USMLE Step 1 Preparation Course

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From American Doctors; USMLE Step 1 Course


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USMLE Step 1 Exam Overview

Opportunity to Become a Doctor in America

The Step 1 exam assesses whether you can understand important concepts of the basic sciences for the practice of medicine, with special emphasis on the principles and mechanisms underlying health, illness, and forms of therapy. Step 1 provides a mastery of not only the sciences that provide a foundation for safe and competent practice of medicine today, but also the scientific principles necessary for the maintenance of competence through lifelong learning. Step 1 is built around an integrated content outline that organizes basic science materials into two dimensions: system and process.

Step 1 is a one-day quiz. It is divided into 7 blocks of 60 minutes and administered in an 8 hour test session. The number of questions per block in a given exam form may vary, but cannot exceed 40. The total number of questions in the general exam form cannot exceed 280.

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USMLE Step 1 Content Description

Step 1 consists of multiple choice questions (MCQs) created by USMLE committees made up of renowned faculty, researchers, and clinicians in their fields. Committee members are selected from the academic, practice, and licensing communities in the United States and Canada.

Step 1 is designed to measure basic science knowledge. Some questions test the test taker’s knowledge on their own. However, many of the questions require the examiner to interpret graphic and tabular materials, identify microscopic pathological and normal samples, and solve problems by applying basic science principles.

The content description is not intended as a curriculum development or study guide. Questions are created in a flexible structure, taking into account new topics, emerging new content areas, and changes in emphasis. Categories and content coverage may vary.

It is aimed to create a strong general understanding of concepts and principles in the basic sciences.

USMLE Step 1 Exam Detailed Information

Outline of Step 1 Questions

The test questions of all USMLE exams are classified in one of 18 main areas depending on their focus on concepts and principles that are important in organ systems or individual organ systems.

Step 1 content weighting for these topics is stated below. The chapters focusing on individual organ systems are subdivided into normal and abnormal processes, including pharmacotherapy mechanisms. In most cases, knowledge of normal processes is evaluated in the context of a disease process or specific pathology.

While not all topics listed in the content master classes are included in every USMLE Step exam, overall content coverage may be encountered across exam forms by different test takers for each step.

General Principles12-16
Blood & Lymphoreticular/Immune Systems7-11
Behavioral Health & Nervous Systems/Special Senses9-13
Musculoskeletal, Skin & Subcutaneous Tissue6-10
Cardiovascular System5-9
Respiratory & Renal/Urinary Systems9-13
Gastrointestinal System5-9
Reproductive & Endocrine Systems9-13
Multisystem Processes & Disorders6-10
Biostatistics & Epidemiology/Population Health4-6
Social Sciences: Communication and Interpersonal Skills6-9
Step 1 Test Content Specifications
Medical Knowledge: Applying Foundational Science Concepts60-70
Patient Care: Diagnosis20-25
History/Physical Examination
Communication and Interpersonal Skills6-9
Practice–based Learning & Improvement4-6
Step 1 Competencies Required in a Doctor
Biochemistry & Nutrition14-24
Gross Anatomy & Embryology11-15
Histology & Cell Biology8-13
Behavioral Sciences8-13
Step 1 Weights of Sections

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USMLE Step 1 Sample Test Questions

A 27-year-old woman comes to the office for counseling prior to conception. She states that a friend recently delivered a newborn with a neural tube defect and she wants to decrease her risk for having a child with this condition. She has no history of major medical illness and takes no medications. Physical examination shows no abnormalities. It is most appropriate to recommend that this patient begin supplementation with a vitamin that is a cofactor in which of the following processes?

(A) Biosynthesis of nucleotides

(B) Protein gamma glutamate carboxylation

(C) Scavenging of free radicals

(D) Transketolation

(E) Triglyceride lipolysis

(Answer: A)

A study is designed to evaluate the feasibility of acupuncture in children with chronic headaches. Sixty children with chronic headaches are recruited for the study. In addition to their usual therapy, all children are treated with acupuncture three times a week for 2 months. Which of the following best describes this study design?

(A) Case-control

(B) Case series

(C) Crossover

(D) Cross-sectional

(E) Historical cohort

(F) Randomized clinical trial

(Answer: B)

A 26-year-old woman comes to the physician with her husband for counseling prior to conception. Her mother and three of her five siblings have type 2 diabetes mellitus. She is 170 cm (5 ft 7 in) tall and weighs 82 kg (180 lb); BMI is 28 kg/m2. Her blood pressure is 148/84 mm Hg. Physical examination shows no other abnormalities. Her fasting serum glucose concentration is 110 mg/dL. Which of the following is the most appropriate initial statement by the physician?

(A) “Let’s review ways you can optimize your own health before conceiving.”

(B) “We should test you for islet cell antibodies before you try to conceive.”

(C) “You can conceive right away since you are in good health.”

(D) “You should avoid gaining weight during pregnancy because you are already overweight and at risk for type 2 diabetes mellitus.”

(E) “You should have no problems with your pregnancy if you start insulin therapy.”

(Answer: A)

A 55-year-old man has had crushing substernal chest pain on exertion over the past 6 weeks. He had a myocardial infarction 2 months ago. He takes nitroglycerin as needed and one aspirin daily. He has smoked two packs of cigarettes daily for 30 years. Examination shows normal heart sounds and no carotid or femoral bruits. Treatment with a β-adrenergic blocking agent is most likely to improve his symptoms due to which of the following mechanisms?

(A) Decreasing myocardial contractility

(B) Dilating the coronary arteries

(C) Peripheral vasodilation

(D) Preventing fibrin and platelet plugs

(Answer: A)

A 31-year-old woman is brought to the emergency department 45 minutes after sustaining injuries in a motor vehicle collision. Physical examination shows tenderness to palpation of the right upper extremity. An x-ray shows a midshaft fracture of the right humerus. The physician wants to assess the integrity of the radial nerve, but the patient has severe pain with movement of the upper extremity. If this patient has sustained damage to the radial nerve, altered sensation to pinprick of which of the following areas would most likely confirm the diagnosis?

(A) Anterior medial surface of the forearm

(B) Palmar surface of the index finger

(C) Palmar surface of the small finger

(D) Posterior lateral surface of the hand

(E) Posterior surface of the small finger

(Answer: D)

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