Step 1 Sample Test Questions

More than 100 sample Step 1 test questions are available in both PDF format and as an interactive testing experience.

Examples of different types of competencies tested on the Step 1 examination are shown below.

Sample Test Questions

Example Question: Pharmacology: Foundational Science

The Step 1 examination continues to assess content related to the discipline of pharmacology. However, the primary focus of this content will be on the mechanisms of actions of drugs rather than on specific pharmacotherapy, drug-drug interactions, adverse effects, or contraindications of medications.

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)

Example Question: Biostatistics

The Step 1 examination includes items pertaining to the understanding of the principles of biostatistics and epidemiology, including principles of research ethics and regulatory issues.

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)

Example Question: Social Sciences (Communications)

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)

Example Question: Applying Foundational Science Concepts (Cardiovascular System)

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)

Example Question: History and Physical Examination (Nervous System and Special Senses)

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)

Example Question: Diagnosis (Renal/Urinary System)

A 28-year-old man comes to the office because of a 1-year history of pain with urination that has increased in severity during the past month. He also has had episodes of blood in his urine during the past 5 years. He lived in sub-Saharan Africa until he came to the USA 6 months ago for graduate school. Temperature is 38.0°C (100.4°F), pulse is 80/min, respirations are 16/min, and blood pressure is 110/84 mm Hg. Physical examination shows suprapubic tenderness. Laboratory studies show:

Hemoglobin 12.3 g/dL
Hematocrit 37%
Leukocyte count 13,400/mm3
   Segmented neutrophils 65%
   Bands 5%
   Eosinophils 5%
   Lymphocytes 22%
   Monocytes 3%
   Urea nitrogen 75 mg/dL
   Creatinine 3.8 mg/dL
   Blood 3+
   RBC 200/hpf
   WBC 100/hpf
   RBC casts absent
   WBC casts absent

Imaging studies show bilateral hydroureter and hydronephrosis and foci of calcification in the region of the bladder. A biopsy specimen of the bladder shows marked chronic inflammation with fibrosis and scattered granulomas. Which of the following best explains the biopsy findings?

(A) Exposure to a chemical toxin

(B) Interstitial cystitis

(C) Malacoplakia

(D) Schistosomiasis

(E) Vesicoureteral reflux

(Answer: D)