Vascular remodeling --&gt; Pulmonary hypertension\nRight heart pumps against\n- Increase pressures --&gt; Remodelling --&gt; R. Ventricular hypertrophy --&gt; Pressure in Right Heart &gt; Pressure in Left Heart --&gt; Switching direction of shunt\" style=\"width:524px;height:auto\"\/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Eisenmenger syndrome&nbsp;occurs when an uncorrected left-to-right shunt reverses direction and becomes a&nbsp;right-to-left shunt. This switch occurs because, over time, vascular remodeling increases the pressure in the right heart until it exceeds that of the left.&nbsp;Patients can have&nbsp;cyanosis,&nbsp;hypoxia,&nbsp;digital clubbing, and polycythemia.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Chaix, M.A., Gatzoulis, M.A., et al. (2019) Eisenmenger syndrome: A multisystem disorder- Do not destabilize the balanced but fragile physiology.&nbsp;The Canadian Journal of Cardiology. 35(12), 1664-1674. Doi: 10.1016\/j.cjca.2019.10.002.&nbsp;<\/li>\n\n\n\n<li>Nashat, H., Kempny, A., et al. (2017) Eisenmenger syndrome: Current perspectives.&nbsp;Research Reports in Clinical Cardiology. 8, 1-12. Doi: 10.2147\/RRCC.S117838.<a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-1\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis by Elsevier today! Get 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 discover 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\/create\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/hm-healthdigital-multisite.go-vip.net\/osmosisblog\/wp-content\/uploads\/sites\/2\/2024\/12\/Blog_Display_Ads_GENERAL3_2023.png\" alt=\"\" class=\"wp-image-5021\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Blog_Display_Ads_GENERAL3_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Blog_Display_Ads_GENERAL3_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>Prepare for your USMLE Step 1 with a question focusing on Eisenmenger syndrome. Can you summarize the pathophysiology of this condition and recognize its key clinical features? Sharpen your understanding of this critical cardiovascular topic! A 25-year-old man is referred to a cardiologist for evaluation for intermittent cyanosis and exercise intolerance. Symptoms began around six [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":5022,"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":[27,20,16,1366,1369,44],"tags":[],"class_list":["post-5020","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","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: Cardiac catheterization - 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-cardiac-catheterization\" \/>\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: Cardiac catheterization - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Prepare for your USMLE Step 1 with a question focusing on Eisenmenger syndrome. Can you summarize the pathophysiology of this condition and recognize its key clinical features? Sharpen your understanding of this critical cardiovascular topic! A 25-year-old man is referred to a cardiologist for evaluation for intermittent cyanosis and exercise intolerance. Symptoms began around six [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2024-12-04T11:36:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-10-01T19:38:24+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Step_1_QOTD_Q4_2024_JTD_3-1.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1080\" \/>\n\t<meta property=\"og:image:height\" content=\"1080\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\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-cardiac-catheterization#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization\"},\"author\":{\"name\":\"Marina Horiates Kerekes, MD &amp; Team\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/c7e60a94ecf3ec6e6cfe4855957afafc\"},\"headline\":\"USMLE\u00ae Step 1 Question of the Day: Cardiac catheterization\",\"datePublished\":\"2024-12-04T11:36:00+00:00\",\"dateModified\":\"2025-10-01T19:38:24+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization\"},\"wordCount\":777,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/#organization\"},\"image\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization#primaryimage\"},\"thumbnailUrl\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Step_1_QOTD_Q4_2024_JTD_3-1.jpg\",\"articleSection\":[\"Allopathic Medicine (MD)\",\"Exam Prep\",\"Osteopathic Medicine (DO)\",\"Questions of the Day\",\"USMLE Step 1\",\"USMLE\u00ae Step 1\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization\",\"url\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization\",\"name\":\"USMLE\u00ae Step 1 Question of the Day: Cardiac catheterization - Osmosis Blog\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization#primaryimage\"},\"image\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization#primaryimage\"},\"thumbnailUrl\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Step_1_QOTD_Q4_2024_JTD_3-1.jpg\",\"datePublished\":\"2024-12-04T11:36:00+00:00\",\"dateModified\":\"2025-10-01T19:38:24+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization#primaryimage\",\"url\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Step_1_QOTD_Q4_2024_JTD_3-1.jpg\",\"contentUrl\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Step_1_QOTD_Q4_2024_JTD_3-1.jpg\",\"width\":1080,\"height\":1080},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/www.osmosis.org\/blog\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"USMLE\u00ae Step 1 Question of the Day: Cardiac catheterization\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#website\",\"url\":\"https:\/\/www.osmosis.org\/blog\/\",\"name\":\"Osmosis Blog\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/www.osmosis.org\/blog\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#organization\",\"name\":\"Osmosis Blog\",\"url\":\"https:\/\/www.osmosis.org\/blog\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/07\/OsmosisElsevierStacked.png\",\"contentUrl\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/07\/OsmosisElsevierStacked.png\",\"width\":1276,\"height\":596,\"caption\":\"Osmosis Blog\"},\"image\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/logo\/image\/\"}},{\"@type\":\"Person\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/c7e60a94ecf3ec6e6cfe4855957afafc\",\"name\":\"Marina Horiates Kerekes, MD &amp; Team\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/c4eaddbf095676223204097f8973e0eed2b2b435a8c32f8f6b8c06da77819aa6?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/c4eaddbf095676223204097f8973e0eed2b2b435a8c32f8f6b8c06da77819aa6?s=96&d=mm&r=g\",\"caption\":\"Marina Horiates Kerekes, MD &amp; Team\"},\"description\":\"Authors: Marina Horiates Kerekes, MD &amp; Osmosis Question Writing Team\",\"url\":\"https:\/\/www.osmosis.org\/blog\/author\/marinahoriateskerekesandteam\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"USMLE\u00ae Step 1 Question of the Day: Cardiac catheterization - Osmosis Blog","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization","og_locale":"en_US","og_type":"article","og_title":"USMLE\u00ae Step 1 Question of the Day: Cardiac catheterization - Osmosis Blog","og_description":"Prepare for your USMLE Step 1 with a question focusing on Eisenmenger syndrome. Can you summarize the pathophysiology of this condition and recognize its key clinical features? Sharpen your understanding of this critical cardiovascular topic! A 25-year-old man is referred to a cardiologist for evaluation for intermittent cyanosis and exercise intolerance. Symptoms began around six [&hellip;]","og_url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization","og_site_name":"Osmosis Blog","article_published_time":"2024-12-04T11:36:00+00:00","article_modified_time":"2025-10-01T19:38:24+00:00","og_image":[{"width":1080,"height":1080,"url":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Step_1_QOTD_Q4_2024_JTD_3-1.jpg","type":"image\/jpeg"}],"author":"Marina Horiates Kerekes, MD &amp; Team","twitter_card":"summary_large_image","schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":["Article","BlogPosting"],"@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization#article","isPartOf":{"@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization"},"author":{"name":"Marina Horiates Kerekes, MD &amp; Team","@id":"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/c7e60a94ecf3ec6e6cfe4855957afafc"},"headline":"USMLE\u00ae Step 1 Question of the Day: Cardiac catheterization","datePublished":"2024-12-04T11:36:00+00:00","dateModified":"2025-10-01T19:38:24+00:00","mainEntityOfPage":{"@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization"},"wordCount":777,"commentCount":0,"publisher":{"@id":"https:\/\/www.osmosis.org\/blog\/#organization"},"image":{"@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization#primaryimage"},"thumbnailUrl":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Step_1_QOTD_Q4_2024_JTD_3-1.jpg","articleSection":["Allopathic Medicine (MD)","Exam Prep","Osteopathic Medicine (DO)","Questions of the Day","USMLE Step 1","USMLE\u00ae Step 1"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization#respond"]}]},{"@type":"WebPage","@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization","url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization","name":"USMLE\u00ae Step 1 Question of the Day: Cardiac catheterization - Osmosis Blog","isPartOf":{"@id":"https:\/\/www.osmosis.org\/blog\/#website"},"primaryImageOfPage":{"@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization#primaryimage"},"image":{"@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization#primaryimage"},"thumbnailUrl":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Step_1_QOTD_Q4_2024_JTD_3-1.jpg","datePublished":"2024-12-04T11:36:00+00:00","dateModified":"2025-10-01T19:38:24+00:00","breadcrumb":{"@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization#primaryimage","url":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Step_1_QOTD_Q4_2024_JTD_3-1.jpg","contentUrl":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Step_1_QOTD_Q4_2024_JTD_3-1.jpg","width":1080,"height":1080},{"@type":"BreadcrumbList","@id":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-cardiac-catheterization#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.osmosis.org\/blog"},{"@type":"ListItem","position":2,"name":"USMLE\u00ae Step 1 Question of the Day: Cardiac catheterization"}]},{"@type":"WebSite","@id":"https:\/\/www.osmosis.org\/blog\/#website","url":"https:\/\/www.osmosis.org\/blog\/","name":"Osmosis Blog","description":"","publisher":{"@id":"https:\/\/www.osmosis.org\/blog\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.osmosis.org\/blog\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/www.osmosis.org\/blog\/#organization","name":"Osmosis Blog","url":"https:\/\/www.osmosis.org\/blog\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.osmosis.org\/blog\/#\/schema\/logo\/image\/","url":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/07\/OsmosisElsevierStacked.png","contentUrl":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/07\/OsmosisElsevierStacked.png","width":1276,"height":596,"caption":"Osmosis Blog"},"image":{"@id":"https:\/\/www.osmosis.org\/blog\/#\/schema\/logo\/image\/"}},{"@type":"Person","@id":"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/c7e60a94ecf3ec6e6cfe4855957afafc","name":"Marina Horiates Kerekes, MD &amp; Team","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/c4eaddbf095676223204097f8973e0eed2b2b435a8c32f8f6b8c06da77819aa6?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/c4eaddbf095676223204097f8973e0eed2b2b435a8c32f8f6b8c06da77819aa6?s=96&d=mm&r=g","caption":"Marina Horiates Kerekes, MD &amp; Team"},"description":"Authors: Marina Horiates Kerekes, MD &amp; Osmosis Question Writing Team","url":"https:\/\/www.osmosis.org\/blog\/author\/marinahoriateskerekesandteam"}]}},"jetpack_featured_media_url":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Step_1_QOTD_Q4_2024_JTD_3-1.jpg","jetpack-related-posts":[{"id":7508,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-respiratory-acidosis","url_meta":{"origin":5020,"position":0},"title":"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Respiratory acidosis","author":"Marina Horiates Kerekes, MD &amp; Team","date":"September 15, 2025","format":false,"excerpt":"A ventilated patient develops cyanosis and respiratory acidosis after an opiate overdose. What clinical factors should be assessed next to determine the cause?","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 Step 2 CK Question of the Day Respiratory acidosis","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/09\/USMLE-Step-2-CK-Question-of-the-Day-Respiratory-acidosis.png","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/09\/USMLE-Step-2-CK-Question-of-the-Day-Respiratory-acidosis.png 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/09\/USMLE-Step-2-CK-Question-of-the-Day-Respiratory-acidosis.png 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/09\/USMLE-Step-2-CK-Question-of-the-Day-Respiratory-acidosis.png 2x"},"classes":[]},{"id":4007,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-oral-mucosal-pallor","url_meta":{"origin":5020,"position":1},"title":"USMLE\u00ae Step 1 Question of the Day: Oral Mucosal Pallor","author":"Marina Horiates Kerekes, MD &amp; Team","date":"June 2, 2021","format":false,"excerpt":"Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics. Today'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\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: Oral Mucosal Pallor","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-20T103854.100.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-20T103854.100.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-20T103854.100.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-20T103854.100.webp 2x"},"classes":[]},{"id":1393,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-asthma-management","url_meta":{"origin":5020,"position":2},"title":"USMLE\u00ae Step 2 CK Question of the Day: Asthma management","author":"Marina Horiates Kerekes, MD &amp; Team","date":"August 23, 2023","format":false,"excerpt":"Prepare for the Step 2 USMLE\u00ae with this comprehensive topic on asthma management. Follow the case of a 42-year-old man in a pulmonology clinic, diagnosed with asthma and currently on a prescribed inhaler. Explore the patient's symptoms, spirometry results, and laboratory findings to determine the most appropriate next step in\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":"","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-asthma-management.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-asthma-management.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-asthma-management.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-asthma-management.webp 2x"},"classes":[]},{"id":808,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-neuroleptic-malignant-syndrome","url_meta":{"origin":5020,"position":3},"title":"USMLE\u00ae Step 1 Question of the Day: Neuroleptic Malignant Syndrome","author":"Marina Horiates Kerekes, MD &amp; Team","date":"October 26, 2023","format":false,"excerpt":"Explore a USMLE\u00ae Step 1 clinical case on serotonin syndrome and discover why myoclonus distinguishes it from similar conditions like neuroleptic malignant syndrome.","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 Step 1 Question of the Day Neuroleptic Malignant Syndrome","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/neuroleptic-malignant-syndrome.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/neuroleptic-malignant-syndrome.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/neuroleptic-malignant-syndrome.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/neuroleptic-malignant-syndrome.webp 2x"},"classes":[]},{"id":1039,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-scleroderma","url_meta":{"origin":5020,"position":4},"title":"USMLE\u00ae Step 1 Question of the Day: Scleroderma","author":"Marina Horiates Kerekes, MD &amp; Team","date":"September 8, 2021","format":false,"excerpt":"Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics. Today's case involves a 56-year-old woman with asthma and notable skin tightening over the face, hands, and forearms.\u00a0Can you figure it out? A 56-year-old woman comes to her primary care physician for evaluation\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":"","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-scleroderma.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-scleroderma.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-scleroderma.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-scleroderma.webp 2x"},"classes":[]},{"id":3178,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-shortness-of-breath","url_meta":{"origin":5020,"position":5},"title":"USMLE\u00ae Step 1 Question of the Day: Shortness of Breath","author":"Marina Horiates Kerekes, MD &amp; Team","date":"May 11, 2022","format":false,"excerpt":"This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.\u00a0Today's case focuses on a 73-year-old woman with shortness of breath. Past medical history is notable for hypertension, chronic obstructive pulmonary disease, and type II diabetes mellitus.\u00a0Can you figure it out? A 73-year-old\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: Shortness of Breath","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T080106.811.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T080106.811.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T080106.811.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T080106.811.webp 2x"},"classes":[]}],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/5020","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=5020"}],"version-history":[{"count":3,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/5020\/revisions"}],"predecessor-version":[{"id":7160,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/5020\/revisions\/7160"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media\/5022"}],"wp:attachment":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media?parent=5020"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/categories?post=5020"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/tags?post=5020"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}