USMLE STEP 1
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USMLE STEP 1 Practcice Exam Questions. Latest 2024-2025
1. A new blood test to detect prostate cancer is evaluated in 300 male
volunteers. A needle biopsy of the prostate gland is done
on all men with serum prostate-specific antigen concentrations greater than
5 ng/mL (N<4). One hundred men undergo
biopsy procedures; 90 are found to have prostate cancer, and five are found
to have chronic prostatitis. Which of the following is necessary to calculate
the sensitivity of this test?
A .Incidence of chronic prostatitis in the general population
B .Number of men with test results greater than 5 ng/mL and a normal
biopsy specimen
C .Prevalence of chronic prostatitis in the general population
D .Prostate biopsies of men with test results equal to or below 5 ng/m: D
2. A 64-year-old man comes to the physician because of swelling in his feet for
the past 2 years. He says that his skin is dry and
itchy and his feet "feel heavy." One of his legs is shown. Which of the
following is the most likely cause of his condition
A .Arteriolar constriction and arteriolar hypertension
B .Arteriolar dilation and venous hypertension
C .Venous constriction and arteriolar constriction
D .Venous hypertension and incompetent valves
E .Venous hypertension and venous constriction: D
3. A 32-year-old woman with HIV infection is brought to the emergency
department 15 minutes after she had a generalized
tonic-clonic seizure. She has a 1-day history of right-sided weakness. Her
temperature is 38.5°C (101.3°F). Muscle strength is
4/5 in the right upper extremities and 4/5 in the right lower extremity.
Laboratory studies show a positive anti-Toxoplasma
IgG and positive anti-cytomegalovirus IgG. Her CD4+ T-lymphocyte count is
32/mm 3 (Ne500), and plasma HIV viral load is
84,000 copies/mL. A gadolinium-enhanced MRI of the brain shows multiple
ring-enhancing lesions. Infection with which of the following agents is the
most likely cause of the findings in this patient?
A .Cryptococcus neoformans
,USMLE STEP 1
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B .Cytomegalovirus
C .Epstein-Barr virus
D .Neisseria meningitidis
E .Streptococcus pneumoniae
F .Toxoplasma gondii: F
4. A previously healthy 27-year-old man is brought to the emergency
department 30 minutes after sustaining stab wounds to the right side of his
neck and arm. He has lost approximately 1000 mL of blood. His pulse is
110/min, respirations are 22/min,
and blood pressure is 95/65 mm Hg. Physical examination shows lacerations of
the right side of the neck and right upper extremity. Which of the following
responses by the kidneys is most likely?
A .Acute tubular necrosis
B .Osmotic diuresis
C .Sodium wasting
D .Vasoconstriction
E .Water conservation: E
5. A 57-year-old man receives radiation therapy for a squamous cell
carcinoma of the lung. Despite therapy, the tumor
progressively increases in size, and he dies 6 months later. His tumor cells
contain a point mutation in the p53 gene (TP53),
leading to an inactive gene product. Based on this finding, the progressive
tumor growth despite irradiation therapy is most likely to be related to a
defect in cell cycle arrest in which of the following phases of the cell cycle?
A .G 0
B .G 1
C .G 2
D .M
E .S: B
6. A male stillborn is delivered at 32 weeks' gestation to a 30-year-old woman.
The pregnancy was complicated by
oligohydramnios. Examination of the stillborn shows the absence of a urethral
opening. Which of the following additional findings is most likely in this
stillborn?
A .Congenital diaphragmatic hernia
,USMLE STEP 1
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B .Intralobar sequestration
C .Pulmonary hypoplasia
D .Situs inversus
E .Tracheoesophageal fistula: C
7. A 36-year-old man with profound intellectual disability is brought to the
physician by staff at his facility because of increasing abdominal girth
during the past 2 weeks. He is unable to speak, and no medical history is
currently available.
Physical examination shows a protuberant abdomen with a fluid wave and
shifting dullness. There are no signs of trauma to
the area. Laboratory studies show no abnormalities. A CT scan of the
abdomen is shown. Fluid is present in which of the following areas as
indicated by the arrow?
AEpiploic foramen
B .Gastrosplenic ligament
C .Hepatorenal pouch (of Morison)
D .Omental bursa (lesser sac)
E .Sulcus pericolicus: D
8. A 59-year-old woman comes to the physician because of yellow skin for 5
days. Physical examination shows jaundice. There is mild epigastric
tenderness on deep palpation. Serum studies show: Bilirubin, total
Direct
Alkaline phosphatase
AST
ALT
9.6 mg/dL
8.9 mg/dL
310 U/L
29 U/L
31 U/L
A CT scan of the abdomen shows a 3-cm mass at the head of the pancreas.
Examination of material from the mass obtained
by fine-needle aspiration shows numerous anaplastic cells. These cells most
likely originated from which of the following components of the pancreas?
Acinar epithelium
B .Duct epithelium
, USMLE STEP 1
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C .Interstitial adipose tissue
D .Interstitial fibrous tissue
E .Islet of Langerhans
F .Vascular endothelium: B
9. A full-term female newborn is examined shortly after birth. She appears to
be small for gestational age, and she has excess
skin on the nape of the neck and lymphedema of the hands and feet.
Chromosomal analysis shows some cells with a normal
46,XY karyotype and some cells with a 45,X karyotype. Which of the
following mechanisms best explains this cytogenetic abnormality?
A .Nondisjunction in mitosis
B .Reciprocal translocation
C .Robertsonian translocation
D .Skewed X-inactivation
E .Uniparental disomy: A
10. A 49-year-old woman comes to the physician for a follow-up examination.
She has a strong family history of coronary artery
disease. Her blood pressure has ranged from 150/95 mm Hg to 130/85 mm Hg
during the previous three visits within the past
2 months. Her blood pressure today is 140/90 mm Hg. Physical examination
shows no other abnormalities. Laboratory studies show: Cholesterol, total
HDL-cholesterol
LDL-cholesterol
Triglycerides
290 mg/dL 40 mg/dL
190 mg/dL
350 mg/dL
Treatment with atorvastatin and losartan is initiated. Which of the
following serum findings is most likely to occur in this patient?: C
11. A 12-year-old boy is brought to the physician by his father because of
redness and swelling of his left foot for 24 hours.
Three days ago, the boy scraped his foot while wading in a drainage ditch.
Examination of the left foot shows a purulent
abrasion with edema, erythema, and tenderness on the lateral side. Infection is
most likely to next spread from the lateral side of the foot to the regional
lymph nodes in which of the following areas?
Study online at https://quizlet.com/_331rd0
USMLE STEP 1 Practcice Exam Questions. Latest 2024-2025
1. A new blood test to detect prostate cancer is evaluated in 300 male
volunteers. A needle biopsy of the prostate gland is done
on all men with serum prostate-specific antigen concentrations greater than
5 ng/mL (N<4). One hundred men undergo
biopsy procedures; 90 are found to have prostate cancer, and five are found
to have chronic prostatitis. Which of the following is necessary to calculate
the sensitivity of this test?
A .Incidence of chronic prostatitis in the general population
B .Number of men with test results greater than 5 ng/mL and a normal
biopsy specimen
C .Prevalence of chronic prostatitis in the general population
D .Prostate biopsies of men with test results equal to or below 5 ng/m: D
2. A 64-year-old man comes to the physician because of swelling in his feet for
the past 2 years. He says that his skin is dry and
itchy and his feet "feel heavy." One of his legs is shown. Which of the
following is the most likely cause of his condition
A .Arteriolar constriction and arteriolar hypertension
B .Arteriolar dilation and venous hypertension
C .Venous constriction and arteriolar constriction
D .Venous hypertension and incompetent valves
E .Venous hypertension and venous constriction: D
3. A 32-year-old woman with HIV infection is brought to the emergency
department 15 minutes after she had a generalized
tonic-clonic seizure. She has a 1-day history of right-sided weakness. Her
temperature is 38.5°C (101.3°F). Muscle strength is
4/5 in the right upper extremities and 4/5 in the right lower extremity.
Laboratory studies show a positive anti-Toxoplasma
IgG and positive anti-cytomegalovirus IgG. Her CD4+ T-lymphocyte count is
32/mm 3 (Ne500), and plasma HIV viral load is
84,000 copies/mL. A gadolinium-enhanced MRI of the brain shows multiple
ring-enhancing lesions. Infection with which of the following agents is the
most likely cause of the findings in this patient?
A .Cryptococcus neoformans
,USMLE STEP 1
Study online at https://quizlet.com/_331rd0
B .Cytomegalovirus
C .Epstein-Barr virus
D .Neisseria meningitidis
E .Streptococcus pneumoniae
F .Toxoplasma gondii: F
4. A previously healthy 27-year-old man is brought to the emergency
department 30 minutes after sustaining stab wounds to the right side of his
neck and arm. He has lost approximately 1000 mL of blood. His pulse is
110/min, respirations are 22/min,
and blood pressure is 95/65 mm Hg. Physical examination shows lacerations of
the right side of the neck and right upper extremity. Which of the following
responses by the kidneys is most likely?
A .Acute tubular necrosis
B .Osmotic diuresis
C .Sodium wasting
D .Vasoconstriction
E .Water conservation: E
5. A 57-year-old man receives radiation therapy for a squamous cell
carcinoma of the lung. Despite therapy, the tumor
progressively increases in size, and he dies 6 months later. His tumor cells
contain a point mutation in the p53 gene (TP53),
leading to an inactive gene product. Based on this finding, the progressive
tumor growth despite irradiation therapy is most likely to be related to a
defect in cell cycle arrest in which of the following phases of the cell cycle?
A .G 0
B .G 1
C .G 2
D .M
E .S: B
6. A male stillborn is delivered at 32 weeks' gestation to a 30-year-old woman.
The pregnancy was complicated by
oligohydramnios. Examination of the stillborn shows the absence of a urethral
opening. Which of the following additional findings is most likely in this
stillborn?
A .Congenital diaphragmatic hernia
,USMLE STEP 1
Study online at https://quizlet.com/_331rd0
B .Intralobar sequestration
C .Pulmonary hypoplasia
D .Situs inversus
E .Tracheoesophageal fistula: C
7. A 36-year-old man with profound intellectual disability is brought to the
physician by staff at his facility because of increasing abdominal girth
during the past 2 weeks. He is unable to speak, and no medical history is
currently available.
Physical examination shows a protuberant abdomen with a fluid wave and
shifting dullness. There are no signs of trauma to
the area. Laboratory studies show no abnormalities. A CT scan of the
abdomen is shown. Fluid is present in which of the following areas as
indicated by the arrow?
AEpiploic foramen
B .Gastrosplenic ligament
C .Hepatorenal pouch (of Morison)
D .Omental bursa (lesser sac)
E .Sulcus pericolicus: D
8. A 59-year-old woman comes to the physician because of yellow skin for 5
days. Physical examination shows jaundice. There is mild epigastric
tenderness on deep palpation. Serum studies show: Bilirubin, total
Direct
Alkaline phosphatase
AST
ALT
9.6 mg/dL
8.9 mg/dL
310 U/L
29 U/L
31 U/L
A CT scan of the abdomen shows a 3-cm mass at the head of the pancreas.
Examination of material from the mass obtained
by fine-needle aspiration shows numerous anaplastic cells. These cells most
likely originated from which of the following components of the pancreas?
Acinar epithelium
B .Duct epithelium
, USMLE STEP 1
Study online at https://quizlet.com/_331rd0
C .Interstitial adipose tissue
D .Interstitial fibrous tissue
E .Islet of Langerhans
F .Vascular endothelium: B
9. A full-term female newborn is examined shortly after birth. She appears to
be small for gestational age, and she has excess
skin on the nape of the neck and lymphedema of the hands and feet.
Chromosomal analysis shows some cells with a normal
46,XY karyotype and some cells with a 45,X karyotype. Which of the
following mechanisms best explains this cytogenetic abnormality?
A .Nondisjunction in mitosis
B .Reciprocal translocation
C .Robertsonian translocation
D .Skewed X-inactivation
E .Uniparental disomy: A
10. A 49-year-old woman comes to the physician for a follow-up examination.
She has a strong family history of coronary artery
disease. Her blood pressure has ranged from 150/95 mm Hg to 130/85 mm Hg
during the previous three visits within the past
2 months. Her blood pressure today is 140/90 mm Hg. Physical examination
shows no other abnormalities. Laboratory studies show: Cholesterol, total
HDL-cholesterol
LDL-cholesterol
Triglycerides
290 mg/dL 40 mg/dL
190 mg/dL
350 mg/dL
Treatment with atorvastatin and losartan is initiated. Which of the
following serum findings is most likely to occur in this patient?: C
11. A 12-year-old boy is brought to the physician by his father because of
redness and swelling of his left foot for 24 hours.
Three days ago, the boy scraped his foot while wading in a drainage ditch.
Examination of the left foot shows a purulent
abrasion with edema, erythema, and tenderness on the lateral side. Infection is
most likely to next spread from the lateral side of the foot to the regional
lymph nodes in which of the following areas?
