USMLE 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®
, This booklet updated March 2016.
Copyright © 2016 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.
1
, 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……………. 44
Answer Key for USMLE Step 1 Sample Test Questions……………… 45
2
, 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 (ie, A, B, C, D, E). A portion of the questions involves 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 μm3. A blood smear shows normochromic, normocytic cells. Which of the following is the
most likely cause?
(A) Acute blood loss (G) Polycythemia vera
(B) Chronic lymphocytic leukemia (H) Sickle cell disease
(C) Erythrocyte enzyme deficiency (I) Sideroblastic anemia
(D) Erythropoietin deficiency (J) β-Thalassemia trait
(E) Immunohemolysis
(F) Microangiopathic hemolysis
(Answer: D)
NOTE: Some item types that appear on the Step 1 examination are NOT depicted in the sample items provided in this
booklet, ie, items with multimedia features, such as audio. Also, when additional item formats are added to the exam,
notice will be provided at the USMLE Web site: www.usmle.org. You must monitor the Web site to stay informed about
the types of items that occur in the exam, and must practice with the downloadable sample test items available on the
USMLE Web site to be fully prepared for the examination.
3
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®
, This booklet updated March 2016.
Copyright © 2016 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.
1
, 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……………. 44
Answer Key for USMLE Step 1 Sample Test Questions……………… 45
2
, 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 (ie, A, B, C, D, E). A portion of the questions involves 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 μm3. A blood smear shows normochromic, normocytic cells. Which of the following is the
most likely cause?
(A) Acute blood loss (G) Polycythemia vera
(B) Chronic lymphocytic leukemia (H) Sickle cell disease
(C) Erythrocyte enzyme deficiency (I) Sideroblastic anemia
(D) Erythropoietin deficiency (J) β-Thalassemia trait
(E) Immunohemolysis
(F) Microangiopathic hemolysis
(Answer: D)
NOTE: Some item types that appear on the Step 1 examination are NOT depicted in the sample items provided in this
booklet, ie, items with multimedia features, such as audio. Also, when additional item formats are added to the exam,
notice will be provided at the USMLE Web site: www.usmle.org. You must monitor the Web site to stay informed about
the types of items that occur in the exam, and must practice with the downloadable sample test items available on the
USMLE Web site to be fully prepared for the examination.
3
