USMLE United States Medical Licensing Exam
Step 1 | Practice Questions & Answers
ID14167
,USMLE United States Medical Licensing Exam Step 1 | Practice Questions & Answers
1. A screening decision depends on age, exposure and prior results. With respect 10. A near miss reveals a weakness in the care process. Which action is most
to Prevention, screening, counseling and risk-factor modification, what is the likely to prevent recurrence of a problem involving Quality improvement?
best FIRST action? A. Hide the near miss because no harm occurred.
A. Order the same screening panel for every patient regardless of risk. B. Replace documentation with informal verbal communication.
B. Match screening or prevention to the patient-specific risk profile and C. Use a structured handoff that communicates current status, pending issues, risks
evidence-based interval, then use shared decision-making where appropriate. and required follow-up, then confirm that the corrective action is effective before
C. Withhold preventive counseling until disease is diagnosed. closure.
D. Repeat screening sooner solely because the previous result was normal. D. Close the issue once the immediate patient leaves the unit.
Correct Answer: B Correct Answer: C
Explanation: The correct choice follows a verify-act-confirm sequence. That is more Explanation: The strongest exam-style response is the one that controls immediate risk,
reliable than bypassing controls or making multiple uncontrolled changes. checks the relevant condition, and then acts within the defined requirements for Quality
improvement.
2. A preventive visit identifies several modifiable risk factors. Which evidence
is most important when evaluating risk-factor modification? 11. A patient deteriorates shortly after a procedure. Which sequence is most
A. Repeat screening sooner solely because the previous result was normal. appropriate when carrying out interpretation of clinical evidence?
B. Review the patient-specific eligibility criteria and recommended interval and A. Select therapy without reviewing allergies, interactions or organ function.
compare the findings with the applicable criteria. B. Withhold escalation despite objective evidence of deterioration.
C. Ignore contraindications because preventive interventions are always low risk. C. Delay stabilization until a complete diagnostic workup has been finished.
D. Withhold preventive counseling until disease is diagnosed. D. Stabilize immediate threats first, then obtain focused data needed for the next
Correct Answer: B decision, then verify the resulting state before moving to the next step.
Explanation: The strongest exam-style response is the one that controls immediate risk, Correct Answer: D
checks the relevant condition, and then acts within the defined requirements for Explanation: The correct response protects the integrity of the process: establish the
risk-factor modification. facts, apply the appropriate control, and verify the result before closure.
3. A medication review reveals a possible interaction. Which response best 12. A care team is deciding whether escalation is required; blood pressure is
controls the primary risk associated with Special populations, comorbidities and 86/54 mmHg. Which choice demonstrates the strongest control of Specialty-specific
age-specific considerations? anatomy, physiology and pathophysiology?
A. Escalate care when instability or a time-critical complication is suspected. A. Verify indications and contraindications before initiating or changing treatment.
B. Withhold escalation despite objective evidence of deterioration. B. Ignore a new contraindication because the treatment was already planned.
C. Delay stabilization until a complete diagnostic workup has been finished. C. Treat an isolated test result without reconciling it with the clinical picture.
D. Select therapy without reviewing allergies, interactions or organ function. D. Change several therapies simultaneously without defining the treatment goal.
Correct Answer: A Correct Answer: A
Explanation: The correct response protects the integrity of the process: establish the Explanation: This approach preserves control of the situation while producing evidence
facts, apply the appropriate control, and verify the result before closure. that can confirm whether the action actually corrected the issue involving
Specialty-specific anatomy, physiology and pathophysiology.
4. A medication review reveals a possible interaction; heart rate rises to
132/min. Before proceeding with work involving Special populations, what should 13. An urgent presentation requires prioritization before definitive diagnosis.
be verified? What is required before accepting the result related to Specialty-specific
A. Treat an isolated test result without reconciling it with the clinical picture. anatomy?
B. Review response to treatment and evidence of complications and compare the findings A. Delay stabilization until a complete diagnostic workup has been finished.
with the applicable criteria. B. Review focused history, examination findings and red-flag features and compare the
C. Change several therapies simultaneously without defining the treatment goal. findings with the applicable criteria.
D. Ignore a new contraindication because the treatment was already planned. C. Select therapy without reviewing allergies, interactions or organ function.
Correct Answer: B D. Withhold escalation despite objective evidence of deterioration.
Explanation: This approach preserves control of the situation while producing evidence Correct Answer: B
that can confirm whether the action actually corrected the issue involving Special Explanation: This answer uses verified evidence before action, which reduces the chance
populations. of masking the real problem and supports a traceable decision about Specialty-specific
anatomy.
5. A patient reports an adverse effect after starting therapy. Which
troubleshooting approach is most appropriate for age-specific considerations? 14. A patient has a common symptom plus a high-risk red-flag feature. Under these
A. Escalate care when instability or a time-critical complication is suspected. conditions, when should the issue involving Clinical presentation, history taking
B. Select therapy without reviewing allergies, interactions or organ function. and focused physical examination be escalated?
C. Withhold escalation despite objective evidence of deterioration. A. Treat a single abnormal result as definitive while ignoring contradictory findings.
D. Delay stabilization until a complete diagnostic workup has been finished. B. Interpret the test in the context of pretest probability and reconcile discordant
Correct Answer: A findings before concluding.
Explanation: This answer uses verified evidence before action, which reduces the chance C. Exclude a serious diagnosis solely because one screening result is normal.
of masking the real problem and supports a traceable decision about age-specific D. Repeat low-value testing instead of reassessing the differential.
considerations. Correct Answer: B
Explanation: The selected action best supports safe, compliant, and technically sound
6. A patient must decide whether to proceed with a treatment that has material performance because it addresses Clinical presentation, history taking and focused
risks. Which action best supports a defensible decision about Ethics, consent, physical examination using observable evidence rather than convenience.
communication, multidisciplinary coordination and patient safety?
A. Protect confidentiality and disclose only through an authorized or legally 15. A test result conflicts with the overall clinical picture. Which comparison
permitted pathway. is most useful for interpreting Clinical presentation?
B. Disclose confidential information because the requester is a relative. A. Review focused history, examination, pretest probability and the diagnostic
C. Alter the record without documenting the correction. performance of the proposed test and compare the findings with the applicable
D. Override a capable patient’s refusal simply because the clinician disagrees. criteria.
Correct Answer: A B. Repeat low-value testing instead of reassessing the differential.
Explanation: The selected action best supports safe, compliant, and technically sound C. Order every available test regardless of likelihood or consequence.
performance because it addresses Ethics, consent, communication, multidisciplinary D. Exclude a serious diagnosis solely because one screening result is normal.
coordination and patient safety using observable evidence rather than convenience. Correct Answer: A
Explanation: A defensible professional decision should be based on current evidence and
7. A patient deteriorates shortly after a procedure. A change affecting applicable criteria. The other choices rely on assumption, remove safeguards, or change
multidisciplinary coordination is being considered. How should it be handled? conditions before the cause is understood.
A. Delay stabilization until a complete diagnostic workup has been finished.
B. Escalate care when instability or a time-critical complication is suspected. 16. Initial testing is nondiagnostic but the pretest probability remains
C. Select therapy without reviewing allergies, interactions or organ function. significant; urine output declines over several hours. Which action best
D. Withhold escalation despite objective evidence of deterioration. distinguishes the underlying cause from a symptom in history taking?
Correct Answer: B A. Exclude a serious diagnosis solely because one screening result is normal.
Explanation: A defensible professional decision should be based on current evidence and B. Interpret the test in the context of pretest probability and reconcile discordant
applicable criteria. The other choices rely on assumption, remove safeguards, or change findings before concluding, then confirm that the corrective action is effective
conditions before the cause is understood. before closure.
C. Treat a single abnormal result as definitive while ignoring contradictory findings.
8. A near miss reveals a weakness in the care process; blood pressure is 86/54 D. Order every available test regardless of likelihood or consequence.
mmHg. The abnormal condition directly affects patient safety. What is the most Correct Answer: B
appropriate response? Explanation: This is the most appropriate option because it connects the observed
A. Replace documentation with informal verbal communication. condition to the governing requirement and leaves a record of why the decision was made.
B. Hide the near miss because no harm occurred.
C. Focus only on blaming the individual involved. 17. Initial testing is nondiagnostic but the pretest probability remains
D. Use a structured handoff that communicates current status, pending issues, risks significant. Which response is most consistent with the professional or
and required follow-up. compliance requirements governing focused physical examination?
Correct Answer: D A. Order every available test regardless of likelihood or consequence.
Explanation: This is the most appropriate option because it connects the observed B. Repeat low-value testing instead of reassessing the differential.
condition to the governing requirement and leaves a record of why the decision was made. C. Build a focused differential from history and examination, then choose testing that
can meaningfully change management.
9. The same documentation gap recurs across several cases. Which documentation D. Treat a single abnormal result as definitive while ignoring contradictory findings.
approach best supports traceability for Quality improvement, documentation and Correct Answer: C
interpretation of clinical evidence? Explanation: The correct choice follows a verify-act-confirm sequence. That is more
A. Focus only on blaming the individual involved. reliable than bypassing controls or making multiple uncontrolled changes.
B. Record the observed condition, supporting evidence, decision and responsible
follow-up; communicate any unresolved risk to the next responsible person. 18. A test result conflicts with the overall clinical picture. Which handoff
C. Close the issue once the immediate patient leaves the unit. practice best reduces error risk for Differential diagnosis and recognition of
D. Hide the near miss because no harm occurred. common versus high-risk conditions?
Correct Answer: B A. Record the observed condition, supporting evidence, decision and responsible
Explanation: The correct choice follows a verify-act-confirm sequence. That is more follow-up; communicate any unresolved risk to the next responsible person.
reliable than bypassing controls or making multiple uncontrolled changes. B. Treat a single abnormal result as definitive while ignoring contradictory findings.
C. Exclude a serious diagnosis solely because one screening result is normal.
D. Repeat low-value testing instead of reassessing the differential.
Correct Answer: A
Explanation: The strongest exam-style response is the one that controls immediate risk,
checks the relevant condition, and then acts within the defined requirements for
Differential diagnosis and recognition of common versus high-risk conditions.
1
,USMLE United States Medical Licensing Exam Step 1 | Practice Questions & Answers
19. History and examination suggest more than one plausible diagnosis. Which 28. A patient becomes acutely unstable during evaluation; SpO2 falls to 88%. The
decision about Differential diagnosis is best supported by the available abnormal condition directly affects Acute stabilization, emergency recognition
evidence? and escalation of care. What is the most appropriate response?
A. Build a focused differential from history and examination, then choose testing that A. Wait for spontaneous improvement despite worsening vital signs.
can meaningfully change management. B. Complete the routine history before responding to objective instability.
B. Repeat low-value testing instead of reassessing the differential. C. Stabilize the time-critical problem before pursuing lower-priority diagnostic
C. Order every available test regardless of likelihood or consequence. detail.
D. Exclude a serious diagnosis solely because one screening result is normal. D. Delay treatment until every diagnostic possibility has been excluded.
Correct Answer: A Correct Answer: C
Explanation: The correct response protects the integrity of the process: establish the Explanation: This approach preserves control of the situation while producing evidence
facts, apply the appropriate control, and verify the result before closure. that can confirm whether the action actually corrected the issue involving Acute
stabilization, emergency recognition and escalation of care.
20. An urgent presentation requires prioritization before definitive diagnosis;
temperature reaches 39.4 C. Which review step adds the most value before closing 29. A patient deteriorates before the definitive diagnosis is known. Which
work involving recognition of common versus high-risk conditions? documentation approach best supports traceability for Acute stabilization?
A. Change several therapies simultaneously without defining the treatment goal. A. Record the observed condition, supporting evidence, decision and responsible
B. Ignore a new contraindication because the treatment was already planned. follow-up; communicate any unresolved risk to the next responsible person.
C. Verify indications and contraindications before initiating or changing treatment, B. Delay treatment until every diagnostic possibility has been excluded.
then confirm that the corrective action is effective before closure. C. Send the patient for a nonurgent test before stabilizing circulation.
D. Treat an isolated test result without reconciling it with the clinical picture. D. Complete the routine history before responding to objective instability.
Correct Answer: C Correct Answer: A
Explanation: This approach preserves control of the situation while producing evidence Explanation: This answer uses verified evidence before action, which reduces the chance
that can confirm whether the action actually corrected the issue involving recognition of masking the real problem and supports a traceable decision about Acute stabilization.
of common versus high-risk conditions.
30. A new presentation includes signs of immediate physiologic compromise. Which
21. Initial testing is nondiagnostic but the pretest probability remains action is most likely to prevent recurrence of a problem involving emergency
significant. With respect to Diagnostic testing, imaging, laboratory recognition?
interpretation and test selection, what is the best FIRST action? A. Complete the routine history before responding to objective instability.
A. Order every available test regardless of likelihood or consequence. B. Wait for spontaneous improvement despite worsening vital signs.
B. Repeat low-value testing instead of reassessing the differential. C. Send the patient for a nonurgent test before stabilizing circulation.
C. Build a focused differential from history and examination, then choose testing that D. Stabilize the time-critical problem before pursuing lower-priority diagnostic
can meaningfully change management. detail, then confirm that the corrective action is effective before closure.
D. Treat a single abnormal result as definitive while ignoring contradictory findings. Correct Answer: D
Correct Answer: C Explanation: The selected action best supports safe, compliant, and technically sound
Explanation: This answer uses verified evidence before action, which reduces the chance performance because it addresses emergency recognition using observable evidence rather
of masking the real problem and supports a traceable decision about Diagnostic testing, than convenience.
imaging, laboratory interpretation and test selection.
31. A new presentation includes signs of immediate physiologic compromise. Which
22. History and examination suggest more than one plausible diagnosis. Which sequence is most appropriate when carrying out escalation of care?
evidence is most important when evaluating Diagnostic testing? A. Send the patient for a nonurgent test before stabilizing circulation.
A. Review whether the test result fits the clinical pattern and changes the next B. Delay treatment until every diagnostic possibility has been excluded.
decision and compare the findings with the applicable criteria. C. Address airway, breathing and circulation threats first, obtain immediate vital
B. Treat a single abnormal result as definitive while ignoring contradictory findings. data and escalate care while the focused diagnostic work proceeds, then verify the
C. Exclude a serious diagnosis solely because one screening result is normal. resulting state before moving to the next step.
D. Repeat low-value testing instead of reassessing the differential. D. Wait for spontaneous improvement despite worsening vital signs.
Correct Answer: A Correct Answer: C
Explanation: The selected action best supports safe, compliant, and technically sound Explanation: A defensible professional decision should be based on current evidence and
performance because it addresses Diagnostic testing using observable evidence rather applicable criteria. The other choices rely on assumption, remove safeguards, or change
than convenience. conditions before the cause is understood.
23. A test result conflicts with the overall clinical picture. Which response 32. A preventive visit identifies several modifiable risk factors; heart rate
best controls the primary risk associated with laboratory interpretation? rises to 132/min. Which choice demonstrates the strongest control of Prevention,
A. Build a focused differential from history and examination, then choose testing that screening, counseling and risk-factor modification?
can meaningfully change management. A. Ignore contraindications because preventive interventions are always low risk.
B. Repeat low-value testing instead of reassessing the differential. B. Address modifiable risks with targeted counseling and document the prevention plan
C. Order every available test regardless of likelihood or consequence. and follow-up.
D. Exclude a serious diagnosis solely because one screening result is normal. C. Repeat screening sooner solely because the previous result was normal.
Correct Answer: A D. Order the same screening panel for every patient regardless of risk.
Explanation: A defensible professional decision should be based on current evidence and Correct Answer: B
applicable criteria. The other choices rely on assumption, remove safeguards, or change Explanation: This is the most appropriate option because it connects the observed
conditions before the cause is understood. condition to the governing requirement and leaves a record of why the decision was made.
24. A test result conflicts with the overall clinical picture; heart rate rises 33. A patient is eligible for risk-reduction counseling but has no current
to 132/min. Before proceeding with work involving test selection, what should be symptoms. What is required before accepting the result related to risk-factor
verified? modification?
A. Exclude a serious diagnosis solely because one screening result is normal. A. Order the same screening panel for every patient regardless of risk.
B. Treat a single abnormal result as definitive while ignoring contradictory findings. B. Withhold preventive counseling until disease is diagnosed.
C. Review whether the test result fits the clinical pattern and changes the next C. Review age, risk factors, prior screening, contraindications and expected
decision and compare the findings with the applicable criteria. benefit/harms and compare the findings with the applicable criteria.
D. Order every available test regardless of likelihood or consequence. D. Repeat screening sooner solely because the previous result was normal.
Correct Answer: C Correct Answer: C
Explanation: This is the most appropriate option because it connects the observed Explanation: The correct choice follows a verify-act-confirm sequence. That is more
condition to the governing requirement and leaves a record of why the decision was made. reliable than bypassing controls or making multiple uncontrolled changes.
25. Two medicines with overlapping adverse effects are prescribed together. Which 34. A diagnostic result conflicts with the initial clinical impression. Under
troubleshooting approach is most appropriate for Evidence-based treatment these conditions, when should the issue involving Special populations,
planning, pharmacologic and nonpharmacologic management? comorbidities and age-specific considerations be escalated?
A. Continue the original dose without reviewing the new organ-function data. A. Treat an isolated test result without reconciling it with the clinical picture.
B. Reconcile the medication list, verify indication, allergies, interactions and organ B. Change several therapies simultaneously without defining the treatment goal.
function, then select or adjust therapy accordingly. C. Ignore a new contraindication because the treatment was already planned.
C. Ignore an interaction because each medicine is acceptable when used alone. D. Verify indications and contraindications before initiating or changing treatment.
D. Add another drug solely to treat an adverse effect before confirming its cause. Correct Answer: D
Correct Answer: B Explanation: The strongest exam-style response is the one that controls immediate risk,
Explanation: The correct choice follows a verify-act-confirm sequence. That is more checks the relevant condition, and then acts within the defined requirements for Special
reliable than bypassing controls or making multiple uncontrolled changes. populations, comorbidities and age-specific considerations.
26. A patient deteriorates shortly after a procedure. Which action best supports 35. A diagnostic result conflicts with the initial clinical impression. Which
a defensible decision about Evidence-based treatment planning? comparison is most useful for interpreting Special populations?
A. Change several therapies simultaneously without defining the treatment goal. A. Select therapy without reviewing allergies, interactions or organ function.
B. Ignore a new contraindication because the treatment was already planned. B. Review diagnostic probability and the consequences of delayed treatment and compare
C. Treat an isolated test result without reconciling it with the clinical picture. the findings with the applicable criteria.
D. Verify indications and contraindications before initiating or changing treatment. C. Withhold escalation despite objective evidence of deterioration.
Correct Answer: D D. Delay stabilization until a complete diagnostic workup has been finished.
Explanation: The strongest exam-style response is the one that controls immediate risk, Correct Answer: B
checks the relevant condition, and then acts within the defined requirements for Explanation: The correct response protects the integrity of the process: establish the
Evidence-based treatment planning. facts, apply the appropriate control, and verify the result before closure.
27. Two medicines with overlapping adverse effects are prescribed together. A 36. An urgent presentation requires prioritization before definitive diagnosis;
change affecting nonpharmacologic management is being considered. How should it temperature reaches 39.4 C. Which action best distinguishes the underlying cause
be handled? from a symptom in age-specific considerations?
A. Ignore an interaction because each medicine is acceptable when used alone. A. Ignore a new contraindication because the treatment was already planned.
B. Continue the original dose without reviewing the new organ-function data. B. Treat an isolated test result without reconciling it with the clinical picture.
C. Stop every medication simultaneously without prioritizing risk. C. Verify indications and contraindications before initiating or changing treatment,
D. Reconcile the medication list, verify indication, allergies, interactions and organ then confirm that the corrective action is effective before closure.
function, then select or adjust therapy accordingly. D. Change several therapies simultaneously without defining the treatment goal.
Correct Answer: D Correct Answer: C
Explanation: The correct response protects the integrity of the process: establish the Explanation: This approach preserves control of the situation while producing evidence
facts, apply the appropriate control, and verify the result before closure. that can confirm whether the action actually corrected the issue involving age-specific
considerations.
2
, USMLE United States Medical Licensing Exam Step 1 | Practice Questions & Answers
37. A documentation error could affect another clinician’s decision. Which 46. History and examination suggest more than one plausible diagnosis. Which
response is most consistent with the professional or compliance requirements action best supports a defensible decision about Clinical presentation?
governing Ethics, consent, communication, multidisciplinary coordination and A. Interpret the test in the context of pretest probability and reconcile discordant
patient safety? findings before concluding.
A. Obtain consent after the procedure so the schedule is not delayed. B. Treat a single abnormal result as definitive while ignoring contradictory findings.
B. Provide understandable information about options, benefits, risks and alternatives, C. Exclude a serious diagnosis solely because one screening result is normal.
confirm capacity/voluntariness, and document the decision. D. Repeat low-value testing instead of reassessing the differential.
C. Override a capable patient’s refusal simply because the clinician disagrees. Correct Answer: A
D. Disclose confidential information because the requester is a relative. Explanation: The selected action best supports safe, compliant, and technically sound
Correct Answer: B performance because it addresses Clinical presentation using observable evidence rather
Explanation: This answer uses verified evidence before action, which reduces the chance than convenience.
of masking the real problem and supports a traceable decision about Ethics, consent,
47. A patient has a common symptom plus a high-risk red-flag feature. A change
communication, multidisciplinary coordination and patient safety.
affecting history taking is being considered. How should it be handled?
38. A medication review reveals a possible interaction. Which handoff practice A. Build a focused differential from history and examination, then choose testing that
best reduces error risk for multidisciplinary coordination? can meaningfully change management.
A. Change several therapies simultaneously without defining the treatment goal. B. Repeat low-value testing instead of reassessing the differential.
B. Record the observed condition, supporting evidence, decision and responsible C. Order every available test regardless of likelihood or consequence.
follow-up; communicate any unresolved risk to the next responsible person. D. Exclude a serious diagnosis solely because one screening result is normal.
C. Ignore a new contraindication because the treatment was already planned. Correct Answer: A
D. Treat an isolated test result without reconciling it with the clinical picture. Explanation: A defensible professional decision should be based on current evidence and
Correct Answer: B applicable criteria. The other choices rely on assumption, remove safeguards, or change
Explanation: The selected action best supports safe, compliant, and technically sound conditions before the cause is understood.
performance because it addresses multidisciplinary coordination using observable
48. A patient has a common symptom plus a high-risk red-flag feature; blood
evidence rather than convenience.
pressure is 86/54 mmHg. The abnormal condition directly affects focused physical
39. The same documentation gap recurs across several cases. Which decision about examination. What is the most appropriate response?
patient safety is best supported by the available evidence? A. Exclude a serious diagnosis solely because one screening result is normal.
A. Close the issue once the immediate patient leaves the unit. B. Treat a single abnormal result as definitive while ignoring contradictory findings.
B. Control the immediate safety risk, document the event, analyze the process cause C. Order every available test regardless of likelihood or consequence.
and implement a measurable corrective action. D. Interpret the test in the context of pretest probability and reconcile discordant
C. Focus only on blaming the individual involved. findings before concluding.
D. Replace documentation with informal verbal communication. Correct Answer: D
Correct Answer: B Explanation: This is the most appropriate option because it connects the observed
Explanation: A defensible professional decision should be based on current evidence and condition to the governing requirement and leaves a record of why the decision was made.
applicable criteria. The other choices rely on assumption, remove safeguards, or change
conditions before the cause is understood.
49. History and examination suggest more than one plausible diagnosis. Which
documentation approach best supports traceability for Differential diagnosis and
40. A preventable infection risk is identified before a procedure; heart rate recognition of common versus high-risk conditions?
rises to 132/min. Which review step adds the most value before closing work A. Order every available test regardless of likelihood or consequence.
involving Quality improvement, documentation and interpretation of clinical B. Repeat low-value testing instead of reassessing the differential.
evidence? C. Record the observed condition, supporting evidence, decision and responsible
A. Replace documentation with informal verbal communication. follow-up; communicate any unresolved risk to the next responsible person.
B. Hide the near miss because no harm occurred. D. Treat a single abnormal result as definitive while ignoring contradictory findings.
C. Focus only on blaming the individual involved. Correct Answer: C
D. Use a structured handoff that communicates current status, pending issues, risks Explanation: The correct choice follows a verify-act-confirm sequence. That is more
and required follow-up, then confirm that the corrective action is effective before reliable than bypassing controls or making multiple uncontrolled changes.
closure.
50. Initial testing is nondiagnostic but the pretest probability remains
Correct Answer: D
Explanation: This is the most appropriate option because it connects the observed
significant. Which action is most likely to prevent recurrence of a problem
condition to the governing requirement and leaves a record of why the decision was made. involving Differential diagnosis?
A. Treat a single abnormal result as definitive while ignoring contradictory findings.
41. The same documentation gap recurs across several cases. With respect to B. Exclude a serious diagnosis solely because one screening result is normal.
Quality improvement, what is the best FIRST action? C. Interpret the test in the context of pretest probability and reconcile discordant
A. Focus only on blaming the individual involved. findings before concluding, then confirm that the corrective action is effective
B. Close the issue once the immediate patient leaves the unit. before closure.
C. Control the immediate safety risk, document the event, analyze the process cause D. Repeat low-value testing instead of reassessing the differential.
and implement a measurable corrective action. Correct Answer: C
D. Hide the near miss because no harm occurred. Explanation: The strongest exam-style response is the one that controls immediate risk,
Correct Answer: C checks the relevant condition, and then acts within the defined requirements for
Explanation: The correct choice follows a verify-act-confirm sequence. That is more Differential diagnosis.
reliable than bypassing controls or making multiple uncontrolled changes.
51. A planned procedure is reconsidered after new history becomes available.
42. A medication review reveals a possible interaction. Which evidence is most Which sequence is most appropriate when carrying out recognition of common versus
important when evaluating interpretation of clinical evidence? high-risk conditions?
A. Review diagnostic probability and the consequences of delayed treatment and compare A. Escalate care when instability or a time-critical complication is suspected, then
the findings with the applicable criteria. verify the resulting state before moving to the next step.
B. Ignore a new contraindication because the treatment was already planned. B. Withhold escalation despite objective evidence of deterioration.
C. Treat an isolated test result without reconciling it with the clinical picture. C. Delay stabilization until a complete diagnostic workup has been finished.
D. Change several therapies simultaneously without defining the treatment goal. D. Select therapy without reviewing allergies, interactions or organ function.
Correct Answer: A Correct Answer: A
Explanation: The strongest exam-style response is the one that controls immediate risk, Explanation: The correct response protects the integrity of the process: establish the
checks the relevant condition, and then acts within the defined requirements for facts, apply the appropriate control, and verify the result before closure.
interpretation of clinical evidence.
52. A patient has a common symptom plus a high-risk red-flag feature; urine
43. A patient reports an adverse effect after starting therapy. Which response output declines over several hours. Which choice demonstrates the strongest
best controls the primary risk associated with Specialty-specific anatomy, control of Diagnostic testing, imaging, laboratory interpretation and test
physiology and pathophysiology? selection?
A. Delay stabilization until a complete diagnostic workup has been finished. A. Exclude a serious diagnosis solely because one screening result is normal.
B. Select therapy without reviewing allergies, interactions or organ function. B. Treat a single abnormal result as definitive while ignoring contradictory findings.
C. Withhold escalation despite objective evidence of deterioration. C. Interpret the test in the context of pretest probability and reconcile discordant
D. Escalate care when instability or a time-critical complication is suspected. findings before concluding.
Correct Answer: D D. Order every available test regardless of likelihood or consequence.
Explanation: The correct response protects the integrity of the process: establish the Correct Answer: C
facts, apply the appropriate control, and verify the result before closure. Explanation: This approach preserves control of the situation while producing evidence
that can confirm whether the action actually corrected the issue involving Diagnostic
44. A planned procedure is reconsidered after new history becomes available;
testing, imaging, laboratory interpretation and test selection.
urine output declines over several hours. Before proceeding with work involving
Specialty-specific anatomy, what should be verified? 53. Initial testing is nondiagnostic but the pretest probability remains
A. Change several therapies simultaneously without defining the treatment goal. significant. What is required before accepting the result related to Diagnostic
B. Ignore a new contraindication because the treatment was already planned. testing?
C. Treat an isolated test result without reconciling it with the clinical picture. A. Order every available test regardless of likelihood or consequence.
D. Review medication list, allergies, renal/hepatic function and interactions and B. Repeat low-value testing instead of reassessing the differential.
compare the findings with the applicable criteria. C. Treat a single abnormal result as definitive while ignoring contradictory findings.
Correct Answer: D D. Review focused history, examination, pretest probability and the diagnostic
Explanation: This approach preserves control of the situation while producing evidence performance of the proposed test and compare the findings with the applicable
that can confirm whether the action actually corrected the issue involving criteria.
Specialty-specific anatomy. Correct Answer: D
Explanation: This answer uses verified evidence before action, which reduces the chance
45. A test result conflicts with the overall clinical picture. Which
of masking the real problem and supports a traceable decision about Diagnostic testing.
troubleshooting approach is most appropriate for Clinical presentation, history
taking and focused physical examination? 54. History and examination suggest more than one plausible diagnosis. Under
A. Order every available test regardless of likelihood or consequence. these conditions, when should the issue involving laboratory interpretation be
B. Repeat low-value testing instead of reassessing the differential. escalated?
C. Treat a single abnormal result as definitive while ignoring contradictory findings. A. Treat a single abnormal result as definitive while ignoring contradictory findings.
D. Build a focused differential from history and examination, then choose testing that B. Exclude a serious diagnosis solely because one screening result is normal.
can meaningfully change management. C. Repeat low-value testing instead of reassessing the differential.
Correct Answer: D D. Interpret the test in the context of pretest probability and reconcile discordant
Explanation: This answer uses verified evidence before action, which reduces the chance findings before concluding.
of masking the real problem and supports a traceable decision about Clinical Correct Answer: D
presentation, history taking and focused physical examination. Explanation: The selected action best supports safe, compliant, and technically sound
performance because it addresses laboratory interpretation using observable evidence
rather than convenience.
3
Step 1 | Practice Questions & Answers
ID14167
,USMLE United States Medical Licensing Exam Step 1 | Practice Questions & Answers
1. A screening decision depends on age, exposure and prior results. With respect 10. A near miss reveals a weakness in the care process. Which action is most
to Prevention, screening, counseling and risk-factor modification, what is the likely to prevent recurrence of a problem involving Quality improvement?
best FIRST action? A. Hide the near miss because no harm occurred.
A. Order the same screening panel for every patient regardless of risk. B. Replace documentation with informal verbal communication.
B. Match screening or prevention to the patient-specific risk profile and C. Use a structured handoff that communicates current status, pending issues, risks
evidence-based interval, then use shared decision-making where appropriate. and required follow-up, then confirm that the corrective action is effective before
C. Withhold preventive counseling until disease is diagnosed. closure.
D. Repeat screening sooner solely because the previous result was normal. D. Close the issue once the immediate patient leaves the unit.
Correct Answer: B Correct Answer: C
Explanation: The correct choice follows a verify-act-confirm sequence. That is more Explanation: The strongest exam-style response is the one that controls immediate risk,
reliable than bypassing controls or making multiple uncontrolled changes. checks the relevant condition, and then acts within the defined requirements for Quality
improvement.
2. A preventive visit identifies several modifiable risk factors. Which evidence
is most important when evaluating risk-factor modification? 11. A patient deteriorates shortly after a procedure. Which sequence is most
A. Repeat screening sooner solely because the previous result was normal. appropriate when carrying out interpretation of clinical evidence?
B. Review the patient-specific eligibility criteria and recommended interval and A. Select therapy without reviewing allergies, interactions or organ function.
compare the findings with the applicable criteria. B. Withhold escalation despite objective evidence of deterioration.
C. Ignore contraindications because preventive interventions are always low risk. C. Delay stabilization until a complete diagnostic workup has been finished.
D. Withhold preventive counseling until disease is diagnosed. D. Stabilize immediate threats first, then obtain focused data needed for the next
Correct Answer: B decision, then verify the resulting state before moving to the next step.
Explanation: The strongest exam-style response is the one that controls immediate risk, Correct Answer: D
checks the relevant condition, and then acts within the defined requirements for Explanation: The correct response protects the integrity of the process: establish the
risk-factor modification. facts, apply the appropriate control, and verify the result before closure.
3. A medication review reveals a possible interaction. Which response best 12. A care team is deciding whether escalation is required; blood pressure is
controls the primary risk associated with Special populations, comorbidities and 86/54 mmHg. Which choice demonstrates the strongest control of Specialty-specific
age-specific considerations? anatomy, physiology and pathophysiology?
A. Escalate care when instability or a time-critical complication is suspected. A. Verify indications and contraindications before initiating or changing treatment.
B. Withhold escalation despite objective evidence of deterioration. B. Ignore a new contraindication because the treatment was already planned.
C. Delay stabilization until a complete diagnostic workup has been finished. C. Treat an isolated test result without reconciling it with the clinical picture.
D. Select therapy without reviewing allergies, interactions or organ function. D. Change several therapies simultaneously without defining the treatment goal.
Correct Answer: A Correct Answer: A
Explanation: The correct response protects the integrity of the process: establish the Explanation: This approach preserves control of the situation while producing evidence
facts, apply the appropriate control, and verify the result before closure. that can confirm whether the action actually corrected the issue involving
Specialty-specific anatomy, physiology and pathophysiology.
4. A medication review reveals a possible interaction; heart rate rises to
132/min. Before proceeding with work involving Special populations, what should 13. An urgent presentation requires prioritization before definitive diagnosis.
be verified? What is required before accepting the result related to Specialty-specific
A. Treat an isolated test result without reconciling it with the clinical picture. anatomy?
B. Review response to treatment and evidence of complications and compare the findings A. Delay stabilization until a complete diagnostic workup has been finished.
with the applicable criteria. B. Review focused history, examination findings and red-flag features and compare the
C. Change several therapies simultaneously without defining the treatment goal. findings with the applicable criteria.
D. Ignore a new contraindication because the treatment was already planned. C. Select therapy without reviewing allergies, interactions or organ function.
Correct Answer: B D. Withhold escalation despite objective evidence of deterioration.
Explanation: This approach preserves control of the situation while producing evidence Correct Answer: B
that can confirm whether the action actually corrected the issue involving Special Explanation: This answer uses verified evidence before action, which reduces the chance
populations. of masking the real problem and supports a traceable decision about Specialty-specific
anatomy.
5. A patient reports an adverse effect after starting therapy. Which
troubleshooting approach is most appropriate for age-specific considerations? 14. A patient has a common symptom plus a high-risk red-flag feature. Under these
A. Escalate care when instability or a time-critical complication is suspected. conditions, when should the issue involving Clinical presentation, history taking
B. Select therapy without reviewing allergies, interactions or organ function. and focused physical examination be escalated?
C. Withhold escalation despite objective evidence of deterioration. A. Treat a single abnormal result as definitive while ignoring contradictory findings.
D. Delay stabilization until a complete diagnostic workup has been finished. B. Interpret the test in the context of pretest probability and reconcile discordant
Correct Answer: A findings before concluding.
Explanation: This answer uses verified evidence before action, which reduces the chance C. Exclude a serious diagnosis solely because one screening result is normal.
of masking the real problem and supports a traceable decision about age-specific D. Repeat low-value testing instead of reassessing the differential.
considerations. Correct Answer: B
Explanation: The selected action best supports safe, compliant, and technically sound
6. A patient must decide whether to proceed with a treatment that has material performance because it addresses Clinical presentation, history taking and focused
risks. Which action best supports a defensible decision about Ethics, consent, physical examination using observable evidence rather than convenience.
communication, multidisciplinary coordination and patient safety?
A. Protect confidentiality and disclose only through an authorized or legally 15. A test result conflicts with the overall clinical picture. Which comparison
permitted pathway. is most useful for interpreting Clinical presentation?
B. Disclose confidential information because the requester is a relative. A. Review focused history, examination, pretest probability and the diagnostic
C. Alter the record without documenting the correction. performance of the proposed test and compare the findings with the applicable
D. Override a capable patient’s refusal simply because the clinician disagrees. criteria.
Correct Answer: A B. Repeat low-value testing instead of reassessing the differential.
Explanation: The selected action best supports safe, compliant, and technically sound C. Order every available test regardless of likelihood or consequence.
performance because it addresses Ethics, consent, communication, multidisciplinary D. Exclude a serious diagnosis solely because one screening result is normal.
coordination and patient safety using observable evidence rather than convenience. Correct Answer: A
Explanation: A defensible professional decision should be based on current evidence and
7. A patient deteriorates shortly after a procedure. A change affecting applicable criteria. The other choices rely on assumption, remove safeguards, or change
multidisciplinary coordination is being considered. How should it be handled? conditions before the cause is understood.
A. Delay stabilization until a complete diagnostic workup has been finished.
B. Escalate care when instability or a time-critical complication is suspected. 16. Initial testing is nondiagnostic but the pretest probability remains
C. Select therapy without reviewing allergies, interactions or organ function. significant; urine output declines over several hours. Which action best
D. Withhold escalation despite objective evidence of deterioration. distinguishes the underlying cause from a symptom in history taking?
Correct Answer: B A. Exclude a serious diagnosis solely because one screening result is normal.
Explanation: A defensible professional decision should be based on current evidence and B. Interpret the test in the context of pretest probability and reconcile discordant
applicable criteria. The other choices rely on assumption, remove safeguards, or change findings before concluding, then confirm that the corrective action is effective
conditions before the cause is understood. before closure.
C. Treat a single abnormal result as definitive while ignoring contradictory findings.
8. A near miss reveals a weakness in the care process; blood pressure is 86/54 D. Order every available test regardless of likelihood or consequence.
mmHg. The abnormal condition directly affects patient safety. What is the most Correct Answer: B
appropriate response? Explanation: This is the most appropriate option because it connects the observed
A. Replace documentation with informal verbal communication. condition to the governing requirement and leaves a record of why the decision was made.
B. Hide the near miss because no harm occurred.
C. Focus only on blaming the individual involved. 17. Initial testing is nondiagnostic but the pretest probability remains
D. Use a structured handoff that communicates current status, pending issues, risks significant. Which response is most consistent with the professional or
and required follow-up. compliance requirements governing focused physical examination?
Correct Answer: D A. Order every available test regardless of likelihood or consequence.
Explanation: This is the most appropriate option because it connects the observed B. Repeat low-value testing instead of reassessing the differential.
condition to the governing requirement and leaves a record of why the decision was made. C. Build a focused differential from history and examination, then choose testing that
can meaningfully change management.
9. The same documentation gap recurs across several cases. Which documentation D. Treat a single abnormal result as definitive while ignoring contradictory findings.
approach best supports traceability for Quality improvement, documentation and Correct Answer: C
interpretation of clinical evidence? Explanation: The correct choice follows a verify-act-confirm sequence. That is more
A. Focus only on blaming the individual involved. reliable than bypassing controls or making multiple uncontrolled changes.
B. Record the observed condition, supporting evidence, decision and responsible
follow-up; communicate any unresolved risk to the next responsible person. 18. A test result conflicts with the overall clinical picture. Which handoff
C. Close the issue once the immediate patient leaves the unit. practice best reduces error risk for Differential diagnosis and recognition of
D. Hide the near miss because no harm occurred. common versus high-risk conditions?
Correct Answer: B A. Record the observed condition, supporting evidence, decision and responsible
Explanation: The correct choice follows a verify-act-confirm sequence. That is more follow-up; communicate any unresolved risk to the next responsible person.
reliable than bypassing controls or making multiple uncontrolled changes. B. Treat a single abnormal result as definitive while ignoring contradictory findings.
C. Exclude a serious diagnosis solely because one screening result is normal.
D. Repeat low-value testing instead of reassessing the differential.
Correct Answer: A
Explanation: The strongest exam-style response is the one that controls immediate risk,
checks the relevant condition, and then acts within the defined requirements for
Differential diagnosis and recognition of common versus high-risk conditions.
1
,USMLE United States Medical Licensing Exam Step 1 | Practice Questions & Answers
19. History and examination suggest more than one plausible diagnosis. Which 28. A patient becomes acutely unstable during evaluation; SpO2 falls to 88%. The
decision about Differential diagnosis is best supported by the available abnormal condition directly affects Acute stabilization, emergency recognition
evidence? and escalation of care. What is the most appropriate response?
A. Build a focused differential from history and examination, then choose testing that A. Wait for spontaneous improvement despite worsening vital signs.
can meaningfully change management. B. Complete the routine history before responding to objective instability.
B. Repeat low-value testing instead of reassessing the differential. C. Stabilize the time-critical problem before pursuing lower-priority diagnostic
C. Order every available test regardless of likelihood or consequence. detail.
D. Exclude a serious diagnosis solely because one screening result is normal. D. Delay treatment until every diagnostic possibility has been excluded.
Correct Answer: A Correct Answer: C
Explanation: The correct response protects the integrity of the process: establish the Explanation: This approach preserves control of the situation while producing evidence
facts, apply the appropriate control, and verify the result before closure. that can confirm whether the action actually corrected the issue involving Acute
stabilization, emergency recognition and escalation of care.
20. An urgent presentation requires prioritization before definitive diagnosis;
temperature reaches 39.4 C. Which review step adds the most value before closing 29. A patient deteriorates before the definitive diagnosis is known. Which
work involving recognition of common versus high-risk conditions? documentation approach best supports traceability for Acute stabilization?
A. Change several therapies simultaneously without defining the treatment goal. A. Record the observed condition, supporting evidence, decision and responsible
B. Ignore a new contraindication because the treatment was already planned. follow-up; communicate any unresolved risk to the next responsible person.
C. Verify indications and contraindications before initiating or changing treatment, B. Delay treatment until every diagnostic possibility has been excluded.
then confirm that the corrective action is effective before closure. C. Send the patient for a nonurgent test before stabilizing circulation.
D. Treat an isolated test result without reconciling it with the clinical picture. D. Complete the routine history before responding to objective instability.
Correct Answer: C Correct Answer: A
Explanation: This approach preserves control of the situation while producing evidence Explanation: This answer uses verified evidence before action, which reduces the chance
that can confirm whether the action actually corrected the issue involving recognition of masking the real problem and supports a traceable decision about Acute stabilization.
of common versus high-risk conditions.
30. A new presentation includes signs of immediate physiologic compromise. Which
21. Initial testing is nondiagnostic but the pretest probability remains action is most likely to prevent recurrence of a problem involving emergency
significant. With respect to Diagnostic testing, imaging, laboratory recognition?
interpretation and test selection, what is the best FIRST action? A. Complete the routine history before responding to objective instability.
A. Order every available test regardless of likelihood or consequence. B. Wait for spontaneous improvement despite worsening vital signs.
B. Repeat low-value testing instead of reassessing the differential. C. Send the patient for a nonurgent test before stabilizing circulation.
C. Build a focused differential from history and examination, then choose testing that D. Stabilize the time-critical problem before pursuing lower-priority diagnostic
can meaningfully change management. detail, then confirm that the corrective action is effective before closure.
D. Treat a single abnormal result as definitive while ignoring contradictory findings. Correct Answer: D
Correct Answer: C Explanation: The selected action best supports safe, compliant, and technically sound
Explanation: This answer uses verified evidence before action, which reduces the chance performance because it addresses emergency recognition using observable evidence rather
of masking the real problem and supports a traceable decision about Diagnostic testing, than convenience.
imaging, laboratory interpretation and test selection.
31. A new presentation includes signs of immediate physiologic compromise. Which
22. History and examination suggest more than one plausible diagnosis. Which sequence is most appropriate when carrying out escalation of care?
evidence is most important when evaluating Diagnostic testing? A. Send the patient for a nonurgent test before stabilizing circulation.
A. Review whether the test result fits the clinical pattern and changes the next B. Delay treatment until every diagnostic possibility has been excluded.
decision and compare the findings with the applicable criteria. C. Address airway, breathing and circulation threats first, obtain immediate vital
B. Treat a single abnormal result as definitive while ignoring contradictory findings. data and escalate care while the focused diagnostic work proceeds, then verify the
C. Exclude a serious diagnosis solely because one screening result is normal. resulting state before moving to the next step.
D. Repeat low-value testing instead of reassessing the differential. D. Wait for spontaneous improvement despite worsening vital signs.
Correct Answer: A Correct Answer: C
Explanation: The selected action best supports safe, compliant, and technically sound Explanation: A defensible professional decision should be based on current evidence and
performance because it addresses Diagnostic testing using observable evidence rather applicable criteria. The other choices rely on assumption, remove safeguards, or change
than convenience. conditions before the cause is understood.
23. A test result conflicts with the overall clinical picture. Which response 32. A preventive visit identifies several modifiable risk factors; heart rate
best controls the primary risk associated with laboratory interpretation? rises to 132/min. Which choice demonstrates the strongest control of Prevention,
A. Build a focused differential from history and examination, then choose testing that screening, counseling and risk-factor modification?
can meaningfully change management. A. Ignore contraindications because preventive interventions are always low risk.
B. Repeat low-value testing instead of reassessing the differential. B. Address modifiable risks with targeted counseling and document the prevention plan
C. Order every available test regardless of likelihood or consequence. and follow-up.
D. Exclude a serious diagnosis solely because one screening result is normal. C. Repeat screening sooner solely because the previous result was normal.
Correct Answer: A D. Order the same screening panel for every patient regardless of risk.
Explanation: A defensible professional decision should be based on current evidence and Correct Answer: B
applicable criteria. The other choices rely on assumption, remove safeguards, or change Explanation: This is the most appropriate option because it connects the observed
conditions before the cause is understood. condition to the governing requirement and leaves a record of why the decision was made.
24. A test result conflicts with the overall clinical picture; heart rate rises 33. A patient is eligible for risk-reduction counseling but has no current
to 132/min. Before proceeding with work involving test selection, what should be symptoms. What is required before accepting the result related to risk-factor
verified? modification?
A. Exclude a serious diagnosis solely because one screening result is normal. A. Order the same screening panel for every patient regardless of risk.
B. Treat a single abnormal result as definitive while ignoring contradictory findings. B. Withhold preventive counseling until disease is diagnosed.
C. Review whether the test result fits the clinical pattern and changes the next C. Review age, risk factors, prior screening, contraindications and expected
decision and compare the findings with the applicable criteria. benefit/harms and compare the findings with the applicable criteria.
D. Order every available test regardless of likelihood or consequence. D. Repeat screening sooner solely because the previous result was normal.
Correct Answer: C Correct Answer: C
Explanation: This is the most appropriate option because it connects the observed Explanation: The correct choice follows a verify-act-confirm sequence. That is more
condition to the governing requirement and leaves a record of why the decision was made. reliable than bypassing controls or making multiple uncontrolled changes.
25. Two medicines with overlapping adverse effects are prescribed together. Which 34. A diagnostic result conflicts with the initial clinical impression. Under
troubleshooting approach is most appropriate for Evidence-based treatment these conditions, when should the issue involving Special populations,
planning, pharmacologic and nonpharmacologic management? comorbidities and age-specific considerations be escalated?
A. Continue the original dose without reviewing the new organ-function data. A. Treat an isolated test result without reconciling it with the clinical picture.
B. Reconcile the medication list, verify indication, allergies, interactions and organ B. Change several therapies simultaneously without defining the treatment goal.
function, then select or adjust therapy accordingly. C. Ignore a new contraindication because the treatment was already planned.
C. Ignore an interaction because each medicine is acceptable when used alone. D. Verify indications and contraindications before initiating or changing treatment.
D. Add another drug solely to treat an adverse effect before confirming its cause. Correct Answer: D
Correct Answer: B Explanation: The strongest exam-style response is the one that controls immediate risk,
Explanation: The correct choice follows a verify-act-confirm sequence. That is more checks the relevant condition, and then acts within the defined requirements for Special
reliable than bypassing controls or making multiple uncontrolled changes. populations, comorbidities and age-specific considerations.
26. A patient deteriorates shortly after a procedure. Which action best supports 35. A diagnostic result conflicts with the initial clinical impression. Which
a defensible decision about Evidence-based treatment planning? comparison is most useful for interpreting Special populations?
A. Change several therapies simultaneously without defining the treatment goal. A. Select therapy without reviewing allergies, interactions or organ function.
B. Ignore a new contraindication because the treatment was already planned. B. Review diagnostic probability and the consequences of delayed treatment and compare
C. Treat an isolated test result without reconciling it with the clinical picture. the findings with the applicable criteria.
D. Verify indications and contraindications before initiating or changing treatment. C. Withhold escalation despite objective evidence of deterioration.
Correct Answer: D D. Delay stabilization until a complete diagnostic workup has been finished.
Explanation: The strongest exam-style response is the one that controls immediate risk, Correct Answer: B
checks the relevant condition, and then acts within the defined requirements for Explanation: The correct response protects the integrity of the process: establish the
Evidence-based treatment planning. facts, apply the appropriate control, and verify the result before closure.
27. Two medicines with overlapping adverse effects are prescribed together. A 36. An urgent presentation requires prioritization before definitive diagnosis;
change affecting nonpharmacologic management is being considered. How should it temperature reaches 39.4 C. Which action best distinguishes the underlying cause
be handled? from a symptom in age-specific considerations?
A. Ignore an interaction because each medicine is acceptable when used alone. A. Ignore a new contraindication because the treatment was already planned.
B. Continue the original dose without reviewing the new organ-function data. B. Treat an isolated test result without reconciling it with the clinical picture.
C. Stop every medication simultaneously without prioritizing risk. C. Verify indications and contraindications before initiating or changing treatment,
D. Reconcile the medication list, verify indication, allergies, interactions and organ then confirm that the corrective action is effective before closure.
function, then select or adjust therapy accordingly. D. Change several therapies simultaneously without defining the treatment goal.
Correct Answer: D Correct Answer: C
Explanation: The correct response protects the integrity of the process: establish the Explanation: This approach preserves control of the situation while producing evidence
facts, apply the appropriate control, and verify the result before closure. that can confirm whether the action actually corrected the issue involving age-specific
considerations.
2
, USMLE United States Medical Licensing Exam Step 1 | Practice Questions & Answers
37. A documentation error could affect another clinician’s decision. Which 46. History and examination suggest more than one plausible diagnosis. Which
response is most consistent with the professional or compliance requirements action best supports a defensible decision about Clinical presentation?
governing Ethics, consent, communication, multidisciplinary coordination and A. Interpret the test in the context of pretest probability and reconcile discordant
patient safety? findings before concluding.
A. Obtain consent after the procedure so the schedule is not delayed. B. Treat a single abnormal result as definitive while ignoring contradictory findings.
B. Provide understandable information about options, benefits, risks and alternatives, C. Exclude a serious diagnosis solely because one screening result is normal.
confirm capacity/voluntariness, and document the decision. D. Repeat low-value testing instead of reassessing the differential.
C. Override a capable patient’s refusal simply because the clinician disagrees. Correct Answer: A
D. Disclose confidential information because the requester is a relative. Explanation: The selected action best supports safe, compliant, and technically sound
Correct Answer: B performance because it addresses Clinical presentation using observable evidence rather
Explanation: This answer uses verified evidence before action, which reduces the chance than convenience.
of masking the real problem and supports a traceable decision about Ethics, consent,
47. A patient has a common symptom plus a high-risk red-flag feature. A change
communication, multidisciplinary coordination and patient safety.
affecting history taking is being considered. How should it be handled?
38. A medication review reveals a possible interaction. Which handoff practice A. Build a focused differential from history and examination, then choose testing that
best reduces error risk for multidisciplinary coordination? can meaningfully change management.
A. Change several therapies simultaneously without defining the treatment goal. B. Repeat low-value testing instead of reassessing the differential.
B. Record the observed condition, supporting evidence, decision and responsible C. Order every available test regardless of likelihood or consequence.
follow-up; communicate any unresolved risk to the next responsible person. D. Exclude a serious diagnosis solely because one screening result is normal.
C. Ignore a new contraindication because the treatment was already planned. Correct Answer: A
D. Treat an isolated test result without reconciling it with the clinical picture. Explanation: A defensible professional decision should be based on current evidence and
Correct Answer: B applicable criteria. The other choices rely on assumption, remove safeguards, or change
Explanation: The selected action best supports safe, compliant, and technically sound conditions before the cause is understood.
performance because it addresses multidisciplinary coordination using observable
48. A patient has a common symptom plus a high-risk red-flag feature; blood
evidence rather than convenience.
pressure is 86/54 mmHg. The abnormal condition directly affects focused physical
39. The same documentation gap recurs across several cases. Which decision about examination. What is the most appropriate response?
patient safety is best supported by the available evidence? A. Exclude a serious diagnosis solely because one screening result is normal.
A. Close the issue once the immediate patient leaves the unit. B. Treat a single abnormal result as definitive while ignoring contradictory findings.
B. Control the immediate safety risk, document the event, analyze the process cause C. Order every available test regardless of likelihood or consequence.
and implement a measurable corrective action. D. Interpret the test in the context of pretest probability and reconcile discordant
C. Focus only on blaming the individual involved. findings before concluding.
D. Replace documentation with informal verbal communication. Correct Answer: D
Correct Answer: B Explanation: This is the most appropriate option because it connects the observed
Explanation: A defensible professional decision should be based on current evidence and condition to the governing requirement and leaves a record of why the decision was made.
applicable criteria. The other choices rely on assumption, remove safeguards, or change
conditions before the cause is understood.
49. History and examination suggest more than one plausible diagnosis. Which
documentation approach best supports traceability for Differential diagnosis and
40. A preventable infection risk is identified before a procedure; heart rate recognition of common versus high-risk conditions?
rises to 132/min. Which review step adds the most value before closing work A. Order every available test regardless of likelihood or consequence.
involving Quality improvement, documentation and interpretation of clinical B. Repeat low-value testing instead of reassessing the differential.
evidence? C. Record the observed condition, supporting evidence, decision and responsible
A. Replace documentation with informal verbal communication. follow-up; communicate any unresolved risk to the next responsible person.
B. Hide the near miss because no harm occurred. D. Treat a single abnormal result as definitive while ignoring contradictory findings.
C. Focus only on blaming the individual involved. Correct Answer: C
D. Use a structured handoff that communicates current status, pending issues, risks Explanation: The correct choice follows a verify-act-confirm sequence. That is more
and required follow-up, then confirm that the corrective action is effective before reliable than bypassing controls or making multiple uncontrolled changes.
closure.
50. Initial testing is nondiagnostic but the pretest probability remains
Correct Answer: D
Explanation: This is the most appropriate option because it connects the observed
significant. Which action is most likely to prevent recurrence of a problem
condition to the governing requirement and leaves a record of why the decision was made. involving Differential diagnosis?
A. Treat a single abnormal result as definitive while ignoring contradictory findings.
41. The same documentation gap recurs across several cases. With respect to B. Exclude a serious diagnosis solely because one screening result is normal.
Quality improvement, what is the best FIRST action? C. Interpret the test in the context of pretest probability and reconcile discordant
A. Focus only on blaming the individual involved. findings before concluding, then confirm that the corrective action is effective
B. Close the issue once the immediate patient leaves the unit. before closure.
C. Control the immediate safety risk, document the event, analyze the process cause D. Repeat low-value testing instead of reassessing the differential.
and implement a measurable corrective action. Correct Answer: C
D. Hide the near miss because no harm occurred. Explanation: The strongest exam-style response is the one that controls immediate risk,
Correct Answer: C checks the relevant condition, and then acts within the defined requirements for
Explanation: The correct choice follows a verify-act-confirm sequence. That is more Differential diagnosis.
reliable than bypassing controls or making multiple uncontrolled changes.
51. A planned procedure is reconsidered after new history becomes available.
42. A medication review reveals a possible interaction. Which evidence is most Which sequence is most appropriate when carrying out recognition of common versus
important when evaluating interpretation of clinical evidence? high-risk conditions?
A. Review diagnostic probability and the consequences of delayed treatment and compare A. Escalate care when instability or a time-critical complication is suspected, then
the findings with the applicable criteria. verify the resulting state before moving to the next step.
B. Ignore a new contraindication because the treatment was already planned. B. Withhold escalation despite objective evidence of deterioration.
C. Treat an isolated test result without reconciling it with the clinical picture. C. Delay stabilization until a complete diagnostic workup has been finished.
D. Change several therapies simultaneously without defining the treatment goal. D. Select therapy without reviewing allergies, interactions or organ function.
Correct Answer: A Correct Answer: A
Explanation: The strongest exam-style response is the one that controls immediate risk, Explanation: The correct response protects the integrity of the process: establish the
checks the relevant condition, and then acts within the defined requirements for facts, apply the appropriate control, and verify the result before closure.
interpretation of clinical evidence.
52. A patient has a common symptom plus a high-risk red-flag feature; urine
43. A patient reports an adverse effect after starting therapy. Which response output declines over several hours. Which choice demonstrates the strongest
best controls the primary risk associated with Specialty-specific anatomy, control of Diagnostic testing, imaging, laboratory interpretation and test
physiology and pathophysiology? selection?
A. Delay stabilization until a complete diagnostic workup has been finished. A. Exclude a serious diagnosis solely because one screening result is normal.
B. Select therapy without reviewing allergies, interactions or organ function. B. Treat a single abnormal result as definitive while ignoring contradictory findings.
C. Withhold escalation despite objective evidence of deterioration. C. Interpret the test in the context of pretest probability and reconcile discordant
D. Escalate care when instability or a time-critical complication is suspected. findings before concluding.
Correct Answer: D D. Order every available test regardless of likelihood or consequence.
Explanation: The correct response protects the integrity of the process: establish the Correct Answer: C
facts, apply the appropriate control, and verify the result before closure. Explanation: This approach preserves control of the situation while producing evidence
that can confirm whether the action actually corrected the issue involving Diagnostic
44. A planned procedure is reconsidered after new history becomes available;
testing, imaging, laboratory interpretation and test selection.
urine output declines over several hours. Before proceeding with work involving
Specialty-specific anatomy, what should be verified? 53. Initial testing is nondiagnostic but the pretest probability remains
A. Change several therapies simultaneously without defining the treatment goal. significant. What is required before accepting the result related to Diagnostic
B. Ignore a new contraindication because the treatment was already planned. testing?
C. Treat an isolated test result without reconciling it with the clinical picture. A. Order every available test regardless of likelihood or consequence.
D. Review medication list, allergies, renal/hepatic function and interactions and B. Repeat low-value testing instead of reassessing the differential.
compare the findings with the applicable criteria. C. Treat a single abnormal result as definitive while ignoring contradictory findings.
Correct Answer: D D. Review focused history, examination, pretest probability and the diagnostic
Explanation: This approach preserves control of the situation while producing evidence performance of the proposed test and compare the findings with the applicable
that can confirm whether the action actually corrected the issue involving criteria.
Specialty-specific anatomy. Correct Answer: D
Explanation: This answer uses verified evidence before action, which reduces the chance
45. A test result conflicts with the overall clinical picture. Which
of masking the real problem and supports a traceable decision about Diagnostic testing.
troubleshooting approach is most appropriate for Clinical presentation, history
taking and focused physical examination? 54. History and examination suggest more than one plausible diagnosis. Under
A. Order every available test regardless of likelihood or consequence. these conditions, when should the issue involving laboratory interpretation be
B. Repeat low-value testing instead of reassessing the differential. escalated?
C. Treat a single abnormal result as definitive while ignoring contradictory findings. A. Treat a single abnormal result as definitive while ignoring contradictory findings.
D. Build a focused differential from history and examination, then choose testing that B. Exclude a serious diagnosis solely because one screening result is normal.
can meaningfully change management. C. Repeat low-value testing instead of reassessing the differential.
Correct Answer: D D. Interpret the test in the context of pretest probability and reconcile discordant
Explanation: This answer uses verified evidence before action, which reduces the chance findings before concluding.
of masking the real problem and supports a traceable decision about Clinical Correct Answer: D
presentation, history taking and focused physical examination. Explanation: The selected action best supports safe, compliant, and technically sound
performance because it addresses laboratory interpretation using observable evidence
rather than convenience.
3
