USMLE Step 1 Test Review

Step One of the United States Medical Licensing Examination measures the candidate’s ability to apply scientific knowledge to the practice of medicine.

This examination is sponsored by the Federation of State Medical Boards and the National Board of Medical Examiners. Questions are created by committees of experts in each of the content areas.

These content areas are:

  • anatomy
  • behavioral sciences
  • biochemistry
  • microbiology
  • pathology
  • pharmacology
  • physiology
  • other topics including genetics, nutrition, and aging.

Between 40 and 50% of the exam covers general principles in these content areas; the remaining 50 to 60% focuses on the following individual organ systems: hematopoietic/lymphoreticular; nervous/special senses; skin/connective tissue; musculoskeletal; respiratory; cardiovascular; gastrointestinal; renal/urinary; reproductive; and endocrine.

The exam will focus on the following themes with respect to the above content areas: normal structure and function (30 to 50% of the exam); abnormal processes (30 to 50%); principles of therapeutics (15 to 25%); and psychosocial, cultural, occupational, and environmental considerations (10 to 20%).

Candidates will often have to incorporate information from charts, tables, graphs, and gross and microscopic specimens.

The questions on the USMLE Step 1 are in a multiple-choice, best-answer format. In other words, though there may be several answers that are somewhat correct, there will be one answer that is clearly more correct. There are 350 questions on the exam. The number of questions answered correctly will be used to calculate the score on both three-digit and two-digit scales. Individuals who do not begin every block of the test will not receive a score.

In order to pass the USMLE Step 1, individuals must receive a minimum score of 182 on the three-digit scale, and 75 on the two-digit scale. The exam takes 8 hours and is administered in 7 one-hour blocks over the course of a day. The USMLE Step 1 is administered year-round by Thomson Prometric; those who wish to take this exam should register for test date and location at the Prometric website.

Free USMLE Step 1 Practice Test Questions

1. A doctor is working in an outpatient orthopedic clinic. During the patient’s history the patient reports, “I tore 3 of my 4 Rotator cuff muscles in the past.” Which of the following muscles cannot be considered as possibly being torn?
  1. Teres minor 
  2. Teres major 
  3. Supraspinatus 
  4. Infraspinatus
2. A doctor at outpatient clinic is determining the appropriate sequence to arrange patients in the afternoon. Which of the following calls should have the highest priority for medical intervention?
  1. A home health patient reports, “I am starting to have breakdown of my heels.” 
  2. A patient that received an upper extremity cast yesterday reports, “I can’t feel my fingers in my right hand today.” 
  3. A young female reports, “I think I sprained my ankle about 2 weeks ago.” 
  4. A middle-aged patient reports, “My knee is still hurting from the TKR.”
3. A doctor working a surgical unit notices a patient is experiencing SOB, calf pain, and warmth over the posterior calf. All of these may indicate which of the following medical conditions?
  1. Patient may have a DVT. 
  2. Patient may be exhibiting signs of dermatitis. 
  3. Patient may be in the late phases of CHF. 
  4. Patient may be experiencing anxiety after surgery.
4. The bacteria Staphylococcus aureus can be classified as a:
  1. Gram-negative cocci 
  2. Spirochetes 
  3. Acid-fast bacilli 
  4. Gram-positive cocci
5. A doctor is assessing a patient’s breath sounds. The patient has had a pneumonectomy to the right lung performed 48 hours ago. Which of the following conditions most likely exists?
  1. Decreased breath sound volume 
  2. Elevated tidal volume
  3. Elevated respiratory capacity
  4. Wheezing

Answers and Explations

1. (B) Teres Minor, Infraspinatus, Supraspinatus, and Subscapularis make up the Rotator Cuff.

2. (B) The patient experiencing neurovascular changes should have the highest priority. Pain following a TKR is normal, and breakdown over the heels is a gradual process. Moreover, a subacute ankle sprain is almost never a medical emergency.

3. (A) All of these factors indicate a DVT.

4. (D) Staphylococcus aureus is a gram-positive cocci.

5. (A) Breath sounds would be softer.