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Last month, during a contentious meeting about Syria policy at the White House, a photographer captured the moment Ms. Pelosi stood up from the table in the Cabinet Room, pointing sternly as she spoke to a scowling Mr. Trump.

The president tweeted the photograph, remarking: “Nervous Nancy’s unhinged meltdown!”

But Ms. Pelosi’s staff quickly posted it on her social media accounts, regarding it as a powerful image of the speaker standing up to a petulant president. She later said it showed the moment she demanded to know whether the president’s decision to remove troops from Syria was a favor to President Vladimir V. Putin of Russia.

Another confrontation took place during a televised Oval Office meeting at the end of last year, when Ms. Pelosi fired back at Mr. Trump’s suggestion that, despite the Democratic victories in the 2018 midterm elections, she lacked political clout in the standoff over spending and a looming government shutdown.

“Mr. President,” she said, “please don’t characterize the strength that I bring to this meeting as the leader of the House Democrats, who just won a big victory.”

A photograph of Ms. Pelosi leaving the White House after that meeting — in sunglasses and a rust-colored coat — quickly went viral. She was also captured on television clapping sardonically at the president during his State of the Union address this year.

Mr. Trump has regularly attacked the speaker on Twitter.

Along with calling her “Nervous Nancy” after the Syria meeting in October, Mr. Trump also tweeted: “Nancy Pelosi needs help fast! There is either something wrong with her ‘upstairs,’ or she just plain doesn’t like our great Country. She had a total meltdown in the White House today. It was very sad to watch. Pray for her, she is a very sick person!”