{"id":614,"date":"2023-03-08T16:24:00","date_gmt":"2023-03-08T16:24:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=614"},"modified":"2025-10-01T11:40:35","modified_gmt":"2025-10-01T19:40:35","slug":"usmle-step-1-question-of-the-day-hairy-leukoplakia","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-hairy-leukoplakia","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Hairy leukoplakia"},"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-hairy-leukoplakia\/#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-hairy-leukoplakia\/#C_Burkitt_lymphoma\" >C. Burkitt lymphoma<\/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-hairy-leukoplakia\/#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-hairy-leukoplakia\/#A_Kaposi_sarcoma\" >A. Kaposi sarcoma<\/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-hairy-leukoplakia\/#B_Shingles\" >B. Shingles&nbsp;<\/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-hairy-leukoplakia\/#D_Cervical_cancer\" >D. Cervical cancer<\/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-hairy-leukoplakia\/#E_Vulvovaginitis\" >E. Vulvovaginitis<\/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-hairy-leukoplakia\/#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-hairy-leukoplakia\/#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-hairy-leukoplakia\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;<\/em><\/strong><strong><em>Today&#8217;s case focuses on a 51-year-old woman who comes to the clinic for an assessment of a tongue lesion. Her history is significant for active IV drug use and homelessness. She was recently hospitalized and treated for Pneumocystis pneumonia six months ago. Oral examination reveals a white lesion on the lateral margin of the tongue with \u201cfeathery\u201d projections. The lesion is not easily scraped away with a tongue depressor. The pathogen implicated in this patient\u2019s tongue lesion is also associated with which of the following diseases?&nbsp;<\/em><\/strong><strong><em>Can you figure it out?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 51-year-old woman comes to the clinic for an assessment of a tongue lesion. She states it is occasionally painful and has impacted her ability to eat. Her history is significant for active IV drug use and homelessness. She was recently hospitalized and treated for Pneumocystis pneumonia six months ago. She takes no medications and has not visited a primary care physician in over ten years. Vitals are within normal limits. Physical examination reveals a thin woman with temporal wasting and minimal muscle mass. Oral examination reveals a white lesion on the lateral margin of the tongue with \u201cfeathery\u201d projections. The lesion is not easily scraped away with a tongue depressor. There are track marks and scars present in the bilateral antecubital fossa. The rest of the physical examination is noncontributory. The pathogen implicated in this patient\u2019s tongue lesion is also associated with which of the following diseases?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Kaposi sarcoma<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Shingles<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Burkitt lymphoma&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Cervical cancer<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Vulvovaginitis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Scroll down to find the answer!<\/p>\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=\"C_Burkitt_lymphoma\"><\/span>C. Burkitt lymphoma<span class=\"ez-toc-section-end\"><\/span><\/h3>\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\">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_Kaposi_sarcoma\"><\/span>A. Kaposi sarcoma<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Kaposi sarcoma is caused by human herpesvirus-8 (HHV-8). Kaposi sarcoma presents with multiple cutaneous lesions (vascular tumors) and is almost exclusively seen in AIDS patients. A different pathogen precipitates this patient\u2019s condition (hairy leukoplakia).<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Shingles\"><\/span><strong>B. Shingles<\/strong><strong>&nbsp;<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Shingles is caused by reactivation of a prior infection with varicella-zoster virus (VZV) (i.e. chickenpox). A different pathogen causes this patient\u2019s condition (hairy leukoplakia).<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Cervical_cancer\"><\/span>D. Cervical cancer<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Cervical cancer is caused by the human papillomavirus (HPV). HPV preferentially infects squamous cells and can result in oropharyngeal cancers. However, this patient\u2019s hairy leukoplakia is caused by a different virus.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Vulvovaginitis\"><\/span>E. Vulvovaginitis<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Vulvovaginitis occurs secondary to colonization with various pathogens, with one of the most common pathogens being Candida albicans. Oropharyngeal candidiasis, also known as oral thrush, is caused by C. albicans. A physical examination will reveal white plaques on the oral mucosa, similar to this patient. However, oral thrush is scrapable with a tongue depressor, unlike leukoplakia and erythroplakia (premalignant lesions).<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\/md\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/79.png?w=700\" alt=\"\" class=\"wp-image-513\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/79.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/79.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span><strong>Main Explanation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Oral hairy leukoplakia<\/strong>&nbsp;(OHL) is an&nbsp;<strong>Epstein-Barr virus (EBV)<\/strong>-mediated mucocutaneous<strong>&nbsp;condition<\/strong>&nbsp;involving the squamous epithelium of the tongue. Hairy leukoplakia is associated with HIV infection or immunosuppression \u2013 as suggested in this vignette by the patient\u2019s history of IV drug use and recent hospitalization with PCP pneumonia. The pathophysiology of OHL depends on several factors, including EBV virulence\/strain and host immune system factors.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The lateral border of the tongue is more susceptible to mechanical trauma, predisposing epidermal cells at this location to infection with EBV. Hence, this condition is commonly discovered as a unilateral non-painful&nbsp;<strong>white lesion<\/strong>&nbsp;on the&nbsp;<strong>lateral margin of the tongue<\/strong>. The lesion may vary in appearance as either a smooth and flat or irregular, &#8220;hairy&#8221; or &#8220;feathery&#8221; lesion with prominent folds or projections. In contrast to oral thrush, OHL lesions are adherent to the surface and&nbsp;<strong>cannot be removed by scraping<\/strong>. The surrounding tissue does not typically demonstrate any signs of erythematous change. EBV is implicated in several conditions beyond OHL, such as infectious mononucleosis,&nbsp;<strong>Burkitt lymphoma<\/strong>, and nasopharyngeal carcinoma.&nbsp;<\/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\">Oral hairy leukoplakia (OHL) is an Epstein-Barr virus (EBV)-a mediated mucocutaneous condition in which the virus infects the squamous epithelium of the tongue. Unlike oral thrush, lesions are adherent to the surface and cannot be removed via scraping.&nbsp;<\/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\">Rathee M, Jain P. Hairy Leukoplakia. [Updated 2020 Apr 22]. In: StatPearls [Internet].&nbsp;<em>Treasure Island (FL)<\/em>: StatPearls Publishing; 2020 Jan-. Available from:&nbsp;<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK554591\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK554591\/<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Khammissa RA, Fourie J, Chandran R, Lemmer J, Feller L.&nbsp;<em>Epstein-Barr Virus and Its Association with Oral Hairy Leukoplakia: A Short Review<\/em>. Int J Dent. 2016;2016:4941783. doi: 10.1155\/2016\/4941783. Epub 2016 Mar 7. PMID: 27047546; PMCID: PMC4800082.<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><br><a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-1\" target=\"_blank\" rel=\"noreferrer noopener\"><br><\/a><\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-1\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-step-1-everything-you-need-to-know-banner.png\" alt=\"\" class=\"wp-image-615\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-step-1-everything-you-need-to-know-banner.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-step-1-everything-you-need-to-know-banner.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><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><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case focuses on a 51-year-old woman who comes to the clinic for an assessment of a tongue lesion. Her history is significant for active IV drug use and homelessness. She was recently hospitalized and treated for Pneumocystis [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":616,"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-614","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: Hairy leukoplakia - 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-hairy-leukoplakia\" \/>\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: Hairy leukoplakia - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case focuses on a 51-year-old woman who comes to the clinic for an assessment of a tongue lesion. Her history is significant for active IV drug use and homelessness. She was recently hospitalized and treated for Pneumocystis [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-hairy-leukoplakia\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2023-03-08T16:24:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-10-01T19:40:35+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/question-of-the-day-hairy-leukoplakia.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-hairy-leukoplakia#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-hairy-leukoplakia\"},\"author\":{\"name\":\"Marina Horiates Kerekes, MD &amp; 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A 60-year-old man is admitted to the emergency department due to a seizure.\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: Glioblastoma Multiforme","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/86.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/86.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/86.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/86.webp 2x"},"classes":[]},{"id":7931,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-vascular-ischemia","url_meta":{"origin":614,"position":4},"title":"USMLE\u00ae Step 1 Question of the Day:\u00a0Vascular ischemia","author":"Rowan Bell, MD &amp; Marina Horiates Kerekes, MD","date":"October 27, 2025","format":false,"excerpt":"Explore a clinical case of acute neurological deficits in an elderly patient, focusing on identifying the affected brainstem vascular territory.","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":"Step 1 Question of the Day Vascular ischemia","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Step-1-Question-of-the-Day-Vascular-ischemia.png","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Step-1-Question-of-the-Day-Vascular-ischemia.png 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Step-1-Question-of-the-Day-Vascular-ischemia.png 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Step-1-Question-of-the-Day-Vascular-ischemia.png 2x"},"classes":[]},{"id":3627,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-progressive-lethargy","url_meta":{"origin":614,"position":5},"title":"USMLE\u00ae Step 1 Question of the Day: Progressive Lethargy","author":"Marina Horiates Kerekes, MD &amp; Team","date":"December 29, 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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