Sample Test Questions
Step 1
A Joint Program of the Federation of State Medical
Boards of the United States, Inc. (FSMB), and National
Board of Medical Examiners (NBME)
, This booklet was updated April 2026.
For Public Release
Copyright © 2026 by the Federation of State Medical Boards of the United States, Inc. (FSMB), and 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 NBME.
1
, CONTENTS
USMLE Step 1 Test Question Formats …………………………………………………………………… 3
Introduction to USMLE Step 1 Sample Test Questions ………………………………………….. 6
USMLE Laboratory Values …………………………………………………………………………………….. 7
USMLE Step 1 Sample Test Questions……………………………………………………………………. 10
Block 1, Items 1–20 ........................................................................................ 10
Block 2, Items 21–40 ...................................................................................... 17
Block 3, Items 41–60 ...................................................................................... 25
Block 4, Items 61–80 ...................................................................................... 33
Block 5, Items 81–100 .................................................................................... 41
Block 6, Items 101–119 .................................................................................. 48
Answer Form for USMLE Step 1 Sample Test Questions………………………………………… 55
Answer Key for USMLE Step 1 Sample Test Questions…………………………………………… 56
2
, USMLE STEP 1 TEST QUESTION FORMATS
Patient Scenario Formats and Single-Item Questions
Patient scenarios for any single test item may be provided in either vignette (paragraph) format, or in
chart/tabular format, followed by four or more response options. The response options are lettered (A, B, C,
D, E). You are required to select the best answer to the question. Other options may be partially correct, but
there is only ONE BEST answer.
The vignette format is the traditional, most frequently used multiple-choice question format on the
examination. Test items using the chart/tabular format are designed to resemble patient charts but are not
intended to be an exact representation of a patient chart. Questions written in chart/tabular format will
contain relevant patient information in list form, organized in clearly marked sections for ease of review.
Familiar medical abbreviations may be used within chart/tabular format questions.
A portion of the questions require interpretation of graphic or pictorial materials.
Strategies for Answering Single One-Best-Answer Test Questions
The following are strategies for answering one-best-answer items:
• Read each patient scenario 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 best to guess since unanswered questions are automatically counted as
wrong answers.
Example Item 1 (Vignette format)
A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure during the past 2 years.
She has not yet started hemodialysis. Examination shows no abnormalities. Hemoglobin concentration is 9.0
g/dL, hematocrit is 28%, and mean corpuscular volume is 94 μm3. Peripheral blood smear shows
normochromic, normocytic cells. Which of the following is the most likely cause of this patient’s current
condition?
(A) Acute blood loss
(B) Chronic lymphocytic leukemia
(C) Erythrocyte enzyme deficiency
(D) Erythropoietin deficiency
(E) Immunohemolysis
(Answer: D)
3
Step 1
A Joint Program of the Federation of State Medical
Boards of the United States, Inc. (FSMB), and National
Board of Medical Examiners (NBME)
, This booklet was updated April 2026.
For Public Release
Copyright © 2026 by the Federation of State Medical Boards of the United States, Inc. (FSMB), and 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 NBME.
1
, CONTENTS
USMLE Step 1 Test Question Formats …………………………………………………………………… 3
Introduction to USMLE Step 1 Sample Test Questions ………………………………………….. 6
USMLE Laboratory Values …………………………………………………………………………………….. 7
USMLE Step 1 Sample Test Questions……………………………………………………………………. 10
Block 1, Items 1–20 ........................................................................................ 10
Block 2, Items 21–40 ...................................................................................... 17
Block 3, Items 41–60 ...................................................................................... 25
Block 4, Items 61–80 ...................................................................................... 33
Block 5, Items 81–100 .................................................................................... 41
Block 6, Items 101–119 .................................................................................. 48
Answer Form for USMLE Step 1 Sample Test Questions………………………………………… 55
Answer Key for USMLE Step 1 Sample Test Questions…………………………………………… 56
2
, USMLE STEP 1 TEST QUESTION FORMATS
Patient Scenario Formats and Single-Item Questions
Patient scenarios for any single test item may be provided in either vignette (paragraph) format, or in
chart/tabular format, followed by four or more response options. The response options are lettered (A, B, C,
D, E). You are required to select the best answer to the question. Other options may be partially correct, but
there is only ONE BEST answer.
The vignette format is the traditional, most frequently used multiple-choice question format on the
examination. Test items using the chart/tabular format are designed to resemble patient charts but are not
intended to be an exact representation of a patient chart. Questions written in chart/tabular format will
contain relevant patient information in list form, organized in clearly marked sections for ease of review.
Familiar medical abbreviations may be used within chart/tabular format questions.
A portion of the questions require interpretation of graphic or pictorial materials.
Strategies for Answering Single One-Best-Answer Test Questions
The following are strategies for answering one-best-answer items:
• Read each patient scenario 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 best to guess since unanswered questions are automatically counted as
wrong answers.
Example Item 1 (Vignette format)
A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure during the past 2 years.
She has not yet started hemodialysis. Examination shows no abnormalities. Hemoglobin concentration is 9.0
g/dL, hematocrit is 28%, and mean corpuscular volume is 94 μm3. Peripheral blood smear shows
normochromic, normocytic cells. Which of the following is the most likely cause of this patient’s current
condition?
(A) Acute blood loss
(B) Chronic lymphocytic leukemia
(C) Erythrocyte enzyme deficiency
(D) Erythropoietin deficiency
(E) Immunohemolysis
(Answer: D)
3
