USMLE STEP 1 EXAM |ACTUAL QUESTIONS AND
VERIFIED ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
Question 1
A previously healthy 30 y/o M is injured in an car accident. He is taken to the emergency
department where he is noted to have multiple lacerations of his extremities, some of
which are bleeding profusely. His BP is 70/palpable mmHg. The decision is made to
transfuse 2 units of blood after rapid cross-matching. No reactions are detected in the
blood bank. 10 minutes after the transfusion, the patient develops a severe cases of hives.
The development of hives in this setting would be most likely to be seen in a patient with
which of the following syndromes?
A. Ataxia telangiectasia
B. DiGeorge Syndrome
C. Selective IgA Deficiency
D. Wiskott-Aldrich Syndrome
CORRECT ANSWER
C
Question 2
A 23 year old woman comes to the doctor for a health maintenance exam. She enjoys
good health and exercises regularly. Her height is 172 cm and weight is 145 lbs. Her BP is
120/80 mmHg, pulse is 74/min, and respirations are 12/min. Physical exam is
unremarkable except for heart auscultation, which reveals an isolated midsystolic click.
Which of the following is the most common cause of this auscultatory finding?
A. Bicuspid aortic valve
B. Congenital pulmonary stenosis
1
, C. Mitral valve prolapse
D. Tricuspid regurgitation
CORRECT ANSWER
C
Question 3
A 50 year old man comes to the doctor because of gingival bleeding, epistaxis, and fever
for 2 days. He appears ill. His temperature is 102 F, BP is 120/77 mmHg, pulse is 120/min,
and respirations are 22/min. Bilateral rhonchi are heard on chest exam. He is admitted for
further evaluation. CXR shows bibasilar infiltrates consistent with bronchopneumonia.
Blood tests show 12,000 leukocytes/mm3 with numerous myeloid blasts. Platelet count is
15,000/mm3. A bone marrow biopsy demonstrates hypercellular marrow, with 35% blasts.
Elongated cytoplasmic inclusions consistent with Auer rods are appreciated in peripheral
and marrow blasts. Which of the following is the most likely dx?
A. ALL
B. AML
C. CML
D. Leukemoid Reaction
CORRECT ANSWER
B
Question 4
A 48 year old man comes to the doctor because of 2 day h/o of severe LBP. He states that
he has had periodic low back pain. He states that he has had periodic low back pain, but
this is more severe than usual and radiates to the buttock and down the right leg. His
temperature is 98.2 F. Exam shows some rigidity of the lumbar spine. The pain is
exacerbated by applying pressure on the paravertebral region in the lower lumbar spine
and by passively raising the leg at 45 degrees while the pt lies supine. A reduced Achilles
2
VERIFIED ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
Question 1
A previously healthy 30 y/o M is injured in an car accident. He is taken to the emergency
department where he is noted to have multiple lacerations of his extremities, some of
which are bleeding profusely. His BP is 70/palpable mmHg. The decision is made to
transfuse 2 units of blood after rapid cross-matching. No reactions are detected in the
blood bank. 10 minutes after the transfusion, the patient develops a severe cases of hives.
The development of hives in this setting would be most likely to be seen in a patient with
which of the following syndromes?
A. Ataxia telangiectasia
B. DiGeorge Syndrome
C. Selective IgA Deficiency
D. Wiskott-Aldrich Syndrome
CORRECT ANSWER
C
Question 2
A 23 year old woman comes to the doctor for a health maintenance exam. She enjoys
good health and exercises regularly. Her height is 172 cm and weight is 145 lbs. Her BP is
120/80 mmHg, pulse is 74/min, and respirations are 12/min. Physical exam is
unremarkable except for heart auscultation, which reveals an isolated midsystolic click.
Which of the following is the most common cause of this auscultatory finding?
A. Bicuspid aortic valve
B. Congenital pulmonary stenosis
1
, C. Mitral valve prolapse
D. Tricuspid regurgitation
CORRECT ANSWER
C
Question 3
A 50 year old man comes to the doctor because of gingival bleeding, epistaxis, and fever
for 2 days. He appears ill. His temperature is 102 F, BP is 120/77 mmHg, pulse is 120/min,
and respirations are 22/min. Bilateral rhonchi are heard on chest exam. He is admitted for
further evaluation. CXR shows bibasilar infiltrates consistent with bronchopneumonia.
Blood tests show 12,000 leukocytes/mm3 with numerous myeloid blasts. Platelet count is
15,000/mm3. A bone marrow biopsy demonstrates hypercellular marrow, with 35% blasts.
Elongated cytoplasmic inclusions consistent with Auer rods are appreciated in peripheral
and marrow blasts. Which of the following is the most likely dx?
A. ALL
B. AML
C. CML
D. Leukemoid Reaction
CORRECT ANSWER
B
Question 4
A 48 year old man comes to the doctor because of 2 day h/o of severe LBP. He states that
he has had periodic low back pain. He states that he has had periodic low back pain, but
this is more severe than usual and radiates to the buttock and down the right leg. His
temperature is 98.2 F. Exam shows some rigidity of the lumbar spine. The pain is
exacerbated by applying pressure on the paravertebral region in the lower lumbar spine
and by passively raising the leg at 45 degrees while the pt lies supine. A reduced Achilles
2
