{"id":952,"date":"2022-05-25T12:59:00","date_gmt":"2022-05-25T12:59:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=952"},"modified":"2026-02-13T17:58:35","modified_gmt":"2026-02-14T01:58:35","slug":"usmle-step-1-question-of-the-day-altered-mental-state","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-altered-mental-state","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Altered Mental State"},"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-altered-mental-state\/#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-altered-mental-state\/#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-altered-mental-state\/#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-altered-mental-state\/#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-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-altered-mental-state\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em>We&#8217;re sharing another <strong>USMLE\u00ae Step 1-style practice question<\/strong> to test your knowledge.&nbsp;Today&#8217;s case involves a <strong>78-year-old man<\/strong> with <strong>altered mental status<\/strong>. The patient has a <strong>Swan-Ganz catheter<\/strong> placed in the <strong>right heart<\/strong>. Can you figure out the most likely <strong>cause <\/strong>of this patient&#8217;s clinical presentation?<\/em> <em>Let&#8217;s find out!<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A <strong>78-year-old man<\/strong> presents to the emergency department with <strong>altered mental status <\/strong>and <strong>fatigue<\/strong>. He is found to be <strong>critically ill<\/strong> and is admitted to the <strong>intensive care unit (ICU) for further evaluation and monitoring<\/strong>. While in the ICU, the patient has a <strong>Swan-Ganz catheter<\/strong> placed in the right heart for <strong>continuous hemodynamic measurements.<\/strong> An initial set of readings is demonstrated below:<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Hemodynamic Parameter&nbsp;<\/strong><\/td><td>&nbsp;<strong>Result<\/strong><\/td><\/tr><tr><td>Pulmonary capillary wedge pressure (PCWP)<\/td><td>&nbsp;20 mmHg (normal 4-12 mmHg)<\/td><\/tr><tr><td>Systemic vascular resistance (SVR)<\/td><td>&nbsp;2000 dyn\u00b7s\/cm<sup>5<\/sup>&nbsp;(normal 700\u20131600 dyn\u00b7s\/cm<sup>5<\/sup>)<\/td><\/tr><tr><td>Cardiac Index (CI)<\/td><td>&nbsp;1.2 L\/min\/m<sup>2&nbsp;<\/sup>(normal 2.6\u20134.2 L\/min\/m<sup>2<\/sup>)<\/td><\/tr><tr><td>Mixed venous oxygen saturation (SvO<sub>2<\/sub>)<\/td><td>&nbsp;50% (normal 65-70%)<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following is the <strong>most likely cause<\/strong> of this patient&#8217;s clinical presentation?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Bacteremia due to a Gram-negative rod<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Impaired sympathetic outflow<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Thrombus in the pulmonary artery<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Hemorrhage due to bleeding peptic ulcer<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Heart failure<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down to find the answer!<\/em><\/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 with Osmosis.<\/strong><\/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<p class=\"wp-block-paragraph\"><strong>E.&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Heart_failure\" target=\"_blank\" rel=\"noreferrer noopener\">Heart failure<\/a><\/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. Bacteremia due to a Gram-negative rod<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong><a href=\"https:\/\/www.osmosis.org\/learn\/Shock:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Septic shock<\/strong><\/a>&nbsp;is a subtype of <strong>distributive shock<\/strong> that presents with <strong>decreased systemic vascular resistance, decreased pulmonary capillary wedge pressure, increased cardiac output, <\/strong>and <strong>increased mixed venous oxygen saturation<\/strong>. This patient\u2019s findings are inconsistent with those of septic shock.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Impaired sympathetic outflow<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong><a href=\"https:\/\/www.osmosis.org\/learn\/Shock:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Neurogenic shock<\/strong><\/a>&nbsp;is another subtype of distributive shock that presents with decreased systemic vascular resistance, decreased pulmonary capillary wedge pressure, decreased cardiac output, and an increased mixed venous oxygen saturation. It is most commonly caused by <strong>spinal cord injury<\/strong> that <strong>disrupts sympathetic outflow<\/strong>. In contrast, this patient has an <strong>elevated systemic vascular resistance<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Thrombus in the pulmonary artery<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong><a href=\"https:\/\/www.osmosis.org\/learn\/Shock:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Obstructive shock<\/strong><\/a>&nbsp;is a subtype of \u201c<strong>cold shock<\/strong>\u201d and can be caused by <strong><a href=\"https:\/\/www.osmosis.org\/learn\/Pulmonary_embolism\">pulmonary embolism<\/a><\/strong>. It can present with <strong>increased systemic vascular resistance, decreased cardiac output, <\/strong>and <strong>decreased mixed venous oxygen saturation.<\/strong> In cases of <strong>obstructive shock secondary to pulmonary embolism,<\/strong> <strong>pulmonary capillary wedge pressure<\/strong> (surrogate of left atrial pressure) is reduced since less blood is reaching the<strong>&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Introduction_to_the_cardiovascular_system\" target=\"_blank\" rel=\"noreferrer noopener\">left heart<\/a><\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Hemorrhage due to bleeding&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Peptic_ulcer\" target=\"_blank\" rel=\"noreferrer noopener\">peptic ulcer<\/a><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;Hemorrhagic shock<\/strong> presents with <strong>increased systemic vascular resistance, decreased pulmonary capillary wedge pressure, decreased cardiac output, <\/strong>and <strong>decreased mixed venous oxygen saturation.<\/strong> It is most commonly due to ongoing <strong>hemorrhage from trauma <\/strong>or <strong>gastrointestinal bleeding<\/strong>.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-1\" 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\/09\/usmle-step-1-everything-you-need-to-know-banner.png?w=700\" 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<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 critically ill patient had a&nbsp;<strong>Swan-Ganz catheter<\/strong>&nbsp;placed and <strong>hemodynamic measurements <\/strong>taken. The findings include a <strong>decreased cardiac output<\/strong> (of which the cardiac index is a surrogate measure taking into account BMI), <strong>increased systemic vascular resistance, increased pulmonary capillary wedge pressure (PCWP), <\/strong>and <strong>decreased mixed venous oxygen saturation (SvO<sub>2<\/sub>)<\/strong>. These parameters are consistent with&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Shock:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>cardiogenic shock<\/strong><\/a>,&nbsp;of which&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Heart_failure\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>heart failure<\/strong><\/a>&nbsp;is a common etiology.<strong>&nbsp;<\/strong><\/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=\"Shock ~high yield~\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/BW4frCs5RoI?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">A&nbsp;Swan-Ganz catheter&nbsp;is a flexible tube passed into the <strong>right side of the heart<\/strong> and the <strong>pulmonary artery<\/strong>. It is used to take measurements of <strong>cardiac output<\/strong> (heart x stroke volume), <strong>systemic vascular resistance<\/strong> (80x (Mean Arterial Pressure &#8211;&nbsp;<a href=\"https:\/\/en.wikipedia.org\/wiki\/Central_venous_pressure\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Mean Venous Pressure<\/strong><\/a>&nbsp;or CVP) \/ Cardiac Output), <strong>PCWP <\/strong>(surrogate of left atrial pressure), and <strong>SvO<sub>2<\/sub>&nbsp;<\/strong>(measure of total body oxygen consumption). While seldom used in modern ICUs, it was <strong>historically used <\/strong>to provide <strong>useful information <\/strong>in determining the <strong>etiology <\/strong>of a patient\u2019s <strong>shock<\/strong>.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"907\" height=\"558\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/table-of-diff-type-of-shock.png\" alt=\"SHOCK\n\nCardiogenic\n- Congestive heart failure\n- Acute myocardial infarction\n- Valvular disease\nCO down, SVR up, PCWP up, SvO2 down\n\nHypovolemic\n- Traumatic hemorrage\n- Vomiting or diarrhea\nCO down, SVR up, PCWP down, SvO2 down (except tamponade)\n\nObstructive\n- Tension pneumothorax\n- Pulmonary embolism\n- Cardic tamponade\nCO down, SVR up, PCWP up, SvO2 down\n\nSeptic Anaphylactic\n- Infection in bloodstream\n- Allergic reaction\nCO up, SVR down, PCWP down, SvO2 up\n\nNeurogenic\n- Injury to CNS\nCO down, SVR down, PCWP down, SvO2 up\" class=\"wp-image-953\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/table-of-diff-type-of-shock.png 907w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/table-of-diff-type-of-shock.png?resize=300,185 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/table-of-diff-type-of-shock.png?resize=768,472 768w\" sizes=\"auto, (max-width: 907px) 100vw, 907px\" \/><\/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\">The etiology of&nbsp;<strong>shock&nbsp;<\/strong>can be elucidated by placement of a&nbsp;<strong>Swan-Ganz catheter<\/strong>&nbsp;and by taking measurements of <strong>SVR, PCWP, CO, <\/strong>and <strong>SvO<sub>2<\/sub><\/strong>.<\/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 class=\"wp-block-list\">\n<li>Ginosar, Y., Sprung, C.L. (1996) The Swan-Ganz catheter. Twenty-five years of monitoring.&nbsp;<em>Critical Care Clinics<\/em>. 12(4), 771-776. Doi:&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/8902370\/\" target=\"_blank\" rel=\"noreferrer noopener\">10.1016\/s0749-0704(05)70278-5.<\/a><\/li>\n\n\n\n<li>Vincent, J.L., De Backer, D. (2013) Circulatory shock.&nbsp;<em>The New England Journal of Medicine<\/em>. 370(6), 583. Doi:&nbsp;<a href=\"https:\/\/www.nejm.org\/doi\/10.1056\/NEJMra1208943\" target=\"_blank\" rel=\"noreferrer noopener\">10.1056\/NEJMra1208943<\/a>.<\/li>\n\n\n\n<li>Walls, R., Hockberger, R., Gausche-Hill, M. (2017)&nbsp;<a href=\"https:\/\/www.elsevier.com\/books\/rosens-emergency-medicine-concepts-and-clinical-practice\/walls\/978-0-323-35479-0\" target=\"_blank\" rel=\"noreferrer noopener\">Rosen&#8217;s Emergency Medicine: Concepts and Clinical Practice<\/a>. Philadelphia, PA: Elsevier. ISBN: 978-0323354790.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><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?w=700\" 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><figcaption class=\"wp-element-caption\"><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><\/figcaption><\/figure>\n\n\n\n<p class=\"has-text-align-left wp-block-paragraph\"><em><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 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>Analyze Swan-Ganz catheter hemodynamics in a critically ill patient with elevated PCWP and SVR, low cardiac index, and low SvO2. What&#8217;s the cause?<\/p>\n","protected":false},"author":202,"featured_media":954,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[27,20,16,1366,1369,44],"tags":[1048,1042,1046,1047,1043,1041,1049,1044,1045,664],"class_list":["post-952","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","tag-cardiac-index","tag-cardiogenic-shock","tag-heart-failure","tag-hemodynamic-parameters","tag-mixed-venous-oxygen-saturation","tag-pulmonary-capillary-wedge-pressure","tag-shock-evaluation","tag-swan-ganz-catheter","tag-systemic-vascular-resistance","tag-usmle-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: Altered Mental State - 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-altered-mental-state\" \/>\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: Altered Mental State - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Analyze Swan-Ganz catheter hemodynamics in a critically ill patient with elevated PCWP and SVR, low cardiac index, and low SvO2. 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He has a history of chronic lower back pain and chronic alcohol use. His partner reported he was less responsive several hours after taking the medication. 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Can you identify the fundoscopy finding that affects a diagnostic lumbar puncture? 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