USMLE Step 1 Practice Question Types

Types of Questions You’ll See on USMLE Step 1

There are many different types of USMLE Step 1 questions, and preparing for each type of question can help students gain confidence in their question approach and test-taking strategy. Prior to preparing for the different types of questions, it is often helpful to know what areas of content will be spanned by the test. Without knowing the areas   The recent changes to the USMLE Step 1 include increased questions about applying basic science concepts and communication competencies. Systems-based practice and patient safety questions are decreasing, while diagnosis and management questions have been eliminated from Step 1 and moved to USMLE Step 2. These changes are likely related to the soon-to-be pass-fail grading system of USMLE Step 1, and demonstrate that USMLE Step 1 is pre-clinical exam, primarily testing application of basic science concepts, as well as communication skills. 

Studying communication is not often prioritized by students, as it is perhaps seen as “common sense” or “low yield.” While communications can often be answered with a gut feeling, spending a limited amount of time preparing for this content can be helpful, particularly as the number of these question types will be increasing on Step 1 exams. Empathetic statements, obtaining more information or prior medical records, open-ended questions, and statements that avoid judgment or declarative statements are often the best answer in communication-style questions.

USMLE Sample Question Categories 

While basic science concepts can be asked by the USMLE Step 1 in multiple different ways, each question on USMLE Step 1 can be fit into 1 of the following 3 categories: most likely, multimedia questions, and chart questions. It is important to note that negatively phrased questions (LEAST likely?; all of the following EXCEPT?; which is NOT?) are no longer present on USMLE Step 1, to the relief of many students. If you are stressed, there are ways to manage USMLE Step 1 Test Anxiety. Questions which were phrased in this way were often confusing and added a layer of complexity which detracted from the subject matter at hand, and were therefore eliminated from USMLE Step 1.

Most Likely Step 1 Questions 

The most likely question students will encounter on the USMLE Step 1 exam is a “most likely” question (eg. Which of the following is the most likely diagnosis?)! Often, “most likely” questions will be asked in the context of a long clinical case. To approach these long cases, it is important for students to put together all the pieces of the puzzle. In order to do this quickly and efficiently, students should read the actual question of the stem first. This is important so students know if they will need to focus on diagnosis, a biochemical correlate, anatomy, etc. while they read through the question. Often, a brief 1-2 second skim through the answer choices will help students put together a framework for what they should be looking for in the stem. While reading, highlighting between 3-5 clues can help students put together the mental puzzle. Often, a clinical case is written, and one or two extra distracting details are added in that may be relevant to some of the (incorrect) answer choices. Because of these distractors, it is extremely important to put together all the clues and treat the case as a whole. 

Multimedia Step 1 Questions

Multimedia questions encompass questions that contain radiologic or pathologic findings, or videos or audio of physical exam maneuvers. These questions often stress students out, and panic sets in the moment they press the “play” button on that dreaded cardiac physical exam. The first thing to do with any multimedia question is to keep calm and carry on. Many multimedia questions can in fact be answered by reading the stem alone! Therefore, the best approach to these types of questions is reading the actual question first, skimming the answer choices, then listening or watching or looking at the image at hand for no longer than 15 seconds, then reading the stem. Sometimes, the physical exam finding or the image will be easily recognized, in which case, great! Use it as one of the clues in the question stem. Sometimes, the multimedia may be harder to interpret – is that a rumbling diastolic murmur? Is it a fixed split S2? Is it a loud S4? In these cases, students should try to use the stem to put together as many clues as they can prior to jumping into the answer choices.

Chart Step 1 Questions

The last type of question that is commonly seen on USMLE Step 1 is a chart question. By this we mean that instead of sentences comprising the answer choices, students find a huge chart that is dominated by an assortment of up, down, and sideways arrows, with a sprinkling of urine findings (different types of casts, for example), CSF findings (protein, glucose levels), or pretty much anything else. Like multimedia questions, students often get easily overwhelmed by the charts and can easily get slipped up. The best way to approach a chart question is to start with the column you are most familiar with and use the process of elimination wisely. It is also important to remember which aspect is the cause, and which aspect may be a consequence – it is extremely easy to get mixed up with all the up and down arrows. Students should take their time and approach chart questions methodically.  As always, if you need additional help or want to incorporate 1-on-1 tutoring into your study schedule, you can contact us here.