SAMPLE TEST QUESTIONS
Step 1
A Joint Program of the Federation of State Medical Boards of the
United States, Inc., and National Board of Medical Examiners®
, This booklet was updated February 2021.
For Public Release
Copyright © 2021 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 ………………………………………….. 4
USMLE Laboratory Values …………………………………………………………………………………….. 5
USMLE Step 1 Sample Test Questions……………………………………………………………………. 8
Answer Form for USMLE Step 1 Sample Test Questions………………………………………. 48
Answer Key for USMLE Step 1 Sample Test Questions…………………………………………. 49
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 (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 during 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 (F) Microangiopathic hemolysis
(B) Chronic lymphocytic leukemia (G) Polycythemia vera
(C) Erythrocyte enzyme deficiency (H) Sickle cell disease
(D) Erythropoietin deficiency (I) Sideroblastic anemia
(E) Immunohemolysis (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.
3
Step 1
A Joint Program of the Federation of State Medical Boards of the
United States, Inc., and National Board of Medical Examiners®
, This booklet was updated February 2021.
For Public Release
Copyright © 2021 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 ………………………………………….. 4
USMLE Laboratory Values …………………………………………………………………………………….. 5
USMLE Step 1 Sample Test Questions……………………………………………………………………. 8
Answer Form for USMLE Step 1 Sample Test Questions………………………………………. 48
Answer Key for USMLE Step 1 Sample Test Questions…………………………………………. 49
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 (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 during 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 (F) Microangiopathic hemolysis
(B) Chronic lymphocytic leukemia (G) Polycythemia vera
(C) Erythrocyte enzyme deficiency (H) Sickle cell disease
(D) Erythropoietin deficiency (I) Sideroblastic anemia
(E) Immunohemolysis (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.
3
