Step 1
SAMPLE TEST QUESTIONS
A Joint Program of the Federation of State Medical Boards of the
United States, Inc., and the National Board of Medical Examiners
®
1
This booklet updated February 2018.
Copyright © 2018 by the Federation of State Medical Boards of the United States, Inc. (FSMB), and the National Board
of Medical Examiners
®
(NBME
®
). All rights reserved. Printed in the United States of America. The United States
Medical Licensing Examination (USMLE
®
) is a joint program of the FSMB and the NBME.
2
CONTENTS
USMLE Step 1 Test Question Formats ……………………………….. 3
Introduction to USMLE Step 1 Sample Test Questions ……………… 4
Normal Laboratory Values …………………………………………….. 5
USMLE Step 1 Sample Test Questions……………………………….. 7
Answer Form for USMLE Step 1 Sample Test Questions……………. 46
Answer Key for USMLE Step 1 Sample Test Questions……………… 47
3
USMLE Step 1 Test Question Formats
Single-Item Questions
A single patient-centered vignette is associated with one question followed by four or more response options. The
response options are lettered (A, B, C, D, E). A portion of the questions require interpretation of graphic or pictorial
materials. You are required to select the best answer to the question. Other options may be partially correct, but there is
only ONE BEST answer. This is the traditional, most frequently used multiple-choice question format on the examination.
Strategies for Answering Single One-Best-Answer Test Questions
The following are strategies for answering one-best-answer items:
Read each patient vignette and question carefully. It is important to understand what is being asked.
Try to generate an answer and then look for it in the response option list.
Alternatively, read
each response option carefully, eliminating those that are clearly incorrect.
Of the remaining options, select the one that is most correct.
If unsure about an answer, it is better to guess since unanswered questions are automatically counted as wrong
answers.
Example Item
A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure over the past 2 years. She has not yet
started dialysis. Examination shows no abnormalities. Her hemoglobin concentration is 9 g/dL, hematocrit is 28%, and
mean corpuscular volume is 94 μm
3
. A blood smear shows normochromic, normocytic cells. Which of the following is the
most likely cause?
(A)
Acute
blood loss
(B)
Chronic lymphocytic leukemia
(C)
Erythrocyte enzyme
deficiency
(D)
Erythropoietin deficiency
(E)
Immunohemolysis
(F)
Microangiopathic hemolysis
(G)
Polycythemia vera
(H)
Sickle cell disease
(I)
Sideroblastic anemia
(J)
β-Thalassemia trait
(Answer: D)
NOTE: Some item types that appear on the Step 1 examination are NOT depicted in the sample items provided in this
booklet, eg, items with multimedia features, such as audio. Also, when additional item formats are added to the exam,
notice will be provided at the USMLE website: http://www.usmle.org. You must monitor the website to stay informed
about the types of items that occur in the exam, and you must practice with the downloadable sample test items available
on the USMLE website to be fully prepared for the examination.
4
Introduction to USMLE Step 1 Sample Test Questions
The following pages include 117 sample test questions. Most of these questions are the same as those you can install on
your computer from the USMLE website. Please note that reviewing the sample questions as they appear on pages 7-45 is
not a substitute for practicing with the test software. You should download and run the Step 1 tutorial and practice test
items that are provided on the USMLE website well before your test date. The sample materials available on the USMLE
website include additional items and item formats that do not appear in this booklet, such as items with associated audio
or video findings. You should become familiar with all item formats that will be used in the actual examination.
Although the sample questions exemplify content on the Step 1 examination overall, they may not reflect the content
coverage on individual examinations. In the actual examination, questions will be
presented in random order; they will not
be grouped according to specific content. The questions will be presented one at a time in a format designed for easy on-
screen reading, including use of the Normal Laboratory Values table (included here on pages 5 and 6) and some pictorials.
Photographs, charts, and x-rays in this booklet are not of the same quality as the pictorials used in the actual examination.
In addition, you will be able to adjust the brightness and contrast of pictorials on the computer screen.
To take the following sample test questions as they would be timed in the actual examination, you should allow a
maximum of 1 hour for each 40-item block, and a maximum of 55 minutes, 30 seconds, for the 37-item block, for a total
of 2 hours, 55 minutes, 30 seconds. Please note that the third block has 37 items instead of 40 because the multimedia
items have been removed, and the recommended time to complete the block has been adjusted accordingly. Please be
aware that most examinees perceive the time pressure to be greater during an actual examination. All examinees are
strongly encouraged to practice with the downloadable version to become familiar with all item formats and exam timing.
An answer form for recording answers is provided on page 46. An answer key is provided on page 47. In the actual
examination, answers
will be selected on the screen; no answer form will be provided.