{"id":8904,"date":"2025-12-03T00:01:21","date_gmt":"2025-12-03T08:01:21","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=8904"},"modified":"2026-07-10T13:58:16","modified_gmt":"2026-07-10T21:58:16","slug":"usmle-step-2-ck-question-of-the-day-constant-headache","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-constant-headache","title":{"rendered":"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Constant headache"},"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-2-ck-question-of-the-day-constant-headache\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 2 Question is\u2026<\/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-2-ck-question-of-the-day-constant-headache\/#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-2-ck-question-of-the-day-constant-headache\/#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-2-ck-question-of-the-day-constant-headache\/#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-2-ck-question-of-the-day-constant-headache\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/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-2-ck-question-of-the-day-constant-headache\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>A patient with a history of HIV presents with a worsening headache , neck stiffness, light senstivity, and occasional fever over the past two weeks. Which of the following is the most likely diagnosis?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 53-year-old man presents to the emergency department for evaluation of <strong>headache<\/strong>. For the past two weeks, the patient has experienced a <strong>gradually intensifying, constant headache<\/strong> with associated <strong>light sensitivity and neck stiffness<\/strong>. The patient has a medical history significant for <strong><a href=\"https:\/\/www.osmosis.org\/learn\/HIV_(AIDS)\">HIV<\/a><\/strong>, and he has been <strong>non-adherent with antiretroviral agents<\/strong>. On review of systems, the patient has had <strong>intermittent fever and cough<\/strong>. The patient does not currently take any medications. <strong>Temperature is 39.0\u00b0C (102.2\u00b0F), pulse is 110\/min, respirations are 22\/min, and blood pressure is 130\/85 mmHg.<\/strong> On physical examination, the patient is <strong>squinting and resisting passive movement of the neck<\/strong>. With <strong>forward flexion of the neck, the hips flex bilaterally.<\/strong> A <strong>lumbar puncture<\/strong> is performed; results are shown below. <\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Cerebrospinal fluid (CSF) analysis<\/strong>&nbsp;<\/td><td><strong>Result<\/strong>&nbsp;<\/td><\/tr><tr><td>Appearance&nbsp;<\/td><td>Clear&nbsp;<\/td><\/tr><tr><td>Glucose&nbsp;<\/td><td>60 mg\/dL&nbsp;<\/td><\/tr><tr><td>Protein&nbsp;<\/td><td>70 mg\/dL&nbsp;<\/td><\/tr><tr><td>White blood cell count&nbsp;<\/td><td>450\/microL&nbsp;<\/td><\/tr><tr><td>Red blood cell count&nbsp;<\/td><td>0\/microL&nbsp;<\/td><\/tr><tr><td>Opening pressure&nbsp;<\/td><td>30 cmH<sub>2<\/sub>O&nbsp;<\/td><\/tr><tr><td>India ink stain&nbsp;<\/td><td>Positive&nbsp;&nbsp;<\/td><\/tr><tr><td>Acid-fast stain&nbsp;<\/td><td>Negative&nbsp;<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Which of the following is the <em>most likely<\/em> causative organism in this patient\u2019s condition?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Cryptococcus neoformans<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Streptococcus pneumoniae<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Listeria monocytogenes<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Herpes simplex virus<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Mycobacterium tuberculosis<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/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=\"Learn with Osmosis\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/iDxHtjjCMbU?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=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_2_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 2 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Cryptococcus neoformans<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/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><em>B. Streptococcus pneumoniae&nbsp;<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> <strong>Bacterial meningitis<\/strong> typically features a <strong>very high CSF white blood cell count (&gt;1,000\/microL)<\/strong>, <strong>low glucose<\/strong>, and <strong>high protein (&gt;100 mg\/dL)<\/strong>. In contrast, this case features a <strong>lower WBC count (450\/microL)<\/strong>, <strong>normal glucose<\/strong>, and <strong>only mildly elevated protein (70 mg\/dL)<\/strong>, along with <strong>positive India ink staining<\/strong>; this profile is more suggestive of <strong>cryptococcal meningitis<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>C. Listeria monocytogenes&nbsp;<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> <strong>Bacterial meningitis<\/strong> typically features a <strong>very high CSF white blood cell count (&gt;1,000\/microL)<\/strong>, <strong>low glucose<\/strong>, and <strong>high protein (&gt;100 mg\/dL)<\/strong>. In contrast, this case features a <strong>lower WBC count (450\/microL)<\/strong>, <strong>normal glucose<\/strong>, and <strong>only mildly elevated protein (70 mg\/dL)<\/strong>, along with <strong>positive India ink staining<\/strong>; this profile is more suggestive of <strong>cryptococcal meningitis<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Herpes simplex virus&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> <strong>Viral meningitis<\/strong> typically features a <strong>slightly higher CSF white blood cell count (up to 1,000\/microL)<\/strong> and the <strong>presence of red blood cells (RBCs)<\/strong>. In contrast, the <strong>lower WBC count (450\/microL)<\/strong>, <strong>positive India ink staining<\/strong>, and <strong>lack of RBCs<\/strong> in this patient\u2019s CSF profile are more suggestive of <strong>cryptococcal meningitis<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Mycobacterium tuberculosis&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> <strong>Tuberculous meningitis<\/strong> typically features <strong>low glucose<\/strong> in the CSF, in addition to a <strong>positive acid-fast test<\/strong>. In contrast, the <strong>normal glucose<\/strong> and <strong>positive India ink staining<\/strong> in this case are more suggestive of <strong>cryptococcal meningitis<\/strong>.<\/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<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"975\" height=\"788\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/12\/image_d98e76.png\" alt=\"Meningitis comparison summary:\nCryptococcal meningitis \u2013 subacute onset; lymphocytic CSF (&lt;500\/\u00b5L); normal or low glucose; normal or high protein; elevated opening pressure; India ink or cryptococcal antigen positive; associated with HIV\/AIDS.\nBacterial meningitis \u2013 acute onset (hours to days); neutrophilic CSF (&gt;1,000\/\u00b5L); low glucose; high protein; high opening pressure; Gram stain and culture positive; symptoms include fever, neck stiffness, possible rash (N. meningitidis).\nTuberculous meningitis \u2013 subacute to chronic onset; lymphocytic CSF (&lt;500\/\u00b5L); low glucose; high protein; high opening pressure; acid-fast stain or PCR positive; associated with night sweats, weight loss, cranial nerve palsies.\nViral meningitis \u2013 acute or subacute; lymphocytic CSF (&lt;1,000\/\u00b5L); normal or slightly low glucose; normal or mildly high protein; normal or slightly high opening pressure; PCR for specific viruses; seasonal, mild illness.\nHSV meningitis \u2013 acute or subacute; lymphocytic CSF with RBCs (&lt;1,000\/\u00b5L); normal or slightly low glucose; normal or mildly high protein; normal or slightly high opening pressure; PCR + RBCs in CSF; associated with seizures, temporal lobe findings, focal deficits.\" class=\"wp-image-8907\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/12\/image_d98e76.png 975w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/12\/image_d98e76.png?resize=300,242 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/12\/image_d98e76.png?resize=768,621 768w\" sizes=\"auto, (max-width: 975px) 100vw, 975px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">This <strong>immunocompromised patient<\/strong> presents with signs and symptoms of <strong>cryptococcal meningitis<\/strong>, including <strong>fever, headache, neck stiffness, and light sensitivity<\/strong>. The <strong>subacute presentation<\/strong> is typical of cryptococcal meningitis, which is most common in patients with a <strong>CD4 count &lt;100 cells\/microL<\/strong>. The <strong>CSF white blood cell (WBC) count<\/strong> is often <strong>elevated but typically not exceeding 500 cells\/microL<\/strong>. <strong>Glucose levels<\/strong> are usually <strong>slightly low or normal<\/strong>, <strong>protein levels<\/strong> may be <strong>normal or elevated<\/strong>, and <strong>opening pressure is often high<\/strong>. A <strong>positive India ink stain<\/strong> is key in distinguishing this from other forms of meningitis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In <strong>tuberculous meningitis<\/strong>, CSF analysis may show a similar WBC count and glucose and protein levels, but the <strong>India ink stain will be negative<\/strong>, and an <strong>acid-fast stain will be positive<\/strong>. <strong>Non-tuberculous bacterial meningitis<\/strong> typically features a <strong>very high WBC count with a neutrophilic predominance<\/strong>, <strong>low glucose<\/strong>, and <strong>elevated protein<\/strong>. <strong>Viral meningitis<\/strong> shows a <strong>variable WBC count with a lymphocytic predominance<\/strong>, <strong>normal or slightly low glucose<\/strong>, and <strong>normal or slightly elevated protein<\/strong>. In <strong>herpes simplex virus (HSV) meningitis<\/strong>, the <strong>red blood cell count<\/strong> may be significantly elevated even with a <strong>non-traumatic lumbar puncture<\/strong>.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"975\" height=\"467\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/12\/image_322e52.png\" alt=\"Cryptococcal meningitis overview: Most common cause is Cryptococcus neoformans. Characteristic halo effect on microscopy. Cerebrospinal fluid shows WBCs &lt;500\/\u00b5L (usually lymphocytic), normal or low glucose, and normal or elevated protein levels. Diagnosis confirmed by CSF culture, cryptococcal antigen test, or PCR.\" class=\"wp-image-8908\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/12\/image_322e52.png 975w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/12\/image_322e52.png?resize=300,144 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/12\/image_322e52.png?resize=768,368 768w\" sizes=\"auto, (max-width: 975px) 100vw, 975px\" \/><\/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\"><strong>Cryptococcal meningitis<\/strong> should be suspected in individuals with <strong>potentially advanced HIV<\/strong>, and it can be differentiated from other forms of infectious meningitis through <strong>CSF analysis<\/strong>, which typically shows a <strong>moderately elevated (&lt;500\/microL), lymphocyte-predominant WBC count<\/strong>, <strong>normal or slightly low glucose<\/strong>, and <strong>normal or slightly elevated protein<\/strong>. <strong>Positive India ink staining is diagnostic.<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch the Osmosis video:<\/strong> <a href=\"https:\/\/www.osmosis.org\/learn\/Meningitis_and_brain_abscess:_Clinical_sciences\"><strong>Meningitis and brain abscess: Clinical sciences<\/strong><\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul start=\"1\" class=\"wp-block-list\">\n<li>Paramitha, P. and Ritarwan, K. (2022). Case Report: Cryptococcal Meningitis. Open Access Macedonian Journal of Medical Sciences 10(T7): 138-141.&nbsp;&nbsp;<\/li>\n<\/ul>\n\n\n\n<ul start=\"2\" class=\"wp-block-list\">\n<li>Pruitt, A.A. (26 May 2021). Central Nervous System Infections in Immunocompromised Patients. Current Neurology and Neuroscience Reports 21(7):1-10.&nbsp;<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter 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\/2020\/09\/Blog_Display_Ads_MD1_2023.png\" alt=\"\" class=\"wp-image-5904\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em><strong>Get your\u00a0<em><a href=\"http:\/\/osmosis.org\/create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/em>\u00a0and discover why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A patient with advanced HIV shows symptoms of meningitis. Learn how CSF analysis and specific staining techniques guide diagnosis among infectious causes.<\/p>\n","protected":false},"author":204,"featured_media":8909,"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":[27,20,16,1366,1370,45],"tags":[2298,2300,613,2304,2297,2301,2299,614,2302,1231,2296,2306,2303,2305],"class_list":["post-8904","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-2-questions","category-step-2","tag-cerebrospinal-fluid","tag-cns-infections","tag-fungal-infections","tag-hiv-complications","tag-hiv-infections","tag-immunocompromised-patient-care","tag-india-ink-stain","tag-infectious-diseases","tag-infectious-meningitis","tag-lumbar-puncture","tag-meningitis","tag-meningitis-diagnosis","tag-meningitis-symptoms","tag-neurological-infections"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 2 CK Question of the Day:\u00a0Constant headache - 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-2-ck-question-of-the-day-constant-headache\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Constant headache - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"A patient with advanced HIV shows symptoms of meningitis. Learn how CSF analysis and specific staining techniques guide diagnosis among infectious causes.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-constant-headache\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2025-12-03T08:01:21+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-07-10T21:58:16+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/12\/Step-2-Question-of-the-Day-Constant-Headache.png\" \/>\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\/png\" \/>\n<meta name=\"author\" content=\"Rowan Bell, MD &amp; Marina Horiates Kerekes, MD\" \/>\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-2-ck-question-of-the-day-constant-headache#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-constant-headache\"},\"author\":{\"name\":\"Rowan Bell, MD &amp; 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