{"id":9767,"date":"2026-04-01T00:05:09","date_gmt":"2026-04-01T08:05:09","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=9767"},"modified":"2026-03-19T16:59:05","modified_gmt":"2026-03-20T00:59:05","slug":"usmle-step-1-question-of-the-day-chronic-cough","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-chronic-cough","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day:\u00a0Chronic cough"},"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-chronic-cough\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 1 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-1-question-of-the-day-chronic-cough\/#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-chronic-cough\/#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-chronic-cough\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/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-chronic-cough\/#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-1-question-of-the-day-chronic-cough\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em><strong>Today\u2019s USMLE\u00ae Step 1 question of the day features a patient with a chronic cough. What&#8217;s the most likely cause? Let&#8217;s find out!<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A patient undergoes a <strong>pulmonary lymph node biopsy<\/strong> to evaluate a <strong>chronic cough<\/strong> with the histologic\u00a0finding\u00a0demonstrated\u00a0below.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"416\" height=\"313\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/04\/image_cb319a.png\" alt=\"\" class=\"wp-image-9771\" style=\"width:370px;height:auto\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/04\/image_cb319a.png 416w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/04\/image_cb319a.png?resize=300,226 300w\" sizes=\"auto, (max-width: 416px) 100vw, 416px\" \/><figcaption class=\"wp-element-caption\">Reproduced from:\u00a0<a href=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f2\/Necrogran10x.jpg\/531px-Necrogran10x.jpg\" target=\"_blank\" rel=\"noreferrer noopener\">Wikipedia<\/a>\u00a0\u00a0<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Which of the following pathological processes likely\u00a0preceded\u00a0the development of this histologic finding?\u00a0<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Infection with Mycobacterium tuberculosis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Beryllium exposure<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Silica exposure<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. CD4+ helper T-cell response to unknown antigen<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Acute inflammation surrounding a foreign body<\/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=\"Osmosis.org at the University College London, UK\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/DIp3u0oTLo4?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_1_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Infection with Mycobacterium tuberculosis<\/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>B. Beryllium exposure<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Beryllium, an alkaline earth metal, can cause chronic restrictive lung disease. Exposure to this element results in non-caseating granulomatous disease.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Silica exposure<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Chronic silica exposure is implicated in the development of non-caseating granulomatous disease.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. CD4+ helper T-cell response to unknown antigen<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> This describes the proposed mechanism of sarcoidosis, a non-caseating granulomatous disease.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Acute inflammation surrounding a foreign body<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> In general, foreign bodies develop non-caseating granulomas; however, the pathological image obtained from the patient demonstrates a caseating granuloma.<\/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\">The above histologic image shows a caseating granuloma (note the area of central necrosis, where no nucleoli can be seen). Of the answer choices listed, only prior infection with tuberculosis is known to induce the formation of caseating granulomas.<\/p>\n\n\n\n<figure class=\"wp-block-table aligncenter\"><table class=\"has-fixed-layout\"><tbody><tr><td class=\"has-text-align-center\" data-align=\"center\"><strong>Caseating\u00a0Granuloma\u00a0<\/strong><\/td><td class=\"has-text-align-center\" data-align=\"center\"><strong>Noncaseating\u00a0Granuloma\u00a0<\/strong><\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\"><img loading=\"lazy\" decoding=\"async\" width=\"285\" height=\"214\" src=\"blob:https:\/\/www.osmosis.org\/dc66a80f-7a03-4bf0-8acc-7edd8f1fdff5\"><br>Reproduced from:\u00a0<a href=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f2\/Necrogran10x.jpg\/531px-Necrogran10x.jpg\" target=\"_blank\" rel=\"noreferrer noopener\">Wikipedia<\/a>\u00a0<\/td><td class=\"has-text-align-center\" data-align=\"center\"><img loading=\"lazy\" decoding=\"async\" width=\"231\" height=\"215\" src=\"blob:https:\/\/www.osmosis.org\/1d6e164b-10f3-4a47-ac2a-08913a803194\"><br>Reproduced from:\u00a0<a href=\"https:\/\/www.flickr.com\/photos\/euthman\/413882702\" target=\"_blank\" rel=\"noreferrer noopener\">Flikr<\/a>\u00a0<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Granulomatous inflammation<\/strong>, a subtype of chronic inflammation, refers to <strong>an immune response where the body attempts to isolate foreign substances that it is otherwise unable to eliminate<\/strong>. Histologically, it is characterized by <strong>epithelioid histiocytes (macrophages with abundant pink cytoplasm)<\/strong> surrounded by giant cells and a rim of lymphocytes. Granulomatous inflammation gets classified into caseating and non-caseating forms (where an area of central necrosis histologically characterizes the latter). In general, <strong>non-caseating granulomas are more commonly due to autoimmune disease<\/strong>, whereas <strong>caseating granulomas arise from underlying infectious etiologies<\/strong>. The table below outlines diseases that encompass both caseating and noncaseating forms.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"975\" height=\"551\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/04\/granulomas-table.jpg\" alt=\"**Alt text:**\nTable comparing granulomas, divided into non-caseating (autoimmune) and caseating (infectious) types. It outlines pathology, key differences, and etiologies. Non-caseating granulomas lack central necrosis and are associated with conditions like sarcoidosis and Crohn disease, while caseating granulomas show central necrosis and are linked to infections such as tuberculosis, cat-scratch disease, and fungal infections.\" class=\"wp-image-9772\" style=\"aspect-ratio:1.769533691711464;width:571px;height:auto\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/04\/granulomas-table.jpg 975w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/04\/granulomas-table.jpg?resize=300,170 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/04\/granulomas-table.jpg?resize=768,434 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&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Caseating granulomas are histologically characterized by epithelioid histiocytes (macrophages with abundant pink cytoplasm) surrounded by giant cells and a rim of lymphocytes and an area of central necrosis.<\/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 this Osmosis video:<\/strong> <strong><a href=\"https:\/\/www.osmosis.org\/learn\/Tuberculosis:_Pathology_review\">Tuberculosis: Pathology review<\/a><\/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>Hoda, Syed A, and Esther Cheng. \u201c<strong>Robbins Basic Pathology<\/strong>.\u201d American Journal of Clinical Pathology 148.6 (2017): 557\u2013557. Web.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><a href=\"http:\/\/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><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Want more <strong>USMLE\u00ae Step 1<\/strong> <strong>practice questions<\/strong>? Try <strong>Osmosis from Elsevier<\/strong> today! Access your&nbsp;<em><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>free trial<\/strong><\/a><\/em>&nbsp;and discover why millions of current and future <strong>clinicians <\/strong>and <strong>caregivers <\/strong>love <strong>learning by Osmosis<\/strong>.<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A histology image reveals a granulomatous lesion with central necrosis. Learn how caseating granulomas develop, how to distinguish infectious etiologies from other causes, and how to integrate histology with clinical context to sharpen differential diagnosis and clinical reasoning.<\/p>\n","protected":false},"author":208,"featured_media":9769,"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":[2885,2884,2888,886,2883,658,2887,2889,84,308,2868,2891,2893,2886,2892,2890],"class_list":["post-9767","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-caseating-granuloma","tag-caseation","tag-central-necrosis","tag-exam-prep","tag-granulomatous-inflammation","tag-histology","tag-infectious-etiologies","tag-lymph-node-biopsy","tag-medical-education","tag-medical-students","tag-nbme","tag-pathology-education","tag-pathology-images","tag-pulmonary-pathology","tag-sarcoidosis","tag-tb"],"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:\u00a0Chronic cough - 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-chronic-cough\" \/>\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:\u00a0Chronic cough - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"A histology image reveals a granulomatous lesion with central necrosis. 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