The USMLE Step 1 is the first of the 3 examinations that you must pass in order to become the licensed physician in the United States. It is a joint endeavor of FSMB and NBME. It is a common exam taken by the US medical students and International graduates. USMLE Step 1 assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. Step 1 is constructed according to an integrated content outline that organizes basic science material along two dimensions:
system and process.
USMLE Step 1 can be taken at the end of second year of medical school.
Step 1 is a one-day examination. It is a computer based test. The testing day includes 322 multiple-choice items divided into 7 blocks of 46 items; 60 minutes are allotted for completion of each block of test items. On the test day, examinees have a minimum of 45 minutes of break time and a 15- minute optional tutorial. The amount of time available for breaks may be increased by finishing a block of test items or the optional tutorial before the allotted time expires.
You will be able to skip back and forth among questions, but ONLY within a block of questions. Once the hour is over, you will be unable to return to those 50 items. The test items aren't grouped by clinical subject but are presented in a random, interdisciplinary sequence. All USMLE questions are in one best-answer format. There are no matching questions on the computerized USMLE Step 1.
Sections focusing on individual organ systems are subdivided according to normal and abnormal processes, including principles of therapy. Each Step 1 examination covers content related to the following traditionally defined disciplines:
- Behavioral sciences
- Biostatistics and epidemiology
The Step 1 examination also covers content related to the following interdisciplinary areas:
- Molecular and cell biology
Step 1 Test Specifications-
Table 1: USMLE Step 1 Test Specifications*
General Principles of Foundational Science**
Immune System, Blood & Lymphoreticular System
Nervous System & Special Senses
Skin & Subcutaneous Tissue
Renal & Urinary System
Pregnancy, Childbirth, & the Puerperium
Female /Male Reproductive & Breast
Multisystem Processes & Disorders
Biostatistics & Epidemiology
Principles of Therapeutics
- Read each question carefully. It is important to understand what is being asked.
- Try to generate an answer and then look for it in the option list.
- Alternatively, read each option carefully, eliminating those that are clearly incorrect.
- Of the remaining options, select the one that is most correct.
- If unsure about an answer, it is better to guess since unanswered questions are automatically counted as wrong answers.
Single-Item Questions :-
A single patient-centered vignette is associated with one question followed by four or more response options. The
response options are lettered (ie, A, B, C, D, E). A portion of the questions involves interpretation of graphic or
pictorial materials. You are required to select the best answer to the question. Other options may be partially correct,
but there is only ONE BEST answer. This is the traditional, most frequently used multiple-choice question format on
The questions are prepared by examination committees composed of faculty members, teachers, investigators, and
clinicians with recognized prominence in their respective fields. Committee members are selected to provide broad
representation from the academic, practice, and licensing communities across the United States and Canada.
A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure over the past 2 years. She has
not yet started dialysis. Examination shows no abnormalities. Her hemoglobin concentration is 9 g/dL, hematocrit is
28%, and mean corpuscular volume is 94 m3. A blood smear shows normochromic, normocytic cells. Which of the
following is the most likely cause?
A. Acute blood loss
B. Chronic lymphocytic leukemia
C. Erythrocyte enzyme deficiency
D. Erythropoietin deficiency
F. Microangiopathic hemolysis
G. Polycythemia vera
H. Sickle cell disease
I. Sideroblastic anemia
J. β-Thalassemia trait
Sequential Item Sets :-
A single patient-centered vignette may be associated with two or three consecutive questions about the information
presented. Each question is linked to the initial patient vignette but is testing a different point. Questions are designed
to be answered in sequential order. You are required to select the ONE BEST answer to each question. Questions
are designed to be answered in sequential order. You must click "Proceed to Next Item" to view the next item in the
set; once you click on this button, you will not be able to add or change an answer to the displayed (previous) item.